Models for implementing testing and treating latent tuberculosis infections among the vulnerable populations

Abstract

The Indian national tuberculosis (TB) prevalence survey conducted during 2019–2021 revealed a 31% TB infection (TBI) burden among individuals above 15 years of age. India has an ambitious plan of eliminating TB by 2025, 5 years ahead of the global agenda, thus focusing on the burden of TBI and management of TBI with TB preventive treatment (TPT) is of utmost importance in achieving the same. States in India adopt different models of implementation of testing and treating the TBI. Some of the states select subcontracting agencies to provide end-to-end TPT and some do adopt the in-house mechanism using the existing health system in providing the same. Moreover, the “Programmatic Management of TPT in India” guideline prioritizes population group for TPT based on elevated risk of progression from infection to TB disease or increased likelihood of exposure to TB disease. Given the background, we propose two models of implementation of TBI diagnosis using interferon-gamma release assay and treatment; one using a subcontracting agency and the other one using the existing health system machinery to test and treat the TBI.

Keywords

• interferon gamma-release assay
• latent tuberculosis
• subcontracting
• test and treat policy
• tuberculosis infection
• tuberculosis preventive treatment