But managing LTBI in such a large population (400 million) is no easy task. So perhaps it becomes more pertinent to identify the groups that have a greater chance of breaking into active disease and then give them preventive treatment. But before we treat for LTBI we have to rule out active TB in these persons.
Test and treat
Dr Sarin shared that "The latest RNTCP guidelines for latent TB management have the test-and-treat strategy. But the recommendation is to treat without testing in certain groups. These are children below 5 years of age who are contacts of a TB patient and people who are living with HIV. In other groups, which include inmates of jails, people in congregate settings and in old-age homes, healthcare workers, people on chronic immunosuppressive therapy, we need to first test for LTBI and in case the person is infected we start that person on treatment."
The tests available in India are the tuberculin skin test or the Interferon Gamma Release Assay (IGRA), which is a blood test. The current treatment in the public-health programme for LTBI management is daily dose of isoniazid for six months. However the country is also considering newer TB-preventive treatment options, such as, a once weekly, 12-week regimen of Isoniazid and Refapentine. As a clinician one can give any of these therapies but from programmatic point of view it has to be operationally feasible for a large population, said Dr Sarin.
Boost our immunity
Dr Surya Kant, Professor and Head of the Department of Respiratory Medicine, King George's Medical University, makes a strong case of beating LTBI through improving the body's immune system. Dr Surya Kant has been the president of three important lung-health professionals' associations in India: Indian Chest Society, National College of Chest Physicians, and Indian College of Allergy, Asthma and Applied Immunology.
Dr Surya Kant said that if we cannot beat the TB bacteria, we can at least make ourselves fitter to fight it. He said that we cannot blame the TB bacteria alone for LTBI. Host immunity is also responsible for it. It is not just about the presence of the bacteria inside the body but also how the body deals with it. Active TB disease results when the body's resistance mechanism is unable to counteract the bacillary load.
Dr Surya Kant's advice is to focus more on developing the immunity of the contacts of TB patients.
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