Overview

These new guidelines supersede previous WHO policy documents on the management of LTBI (Latent Tuberculosis Infection) 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.

Contents

• Acknowledgements
• Declaration and management of conflicts of interest
• Abbreviations
• Definitions
• Executive summary
  • A. Identification of at-risk populations for LTBI testing and treatment
  • B. Algorithms to rule out active TB disease
  • C. Testing for LTBI
  • D. Treatment options for LTBI
  • E. Preventive treatment for contacts of patients with multidrug-resistant-TB
• 1. Introduction
  • 1.1. Background
  • 1.2. Rationale
  • 1.3. Scope
  • 1.4. Target
  • 1.5. Development of the guidelines
  • 1.6. Quality of evidence and strength of the recommendations
  • 1.7. Publication, implementation, evaluation and expiry
  • 1.8. Presentation of the guidelines and recommendations
• 2. Identification of populations for testing and treatment of latent tuberculosis infection
  • 2.1. Adults and adolescents living with HIV
  • 2.2. Infants and children living with HIV
  • 2.3. HIV-negative household contacts of a person with pulmonary TB
  • 2.4. Other HIV-negative at-risk groups
• 3. Algorithms for ruling out active tuberculosis disease
  • 3.1. Adults, adolescents, children and infants living with HIV
  • 3.2. HIV-negative infants, children and adults who are household contacts of a person with pulmonary TB
  • 3.3. Considerations for implementation
• 4. Testing for latent tuberculosis infection
  • Summary of evidence
  • Rationale for the recommendations
  • Considerations for implementation
• 5. Treatment options for latent tuberculosis infection
  • Summary of evidence
• 6. Preventive treatment for contacts of patients with multidrug-resistant tuberculosis
  • Summary of evidence
  • Rationale for the recommendations
  • Considerations for implementation
• 7. Issues in implementation
  • 7.1. Ethical considerations
  • 7.2. Programme management, monitoring and evaluation
• 8. Research priorities
  • 8.1. Risks of at-risk populations for progression to active TB disease
  • 8.2. Defining the best algorithm for ruling out active TB
  • 8.3. Improved diagnostic tests and performance of LTBI tests in at-risk populations
  • 8.4. Treatment options for LTBI
  • 8.5. Monitoring of adverse events
  • 8.6. Risk of drug resistance following LTBI treatment
  • 8.7. Adherence to and completion of treatment
  • 8.8. Cost-effectiveness
  • 8.9. Preventive treatment for contacts of people with MDR-TB
  • 8.10. Programme management
• 9. References
• Annex 1. GRADE profile tables for new recommendations
• Annex 2. Evidence-to-Decision and GRADE tables
• Annex 3. Values and preferences for the management of latent tuberculosis infection: survey of populations affected by the recommendations

Suggested citation:

Latent tuberculosis infection: updated and consolidated guidelines for programmatic management. Geneva: World Health Organization; 2018. Licence: CC BY-NC-SA 3.0 IGO.

General disclaimers. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement.

The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.

All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use.