Abstract
ObjectiveTo review policies on management of latent tuberculosis infection in countries with low and high burdens of tuberculosis.MethodsWe divided countries reporting data to the World Health Organization (WHO) Global Tuberculosis Programme into low and high tuberculosis burden, based on WHO criteria. We identified national policy documents on management of latent tuberculosis through online searches, government websites, WHO country offices and personal communication with programme managers. We made a descriptive analysis with a focus on policy gaps and deviations from WHO policy recommendations.FindingsWe obtained documents from 68 of 113 low-burden countries and 30 of 35 countries with the highest burdens of tuberculosis or human immunodeficiency virus (HIV)-associated tuberculosis. Screening and treatment of latent tuberculosis infection in people living with HIV was recommended in guidelines of 29 (96.7%) high-burden and 54 (79.7%) low-burden countries. Screening for children aged < 5 years with household tuberculosis contact was the policy of 25 (83.3%) high- and 28 (41.2%) low-burden countries. In most high-burden countries the recommendation was symptom screening alone before treatment, whereas in all low-burden countries it was testing before treatment. Some low-burden countries’ policies did not comply with WHO recommendations: nine (13.2%) recommended tuberculosis preventive treatment for travellers to high-burden countries and 10 (14.7%) for patients undergoing abdominal surgery.ConclusionLack of solid evidence on certain aspects of management of latent tuberculosis infection results in national policies which vary considerably. This highlights a need to advance research and develop clear, implementable and evidence-based WHO policies.
Highlights
Tuberculosis is currently the leading infectious cause of death worldwide
The World Health Organization (WHO) End Tuberculosis strategy aims to substantially reduce tuberculosis incidence by 90% and mortality by 95% compared with the 2015 baselines of 142 cases per 100 000 population and 5.3 to 19 cases per 100 000 (depending on human immunodeficiency virus (HIV) status), respectively[1,2] Achieving this goal requires successful management of latent tuberculosis infection, which serves as a reservoir for new tuberculosis cases.[3]
A recent randomized controlled trial in a high tuberculosis burden country showed that the benefits of preventive treatment in people living with HIV can last for more than 5 years.[6,7]
Summary
Tuberculosis is currently the leading infectious cause of death worldwide. The World Health Organization (WHO) End Tuberculosis strategy aims to substantially reduce tuberculosis incidence by 90% and mortality by 95% compared with the 2015 baselines of 142 cases per 100 000 population and 5.3 to 19 cases per 100 000 (depending on human immunodeficiency virus (HIV) status), respectively[1,2] Achieving this goal requires successful management of latent tuberculosis infection, which serves as a reservoir for new tuberculosis cases.[3]. The WHO recommends tailored latent tuberculosis infection management based on tuberculosis burden and resource availability.[8] Systematic testing and treatment for latent infection is strongly recommended for people living with HIV and for children younger than 5 years who are household contacts of a pulmonary tuberculosis case, regardless of the country’s background tuberculosis burden or resource availability.[9,10] In upper-middle or high-income countries, depending on low tuberculosis burden and availability of resources, systematic testing and treatment of latent tuberculosis is strongly recommended for certain other risk groups: adult household contacts of pulmonary tuberculosis cases; patients with silicosis; patients initiating anti-tumour necrosis factor treatment; patients on dialysis; and organ transplant recipients.[11,12]
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