Programmatic management of tuberculosis preventive therapy: Past, present, future.

BACKGROUND

Tuberculosis (TB) infection (TBI) is an emerging public health priority, involving about one-fourth of the world population. Because patients with TBI are the reservoir for TB, stopping the progression to active disease by preventive treatment is one of the main interventions needed to achieve TB elimination. As of today, the proportion of people with TBI receiving treatment is minimal at the global level, mostly because current international policies recommend systematic testing and treatment for less than 2% of infected people.

PRESENT: FACTS AND GAPS: The programmatic management of TB preventive treatment involves a set of cascading interventions, of which the effectiveness is limited by the poor predictivity of diagnostic tests, the length and the potential toxicity of treatment, and the suboptimal prioritization within global policies. Partly because of this, competing priorities and the lack of adequate funding are significant barriers for scale-up, particularly in low- and middle-income countries.

MONITORING AND EVALUATION: To date, there is no universal system of monitoring and evaluation for the programmatic management of TB preventive treatment elements, and just a few countries use the standard recording and reporting tools, contributing to leaving TBI a neglected condition.

CONCLUSION

Better financed research and resources reallocation are essential steps to progress toward TB elimination worldwide.