South-East Asia Regional Action Plan on Programmatic Management of Latent Tuberculosis Infection
Overview
Latent tuberculosis infection (LTBI) is a state of persistent immune response to stimulation by Mycobacterium tuberculosis antigens without evidence of clinically manifested active TB. Although individuals with LTBI do not have active TB disease, they may develop the disease in future, making the person ill and putting them at risk of passing the infection to other people. The WHO End TB Strategy requires diagnosis and treatment of LTBI at a wider scale along with concerted efforts of management of all forms of active TB diseases to accelerate the decline in TB incidence. Such a combined package of curative and preventive treatment of TB is cost-effective in decreasing the rate of TB incidence, disability-adjusted life years (DALYs) averted and lives saved. The targets committed to by Member States as part of the Political Declaration at the United Nations High-Level Meeting (UNHLM) on TB (September 2018) include treating 40 million patients with TB and 30 million people with LTBI by 2022. World Health Organization (WHO) updated the guidelines for programmatic management of LTBI in 2018 to assist Member States in strengthening their capacities and systems to tackle LTBI with shorter and safer treatment regimens. Member States in the South-East Asia (SEA) Region have also made commitments to mobilize additional resources to enhance TB preventive treatment (TPT) in their respective countries.
The SEA Region bears more than 40% of the global burden of incident TB cases including almost 35% of the LTBI burden of the world. This is starkly disproportionate to only about 26% of the global population that lives in the Region. The current response to the TB situation in the SEA Region needs to be accelerated urgently if significant progress is to be made towards achieving the targets of the End TB Strategy.
Accelerating efforts to End TB by 2030 is a Regional Flagship Priority. To make a real dent in the TB epidemic, preventive treatment must become a key priority, in addition to accelerating TB case-finding and treatment. To align with the xvi South-East Asia Regional Action Plan on the Programmatic Management of Latent Tuberculosis Infection global commitments made at the UNHLM on TB in September 2018 by Member States, the Region needs to reach and treat at least 10.5 million people with LTBI by 2022. This will require urgent and rapid scaling up of access to TB preventive treatment (TPT).
The WHO Regional Office for South-East Asia, in consultation with Member States, technical partners, community representatives and individual experts, has prepared this document for the scale up of programmatic management of LTBI. It aims to support the Member States in developing clear policies and targets, while helping to address operational modalities.
It is conservatively estimated that there are 15 million people in the SEA Region who are eligible for TPT as per the WHO 2018 guidelines for programmatic management of LTBI. These people are likely to have been recently infected (within past few months) and have the highest probability of going on to develop active TB disease. Treating this pool of people living with recently acquired TB infection will help to reduce the incidence of TB by an additional 12-15% per year, or about 270 000 fewer TB cases each year over and above what can be achieved by improving diagnosis and treatment of active TB. If the coverage of this intervention is rapidly scaled up within the next 3 years, it will prevent more than 1 356 569 new TB cases in the Region and avert more than 2.3 million DALYs by 2025. With an anticipated massive cost reduction of new and safer drugs, preventive treatment will become highly cost-effective, with less than US$ 400 per DALY averted on average across the Region, and these costs are expected to get lower as the programmatic management of LBTI scales up.
