Research has shown that in areas with a low prevalence of TB, people who have been exposed and have confirmed TB infection should be given priority treatment, regardless of their age. In areas with a high burden of the disease, preventive treatment should be considered for all exposed individuals, even if they do not have a confirmed infection. This approach can help to bring an end to the TB epidemic and support global public health efforts to reduce TB mortality by 95% by 2035. Preventive treatment for TB can prevent latent TB infections from progressing.A recent study from a researcher at Boston University School of Public Health has shed light on the prioritization of preventive treatment for individuals exposed to TB. The study suggests that those with confirmed TB infection, regardless of age, should receive priority treatment in areas where the disease is not widespread. This is important as there is no global consensus on who should be prioritized for preventive TB treatment, and whether the benefits of the treatment differ based on factors such as age or confirmed infection.
However, in high-burden settings, all exposed individuals should be considered for preventative treatment, even without a confirmed infection, according to the findings published in The Lancet Respiratory Medicine.
This approach can help put an end to the tuberculosis epidemic and support global public health efforts to reduce TB mortality by 95 percent by 2035 (from 2015 estimates). In 2022, there were more than 10 million cases of active TB worldwide, resulting in 1.5 million deaths.
“Tuberculosis affects tens of millions of people every year and has long-lasting effects, even after people recover,” saysThe research was led by Dr. Leonardo Martinez, an assistant professor of epidemiology at BUSPH, who emphasized the importance of finding ways to improve prevention in order to address the epidemic. The study involved a thorough review and analysis conducted by Dr. Martinez and his colleagues to identify new cases of TB among individuals who had close contact with those diagnosed with the disease. They also compared the effectiveness of preventive treatment in these exposed individuals, taking into account factors such as age, infection status, and the prevalence of TB in their environments. The team discovered that among the 439,644 participants, preventive TB treatment was found to be 49 percent effective.The study identified 2,496 people who developed TB, especially those with a positive skin or blood test (with an 80 percent effectiveness rate).
Interestingly, the researchers discovered that preventive TB treatment was not effective for most people without evidence of infection, except for children under 5.
For those with a positive skin or blood test, the treatment’s effectiveness was similar across all age groups – adults, children ages 5-17, and children under 5. It was also more effective for individuals in high-burden settings.The team also calculated the number of individuals needed to receive treatment (NNT) to prevent one person from developing TB disease. They found that the NNT was lower in high-burden settings (29 to 43 people) compared to low-burden settings (213 to 455 people, regardless of infection status. Even though people with negative blood or skin tests may not benefit from preventive treatments, the researchers suggest that the overall low NNT may warrant prioritizing this treatment to all exposed contacts in areas where testing for TB infection is not available.”People with latent TB need treatment to end the threat of global TB,” says Dr. C. Robert Horsburgh, a professor of global health and coauthor of the study. The study shows the effectiveness of such treatment.
