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Free Content Latent tuberculosis infection and the EndTB Strategy: ethical tensions and imperatives

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Latent tuberculosis infection (LTBI) is increasingly recognised as central to programmatic TB activity, and a critical element in global progress towards TB elimination. LTBI affects a much larger group of people than active disease, who by definition are asymptomatic. Furthermore, while LTBI represents a state of risk, there remains significant uncertainty regarding which individuals will progress to active disease. Therefore, the development and implementation of LTBI management policies within the End TB Strategy requires careful ethical consideration. This article reviews ethical issues related to developments in LTBI diagnosis and management, including new tools and emerging policies and practice. Implications of LTBI management practices in specific settings are discussed, including healthcare worker infection and management of likely multidrug-resistant (MDR) LTBI. Better prediction of progression to active disease and less burdensome treatments would allow ethically appropriate expansion of testing programmes in future. However, even with existing tools there is a strong ethical imperative to provide the most effective and least burdensome therapy possible to those with LTBI, particularly those at highest risk of progression and/or poor outcomes from active disease. Greater community engagement is required in designing optimal LTBI management programmes, and ensure harms and benefits are appropriately balanced in specific settings.
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Keywords: EndTB Strategy; LTBI; TB elimination; ethics

Document Type: Research Article

Affiliations: 1: Victorian Tuberculosis Program, Melbourne, VIC, Australia 2: Pedro Kourí Tropical Medicine Institute, Havana, Cuba 3: KNCV Tuberculosis Foundation KNCV Tuberculosis Foundation, Mariahoeve, South Holland Province, Netherlands

Publication date: May 1, 2020

More about this publication?
  • The International Journal of Tuberculosis and Lung Disease (IJTLD) is for clinical research and epidemiological studies on lung health, including articles on TB, TB-HIV and respiratory diseases such as COVID-19, asthma, COPD, child lung health and the hazards of tobacco and air pollution. Individuals and institutes can subscribe to the IJTLD online or in print – simply email us at [email protected] for details.

    The IJTLD is dedicated to understanding lung disease and to the dissemination of knowledge leading to better lung health. To allow us to share scientific research as rapidly as possible, the IJTLD is fast-tracking the publication of certain articles as preprints prior to their publication. Read fast-track articles.

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