While the diagnosis and treatment of active TB disease is similar around the world, the testing and treatment of latent tuberculosis infection (LTBI) varies greatly. In the context of the general population, recommendations dictate that the focus of TB resources should not be diverted from diagnosing and treating new and retreatment TB cases, especially where case detection is low. An important exception, however, lies in highly vulnerable populations such as young household contacts of TB patients and in immunosuppressed persons. Despite their risk of occupational exposure to LTBI, health care workers (HCWs) are often not included in the definition of highly vulnerable populations. In many lower-burden settings, moreover, testing, and treatment for LTBI among HCWs is a long-established intervention of proven effectiveness.
In the 2017 USAID Evidence to Action meeting, participants discussed the key issues, challenges, and potential interventions on both topics, implementation strategies as well as future areas for discussion to reduce TB infection and ensure effective care and treatment. The two-day meeting identified key knowledge gaps for sustainable implementation and defined a path forward for LTBI pilot implementation. As well as identifying strategies for serving the needs of those with chronic and uncured MDR and XDR-TB cases, participants developed implementation models for providing palliative care to uncured MDR and XDR-TB cases and infection control strategies at community and household levels.