Public health guidance on programmatic management of latent tuberculosis infection in the European Union/European Economic Area

Timely detection and appropriate treatment of latent tuberculosis infection (LTBI) are key interventions for achieving tuberculosis (TB) elimination, particularly in countries with low TB incidence. In October 2018, the European Centre for Disease Prevention and Control (ECDC) published a public health guidance with the purpose of supporting the implementation of programmatic management of LTBI in the European Union/European Economic Area (EU/EEA). For the development of the guidance a systematic approach was used including collecting, apprising and summarising the available evidence; performing mathematical modelling and cost-effectiveness studies, and formulating expert consensus opinions. The collected information was assessed by ECDC and used to propose public health measures for implementation at national level in the EU/EEA. The guidance promotes the implementation of a comprehensive package of public health measures categorised under the following key components: identification of groups at risk; definition of diagnostic approach for LTBI detection; provision of LTBI treatment; implementation of patient-centred strategies for service delivery; effective health education and communication with target groups and healthcare providers; and, programme monitoring and evaluation. Country-level implementation of programmatic management of LTBI requires in-depth knowledge of the local TB epidemiology and the health system structure as well as cost-effective resource allocation and political commitment.