Clinical standards for the diagnosis, treatment and prevention of TB infection.
Migliori GB., Wu SJ., Matteelli A., Zenner D., Goletti D., Ahmedov S., Al-Abri S., Allen DM., Balcells ME., Garcia-Basteiro AL., Cambau E., Chaisson RE., Chee CBE., Dalcolmo MP., Denholm JT., Erkens C., Esposito S., Farnia P., Friedland JS., Graham S., Hamada Y., Harries AD., Kay AW., Kritski A., Manga S., Marais BJ., Menzies D., Ng D., Petrone L., Rendon A., Silva DR., Schaaf HS., Skrahina A., Sotgiu G., Thwaites G., Tiberi S., Tukvadze N., Zellweger J-P., D Ambrosio L., Centis R., Ong CWM.
BACKGROUND: Tuberculosis (TB) preventive therapy (TPT) decreases the risk of developing TB disease and its associated morbidity and mortality. The aim of these clinical standards is to guide the assessment, management of TB infection (TBI) and implementation of TPT.METHODS: A panel of global experts in the field of TB care was identified; 41 participated in a Delphi process. A 5-point Likert scale was used to score the initial standards. After rounds of revision, the document was approved with 100% agreement.RESULTS: Eight clinical standards were defined: Standard 1, all individuals belonging to at-risk groups for TB should undergo testing for TBI; Standard 2, all individual candidates for TPT (including caregivers of children) should undergo a counselling/health education session; Standard 3, testing for TBI: timing and test of choice should be optimised; Standard 4, TB disease should be excluded prior to initiation of TPT; Standard 5, all candidates for TPT should undergo a set of baseline examinations; Standard 6, all individuals initiating TPT should receive one of the recommended regimens; Standard 7, all individuals who have started TPT should be monitored; Standard 8, a TBI screening and testing register should be kept to inform the cascade of care.CONCLUSION: This is the first consensus-based set of Clinical Standards for TBI. This document guides clinicians, programme managers and public health officers in planning and implementing adequate measures to assess and manage TBI.