Finding and treating both tuberculosis disease and latent infection during population-wide active case finding for tuberculosis elimination

Frontiers in Medicine

Medicine

Guy B. Marks¹  Romain Ragonnet²  James M. Trauer²  Ben J. Marais³  Mikaela Coleman⁴  Jeremy Hill⁴  Greg J. Fox⁵  Boi Khanh Luu⁶  Thu-Anh Nguyen⁷ 

[1] Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia;Woolcock Institute of Medical Research, Sydney, NSW, Australia;Department of Medicine and Health, University of New South Wales, Sydney, NSW, Australia;School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia;WHO Collaborating Centre for Tuberculosis and the Sydney Infectious Diseases Institute (Sydney ID), The University of Sydney, Sydney, NSW, Australia;WHO Collaborating Centre for Tuberculosis and the Sydney Infectious Diseases Institute (Sydney ID), The University of Sydney, Sydney, NSW, Australia;Centenary Institute, The University of Sydney, Sydney, NSW, Australia;WHO Collaborating Centre for Tuberculosis and the Sydney Infectious Diseases Institute (Sydney ID), The University of Sydney, Sydney, NSW, Australia;Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia;Woolcock Institute of Medical Research, Sydney, NSW, Australia;Woolcock Institute of Medical Research, Hanoi, Vietnam;Woolcock Institute of Medical Research, Hanoi, Vietnam;Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia;

关键词: Mycobacterium tuberculosis;    TB;    latent infection;    TPT;    LTBI;    active case finding;    systematic screening;    prevention;   

DOI  :  10.3389/fmed.2023.1275140

 received in 2023-08-09, accepted in 2023-10-02,  发布年份 2023

来源: Frontiers

【 摘 要 】

In recognition of the high rates of undetected tuberculosis in the community, the World Health Organization (WHO) encourages targeted active case finding (ACF) among “high-risk” populations. While this strategy has led to increased case detection in these populations, the epidemic impact of these interventions has not been demonstrated. Historical data suggest that population-wide (untargeted) ACF can interrupt transmission in high-incidence settings, but implementation remains lacking, despite recent advances in screening tools. The reservoir of latent infection—affecting up to a quarter of the global population –complicates elimination efforts by acting as a pool from which future tuberculosis cases may emerge, even after all active cases have been treated. A holistic case finding strategy that addresses both active disease and latent infection is likely to be the optimal approach for rapidly achieving sustainable progress toward TB elimination in a durable way, but safety and cost effectiveness have not been demonstrated. Sensitive, symptom-agnostic community screening, combined with effective tuberculosis treatment and prevention, should eliminate all infectious cases in the community, whilst identifying and treating people with latent infection will also eliminate tomorrow’s tuberculosis cases. If real strides toward global tuberculosis elimination are to be made, bold strategies are required using the best available tools and a long horizon for cost-benefit assessment.

【 授权许可】

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Copyright © 2023 Coleman, Nguyen, Luu, Hill, Ragonnet, Trauer, Fox, Marks and Marais.