Identifying gaps in the quality of latent tuberculosis infection care

Latent tuberculosis infection (LTBI) occurs after transmission and acquisition of infection, when the tuberculosis (TB) bacteria lie dormant in a person. Nearly one-quarter of the world's population is estimated to have LTBI, yet few studies have been published assessing the quality of LTBI services globally. This paper reviews issues to providing patient-centered LTBI services and offers an example framework to formally assess the quality of LTBI patient care. By applying the LTBI cascade of care model, TB programmes can evaluate the gaps and barriers to high-quality care and develop locally-driven solutions to improve LTBI services. Quality care for LTBI must address some of the key challenges to services including: (1) low prioritization of LTBI; (2) gaps in healthcare provider knowledge about testing and treatment; and (3) patient concerns about side effects of preventive treatment regimens. TB programmes need to ensure that these issues are addressed in a patient-centered manner, with clear communication and ongoing evaluation of the quality of LTBI services. Quality LTBI care must be a central focus, particularly identifying and engaging more household contacts in preventive treatment, in order to halt the progression to active disease thereby stopping TB transmission globally.