How do we do that?
While conceding that all contacts should be tested for LTBI, he stressed upon the urgent need of awareness campaigns in targeted groups for all contacts of TB patients to take proper nutrition, not smoke or consume alcohol, maintain proper blood-sugar levels, do physical activity, meditate to reduce stress, and maintain proper hygiene. These are all proven preventive measures to prevent LTBI from progressing to active TB and should be an integral part of TB care and control, rather than providing just TB-preventive treatment. Malnutrition is the bane of TB and LTBI control, and so nutritional support must be provided not only to TB patients, but also to their contacts, he said.
Latent TB management in Indonesia
Indonesia harbours the third highest burden of TB (6%) globally. Also an estimated 85 million of the Indonesian population is infected by latent TB. Dr Erlina Burhan, head of TB DOTS and MDR-TB at Persahabatan Hospital, Indonesia, and member of Board of Directors of International Union Against Tuberculosis and Lung Disease (The Union), told CNS that: "If Indonesia would like to have TB elimination by 2030, we cannot be just working at the end (treating active TB) but we have to prevent TB by finding people with LTBI - through contact investigation, screening at the community level, screening in high-risk groups - and give them TB-preventive treatment to prevent LTBI from developing into active TB disease. But as it is difficult to treat 85 million people, right now the government is prioritizing high-risk groups such as children under 5 years of age and people living with HIV for TB-preventive treatment. But as a clinician, I feel that we need to expand beyond these two groups and also target other risk groups to be screened and treated for LTBI."
Dr Erlina shared that in Indonesia's public-health programme the Mantoux tuberculin skin test is being used. Even though the QuantiFERON - an interferon-gamma release assay (IGRA) test - is a better diagnostic test, it is very costly. So the government is discussing the use of IGRA in future, provided the company reduces its cost.
As for TB-preventive treatment, currently a 6-month daily regimen of isoniazid is offered in the government programme. But another 12-dose regimen 3HP (once weekly doses of two drugs- isoniazid and rifapentine for 3 months) could soon become a reality in Indonesia.
Annual TB rate decline needed to end TB is 17%
Achieving the targets of an 80% reduction in TB incidence from the 2015 level by 2030 would require a 17% annual rate of decline in TB incidence. This in turn will require substantial reductions in the progression from LTBI to active TB disease. Healthcare interventions that could help to cut the risk of progression from LTBI to active TB disease include new diagnostic tests that are better at predicting who is at risk of progression to active TB disease; more effective drug treatments for people with LTBI; and action on the broader enablers of TB, which include improved nutrition, proper housing, better ventilation for fresh air and sunshine, improve sanitation and better infection control.
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