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LTBI Fact Sheet

Latent TB infection occurs when TB germs are present in the body but are not active and cannot be spread. About one-fourth of the global population is infected with latent TB. TB preventive treatment can reduce the risk of latent TB developing into active TB disease by 60-90%. At-risk groups for latent TB testing and treatment include people living with HIV, young child contacts of active TB patients, healthcare workers, prisoners, and those with conditions like silicosis. Testing involves the TST or IGRA tests. If no active TB is found, treatment options include 3-6 months of daily isoniazid or 12 weeks of once-weekly isoniazid-rifapentine. Patients are

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59 views

LTBI Fact Sheet

Latent TB infection occurs when TB germs are present in the body but are not active and cannot be spread. About one-fourth of the global population is infected with latent TB. TB preventive treatment can reduce the risk of latent TB developing into active TB disease by 60-90%. At-risk groups for latent TB testing and treatment include people living with HIV, young child contacts of active TB patients, healthcare workers, prisoners, and those with conditions like silicosis. Testing involves the TST or IGRA tests. If no active TB is found, treatment options include 3-6 months of daily isoniazid or 12 weeks of once-weekly isoniazid-rifapentine. Patients are

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Larry Kivaya
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FACTS ABOUT

LATENT TB INFECTIONS

Introduction to Management of Latent


TB infections (LTBI)
Latent TB is a state of persistent immune response to
stimulation by M. tuberculosis antigens with no evidence
of clinically manifested active TB, meaning, signs and 1/4
symptoms of TB are not present. of the global population is infected
with latent tuberculosis
TB preventive treatment is the treatment offered to
individuals who are considered at risk of TB disease in
order to reduce that high risk.

Provision of preventive treatment has proven to be an


effective intervention to avert the development of active
TB disease, with efficacy ranging from 60% to 90%, hence
it is a principle strategy in achieving the global agenda
of Ending TB by 2035. 10-15%
will go on to develop TB
disease

Latent TB Infection TB Disease 1 in 10


Latent TB Infection means TB If TB germs become active and Without treatment, 1 in 10
germs are in the body, but not multiply, latent TB infection can people with latent TB infection
enough to cause sickness or turn into TB disease. will develop TB disease.
spread germs to others.

To End TB, we need to stop Latent TB!


Pathophysiology of Latent TB infections
When a person inhales air droplets with M. tuberculosis
bacilli, most of the larger droplets become lodged in
the upper respiratory tract (the nose and throat).

However, the smaller droplet nuclei may reach the


Prevention is small air sacs of the lung (the alveoli), where infection
may begin.
better than cure
In the alveoli, some of the tubercle bacilli are killed, but
a few multiply in the alveoli and enter the bloodstream
and spread throughout the body. Bacilli may reach any
part of the body.

Within 2 to 8 weeks, however, the body’s immune


system usually intervenes, halting multiplication and
preventing further spread.

The immune system is the system of cells and tissues in


the body that protect the body from foreign substances.

At this point, the person does not manifest any signs


or symptoms of TB hence said to have latent TB
infection (LTBI).

Most people with LTBI are unaware of the danger that may
have already quietly settled in them

2
Populations to be offered Tuberculosis Preventive Therapy (TPT)

The most at-risk populations for whom systematic LTBI testing and treatment is recommended
for the country include;

1.
People Living with HIV
1. Aged more than 12 months regardless of TB exposure
history
2. Aged less than 12 months exposed to bacteriologically
People Living confirmed TB. 
With HIV

CONTACTS
5 Years old
2. Household contacts of bacteriologically
confirmed TB (children and adults). 
CHILD CONTACTS
Under 5 Years old
and older

HEALTHCARE
WORKERS
3. Health care workers and support staff working in health
care settings.

IN PRISON
4. Prisons (Inmates and prison staff).

5.
Others population at risk.
1. Patients initiating chemotherapy or those who are taking
certain immunosuppressive drugs.
2. Patients receiving dialysis
3. Patients preparing for an organ or haematological transplant 
4. Patients who have silicosis. 

RECEIVING ORGAN RECEIVING TNF HAVE


OR HAEMATOLOGICAL TREATMENT SILICOSIS
TRANSPLATATION

3
How to rule out active TB

Before initiating TB preventive therapy, the health care workers should rule out active TB using
the symptoms screening questions: 
Cough of any duration
Weight loss
Night sweats
Fever. 

For children, screen for;


Cough of any duration
Reduced playfulness/ lethargy
Failure to thrive/ poor weight gain
Fever/ night sweats
History of contact with a person with TB

Diagnosis of Latent TB infections


The goal of testing for LTBI is to identify persons who are at
increased risk for developing TB and who would benefit from
treatment of the infection.
Either a tuberculin skin test (TST) or Interferon-Gamma Release
Assay (IGRA) can be used to test LTBI.

NOTE

All the at-risk populations found to have none of these symptoms should be tested using IGRA/
TST before initiating TB Preventive Therapy except people living with HIV and children under the
age of five years who are household contacts of bacteriologically-confirmed TB..

Any client found to have any of the symptoms suggestive of TB should not be offered TPT
instead they should be evaluated further for active TB disease.

4
Treatment options for Latent TB Infections

3RH: Given once daily for 3 months


Availability of child-friendly formulation (75/50mg)
Offered as preventive treatment for children and
adolescents aged <15 years
Better adherence (shorter regimen)
Do not give to patients on PI or NVP based ART
Less costly
Available in fixed dose combination

3HP: Given once a week for 12 weeks


Very promising regimen
1-month daily treatment option (1HP) being evaluated in PLHIV
Better adherence (shorter regimen)
FDC now available
Child-friendly formulation not available yet
No evidence for use in children <2 years
Do not give to patients on PI or NVP based ART
Safe to use in PLHIV on EFV and RAL
Studies on use with DTG- so far no interactions

6 H: Given daily for 6 months


Longer treatment duration
Higher rates of hepatotoxity than other regimens
Still regimen of choice for PLHIV on PI based ART regimen and on
HIV exposed children on Nevirapine (NVP) prophylaxis.
Lowest cost (uncoated tab), high cost dispersible tab
A syrup formulation is available for children

NOTE

The treatment of Latent TB infection is given based on the patient’s weight

Full patient dose should be available for the entire treatment period before initiating treatment
in patient.

5
Follow Up of Patients on TB Preventive Therapy (TPT)

Patients on TPT should be followed up on monthly basis and clinic appointments harmonized
with any other routine clinic schedule. During each clinic visit, the health care worker will conduct
the following;
 Conduct symptom based TB screening at every clinic visit for patients on TPT and update
TB status

 Assess and reinforce adherence of the patients at every visit to ascertain compliance and
completion of doses

 If a patient screens positive for TB while on TPT, stop TPT and manage according to National
TB guidelines

 Assess for any adverse drug reactions at each visit and intervene appropriately.

6
Algorithm for children (below 15 years) who are
contacts of Bacteriologically confirmed TB patients

NOTE
1
If TB is ruled out, antibiotics have been given and they are now asymptomatic, offer TPT according
to their age and weight.
2
Contra-indications include active hepatitis (Look for jaundice, tender abdomen), Symptoms of
peripheral neuropathy (Look for inability to walk…. etc.)
3
Screen for TB symptoms at every visit to rule out active TB.
4
Repeat symptomatic screening and physical examination to be sure that they are not a TB case.

7
Algorithm for all other risky population - Adults

NOTE
1
If TB is ruled out, antibiotics have been given and they are now asymptomatic, offer TPT according
to their age.
2
Contra-indications include active hepatitis (Look for jaundice, tender abdomen), Symptoms of
peripheral neuropathy (Look for inability to walk etc.
3
Repeat symptomatic screening and physical examination to be sure that they are not a TB case.
4
Screen for TB symptoms at every visit to rule out active TB.

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