Latent tuberculosis infection: updated and consolidated guidelines for programmatic management. Geneva: World Health Organization; 2018
(2018; 78 pages) [French] [Russian]

Abstract

Latent tuberculosis infection (LTBI) is defined as a state of persistent immune response to stimulation by Mycobacterium tuberculosis antigens with no evidence of clinically manifest active TB. There is no gold standard test for LTBI. The WHO guidelines on LTBI consider the probability of progression to active TB disease in a specific risk group, the epidemiology and burden of TB, the availability of resources and the likelihood of a broad public health impact. Two fragmented recommendations have been made for the management of LTBI, which resulted in a number of guideline documents, posing a challenge to implementation. Therefore, several WHO Member States requested consolidated guidelines on LTBI management.

The updated, consolidated guidelines in this document respond to that request. They provide a comprehensive set of WHO recommendations for programmatic management of LTBI and the basis and rationale for national guidelines. These guidelines supersede previous WHO policy documents on the management of LTBI in people living with HIV and household contacts of people with TB and other at-risk groups. The guidelines were prepared in accordance with the requirements and recommended process of the WHO Guideline Review Committee. Seven systematic reviews were conducted to update the recommendations and make new ones. The Guideline Development Group considered the quality of the evidence, benefits and harms, values and preferences, equity, costs, acceptability and feasibility of implementation in formulating the recommendations and determining their strength.

The recommendations are presented logically according to the cascade of care for managing LTBI: identification of at-risk populations (adults and children living with HIV, HIV-negative adult and child contacts and other HIV-negative at-risk groups), ruling out active TB disease, testing for LTBI, providing treatment, monitoring adverse events, adherence and completion of treatment and monitoring and evaluation. The recommendations are categorized as: existing ones previously approved by the review committee and published, which are still valid; updated recommendations that were previously approved by the review committee but for which the evidence was reviewed, discussed with the Guidelines Development Group (GDG) and updated (including for clarity); and new recommendations. There are 10 existing, 7 updated and 7 new recommendations.

 
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