Recommendations on the Diagnosis and Treatment of Tuberculosis Infection: SEPAR/SEIMC/Spanish Ministry of Health Consensus Statement

All strategies on the pathway to tuberculosis (TB) elimination prioritise, among other measures, addressing tuberculosis infection (TBI), particularly the identification of individuals and population groups who should be candidates for tuberculosis preventive treatment (TPT). In Spain, a TBI test is required before recommending TPT. An interferon-gamma release assay (IGRA) is preferred over the tuberculin skin test (TST), although the latter may be used in settings where IGRAs are not available or when deemed necessary to increase diagnostic sensitivity. On the other hand, new skin tests employing specific antigens (TBST) may play a key role. As a general principle, screening for TBI should include all individuals at high risk for progressing from TBI to TB, as described in this guideline, prioritising pulmonary TB contacts, people living with HIV, immunocompromised individuals and those in other situations associated with an elevated risk of developing TB. Once TBI has been diagnosed in these high-risk groups, the algorithm set out in this guideline should be applied to rule out TB disease. Once TB has been excluded, TPT should be recommended. The preferred regimen is daily isoniazid (H) plus rifampicin (R) for 3 months (3HR). However, once rifapentine becomes available in Spain, both the 1-month daily (1HP) and the 3-month weekly (3HP) regimens combining H and rifapentine (P) may also be used. Finally, measures must be taken to ensure adherence to TPT and to monitor and manage potential drug-related adverse effects.