Latent TB Infection : Updated and consolidated guidelines for programmatic management
The programmatic management of latent tuberculosis infection (LTBI) in populations most at risk of developing TB remains a critical activity to disrupt Mycobacterium tuberculosis transmission, as identified in the End TB Strategy. LTBI is defined as a state of persistent immune response to stimulation by Mycobacterium tuberculosis antigens with no evidence of clinically manifest active TB. Up to one third of the world’s population is estimated to be infected with Mycobacterium tuberculosis, and on average, 5–10% of those who are infected will develop active TB disease over their lifetime. The risk for active TB disease after infection depends on several factors, the most important being immunological status. The management of LTBI involves a comprehensive package of interventions: identifying and testing those individuals who should be tested, delivering effective, safe treatment in such a way that the majority of those starting a treatment regimen will complete it with no or minimal risk of adverse events, and monitoring and evaluation of the process. The WHO guidelines on the programmatic management of LTBI considers a wide array of factors including the probability of progression to active TB disease in specific population risk groups, the epidemiology and burden of TB, the availability of resources and the likelihood of a broad public health impact.
These new guidelines supersede previous WHO policy documents on the management of LTBI in people living with HIV, household contacts of people with active TB, other groups at risk of developing TB, and for LTBI testing. The consolidated guidelines are expected to provide the basis and rationale for the development of national guidelines for LTBI management, adapted to the national and local epidemiology of TB, the availability of resources, the health infrastructure and other national and local determinants. The guidelines are to be used primarily in national TB and HIV control programmes, or their equivalents in ministries of health, and for other policy-makers working on TB and HIV and infectious diseases. They are also appropriate for officials in other line ministries with work in the areas of health.