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CONTROLLING THE SEEDBEDS OF TUBERCULOSIS: DIAGNOSIS AND TREATMENT OF TUBERCULOSIS INFECTION
Author
Affilliation
University College London. Institute of Epidemiology and Health. London, UK / University of Cape Town. Institute of Infectious Disease and Molecular Medicine. Cape Town, South Africa.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.
University of Sydney. Children’s Hospital at Westmead. Sydney, Australia / Centre for Research Excellence in Tuberculosis. Sydney, Australia.
Cambodian Health Committee. Phnom Penh, Cambodia.
University of Witwatersrand. Perinatal HIV Research Unit. Soweto, South Africa.
National Institute for Research on Tuberculosis. Chennai, India.
Johns Hopkins University. School of Medicine. Center for Tuberculosis Research. Baltimore, MD, USA.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.
University of Sydney. Children’s Hospital at Westmead. Sydney, Australia / Centre for Research Excellence in Tuberculosis. Sydney, Australia.
Cambodian Health Committee. Phnom Penh, Cambodia.
University of Witwatersrand. Perinatal HIV Research Unit. Soweto, South Africa.
National Institute for Research on Tuberculosis. Chennai, India.
Johns Hopkins University. School of Medicine. Center for Tuberculosis Research. Baltimore, MD, USA.
Abstract
The billions of people with latent tuberculosis infection serve as the seedbeds for future cases of active tuberculosis. Virtually all episodes of tuberculosis disease are preceded by a period of asymptomatic Mycobacterium tuberculosis infection; therefore, identifying infected individuals most likely to progress to disease and treating such subclinical infections to prevent future disease provides a crucial opportunity to interrupt tuberculosis transmission and reduce the global burden of tuberculosis disease. Programmes focusing on single strategies rather than comprehensive programmes that deliver an integrated arsenal for tuberculosis control might continue to struggle. Tuberculosis preventive therapy is a poorly used method that is essential for controlling the reservoirs of disease that drive the epidemic. Comprehensive control strategies that combine preventive therapy for the most high-risk populations and communities with improved case-fi nding and treatment, control of transmission, and health systems strengthening could ultimately lead to worldwide tuberculosis elimination. In this Series paper we outline challenges to implementation of preventive therapy and provide pragmatic suggestions for overcoming them. We further advocate for tuberculosis preventive therapy as the core of a renewed worldwide focus to implement a comprehensive epidemic control strategy that would reduce new tuberculosis cases to elimination targets. This strategy would be underpinned by accelerated research to further understand the biology of subclinical tuberculosis infections, develop novel diagnostics and drug regimens specifi cally for subclinical tuberculosis infection, strengthen health systems and community engagement, and enhance sustainable large scale implementation of preventive therapy programmes.
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