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

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Global Health Policy

Background:

• Tuberculosis infection (TBI) affects a quarter of the global population, posing a significant public health challenge.
• Preventive treatment is key to TB elimination by halting disease progression in infected individuals.
• Current global policies limit systematic TBI testing and treatment to less than 2% of infected people.

Purpose of the Study:

• To highlight the challenges and gaps in the programmatic management of TB preventive treatment.
• To emphasize the need for improved strategies to scale up TBI preventive treatment globally.
• To advocate for increased research funding and resource reallocation for TB elimination efforts.

Main Methods:

• Analysis of current policies and programmatic management of TB preventive treatment.
• Identification of limitations including diagnostic test predictivity, treatment length/toxicity, and policy prioritization.
• Assessment of barriers to scale-up, such as competing priorities and inadequate funding, especially in LMICs.

Main Results:

• Effectiveness of TB preventive treatment is hampered by diagnostic limitations, treatment challenges, and suboptimal policy prioritization.
• Lack of universal monitoring and evaluation systems for TB preventive treatment contributes to its neglect.
• Inadequate funding and competing priorities are major obstacles to scaling up TBI management.

Conclusions:

• Significant improvements in research funding and resource allocation are necessary for global TB elimination.
• Addressing the identified gaps in programmatic management is crucial for effective TBI control.