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Diagnosing latent tuberculosis in high-risk individuals: rising to the challenge in high-burden areas.

Kasprowicz, Victoria O, Churchyard, Gavin, Lawn, Stephen D, Squire, Bertie ORCID: https://orcid.org/0000-0001-7173-9038 and Lalvani, Ajit (2011) 'Diagnosing latent tuberculosis in high-risk individuals: rising to the challenge in high-burden areas.'. Journal of Infectious Disease, Vol 204, Issue Supp 4, S1168-78.

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Abstract

A key challenge to greater progress in tuberculosis (TB) control is the reservoir of latent TB infection (LTBI), which represents a huge long-lived reservoir of potential TB disease. In parts of Africa, as many as 50% of 15-year-olds and 77%-89% of adults have evidence of LTBI. A second key challenge to TB control is the human immunodeficiency virus (HIV)-associated TB epidemic, and Africa alone accounts for one-quarter of the global burden of HIV-associated TB. HIV co-infection promotes both reactivation TB from LTBI and rapidly progressive primary TB following recent exposure to Mycobacterium tuberculosis. Preventing active TB and tackling latent infection in addition to the Directly Observed Treatment, Short-Course (DOTS) strategy could improve TB control in high-burden settings, especially where there is a high prevalence of HIV co-infection. Current strategies include intensified case finding (ICF), TB infection control, antiretroviral therapy (ART), and isoniazid preventive therapy (IPT). Although ART has been widely rolled out, ICF and IPT have not. A key factor limiting the rollout and effectiveness of IPT and ICF is the limitations of existing tools to both diagnose LTBI and identify those persons most at risk of progressing to active TB. In this review, we examine the obstacles and consider current progress toward the development of new tools to address this pressing global problem.

Item Type: Article
Subjects: WA Public Health > WA 30 Socioeconomic factors in public health (General)
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WF Respiratory System > Tuberculosis > WF 200 Tuberculosis (General)
WF Respiratory System > Tuberculosis > WF 205 Epidemiology
Digital Object Identifer (DOI): https://doi.org/10.1093/infdis/jir449
Depositing User: Helen Rigby
Date Deposited: 01 Aug 2012 10:57
Last Modified: 07 Dec 2018 10:27
URI: http://archive.lstmed.ac.uk/id/eprint/2841

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