Bull World Health Organ 2018;96:173–184F | doi: http://dx.doi.org/10.2471/BLT.17.199414

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173

National policies on the management of latent tuberculosis infection: review of 98 countriesAnn Jagger,a Silke Reiter-karam,b Yohhei Hamadab & Haileyesus Getahunb

IntroductionTuberculosis is currently the leading infectious cause of death worldwide. The World Health Organization (WHO) End Tu-berculosis strategy aims to substantially reduce tuberculosis incidence by 90% and mortality by 95% compared with the 2015 baselines of 142 cases per 100 000 population and 5.3 to 19 cases per 100 000 (depending on human immunodefi-ciency virus (HIV) status), respectively1,2 Achieving this goal requires successful management of latent tuberculosis infec-tion, which serves as a reservoir for new tuberculosis cases.3 In high-income countries which already have a low incidence of tuberculosis, management of latent infection can contribute to elimination of the disease.4 A review of treatment regimens found that treatment of latent tuberculosis can reduce the risk of disease reactivation by 60% to 90%.5 A recent randomized controlled trial in a high tuberculosis burden country showed that the benefits of preventive treatment in people living with HIV can last for more than 5 years.6,7

The WHO recommends tailored latent tuberculosis infec-tion management based on tuberculosis burden and resource availability.8 Systematic testing and treatment for latent infec-tion is strongly recommended for people living with HIV and for children younger than 5 years who are household contacts of a pulmonary tuberculosis case, regardless of the country’s background tuberculosis burden or resource availability.9,10 In upper-middle or high-income countries, depending on low tuberculosis burden and availability of resources, systematic testing and treatment of latent tuberculosis is strongly recom-mended for certain other risk groups: adult household contacts of pulmonary tuberculosis cases; patients with silicosis; pa-

tients initiating anti-tumour necrosis factor treatment; patients on dialysis; and organ transplant recipients.11,12

Despite some progress, particularly over the last decade, the scale-up of tuberculosis preventive treatment remains suboptimal globally. The 161 740 children started on tuber-culosis preventive treatment in 2016 represented only 13% of the 1.3 million children estimated to be eligible for treat-ment.1 The total number of people living with HIV who were started on tuberculosis preventive treatment in 2016 was at least 1.3 million.1 Data for other risk groups are not available or very limited.

Barriers to scale-up of tuberculosis preventive treatment include the absence of national policies and a lack of monitor-ing and evaluation systems.13 Here we review national policy documents to identify differences in programmatic manage-ment of latent tuberculosis infection in high- and low-burden countries.

MethodsThe baseline for this descriptive policy review was the 216 countries and territories reporting data to the WHO Global Tuberculosis Programme (194 Member States and 22 asso-ciate Member States and territories). Based on the current WHO approach11 we divided countries into two groups: low burden and high burden. We defined low-burden countries as upper-middle or high-income countries with an estimated annual tuberculosis incidence of less than 100 cases per 100 000 population.11 High-burden countries were low- to lower-middle-income or other income countries with annual tuberculosis incidence of 100 or more cases

Objective To review policies on management of latent tuberculosis infection in countries with low and high burdens of tuberculosis.Methods We divided countries reporting data to the World Health Organization (WHO) Global Tuberculosis Programme into low and high tuberculosis burden, based on WHO criteria. We identified national policy documents on management of latent tuberculosis through online searches, government websites, WHO country offices and personal communication with programme managers. We made a descriptive analysis with a focus on policy gaps and deviations from WHO policy recommendations.Findings We obtained documents from 68 of 113 low-burden countries and 30 of 35 countries with the highest burdens of tuberculosis or human immunodeficiency virus (HIV)-associated tuberculosis. Screening and treatment of latent tuberculosis infection in people living with HIV was recommended in guidelines of 29 (96.7%) high-burden and 54 (79.7%) low-burden countries. Screening for children aged < 5 years with household tuberculosis contact was the policy of 25 (83.3%) high- and 28 (41.2%) low-burden countries. In most high-burden countries the recommendation was symptom screening alone before treatment, whereas in all low-burden countries it was testing before treatment. Some low-burden countries’ policies did not comply with WHO recommendations: nine (13.2%) recommended tuberculosis preventive treatment for travellers to high-burden countries and 10 (14.7%) for patients undergoing abdominal surgery.Conclusion Lack of solid evidence on certain aspects of management of latent tuberculosis infection results in national policies which vary considerably. This highlights a need to advance research and develop clear, implementable and evidence-based WHO policies.

a University of California Berkeley, School of Public Health, Berkeley, California, United States of America.b Global Tuberculosis Programme, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland.Correspondence to Yohhei Hamada (email: hamaday@who.int).(Submitted: 26 June 2017 – Revised version received: 17 December 2017 – Accepted: 18 December 2017 – Published online: 5 February 2018 )

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ResearchNational policies on latent tuberculosis Ann Jagger et al.

per 100 000. Among the high-burden countries, we focused on the top 30 countries in terms of high burden of tuberculosis (both in terms of number of cases and incidence) and on the

top 30 countries in terms of high bur-den of HIV-associated tuberculosis. These countries account for most of the global burden of tuberculosis (9.1 out of 10.4 million cases, 88%) and

HIV-associated tuberculosis (0.91 out of 1.03 million, 88%).1 Because many countries feature in the top 30 of both lists, this produced a list of 35 target countries. Our approach resulted in

Fig. 1. Selection of countries for the review of national policies on management of latent tuberculosis infection

Countries and territories reporting data to the Global Tuberculosis Programme: 194 WHO Member States and 22 associate Member States and territories

113 high- and upper-middle income countries with an estimated annual tuberculosis incidence <100 per 100 000

68 policy documents obtained and included in the analysis

103 low- and lower-middle or other income countries with an estimated annual tuberculosis incidence ≥ 100 per 100 000

35 countries belonging to the 30 high tuberculosis or HIV-associated tuberculosis burden countries

30 policy documents obtained and included in the analysis

68 countries not belonging to the 30 high tuberculosis or HIV-associated

tuberculosis burden countries

45 policy documents on latent tuberculosis could not be obtained

5 policy documents on latent tuberculosis could not be obtained

HIV: human immunodeficiency virus.

Table 1. World Health Organization recommendations for the management of latent tuberculosis infection in low and high tuberculosis burden countries, October 2017

Tuberculosis burden classifica-tion

Risk groups defined Testing recommendations Diagnostic algorithms to exclude active tuberculosis

Treatment recommenda-tions

Low-burden countries

Strong recommendation: people living with HIV; adult and child household contacts of pulmonary tuberculosis cases; treatment with anti-tumour necrosis factor; organ transplantation; silicosis; end-stage renal disease Conditional recommendation: health-care workers; prisoners; immigrants from high-burden countries; illicit drug users; homeless people

Tuberculin skin test or interferon-gamma release assay

Symptomatic screening plus chest X-ray

6 months daily isoniazid; or 9 months daily isoniazid; or 3 months weekly rifapentine plus isoniazid; or 3–4 months daily isoniazid plus rifampicin; or 3–4 months daily rifampicin

High-burden countries

People living with HIV; children aged < 5 years; household contacts of pulmonary tuberculosis cases

Tuberculin skin test or interferon-gamma release assay not required. Tuberculin skin test encouraged for people living with HIV

Symptomatic screening alone

6 months daily isoniazid

HIV: human immunodeficiency virus. Sources: World Health Organization (WHO) Guidelines on the management of latent tuberculosis infection.11 WHO Recommendations for investigating contacts of persons with infectious tuberculosis in low- and middle-income countries.9 WHO Guidelines for intensified case-finding and isoniazid preventative therapy for people living with HIV in resource-constrained settings.10

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ResearchNational policies on latent tuberculosisAnn Jagger et al.

Table 2. Definitions of symptoms to exclude active tuberculosis before providing tuberculosis preventive treatment to adults and children living with human immunodeficiency virus (HIV) in countries with the highest burdens of tuberculosis or HIV-associated tuberculosis

Country Adults living with HIV Children living with HIV

Symptoms defined by WHO Additional symptoms or findings

Symptoms defined by WHO Additional symptoms or findings

Angola Current cough; fever; night sweats; weight loss

N/A Current cough; fever; weight loss or poor weight gain

Chest X-ray findings suggestive of tuberculosis

Bangladesh N/A N/A Current cough; fever; contact history with a tuberculosis case; weight loss or poor weight gain

Fatigue, lethargy, neck mass, wheeze, ascites

Botswana N/A N/A N/A N/ACambodia Current cough; fever; night

sweats Fatigue; lethargy; wheeze; neck mass; abdominal mass; ascites

Current cough; fever; contact history with a tuberculosis case; weight loss or poor weight gain

Failure to thrive, enlarged lymph nodes

Cameroon Current cough; fever; night sweats; weight loss

N/A Current cough; fever; weight loss or poor weight gain

N/A

Central African Republic

Current cough; fever; night sweats; weight loss

N/A Current cough; fever; contact history with a tuberculosis case; weight loss or poor weight gain

N/A

Democratic Republic of the Congo

Current cough; fever; night sweats; weight loss

N/A Current cough; fever; contact history with a tuberculosis case; weight loss or poor weight gain

N/A

Ethiopia Current cough; fever; night sweats; weight loss

N/A Current cough; fever; contact history with a tuberculosis case; weight loss or poor weight gain

N/A

Ghana N/A N/A Current cough; fever; contact history with a tuberculosis case; weight loss or poor weight gain

Fatigue, lethargy, neck swelling, wheeze

India Current cough; fever; night sweats; weight loss

N/A N/A N/A

Indonesia Current cough; fever; night sweats; weight loss

Signs of extrapulmonary tuberculosis

N/A N/A

Kenya Current cough; fever; night sweats; weight loss

N/A Current cough; fever; contact history with a tuberculosis case; weight loss or poor weight gain

Lethargy, less playful than usual

Lesotho Current cough; fever; night sweats; weight loss

N/A Current cough; fever; contact history with a tuberculosis case; weight loss or poor weight gain

N/A

Malawi Current cough; fever; night sweats; weight loss

N/A Current cough; fever Failure to thrive, night sweats, malnutrition

Mozambique N/A N/A Current cough; fever; weight loss or poor weight gain

N/A

Myanmar Current cough; fever; night sweats; weight loss

N/A Current cough; fever; contact history with a tuberculosis case; weight loss or poor weight gain

N/A

Namibia Current cough; fever; night sweats; weight loss

Chest pain; shortness of breath; haemoptysis; loss of appetite; diarrhoea; fatigue; enlarged lymph nodes

Current cough; fever; contact history with a tuberculosis case; weight loss or poor weight gain

Enlarged lymph nodes

(continues. . .)

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ResearchNational policies on latent tuberculosis Ann Jagger et al.

a target of 148 countries (113 low-burden countries and 35 high-burden countries) for the study (Fig. 1).

We aimed to analyse each country’s or territory’s national guidelines on the management of tuberculosis, HIV, pae-diatric tuberculosis, latent tuberculosis infection and HIV-associated tuberculo-sis, and standard national operating pro-cedures for tuberculosis. We obtained documents by contacting WHO country offices or national programme manag-ers or by downloading them from the official website of the ministry of health or other national health organization.

We selected the information to be extracted a priori based on WHO recommendations for the manage-ment of latent tuberculosis infection (Table 1 and Table 2).9–11 We collected information on the following: (i) at-risk

populations targeted; (ii) recommended tests for latent tuberculosis infection; (iii) diagnostic algorithms to exclude active tuberculosis before starting treat-ment for latent tuberculosis infection; (iv) treatment regimens for latent tu-berculosis infection; and (v) presence of monitoring and evaluation systems for the management of latent tuberculosis infection. For high-burden countries, we focused the review only on people living with HIV and children younger than 5 years who have household contact with a tuberculosis case. One researcher collected and entered the data for all low-burden countries and another researcher for all high-burden countries using data extraction forms developed for the study.

Statistical analysis of the data was performed using GraphPad Prism

(GraphPad Software Inc., La Jolla, Unit-ed States of America) and STATA (Stata Corp LLC, College Station, USA) soft-ware. Where percentages are indicated, binary indicators (0,1) were created for the absence or presence of each policy item extracted. The means of those binary indicators corresponded to the percentage of countries addressing each policy item. The number and percentage of countries addressing each policy item were calculated and presented.

Results

Results of search

We obtained and analysed copies of policy documents from 98 countries (Table 3; available at: http://www.who.int/bulletin/volumes/96/3/17-199414).

Country Adults living with HIV Children living with HIV

Symptoms defined by WHO Additional symptoms or findings

Symptoms defined by WHO Additional symptoms or findings

Nigeria Current cough; fever; night sweats; weight loss

N/A N/A N/A

Pakistan Current cough; fever; night sweats; weight loss

N/A Current cough; fever; contact history with a tuberculosis case; weight loss or poor weight gain

N/A

Papua New Guinea Current cough; night sweats; weight loss

N/A N/A N/A

Philippines Current cough; fever; night sweats; weight loss

N/A N/A N/A

Sierra Leone Current cough; fever; night sweats; weight loss

N/A N/A N/A

South Africa Current cough; fever; night sweats; weight loss

N/A Current cough; fever; contact history with a tuberculosis case; weight loss or poor weight gain

Fatigue

Swaziland Current cough; fever; night sweats; weight loss

N/A Current cough; fever; contact history with a tuberculosis case; weight loss or poor weight gain

N/A

Thailand N/A N/A N/A N/AUganda Current cough; fever; night

sweats; weight loss N/A N/A N/A

United Republic of Tanzania

Current cough; fever; night sweats; weight loss

N/A Fever; contact history with a tuberculosis case; weight loss or poor weight gain

N/A

Viet Nam Current cough; fever; night sweats; weight loss

N/A N/A N/A

Zambia Current cough; fever; night sweats; weight loss

N/A Current cough; fever; contact history with a tuberculosis case; weight loss or poor weight gain

N/A

Zimbabwe Current cough; fever; night sweats; weight loss

Haemoptysis N/A N/A

HIV: human immunodeficiency virus; N/A: data not available; WHO: World Health Organization. Notes: WHO recommended four-symptom algorithm for people living with HIV includes: current cough, fever, night sweats and weight loss for adults and current cough, fever, poor weight gain and contact history with a tuberculosis case for children.10

(. . .continued)

Ann Jagger et al. National policies on latent tuberculosisResearch

177Bull World Health Organ 2018;96:173–184F| doi: http://dx.doi.org/10.2471/BLT.17.199414

For high-burden countries, we obtained guidelines from 30 of 35 (85.7%) high-burden countries. We were unable to retrieve any national policies pertaining to latent tuberculosis infection for Chad, Democratic People’s Republic of Korea, Guinea Bissau, Liberia and Congo. For guidelines obtained, publication year ranged between 2007 and 2016. We also included one draft guideline under review.

For low-burden countries, we were able to obtain policy documents from 68 of 113 (60.2%) countries, with a publica-tion year ranging from 2001 to 2015. The policy documents ranged from detailed policies focusing on latent tuberculosis infection to a brief mention of latent tuberculosis infection in a general tu-berculosis policy.

High-burden countries

Risk groups defined

Of the 30 high-burden countries for which guidelines were obtained, infor-mation on the management of latent tuberculosis infection among children with a household contact was available for 25 countries. In four countries the relevant tuberculosis guidelines could not be obtained and in one country the guidelines were written in local languages that we were not able to translate. All 25 countries followed WHO policy (Table 1) recommending treatment for children younger than 5 years with a household tuberculosis contact (Table 4); 17 of these specifically targeted contacts of smear-positive cases. India and Nigeria recommended preventive treatment for children under 6 years old with a house-hold contact. No policy recommended preventive treatment for contacts of a multidrug-resistant tuberculosis case.

For people living with HIV, 29 countries (96.7%) had recommenda-tions on tuberculosis preventive treat-ment; only Ghana did not provide any recommendations.

Testing recommendations

For children younger than 5 years with a household contact, 24/25 (96.0%) of the countries analysed did not have recommendations for testing for latent tuberculosis before starting preventive treatment. Only in the Philippines was a tuberculin skin test recommended, with the option to provide preventive treat-ment without testing when testing was

not available. To exclude active tuber-culosis before treatment of latent tuber-culosis, most countries (24/25, 96.0%) had a policy on symptomatic screening alone. Symptom-based algorithms to ex-clude active tuberculosis were defined in the guidelines of 12 countries (Table 2).

Of these, 11 countries included cough, fever and weight loss or poor weight gain in their algorithms. The presence of a va-riety of additional symptoms and signs were also specified: fatigue, wheeze, neck mass, abdominal mass, ascites, diarrhoea, loss of appetite and night

Table 4. Recommendations for management of latent tuberculosis infection in countries with the highest burdens of tuberculosis or HIV-associated tuberculosis

Indicator Total no. of countries reviewed

No. (%) following recommendation

Guidelines identified on testing and treatment of tuberculosis, with or without HIV

35 30 (85.7)

Latent tuberculosis infection treatment recommended for:

Children aged < 5 years with household tuberculosis contact

Yes 30 25 (83.3) Unknowna 30 5 (16.7)People living with HIV Yes 30 29 (96.7) No 30 1 (3.3)Recommended treatment regimens 6 months isoniazid monotherapy 30 18 (60.0)6–9 months isoniazid monotherapy 30 6 (20.0)Isoniazid monotherapy, other durations 30 5 (16.7)6 months isoniazid and 3 months rifampicin 30 1 (3.3)Monitoring and evaluation indicators Isoniazid preventive therapy for children aged < 5 years with household tuberculosis contact

30 4 (13.3)

Screening coverage among children aged < 5 years with household tuberculosis contact

30 7 (23.3)

Isoniazid preventive treatment coverage among HIV-infected people

30 18 (60.0)

Isoniazid preventive treatment reporting tool available 30 15 (50.0)Screening of children aged < 5 years old with household tuberculosis contact

Clinical examination only 30 24 (80.0)Clinical examination and tuberculin skin test 30 1 (3.3)Unknown 30 5 (16.7)Screening of HIV-infected people Adults Clinical examination only 30 26 (86.7) Clinical examination and tuberculin skin test 30 1 (3.3) Not defined 30 3 (10.0)Children aged > 12 months Clinical examination only 30 20 (66.7) Clinical examination and tuberculin skin test 30 1 (3.3) Clinical examination and chest X-ray 30 1 (3.3) Not defined 30 8 (26.7)

HIV: human immunodeficiency virus. a We could not obtain any relevant treatment guidelines for child contacts and we found no

recommendations in other available guidelines (4 countries) or the guidelines were written in a local language and we were unable to translate them with confidence (1 country).

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sweats. The exclusion algorithm was not defined in the remaining countries.

For people living with HIV, 86.7% (26/30) of the high-burden countries analysed provided preventive treatment for latent tuberculosis without testing for infection. In South Africa the recom-mendation was for a tuberculin skin test before starting preventive treatment, but this was not specified by the remaining countries. The majority of the countries (20/30) applied the WHO four-symp-tom screening rule (current cough, fever, weight loss and night sweats) for ex-cluding pulmonary tuberculosis before starting preventive treatment (Table 2). Five countries specified a different set of symptoms and another five countries did not specify the symptoms to be used in the exclusion algorithm.

For children older than 12 months living with HIV, 66.7% (20/30) of high-burden countries had a recom-mendation for symptomatic screening alone before starting preventive treat-ment. Only India had a policy of doing a tuberculin skin test in addition to symptomatic screening before starting such treatment. In Angola, the recom-mendations were for chest radiography in addition to symptomatic screening. Only eight (26.7%) countries followed the WHO recommendation to exclude active tuberculosis based on poor weight gain, fever, current cough or contact his-tory with a tuberculosis case (Table 2).

Treatment recommendations

WHO recommends 6 months of iso-niazid monotherapy both for people living with HIV and children with a household contact in high-burden coun-tries (Table 1). Among the high-burden countries reviewed, the majority (18/30) of guidelines recommended 6 months of isoniazid monotherapy, while in six countries (Cambodia, Democratic Republic of Congo, Namibia, Thailand, Viet Nam and Zimbabwe) it was a course of 6‒9 months. Central African Republic had a policy of 3 months of rifampicin plus isoniazid, as well as 6 months of iso-niazid (Table 4). In Uganda and Pakistan recommendations were for an additional course of prolonged isoniazid treatment (12 and 36 months, respectively) for people living with HIV who have tuber-culosis contact history. In South Africa the recommendations were 6‒36 months of isoniazid treatment, depending on the

results and availability of tuberculin skin testing. In Malawi the policy was contin-uation of isoniazid treatment for those not receiving antiretroviral therapy but discontinuation once therapy is started.

Monitoring and evaluation indicators

Of the high-burden countries, only Ke-nya, Malawi, South Africa and Thailand had guidelines that defined indicators to evaluate the coverage of tuberculosis screening and preventive treatment among children younger than 5 years with a household contact. Most coun-tries (18/30) defined an indicator for coverage of preventive treatment in people living with HIV (Table 4). In 2017, 10 of these countries reported data to the Global tuberculosis report1 about the proportion of patients newly enrolled in HIV care who were provided with tuberculosis preventive treatment (Table 5). Fifteen countries included information on recording and reporting tools for isoniazid preventive treatment in their guidelines (Table 4).

Low-burden countries

Risk groups defined

The risk groups strongly recommended by WHO to be targeted for latent tu-berculosis infection screening (Table 1) were included in the national latent tu-berculosis infection policies of between 19 (27.9%) and 54 (79.4%) of 68 low-burden countries (Fig. 2). Specifically, 28 countries (42.1%) had a recommen-dation to screen children younger than 5 years who are contacts of a tubercu-losis case. An additional 49 countries (70.1%) had recommendations to screen all contacts of a tuberculosis case, mak-ing no distinction between adults and children. For people living with HIV, the policy in 54 (79.4%) countries was to screen people living with HIV for latent tuberculosis infection and in 23 (33.8%) countries it was to screen im-munocompromised individuals, which includes people living with HIV.

In contrast, some of the condition-ally recommended categories (such as

Table 5. Tuberculosis preventive treatment for people newly enrolled in human immunodeficiency virus (HIV) care in countries with the highest burdens of tuberculosis or HIV-associated tuberculosis, 2016

Country No. (%) of people living with HIV who were newly enrolled in HIV carea

Indicator defined in national policyb

Total Provided with tuberculosis preven-

tive treatment

Diagnosed with active tubercu-

losis

Cambodia 3 193 631 (19.8) N/A YesEthiopia 36 761 19 244 (52.3) 2 165 (5.9) YesIndia 174 125 8 135 (4.7) 21 032 (12.1) NoIndonesia 36 294 877 (2.4) 9 792 (27.0) YesLiberia 4 528 390 (8.6) 1 219 (26.9) N/AMalawi 145 117 72 446 (49.9) 2 402 (1.7) YesMozambique 315 712 162 646 (51.5) N/A YesMyanmar 34 765 1 018 (2.9) 3 960 (11.4) YesNigeria 216 293 62 781 (29.0) 14 794 (6.8) YesPhilippines 5 966 2 938 (49.2) 1 645 (27.6) NoSierra Leone 17 843 3 609 (20.2) 1 627 (9.1) NoSouth Africa 751 620 385 932 (51.3) N/A YesSwaziland 138 016 21 320 (15.4) 2 342 (1.7) YesUnited Republic of Tanzania

49 351 4 202 (8.5) N/A Yes

Viet Nam 13 593 3 474 (25.6) N/A NoZimbabwe 168 968 123 846 (73.3) 9 176 (5.4) No

N/A: data not available.a Data are from the World Health Organization Global tuberculosis report.1 b Indicator for coverage of preventive treatment in people living with HIV was defined in the national policy.

Note: The table includes only the 16 countries that reported data on preventive treatment among people living with HIV in 2017.

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ResearchNational policies on latent tuberculosisAnn Jagger et al.

prisoners and illicit drug users; Table 1) were rarely mentioned in policies (Fig. 2). Notably, some countries in-cluded categories that are not recom-mended by the WHO; nine countries (13.2%) recommended tuberculosis preventive treatment for travellers to high tuberculosis burden countries and 10 (14.7%) for patients undergoing abdominal surgery.

Testing recommendations

The WHO latent tuberculosis infection guidelines indicate that in low-burden countries either a tuberculin skin test or interferon-gamma release assay can be used for diagnosis (Table 1). Of the low-burden countries 33/68 (48.5%) had a recommendation to use tuberculin

skin testing as the primary screen-ing method compared with only 2/68 (2.8%) recommending interferon assay (Fig. 3). In 21 countries (30.8%), the policy was either tuberculin skin test or interferon assay as the primary method of screening. In addition, multiple poli-cies specified situations when using one test over the other was preferable. For example, in 21 (30.8%) countries the policy was that interferon assay should be used for individuals vaccinated with bacille Calmette–Guérin (BCG) and in 17 (25.0%) countries that interferon assay and tuberculin skin test should be used sequentially. For some countries, including Costa Rica and Uruguay, there were no explicit recommendations on methods of testing.

An algorithm for excluding active tuberculosis was specified in the poli-cies of 43 (63.2%) low-burden countries, although the content of that algorithm varied greatly from country to country. In Colombia, Ecuador and Uruguay the recommendation was only that active tuberculosis should be ruled out, with no mention of an exclusion algorithm. All other countries required at least a chest X-ray.

Treatment recommendations

The most commonly recommended treatments in low-burden countries were isoniazid for 6 months (55 coun-tries; 80.8%) or 9 months (55 countries, 80.8%) (Fig. 4), which is in line with the WHO guidelines on treatment of latent tuberculosis (Table 1). Alternative treatment options recommended by the WHO were also frequently mentioned in other policies, but to a lesser extent, ranging from 8 (11.7%) to 51 (75.0%) countries.

Monitoring and evaluation indicators

Monitoring and evaluation of latent tuberculosis infection screening was mentioned in the policies of 32 (47.1%) low-burden countries. Even among the countries that mentioned reporting requirements, those were often specific to active tuberculosis, and therefore the form may be inappropriate for latent tuberculosis infection.

DiscussionThis review identified that the majority of both high- and low-burden countries had a national policy that addressed la-tent tuberculosis infection management in people living with HIV and children younger than 5 years with a household contact. Clinical high-risk groups were also covered by most guidelines from low-burden countries. However, the content of the guidelines varied con-siderable across countries. For example, clear and standard algorithms for ex-cluding tuberculosis before treatment and latent tuberculosis infection testing were not available in many countries, and indicators for monitoring and evalu-ation were rarely defined. Guidelines are the first step in implementing the programmatic management of latent tu-berculosis infection, hence it is essential to provide clear and simple operational

Fig. 2. Compliance of national policies with World Health Organization guidelines on screening for latent tuberculosis infection among high-risk population groups in low-burden countries

Homeless peopleChildren aged <5 years with new tuberculosis infection

Patients with haematologic malignanciesIllicit drug users

Travellers to high tuberculosis burden countriesPatients with gastrectomy

Malnourished or underweight peoplePatients with diabetes

Patients with incomplete tuberculosis treatmentPatients with tuberculin skin test conversion

Patients with jejunoileal bypassPatients with radiographic evidence

Immigrants from high tuberculosis burden countriesPatients with end-stage renal disease

PrisonersPatients with silicosis

Immunocompromized (nonspecific) peoplePatients with head or neck carcinoma

Children aged <15 yearsOther occupational groups

Health-care workersOrgan transplant or blood transfusion recipients

Patients treated with anti-tumour necrosis factorPeople with a tuberculosis contact

People living with HIV infection

Risk

gro

ups

% of countries recommending screening0 10 20 30 40 50 60 70 80 90 100

Conditionally recommended by WHONot recommended by WHO

Strongly recommended by WHO

WHO: World Health Organization.Notes: WHO Guidelines on screening for latent tuberculosis infection11 are summarized in Table 1. Risk groups targeted by fewer than 3% of low-burden countries are not shown on the chart. The risk categories not shown are: people with harmful alcohol use; patients with incomplete tuberculosis treatment; elderly people; children born to tuberculosis-positive mothers; and tobacco smokers. The total number of countries analysed was 68.

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ResearchNational policies on latent tuberculosis Ann Jagger et al.

guidance, including evidence-based standardized algorithms and a frame-work of monitoring and evaluation.14

The advantage of an evidence-based standardized algorithm was demon-strated by the WHO recommended four-symptom screening rule to exclude active tuberculosis before starting pre-ventive treatment for people living with HIV.10 This simple algorithm adds to the clarity of the policy and has resulted in a steep rise in implementation of isoniazid preventive treatment among people living with HIV in settings with a high prevalence of tuberculosis and low resources, reaching 1.3 million in 2016.1 Ensuring that guidelines and algorithms are simple can also facilitate their in-corporation into national guidelines. For example, seven out of 10 countries that had algorithms different from the WHO recommendation in a previous policy review15 have now adopted them (Cameroon, Lesotho, Nigeria, South Africa, Swaziland, United Republic of Tanzania and Viet Nam).

In contrast to the uptake of the screening algorithm for people living

with HIV, the corresponding screening algorithm for children was not taken up or defined in national policies. This could be due to the limited evidence about the effectiveness of the algorithm, as it was recommended largely based on expert opinion.16 Further research is needed to evaluate the performance of the algorithm and identify the optimal approach to exclude active tuberculosis in children before starting preventive treatment.

Consistent with our previous study,13 we found that the national policies and guidelines in the major-ity of low-burden countries addressed latent tuberculosis infection specifically or as part of the general tuberculosis policy. The Netherlands has revised its guidelines since the publication of the 2015 WHO latent tuberculosis infection guidelines,17 which are now mostly con-sistent with WHO recommendations. A similar revision by other countries would increase alignment between na-tional policies and WHO recommenda-tions. This could lead to more consistent and comprehensive latent tuberculosis

infection policies and pave the way for global monitoring and evaluation of the programmatic management of latent tuberculosis infection. Although it may be too early to evaluate the impact of such policy changes on tuberculosis incidence, it is a question that needs to be addressed in the future.

Tuberculin skin testing was the most frequently recommended diag-nostic tool. The test requires no labora-tory work and is comparably cheaper per unit test than interferon-gamma release assay. That may explain the overwhelming preference for the test over interferon assay in the policies of low-burden countries. Several coun-tries specified additional diagnostic algorithms, such as different tuberculin skin test cut-off points among specific risk groups, sequential use of the two tests, or use of interferon assay for BCG-vaccinated individuals. A system-atic review did not show a significant difference in the prediction of progres-sion to active tuberculosis between the two tests in head-to-head analysis.11 However, there were insufficient data on the predictive utility among specific populations. The diversity of policies across countries calls for more research in how to use interferon-gamma re-lease assay and tuberculin skin testing together among different risk groups based on the underlying tuberculosis epidemiology.

This policy review has limitations. First, determining the latest published guidelines was done through contact-ing national programmes, WHO of-fices and through extensive internet searches; however some policies may not have been identified. Even though latent tuberculosis infection monitor-ing and evaluation indicators may not have been defined in guidelines they may nevertheless exist within a coun-try’s national tuberculosis programme or other guidelines. These limitations might have led to misclassification of the findings. Second, a single person was responsible for reviewing policies, extracting relevant information and entering data within each group (high-and low-burden countries). While this provided internal consistency, the data collection may have been subject to reviewer bias.

Fig. 3. Recommendations for screening methods for latent tuberculosis infection in the national policies of low-burden countries

Interferon assay (primary)

Tuberculin skin test for repeat testing (e.g. contact investigation)

Interferon assay for outbreak investigation for children aged >5 years

Interferon assay for immunocompromised people

Sequential use of tuberculin skin test and interferon assay

Tuberculin skin test for contact investigation for children aged <5 years

Interferon assay for BCG-vaccinated people

Tuberculin skin test or interferon assay

Tuberculin skin test (primary)

Scre

enin

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% of countries recommending method0 10 20 30 40 50 60 70 80 90 100

BCG: bacille Calmette-Guérin; WHO: World Health Organization.Notes: World Health Organization guidelines are that either tuberculin skin test or interferon-gamma release assay can be used to screen for latent tuberculosis infection.11 Interferon assay refers to interferon-gamma release assay. The total number of countries analysed was 68.

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ملخصالسياسات الوطنية املتبعة للتعامل مع عدوى السل الكامنة: مراجعة شملت 98 بلًدا

الغرض مراجعة السياسات املتبعة للتعامل مع عدوى السل الكامنة يف البلدان التي تعاين من معدالت منخفضة لإلصابة بمرض السل

والبلدان التي تعاين من معدالت مرتفعة لإلصابة باملرض.العاملي للربنامج بيانات التي قدمت البلدان بتقسيم قمنا الطريقة إىل السل مرض بمكافحة واملعني العاملية الصحة ملنظمة التابع بلدان لدهيا معدالت منخفضة وأخرى تعاين من معدالت مرتفعة العاملية. وقد استناًدا ملعايري منظمة الصحة بالسل وذلك لإلصابة حددنا وثائق السياسات الوطنية للتعامل مع مرض السل الكامن اإللكرتونية واملواقع اإلنرتنت شبكة عىل البحث خالل من واالتصال العاملية الصحة ملنظمة الُقطرية واملكاتب للحكومات الشخيص مع مديري الربنامج. كام قمنا بإجراء حتليل وصفي يركز توصيات عن املتبعة السياسات يف احليود وحاالت الثغرات عىل

السياسات ملنظمة الصحة العاملية.113 بلًدا أصل من 68 بلًدا من وثائق عىل حصلنا النتائج السل مرض أو السل بمرض لإلصابة منخفضة معدالت لدهيا املصاحب لفريوس عوز املناعة البرشي )HIV(، كام حصلنا عىل 35 بلًدا تعاين من معدالت مرتفعة. 30 بلًدا من أصل وثائق من الكامنة لدى السل وقد وردت توصيات بفحص وعالج عدوى

املتبعة التوجيهية املبادئ املناعة البرشي يف املصابني بفريوس عوز لدى 29 بلًدا )بواقع 96.7 %( تعاين من ارتفاع معدالت اإلصابة معدالت لدهيا )% 79.7 )بواقع بلًدا 54 يف وكذلك باملرض، منخفضة لإلصابة باملرض. ونصت السياسات عىل وجوب إجراء أفراد العرضة لالتصال مع 5 سنوات فحص لألطفال دون عمر األرسة املصابني بمرض السل، وذلك يف 25 بلًدا )بنسبة 83.3 %( 28 بلًدا يف وكذلك باملرض لإلصابة مرتفعة معدالت من تعاين التوصيات لدهيا معدالت منخفضة. واقترصت )% 41.2 )بنسبة يف معظم البلدان التي تعاين من معدالت مرتفعة لإلصابة باملرض عىل جمرد إجراء فحص قائم عىل أعراض اإلصابة قبل العالج، يف حني أن البلدان التي لدهيا معدالت منخفضة لإلصابة تلتزم بإجراء االختبارات قبل العالج. وال تتوافق سياسات بعض البلدان التي الصحة منظمة توصيات مع لإلصابة منخفضة معدالت لدهيا العاملية؛ حيث أوصت تسعة بلدان )13.2 %( املسافرين إىل ابلدان باحلصول السل بمرض اإلصابة معدالت ارتفاع من تعاين التي عىل عالج وقائي للمرض، يف حني أوصت عرشة بلدان )14.7 %( باحلصول عىل العالج الوقائي للمرىض الذين خيضعون جلراحة يف

البطن.

In conclusion, our review identi-fied large variations across countries in their national tuberculosis policies. The differences are probably attributable to different country contexts and disease epidemiology and lack of consensus on some aspects of latent tuberculosis infection management. There are unique challenges associated with management of latent tuberculosis infection, such as exclusion of active tuberculosis, test-ing for latent tuberculosis infection and treatment initiation. It is therefore important to continue to develop clear, implementable and evidence-based WHO policies. An important compo-nent of such policies should be monitor-ing and evaluation, as this is essential to assess progress in the implementation and to make policy decisions. Lack of a monitoring and evaluation component in more than half of the national poli-cies presents a barrier to programmatic management of latent tuberculosis in-fection. ■

AcknowledgementsThe authors thank Fatima Kazi, Annabel Baddeley and all the programme manag-ers, WHO regional and country staff.

Competing interests: None declared.

Fig. 4. Compliance of national policies with World Health Organization guidelines on treatment of latent tuberculosis infection in low-burden countries

3 months twice weekly isoniazid + rifampicin

3 months weekly rifapentine + isoniazid

6 months rifampicin

6–9 months weekly isoniazid

12 months isoniazid

Special instructions for children

4 months isoniazid + rifampicin

3 months isoniazid + rifampicin

3–4 months rifampicin

9 months isoniazid

6 months isoniazid

Trea

tmen

t for

late

nt tu

berc

ulos

is

% of countries recommending treatment0 10 20 30 40 50 60 70 80 90 100

Not recommended by WHO

Recommended by WHO

WHO: World Health Organization.Notes: WHO guidelines on treatment of latent tuberculosis infection11 are summarized in Table 1. Special instructions for children refer to any policy recommendation for an alternative treatment or duration of treatment for children younger than 5 years. The total number of countries analysed was 68.

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ResearchNational policies on latent tuberculosis Ann Jagger et al.

摘要潜伏性结核感染管理国家政策：对 98 个国家的回顾目标 回顾结核病低负担国家和结核病高负担国家在潜伏性结核感染上的管理政策。方法 我 们 根 据 世 界 卫 生 组 织 (WHO) 的 标 准 将向 WHO 全球结核病项目汇报数据的国家划分为结核病低负担国家和结核病高负担国家。我们通过在线搜索、政府网站、WHO 国家办事处和与项目管理者的个人沟通，确定了关于潜伏性结核感染管理的国家政策文件。我们进行了描述性分析，重点关注该国政策与 WHO 政策建议的差距和偏差。结果 在 113 个结核病低负担国家和 35 个结核病高负担国家中，我们分别获得了 68 个国家和 30 个国 家 的 结 核 病 或 人 类 免 疫 缺 陷 病 毒 (HIV) 相关 结 核 病 的 文 件。 在 29 个 结 核 病 高 负 担 国家 (96.7%) 和 54 个 (79.7%) 结核病低负担国家的指

导方针中，建议对 HIV 感染者进行潜伏性结核感染 的 筛 查 和 治 疗。25 个 (83.3%) 结 核 病 高 负 担 国家和 28 个 (41.2%) 结核病低负担国家的政策规定，对 5 岁以下、家中有结核病接触的孩子进行筛查。在大多数高负担国家，建议在治疗前单独进行症状筛查，而在全部低负担国家，则在治疗之前进行检测。一些低负担国家的政策不符合 WHO 建议 ：其中有 9 项 （13.2％） 政策建议对准备去结核病高负担国家的游客进行结核病预防治疗，10 项 （14.7％） 建议患者接受腹部手术。结论 潜伏性结核感染管理的某些方面缺乏确凿依据，导致国家政策方面有很大差异。这突出了对推动研究，制定清晰、可执行和以证据为基础的 WHO 政策的需求。

Résumé

Politiques nationales pour la prise en charge de l’infection tuberculeuse latente: revue de 98 paysObjectif Passer en revue les politiques relatives à la prise en charge de l’infection tuberculeuse latente de pays faiblement ou fortement touchés par la tuberculose.Méthodes Nous avons séparé les pays qui transmettent des données au Programme mondial de lutte contre la tuberculose de l’Organisation mondiale de la Santé (OMS) selon qu’ils présentaient une charge de morbidité tuberculeuse faible ou élevée, suivant les critères de l’OMS. Nous avons trouvé les politiques nationales pour la prise en charge de la tuberculose latente grâce à des recherches en ligne, aux sites Internet des gouvernements, aux bureaux de l’OMS dans les pays et à des communications personnelles avec des responsables de programmes. Nous avons fait une analyse descriptive axée particulièrement sur les lacunes des politiques et leurs écarts des recommandations de l’OMS.Résultats Nous avons obtenu des documents de 68 pays sur 113 ayant une faible charge de morbidité tuberculeuse et de 30 pays sur 35 ayant les plus fortes charges de morbidité dues à la tuberculose ou à la tuberculose associée au virus de l’immunodéficience humaine (VIH). Le dépistage et le traitement de l’infection tuberculeuse latente chez les personnes vivant avec le VIH étaient recommandés dans les

directives de 29 pays (96,7%) à la charge de morbidité élevée et de 54 pays (79,7%) où cette charge était faible. Le dépistage des enfants de moins de 5 ans en contact familial avec la tuberculose était prévu dans 25 pays (83,3%) à la charge de morbidité élevée et dans 28 (41,2%) à la charge de morbidité faible. Dans la plupart des pays à la charge de morbidité élevée, seule la recherche des symptômes avant traitement était recommandée, tandis que tous les pays à la charge de morbidité faible recommandaient un dépistage avant traitement. Les politiques de certains pays à la charge de morbidité faible ne suivaient pas les recommandations de l’OMS: neuf (13,2%) recommandaient un traitement préventif contre la tuberculose pour les personnes se rendant dans des pays à la charge de morbidité élevée et 10 (14,7%) pour les patients subissant une chirurgie abdominale.Conclusion En l’absence de preuves solides concernant certains aspects de la prise en charge de l’infection tuberculeuse latente, les politiques nationales varient considérablement les unes des autres. Cela met en lumière la nécessité de faire progresser la recherche et, pour l’OMS, d’élaborer des politiques claires, applicables et fondées sur des éléments probants.

Резюме

Национальная политика по борьбе с латентной туберкулезной инфекцией: обзор 98 странЦель Провести обзор политики по борьбе с латентной туберкулезной инфекцией в странах с низким и высоким бременем туберкулеза.Методы На основе критериев ВОЗ авторы разделили страны, предоставляющие данные для Глобальной программы борьбы с туберкулезом Всемирной организации здравоохранения (ВОЗ), на несущие низкое и высокое бремя туберкулеза. Авторы

определили документы национальной политики по борьбе с латентным туберкулезом посредством онлайн-поиска, правительственных веб-сайтов, региональных бюро ВОЗ и личного общения с руководителями программ. Был проведен описательный анализ с упором на пробелы и отклонения от рекомендаций ВОЗ в политике.

االستنتاج يقود االفتقار إىل أدلة قوية بشأن بعض جوانب التعامل مع عدوى السل الكامنة إىل اعتامد سياسات وطنية متفاوتة بصورة بالبحث النهوض إىل احلاجة عىل الضوء ذلك ويسلط كبرية.

من األدلة عىل وقائمة للتنفيذ وقابلة واضحة سياسات وتطوير جانب منظمة الصحة العاملية.

Bull World Health Organ 2018;96:173–184F| doi: http://dx.doi.org/10.2471/BLT.17.199414 183

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Результаты Были получены документы от 68 из 113 стран с низким бременем и от 30 из 35 стран с самым высоким бременем туберкулеза или вируса иммунодефицита человека (ВИЧ), связанного с туберкулезом. Скрининговое обследование и лечение латентной туберкулезной инфекции у людей с ВИЧ были рекомендованы в руководящих принципах 29 стран (96,7%) с высоким бременем и 54 стран (79,7%) с низким бременем туберкулеза. Скрининговое обследование детей в возрасте до 5 лет, находящихся в контакте с больными туберкулезом в бытовых условиях, проводился в рамках политики 25 стран (83,3%) с высоким бременем и 28 стран (41,2%) с низким бременем. В большинстве стран с высоким бременем туберкулеза перед началом лечения рекомендовано только скрининговое

обследование симптомов, тогда как во всех странах с низким бременем проводится тестирование. Политика некоторых стран с низким бременем не соответствовала рекомендациям ВОЗ: в девяти странах (13,2%) рекомендована профилактика туберкулеза для путешественников, выезжающих в страны с высоким бременем, и в 10 (14,7%) — для пациентов, перенесших абдоминальное хирургическое вмешательство.Вывод Отсутствие убедительных доказательств некоторых аспектов борьбы с латентной туберкулезной инфекцией приводит к значительным различиям в национальной политике. Это подчеркивает необходимость продвижения исследований и разработки четкой, реализуемой и основанной на фактических данных политики ВОЗ.

Resumen

Las políticas nacionales sobre el tratamiento de la infección de tuberculosis latente: análisis de 98 paísesObjetivo Analizar las políticas sobre el tratamiento de la infección de tuberculosis latente en países con niveles bajos y elevados de tuberculosis.Métodos Dividimos a los países que informan datos al Programa Global de Tuberculosis de la Organización Mundial de la Salud (OMS) en nivel de tuberculosis bajo y elevado, conforme a los criterios de la OMS. Identificamos los documentos de políticas nacionales sobre el tratamiento de la tuberculosis latente a través de búsquedas en línea, sitios web gubernamentales, sedes nacionales de la OMS y comunicación personal con los administradores del programa. Realizamos un análisis descriptivo enfocado en las desviaciones y los vacíos de las políticas con respecto a las recomendaciones de políticas de la OMS.Resultados Obtuvimos documentos de 68 de 113 países con nivel bajo y de 30 de 35 países con los niveles más elevados de tuberculosis o tuberculosis asociada con el virus de la inmunodeficiencia humana (VIH). En las pautas de 29 (96,7%) países con nivel elevado y 54 (79,7%) países con nivel bajo se recomendaron exámenes de detección y

tratamiento de la infección de tuberculosis latente en personas que viven con el VIH. La política de 25 (83,3%) países con nivel elevado y de 28 (41,2%) países con nivel bajo se basó en exámenes de detección en niños menores de cinco años de edad con contacto doméstico con tuberculosis. En casi todos los países con nivel elevado, la recomendación consistió únicamente en el examen de detección de los síntomas antes del tratamiento, mientras que, en todos los países con nivel bajo, esta consistió en pruebas antes del tratamiento. Las políticas de algunos países con nivel bajo no cumplen con las recomendaciones de la OMS: nueve (13,2%) recomendaron el tratamiento preventivo de la tuberculosis para viajeros que se dirijan a países con nivel elevado y 10 (14,7%) para pacientes que se sometan a una cirugía abdominal.Conclusión La falta de pruebas sólidas sobre ciertos aspectos del tratamiento de la infección de tuberculosis latente da lugar a políticas nacionales que varían considerablemente. Esto subraya la necesidad de realizar investigaciones avanzadas y desarrollar políticas de la OMS que sean claras, implementables y empíricas.

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uand

a: M

inist

erio

da

Saud

e, In

situt

o N

acio

nal d

e Lu

ta c

ontra

a S

IDA;

201

4.

Bang

lade

shSE

AH

igh

tube

rcul

osis

burd

enNa

tiona

l gui

delin

es fo

r the

man

agem

ent o

f tub

ercu

losis

in ch

ildre

n. D

haka

: Nat

iona

l Tub

ercu

losis

Con

trol

Prog

ram

me,

Min

istry

of H

ealth

and

Fam

ily W

elfa

re; 2

012.

Nat

iona

l gui

delin

es o

f ant

iretro

vira

l the

rapy

, Ba

ngla

desh

. Dha

ka: N

atio

nal A

IDS/

STD

Pro

gram

me,

Dire

ctor

ate

Gen

eral

Hea

lth S

ervi

ces,

Min

istry

of H

ealth

an

d Fa

mily

Wel

fare

; 201

1.

Bots

wan

aAF

RH

igh

HIV

-ass

ocia

ted

tube

rcul

osis

burd

en

Bots

wan

a na

tiona

l HIV

and

AID

S tre

atm

ent g

uide

lines

. Gab

oron

e: M

inist

ry o

f Hea

lth; 2

012.

Tube

rcul

osis/

HIV

polic

y gui

delin

es. G

abor

one:

Min

istry

of H

ealth

; 201

1.Ca

mbo

dia

WPR

Hig

h tu

berc

ulos

is bu

rden

Na

tiona

l gui

delin

es fo

r dia

gnos

is an

d tre

atm

ent o

f tub

ercu

losis

in ch

ildre

n. P

hnom

Pen

h: N

atio

nal C

entre

for

Tube

rcul

osis

and

Lepr

osy

Cont

rol, M

inist

ry o

f Hea

lth; 2

008.

Sta

ndar

d op

erat

ing

proc

edur

es fo

r im

plem

entin

g th

e th

ree

I’s in

cont

inuu

m o

f car

e se

tting

s. Ph

nom

Pen

h: N

atio

nal C

entre

for H

IV/A

IDS

Der

mat

olog

y an

d ST

D

and

Nat

iona

l Cen

tre fo

r Tub

ercu

losis

and

Lep

rosy

Con

trol;

2010

. Ca

mer

oon

AFR

Hig

h H

IV-a

ssoc

iate

d tu

berc

ulos

is bu

rden

D

irect

ives

nat

iona

les d

e pr

even

tion

et d

e pr

ise e

n ch

arge

du

VIH

au C

amer

oun.

Yaou

ndé:

Min

istèr

e de

la

Sant

é; 2

015.

Gui

de te

chni

que

pour

les p

erso

nnel

s de

Sant

é. Ya

ound

é: P

rogr

amm

e N

atio

nal d

e Lu

tte c

ontre

la

Tube

rcul

ose,

Min

istèr

e de

la S

anté

; 201

2.

Cent

ral A

frica

n Re

publ

icAF

RH

igh

tube

rcul

osis

and

HIV

-ass

ocia

ted

tube

rcul

osis

burd

enGu

ide

de p

rise

en ch

arge

de

la tu

berc

ulos

e de

l’adu

lte. B

angu

i: Pr

ogra

mm

e N

atio

nal d

e Lu

tte c

ontre

la

Tube

rcul

ose.

Min

istèr

e de

la S

anté

de

l’Hyg

iene

Pub

lique

et d

e la

Pop

ulat

ion;

201

6. G

uide

de

prise

en

char

ge

de la

tube

rcul

ose

de l’e

nfan

t. Ba

ngui

: Pro

gram

me

Nat

iona

l de

Lutte

Con

tre la

Min

istèr

e de

la S

anté

de

l’Hyg

iene

Pub

lique

et d

e la

Pop

ulat

ion;

201

6.

Dem

ocra

tic R

epub

lic o

f the

Co

ngo

AFR

Hig

h tu

berc

ulos

is an

d H

IV-a

ssoc

iate

d tu

berc

ulos

is bu

rden

Guid

e na

tiona

l de

prise

en

char

ge d

e l’in

fect

ion

a VI

H en

RD

C. K

insh

asa:

Pro

gram

me

Nat

iona

l de

Lutte

Con

tre

le V

IH/S

IDA

et le

s IST

s PN

LS; 2

013.

Gui

de d

e pr

ise e

n ch

arge

de

la co

-infe

ctio

n VI

H-tu

berc

ulos

e da

ns la

zone

de

sant

é. K

insh

asa:

Min

istèr

e de

la S

anté

Pub

lic; 2

012.

Et

hiop

iaAF

RH

igh

tube

rcul

osis

and

HIV

-ass

ocia

ted

tube

rcul

osis

burd

enGu

idel

ines

for c

linica

l pro

gram

mat

ic m

anag

emen

t of t

uber

culo

sis, t

uber

culo

sis/H

IV a

nd le

pros

y in

Ethi

opia

. M

inist

ry o

f Hea

lth; 2

013.

Nat

iona

l gui

delin

es fo

r com

preh

ensiv

e HI

V pr

even

tion,

care

and

trea

tmen

t. Ad

dis

Abab

a: M

inist

ry o

f Hea

lth; 2

014.

Nat

iona

l chi

ldho

od tu

berc

ulos

is im

plem

enta

tion

guid

e. Ad

dis A

baba

: M

inist

ry o

f Hea

lth; 2

015.

Gh

ana

AFR

Hig

h H

IV-a

ssoc

iate

d tu

berc

ulos

is bu

rden

Gu

idel

ines

for d

iagn

osis

and

man

agem

ent o

f tub

ercu

losis

in ch

ildre

n. A

ccra

: Gha

na H

ealth

Ser

vice

; 201

2.

Guid

elin

es fo

r the

clin

ical m

anag

emen

t of t

uber

culo

sis a

nd H

IV co

-infe

ctio

n. A

ccra

: Gha

na H

ealth

Ser

vice

; 200

7.

Guid

elin

es fo

r ant

iretro

vira

l the

rapy

in G

hana

. Acc

ra: N

atio

nal H

IV/A

IDS/

STI C

ontro

l Pro

gram

me,

Min

istry

of

Hea

lth a

nd G

hana

Hea

lth S

ervi

ce; 2

008.

Indi

aSE

AH

igh

tube

rcul

osis

and

HIV

-ass

ocia

ted

tube

rcul

osis

burd

enNa

tiona

l gui

delin

es o

n di

agno

sis a

nd tr

eatm

ent o

f pae

diat

ric tu

berc

ulos

is. N

ew D

elhi

: Cen

tral T

uber

culo

sis

Div

ision

, Dire

ctor

ate

Gen

eral

of H

ealth

Ser

vice

s, M

inist

ry o

f Hea

lth a

nd F

amily

Wel

fare

; 201

2. D

OTS-

plus

gu

idel

ines

. New

Del

hi: R

evise

d N

atio

nal T

uber

culo

sis C

ontro

l Pro

gram

me;

201

0.

Stan

dard

s for

tube

rcul

osis

care

in In

dia.

New

Del

hi: C

entra

l Tub

ercu

losis

Div

ision

, Dire

ctor

ate

Gen

eral

of

Hea

lth S

ervi

ces,

Min

istry

of H

ealth

and

Fam

ily W

elfa

re; 2

014.

In

done

siaSE

AH

igh

tube

rcul

osis

and

HIV

-ass

ocia

ted

tube

rcul

osis

burd

enNa

tiona

l pol

icy o

n tu

berc

ulos

is/HI

V co

llabo

ratio

n [tr

ansla

ted]

. Jak

arta

: Min

istry

of H

ealth

; 201

5. Te

chni

cal

guid

elin

es o

n m

anag

emen

t of t

uber

culo

sis in

child

ren

[tran

slate

d]. J

akar

ta: M

inist

ry o

f Hea

lth; 2

013.

(con

tinue

s. . .

)

Ann Jagger et al.National policies on latent tuberculosisResearch

184B Bull World Health Organ 2018;96:173–184F| doi: http://dx.doi.org/10.2471/BLT.17.199414

Co

untr

y or t

errit

ory

WHO

regi

onCo

untr

y gro

upDa

ta so

urce

Keny

aAF

RH

igh

tube

rcul

osis

and

HIV

-ass

ocia

ted

tube

rcul

osis

burd

enNa

tiona

l ison

iazid

pre

vent

ativ

e th

erap

y sta

ndar

d op

erat

ing

proc

edur

e. N

airo

bi: M

inist

ry o

f Hea

lth; 2

015.

Gu

idel

ines

for m

anag

emen

t of t

uber

culo

sis a

nd le

pros

y in

Keny

a. N

airo

bi: M

inist

ry o

f Hea

lth; 2

013.

Leso

tho

AFR

Hig

h tu

berc

ulos

is an

d H

IV-a

ssoc

iate

d tu

berc

ulos

is bu

rden

Natio

nal g

uide

lines

for t

he th

ree

I’s (i

soni

azid

pre

vent

ive

ther

apy (

IPT)

inte

nsifi

ed ca

se fi

ndin

g (IC

F) a

nd in

fect

ion

cont

rol (

IC).

Mas

eru:

Gov

ernm

ent o

f Les

otho

; 201

1. N

atio

nal t

uber

culo

sis p

rogr

amm

e po

licy a

nd m

anua

l. M

aser

u: G

over

nmen

t of L

esot

ho; 2

007.

Mal

awi

AFR

Hig

h H

IV-a

ssoc

iate

d tu

berc

ulos

is bu

rden

Na

tiona

l tub

ercu

losis

cont

rol p

rogr

amm

e m

anua

l. Li

long

we:

Min

istry

of H

ealth

; 201

2. C

linica

l man

agem

ent o

f HI

V in

child

ren

and

adul

ts. L

ilong

we:

Min

istry

of H

ealth

; 201

4.M

ozam

biqu

eAF

RH

igh

tube

rcul

osis

and

HIV

-ass

ocia

ted

tube

rcul

osis

burd

enGu

ia d

e tra

tam

ento

ant

iretro

vira

l e in

fecç

ões o

port

unist

as n

o ad

ulto

, ado

lesc

ente

grá

vida

e cr

ianç

a. M

aput

o:

Min

istro

da

Saúd

e; 2

014.

Mya

nmar

SEA

Hig

h tu

berc

ulos

is an

d H

IV-a

ssoc

iate

d tu

berc

ulos

is bu

rden

Guid

elin

es fo

r the

pro

gram

mat

ic m

anag

emen

t of t

uber

culo

sis/H

IV in

Mya

nmar

. Nay

pyid

aw: N

atio

nal

Tube

rcul

osis

Prog

ram

me

and

Nat

iona

l AID

S Pr

ogra

mm

e; 2

015.

Nam

ibia

AFR

Hig

h tu

berc

ulos

is an

d H

IV-a

ssoc

iate

d tu

berc

ulos

is bu

rden

Natio

nal g

uide

lines

for t

he m

anag

emen

t of t

uber

culo

sis. W

indh

oek:

Min

istry

of H

ealth

and

Soc

ial S

ervi

ces;

2011

. Nat

iona

l gui

delin

es fo

r HIV

pre

vent

ion

treat

men

t and

care

. Win

dhoe

k: M

inist

ry o

f Hea

lth a

nd S

ocia

l Se

rvic

es; 2

014.

Nig

eria

AFR

Hig

h tu

berc

ulos

is an

d H

IV-a

ssoc

iate

d tu

berc

ulos

is bu

rden

Natio

nal t

uber

culo

sis a

nd le

pros

y con

trol p

rogr

amm

e –

wor

ker’s

man

ual.

Abuj

a: D

epar

tmen

t of P

ublic

Hea

lth,

Fede

ral M

inist

ry o

f Hea

lth; 2

010.

Paki

stan

EMR

Hig

h tu

berc

ulos

is bu

rden

Na

tiona

l gui

delin

es fo

r the

cont

rol o

f tub

ercu

losis

in P

akist

an. I

slam

abad

: Nat

iona

l TB

Cont

rol P

rogr

amm

e,

Min

istry

of N

atio

nal H

ealth

Ser

vice

s, Re

gula

tion

and

Coor

dina

tion;

201

5.

Papu

a N

ew G

uine

aW

PRH

igh

tube

rcul

osis

and

HIV

-ass

ocia

ted

tube

rcul

osis

burd

enNa

tiona

l tub

ercu

losis

man

agem

ent p

roto

col.

Port

Mor

esby

: Dep

artm

ent o

f Hea

lth, D

iseas

e Co

ntro

l Bra

nch,

N

atio

nal T

uber

culo

sis P

rogr

amm

e; 2

011.

Gui

delin

es fo

r HIV

care

and

trea

tmen

t in

Papu

a Ne

w G

uine

a. P

ort

Mor

esby

: Dep

artm

ent o

f Hea

lth; 2

009.

Ph

ilipp

ines

WPR

Hig

h tu

berc

ulos

is bu

rden

Na

tiona

l tub

ercu

losis

cont

rol p

rogr

amm

e: m

anua

l of p

roce

dure

s, 5t

h ed

ition

. Man

ila: D

epar

tmen

t of H

ealth

; 20

14.

Sier

ra L

eone

AFR

Hig

h tu

berc

ulos

is bu

rden

Tu

berc

ulos

is tre

atm

ent g

uide

lines

[dra

ft]. F

reet

own:

Min

istry

of H

ealth

and

San

itatio

n; 2

016.

Na

tiona

l ant

iretro

vira

l tre

atm

ent g

uide

lines

. Fre

etow

n: M

inist

ry o

f Hea

lth a

nd S

anita

tion;

201

5.So

uth

Afric

aAF

RH

igh

tube

rcul

osis

and

HIV

-ass

ocia

ted

tube

rcul

osis

burd

enGu

idel

ines

for t

he m

anag

emen

t of t

uber

culo

sis in

child

ren.

Pre

toria

: Dep

artm

ent o

f Hea

lth, 2

013.

Na

tiona

l tub

ercu

losis

man

agem

ent g

uide

lines

. Pre

toria

: Dep

artm

ent o

f Hea

lth; 2

014.

Gu

idel

ines

for t

uber

culo

sis p

reve

ntiv

e th

erap

y am

ong

HIV

infe

cted

indi

vidu

als i

n So

uth

Afric

a. P

reto

ria:

Dep

artm

ent o

f Hea

lth; 2

010.

Na

tiona

l con

solid

ated

gui

delin

es fo

r the

pre

vent

ion

of m

othe

r-to-

child

tran

smiss

ion

of H

IV (P

MTC

T) a

nd th

e m

anag

emen

t of H

IV in

child

ren,

ado

lesc

ents

and

adu

lts. P

reto

ria: D

epar

tmen

t of H

ealth

; 201

4.Sw

azila

ndAF

RH

igh

HIV

-ass

ocia

ted

tube

rcul

osis

burd

en

Swaz

iland

inte

grat

ed H

IV m

anag

emen

t gui

delin

es. M

baba

ne: M

inist

ry o

f Hea

lth; 2

015.

Nat

iona

l pol

icy

guid

elin

es o

n TB

/HIV

colla

bora

tive

activ

ities

. Mba

bane

: Min

istry

of H

ealth

; 201

5.Th

aila

ndSE

AH

igh

tube

rcul

osis

and

HIV

-ass

ocia

ted

tube

rcul

osis

burd

enCl

inica

l pra

ctice

s gui

delin

es o

f tub

ercu

losis

trea

tmen

t in

adul

ts. N

onth

abur

i: D

epar

tmen

t of T

uber

culo

sis,

Dep

artm

ent o

f Dise

ase

Cont

rol, M

inist

ry o

f Pub

lic H

ealth

; 201

3.

Uga

nda

AFR

Hig

h H

IV-a

ssoc

iate

d tu

berc

ulos

is bu

rden

M

inist

ry o

f hea

lth m

anua

l of t

he n

atio

nal t

uber

culo

sis a

nd le

pros

y pro

gram

me.

Kam

pala

: Min

istry

of H

ealth

; 20

10. T

he in

tegr

ated

nat

iona

l gui

delin

es o

n an

tiret

rovi

ral t

hera

py p

reve

ntio

n of

mot

her t

o ch

ild tr

ansm

issio

n of

HI

V in

fant

and

youn

g ch

ild fe

edin

g. K

ampa

la: M

inist

ry o

f Hea

lth; 2

012.

(. . .

cont

inue

d)

(con

tinue

s. . .

)

Ann Jagger et al. National policies on latent tuberculosisResearch

184CBull World Health Organ 2018;96:173–184F| doi: http://dx.doi.org/10.2471/BLT.17.199414

Co

untr

y or t

errit

ory

WHO

regi

onCo

untr

y gro

upDa

ta so

urce

Uni

ted

Repu

blic

of T

anza

nia

AFR

Hig

h tu

berc

ulos

is an

d H

IV-a

ssoc

iate

d tu

berc

ulos

is bu

rden

Natio

nal g

uide

lines

for t

he m

anag

emen

t of t

uber

culo

sis in

child

ren.

Dar

es S

alaa

m: M

inist

ry o

f Hea

lth a

nd S

ocia

l W

elfa

re; 2

013.

M

anua

l for

the

man

agem

ent o

f tub

ercu

losis

and

lepr

osy.

Dar

es S

alaa

m: M

inist

ry o

f Hea

lth a

nd S

ocia

l Wel

fare

; 20

13. N

atio

nal p

olic

y gui

delin

es fo

r col

labo

rativ

e TB

/HIV

act

iviti

es. D

ar e

s Sal

aam

: Min

istry

of H

ealth

and

Soc

ial

Wel

fare

; 200

8. N

atio

nal g

uide

lines

for t

he m

anag

emen

t of H

IV a

nd A

IDS.

Dar

es S

alaa

m: M

inist

ry o

f Hea

lth a

nd

Soci

al W

elfa

re; 2

012.

Viet

Nam

WPR

Hig

h tu

berc

ulos

is bu

rden

D

iagn

osis,

trea

tmen

t, an

d pr

even

tion

of tu

berc

ulos

is [tr

ansla

ted]

. Han

oi: M

inist

ry o

f Hea

lth; 2

015.

Gui

delin

es

for H

IV/A

IDS

diag

nosis

and

trea

tmen

t. H

anoi

: Min

istry

of H

ealth

; 201

4. C

olla

bora

tive

prot

ocol

for T

B/HI

V di

agno

sis, t

reat

men

t and

case

man

agem

ent.

Han

oi: M

inist

ry o

f Hea

lth; 2

007.

Zam

bia

AFR

Hig

h tu

berc

ulos

is an

d H

IV-a

ssoc

iate

d tu

berc

ulos

is bu

rden

Natio

nal g

uide

lines

on

man

agem

ent o

f tub

ercu

losis

in ch

ildre

n. L

usak

a: M

inist

ry o

f Hea

lth, D

ivisi

on o

f Le

pros

y, Tu

berc

ulos

is an

d Lu

ng D

iseas

e; 2

013.

Zam

bia

cons

olid

ated

gui

delin

es fo

r tre

atm

ent a

nd p

reve

ntio

n of

HIV

infe

ctio

n. L

usak

a: M

inist

ry o

f Hea

lth a

nd M

inist

ry o

f Com

mun

ity D

evel

opm

ent,

Mot

her a

nd C

hild

H

ealth

; 201

4.

Zim

babw

eAF

RH

igh

tube

rcul

osis

and

HIV

-ass

ocia

ted

tube

rcul

osis

burd

enNa

tiona

l TB

guid

elin

es, 4

th e

ditio

n. H

arar

e: N

atio

nal T

uber

culo

sis C

ontro

l Pro

gram

me,

Min

istry

of H

ealth

an

d Ch

ild W

elfa

re; 2

010.

Nat

iona

l gui

delin

es fo

r TB/

HIV

co-m

anag

emen

t. H

arar

e: N

atio

nal H

IV/A

IDS

and

Tube

rcul

osis

Cont

rol P

rogr

amm

es. M

inist

ry o

f Hea

lth a

nd C

hild

Wel

fare

; 201

4.Lo

w-t

uber

culo

sis

burd

en

coun

trie

sAl

geria

AFR

Low

-tub

ercu

losis

bur

den

Mea

sure

de

prev

entio

n po

ur le

s suj

ets c

onta

ct. C

hapi

tre V

I. In

: La

prev

entio

n de

la tu

berc

ulos

e. Al

ger:

Min

istèr

e de

la S

anté

, de

la P

opul

atio

n et

de

la R

éfor

me

Hos

pita

lière

; 201

1Am

eric

an S

amoa

WPR

Low

-tub

ercu

losis

bur

den

Late

nt tu

berc

ulos

is in

fect

ion:

a g

uide

for p

rimar

y car

e pr

ovid

ers.

Atla

nta:

Uni

ted

Stat

es C

ente

rs fo

r Dise

ase

Cont

rol a

nd P

reve

ntio

n; 2

013.

An

tigua

and

Bar

buda

AMR

Low

tube

rcul

osis

burd

enCa

ribbe

an g

uide

lines

for t

he p

reve

ntio

n, tr

eatm

ent,

care

and

cont

rol o

f tub

ercu

losis

and

HIV

/TB.

Was

hing

ton:

Ca

ribbe

an H

IV/A

IDS

Regi

onal

Trai

ning

Net

wor

k; 2

010.

Ar

gent

ina

AMR

Low

tube

rcul

osis

burd

enPr

ogra

ma

naci

onal

de

cont

rol d

e la

tube

rcul

osis.

Nor

mas

técn

icas.

Buen

os A

ires:

Min

ister

io d

e Sa

lud

de la

N

ació

n; 2

013.

Arub

aAM

RLo

w tu

berc

ulos

is bu

rden

Carib

bean

gui

delin

es fo

r the

pre

vent

ion,

trea

tmen

t, ca

re a

nd co

ntro

l of t

uber

culo

sis a

nd H

IV/t

uber

culo

sis.

Was

hing

ton:

Car

ibbe

an H

IV/A

IDS

Regi

onal

Trai

ning

Net

wor

k; 2

010.

Au

stra

liaW

PRLo

w tu

berc

ulos

is bu

rden

CDNA

nat

iona

l gui

delin

es fo

r the

pub

lic h

ealth

man

agem

ent o

f tub

ercu

losis

. Can

berra

: Dep

artm

ent o

f Hea

lth;

2013

.Au

stria

EUR

Low

tube

rcul

osis

burd

enÖ

ster

reic

hisc

he le

itlin

ie zu

rtub

erku

lose

– u

mge

bung

sunt

ersu

chun

g. V

ienn

a: B

unde

smin

ister

ium

für

Ges

undh

eit;

2013

.Ba

ham

asAM

RLo

w tu

berc

ulos

is bu

rden

Tube

rcul

osis

cont

rol [

Inte

rnet

]. N

assa

u: M

inist

ry o

f Hea

lth; 2

011.

Barb

ados

AMR

Low

tube

rcul

osis

burd

enCa

ribbe

an g

uide

lines

for t

he p

reve

ntio

n, tr

eatm

ent,

care

and

cont

rol o

f tub

ercu

losis

and

HIV

/TB.

Was

hing

ton:

Ca

ribbe

an H

IV/A

IDS

Regi

onal

Trai

ning

Net

wor

k; 2

010.

Be

lgiu

mEU

RLo

w tu

berc

ulos

is bu

rden

Reco

mm

enda

tions

conc

erna

nt le

dep

istag

e ci

ble

et le

trai

tem

ent d

e l’in

fect

ion

tube

rcul

euse

late

nte.

Brus

sels:

Fo

ndat

ion

Cont

re L

es A

ffect

ions

Res

pira

toire

s et P

our L

’Edu

catio

n a

La S

ante

; 200

3.Be

lize

AMR

Low

tube

rcul

osis

burd

enCa

ribbe

an g

uide

lines

for t

he p

reve

ntio

n, tr

eatm

ent,

care

and

cont

rol o

f tub

ercu

losis

and

HIV

/TB.

Was

hing

ton:

Ca

ribbe

an H

IV/A

IDS

Regi

onal

Trai

ning

Net

wor

k; 2

010.

Be

rmud

aAM

RLo

w tu

berc

ulos

is bu

rden

Carib

bean

gui

delin

es fo

r the

pre

vent

ion,

trea

tmen

t, ca

re a

nd co

ntro

l of t

uber

culo

sis a

nd H

IV/T

B. W

ashi

ngto

n:

Carib

bean

HIV

/AID

S Re

gion

al Tr

aini

ng N

etw

ork;

201

0.

(. . .

cont

inue

d)

(con

tinue

s. . .

)

Ann Jagger et al.National policies on latent tuberculosisResearch

184D Bull World Health Organ 2018;96:173–184F| doi: http://dx.doi.org/10.2471/BLT.17.199414

Co

untr

y or t

errit

ory

WHO

regi

onCo

untr

y gro

upDa

ta so

urce

Braz

ilAM

RLo

w tu

berc

ulos

is bu

rden

Man

ual d

e re

com

enda

coes

par

a o

cont

role

da

tube

rcul

ose

no B

razil

. Bra

sília

: Min

ister

io d

a Sa

lude

; 201

1.Br

unei

Dar

ussa

lam

WPR

Low

tube

rcul

osis

burd

enGu

idel

ines

for t

uber

culo

sis co

ntro

l in B

rune

i Dar

ussa

lam

. Ban

dar S

eri B

egaw

an: M

inist

ry o

f Hea

lth; 2

013.

Ca

nada

AMR

Low

tube

rcul

osis

burd

enCa

nadi

an tu

berc

ulos

is st

anda

rds,

7th

editi

on. O

ttaw

a: P

ublic

Hea

lth A

genc

y of

Can

ada;

201

4.

Chile

AMR

Low

tube

rcul

osis

burd

enNo

rmas

tecn

icas p

ara

el co

ntro

l y la

elim

inac

ion

de la

tube

rcul

osis.

San

tiago

: Pro

gram

a N

acio

nal p

ara

el

Cont

rol y

la E

limin

acio

n de

la Tu

berc

ulos

is; 2

014.

Ch

ina,

Hon

g Ko

ng S

peci

al

Adm

inist

rativ

e Re

gion

WPR

Low

tube

rcul

osis

burd

enGu

idel

ines

on

targ

eted

tube

rcul

in te

stin

g an

d tre

atm

ent o

f lat

ent t

uber

culo

sis in

fect

ion.

Hon

g Ko

ng:

Tube

rcul

osis

and

Ches

t Ser

vice

; 201

5 (la

st u

pdat

e on

31

Mar

ch 2

015)

. Co

lom

bia

AMR

Low

tube

rcul

osis

burd

enGu

ías d

e pr

omoc

ión

de la

salu

d y p

reve

nció

n de

enf

erm

edad

es e

n la

salu

d pú

blica

. Guí

a II:

Guí

a de

ate

nció

n de

la tu

berc

ulos

is pu

lmon

ar y

extra

pulm

onar

. Bog

otá:

Pro

gram

a de

Apo

yo a

la R

efor

ma

de S

alud

/PAR

S,

Min

ister

io d

e la

Pro

tecc

ión

Soci

al; 2

005.

Co

sta

Rica

AMR

Low

tube

rcul

osis

burd

enM

anua

l de

norm

as d

e at

enci

on y

vigi

lanc

ia p

ara

el co

ntro

l de

la tu

berc

ulos

is. S

an Jo

sé: P

rogr

ama

Nac

iona

l pa

ra e

l Con

trol d

e la

Tube

rcul

osis;

200

3.Cy

prus

EUR

Low

tube

rcul

osis

burd

enPr

olyp

si tis

met

ados

is fy

mat

iosis

se xo

rous

par

oxhs

yper

esio

n yg

eias

. [Pr

even

tion

of th

e tra

nsm

issio

n of

tu

berc

ulos

is to

hea

lth-c

are

faci

litie

s.] N

icos

ia: M

inist

ry o

f Hea

lth; 2

015.

Cz

echi

aEU

RLo

w tu

berc

ulos

is bu

rden

Vyhl

áška

473

/200

8 Sb

: Min

ister

stva

zdra

votn

ictv

í ze

dne

17 p

rosin

ce 2

008

o sy

stém

u ep

idem

iolo

gick

é bd

ělos

ti pr

o vy

bran

é in

fekc

e. [D

ecla

ratio

n 47

3/20

08 S

b by

the

Min

istry

of H

ealth

of 1

7 D

ecem

ber 2

008

on a

n ep

idem

iolo

gica

l ale

rt sy

stem

for s

elec

ted

infe

ctio

ns.]

Prag

ue: M

inist

ry o

f Hea

lth; 2

008.

D

omin

ican

Rep

ublic

AMR

Low

tube

rcul

osis

burd

enRe

glam

ento

tecn

ico p

ara

la p

reve

ncio

n y e

l con

trol d

e la

tube

rcul

osis.

San

to D

omin

go: M

inist

erio

de

Salu

d Pu

blic

a; 2

014.

Nor

mas

nac

iona

les p

ara

el co

ntro

l de

la tu

berc

ulos

is en

Rep

ublic

a D

omin

icana

. Ser

ie d

e no

rmas

na

cion

ales

no.

16.

San

to D

omin

go D

.N.: E

cret

aria

de

Esta

do d

e Sa

lud

Publ

ica

y As

isten

cia

Soci

al, P

rogr

ama

Nac

iona

l de

Cont

rol d

e la

Tube

rcul

osis;

200

3.Ec

uado

rAM

RLo

w tu

berc

ulos

is bu

rden

Man

ual d

e no

rmas

y pr

oced

imie

ntos

par

a el

cont

rol d

e la

tube

rcul

osis

en E

cuad

or. Q

uito

: Min

ister

io d

e Sa

lud

Publ

ica;

201

0.Fi

jiW

PRLo

w tu

berc

ulos

is bu

rden

Tube

rcul

osis

guid

elin

e. Su

va: N

atio

nal T

uber

culo

sis P

rogr

amm

e; 2

011.

Finl

and

EUR

Low

tube

rcul

osis

burd

enSu

ositu

s tub

erku

loos

in ko

ntak

tisel

vity

ksen

tote

utta

mise

ksi.

Hel

sinki

: Ter

veyd

en ja

hyv

invo

inni

n la

itos;

2011

. Fr

ance

EUR

Low

tube

rcul

osis

burd

enAv

is du

cons

eil s

uper

ieur

d’h

ygie

ne p

ubliq

ue d

e Fr

ance

sect

ion

mal

adie

s tra

nsm

issib

les.

Rela

tif a

u tra

itmen

t de

la tu

berc

ulos

e-in

fect

ion.

Par

is: D

irect

ion

Gen

eral

de

la S

anté

. Min

istèr

e de

la S

anté

, de

la F

amill

e et

des

Pe

rson

nes h

andi

capé

es; 2

003.

Fr

ench

Pol

ynes

iaW

PRLo

w tu

berc

ulos

is bu

rden

Guid

e pr

atiq

ue a

l’int

entio

n de

pro

fess

ione

ls de

sant

é. Pa

peet

e: D

irect

ion

de la

San

té, D

épar

tem

ent d

es

Prog

ram

mes

de

Prév

entio

n, P

rogr

amm

e Co

ntre

la Tu

berc

ulos

e; 2

011.

G

erm

any

EUR

Low

tube

rcul

osis

burd

enNe

w re

com

men

datio

ns fo

r con

tact

trac

ing

in tu

berc

ulos

is. S

tuttg

art:

Ger

man

Cen

tral C

omm

ittee

aga

inst

Tu

berc

ulos

is; 2

011.

Gree

ceEU

RLo

w tu

berc

ulos

is bu

rden

Fym

atio

si: a

po ti

dia

gnos

i sti

ther

apia

. [Tu

berc

ulos

is: fr

om d

iagn

osis

to th

erap

ies.]

Ath

ens:

Ellin

iki P

neum

olog

iki

Etai

ria; 2

012.

Gren

ada

AMR

Low

tube

rcul

osis

burd

enCa

ribbe

an g

uide

lines

for t

he p

reve

ntio

n, tr

eatm

ent,

care

and

cont

rol o

f tub

ercu

losis

and

HIV

/tub

ercu

losis

. W

ashi

ngto

n: C

arib

bean

HIV

/AID

S Re

gion

al Tr

aini

ng N

etw

ork;

201

0.

Irela

ndEU

RLo

w tu

berc

ulos

is bu

rden

Guid

elin

es o

n th

e pr

even

tion

and

cont

rol o

f tub

ercu

losis

in Ir

elan

d. D

ublin

: Hea

lth P

rote

ctio

n an

d Su

rvei

llanc

e Ce

ntre

; 201

0 [a

men

ded

2014

]. Isr

ael

EUR

Low

tube

rcul

osis

burd

enD.

Che

mto

b, A

. Lev

enth

al,Y.

Ber

low

itz,D

. Wei

ler-

Rave

ll. Th

e ne

w n

atio

nal t

uber

culo

sis c

ontro

l pro

gram

me

in

Israe

l, a c

ount

ry o

f hig

h im

mig

ratio

n. In

t J Tu

berc

Lung

Dis.

200

3 Se

p;7(

9):8

28–3

6. P

MID

:129

7166

5

(. . .

cont

inue

d)

(con

tinue

s. . .

)

Ann Jagger et al. National policies on latent tuberculosisResearch

184EBull World Health Organ 2018;96:173–184F| doi: http://dx.doi.org/10.2471/BLT.17.199414

Co

untr

y or t

errit

ory

WHO

regi

onCo

untr

y gro

upDa

ta so

urce

Jam

aica

AMR

Low

tube

rcul

osis

burd

enCa

ribbe

an g

uide

lines

for t

he p

reve

ntio

n, tr

eatm

ent,

care

and

cont

rol o

f tub

ercu

losis

and

HIV

/tub

ercu

losis

. W

ashi

ngto

n: C

arib

bean

HIV

/AID

S Re

gion

al Tr

aini

ng N

etw

ork;

201

0.

Japa

nW

PRLo

w tu

berc

ulos

is bu

rden

Trea

tmen

t gui

delin

es fo

r lat

ent t

uber

culo

sis in

fect

ion.

Toky

o: P

reve

ntio

n Co

mm

ittee

and

the

Trea

tmen

t Co

mm

ittee

of t

he Ja

pane

se S

ocie

ty fo

r Tub

ercu

losis

; 201

3.

Mal

aysia

WPR

Low

tube

rcul

osis

burd

enM

anag

emen

t of t

uber

culo

sis, 3

rd e

ditio

n. P

utra

jaya

: Mal

aysia

Hea

lth Te

chno

logy

Ass

essm

ent S

ectio

n; 2

012.

M

alta

EUR

Low

tube

rcul

osis

burd

enPr

even

tion,

cont

rol a

nd m

anag

emen

t of t

uber

culo

sis: a

nat

iona

l stra

tegy

for M

alta

. Msid

a: In

fect

ious

Dise

ase

Prev

entio

n an

d Co

ntro

l Uni

t, M

inist

ry o

f Hea

lth; 2

012.

M

exic

oAM

RLo

w tu

berc

ulos

is bu

rden

Norm

a ofi

cial

Mex

icana

NO

M-0

06-S

SA2–

2013

, par

a la

pre

venc

ión

y con

trol d

e la

tube

rcul

osis.

Mex

ico

City

: Se

cret

aría

de

Salu

d; 2

013.

N

ethe

rland

sEU

RLo

w tu

berc

ulos

is bu

rden

Rich

tlijn

beh

ande

ling

late

nte

tube

rcul

ose-

infe

ctie

. The

Hag

ue: K

NCV

Tube

rcul

osis

Foun

datio

n; 2

015.

N

ew Z

eala

ndW

PRLo

w tu

berc

ulos

is bu

rden

Guid

elin

es fo

r tub

ercu

losis

cont

rol in

New

Zea

land

201

0. C

hapt

er 8

. Wel

lingt

on: M

inist

ry o

f Hea

lth; 2

010.

N

orw

ayEU

RLo

w tu

berc

ulos

is bu

rden

Tube

rkul

osev

eile

dere

n: 1

0. Fo

reby

ggen

de b

ehan

dlin

g av

late

nt tu

berk

ulos

e (L

TB).

Oslo

: Fol

kehe

lsein

stitu

ttet;

2010

. O

man

EMR

Low

tube

rcul

osis

burd

enST

OP

tube

rcul

osis.

Man

ual o

f tub

ercu

losis

cont

rol p

rogr

amm

e, 4t

h ed

ition

, Apr

il 200

7. M

usca

t: N

atio

nal

Tube

rcul

osis

Cont

rol P

rogr

amm

e D

epar

tmen

t of C

omm

unic

able

Dise

ase

Surv

eilla

nce

and

Cont

rol,

Dire

ctor

ate

Gen

eral

of H

ealth

Affa

irs, M

inist

ry o

f Hea

lth; 2

007.

Pa

lau

WPR

Low

tube

rcul

osis

burd

enLa

tent

tube

rcul

osis

infe

ctio

n: a

gui

de fo

r prim

ary c

are

prov

ider

s. At

lant

a: U

nite

d St

ates

Cen

ters

for D

iseas

e Co

ntro

l and

Pre

vent

ion;

201

3.Pa

nam

aAM

RLo

w tu

berc

ulos

is bu

rden

Norm

a na

cion

al p

ara

la p

reve

ncio

n y c

ontro

l de

la tu

berc

ulos

is. P

anam

a Ci

ty: M

inist

erio

de

Salu

d; ;

2015

.Po

land

EUR

Low

tube

rcul

osis

burd

enTu

berc

ulos

is m

anua

l: nat

iona

l tub

ercu

losis

pro

gram

me

guid

elin

es. W

arsa

w: N

atio

nal T

uber

culo

sis a

nd L

ung

Dise

ases

Res

earc

h In

stitu

te; 2

001.

Port

ugal

EUR

Low

tube

rcul

osis

burd

enTr

atam

ento

da

tube

rcul

ose

late

nte

revi

são

das n

orm

as. L

isbon

: Soc

ieda

de P

ortu

gues

a de

Pne

umol

ogia

; 201

4.Pu

erto

Ric

oAM

RLo

w tu

berc

ulos

is bu

rden

Late

nt tu

berc

ulos

is in

fect

ion:

a g

uide

for p

rimar

y car

e pr

ovid

ers.

Atla

nta:

Uni

ted

Stat

es C

ente

rs fo

r Dise

ase

Cont

rol a

nd P

reve

ntio

n; 2

013.

Sain

t Kitt

s and

Nev

isAM

RLo

w tu

berc

ulos

is bu

rden

Carib

bean

gui

delin

es fo

r the

pre

vent

ion,

trea

tmen

t, ca

re a

nd co

ntro

l of t

uber

culo

sis a

nd H

IV/t

uber

culo

sis.

Was

hing

ton:

Car

ibbe

an H

IV/A

IDS

Regi

onal

Trai

ning

Net

wor

k; 2

010.

Sa

int L

ucia

AMR

Low

tube

rcul

osis

burd

enCa

ribbe

an g

uide

lines

for t

he p

reve

ntio

n, tr

eatm

ent,

care

and

cont

rol o

f tub

ercu

losis

and

HIV

/tub

ercu

losis

. W

ashi

ngto

n: C

arib

bean

HIV

/AID

S Re

gion

al Tr

aini

ng N

etw

ork;

201

0.

Sain

t Vin

cent

and

the

Gren

adin

esAM

RLo

w tu

berc

ulos

is bu

rden

Carib

bean

gui

delin

es fo

r the

pre

vent

ion,

trea

tmen

t, ca

re a

nd co

ntro

l of t

uber

culo

sis a

nd H

IV/t

uber

culo

sis.

Was

hing

ton:

Car

ibbe

an H

IV/A

IDS

Regi

onal

Trai

ning

Net

wor

k; 2

010.

Sa

udi A

rabi

aEM

RLo

w tu

berc

ulos

is bu

rden

Saud

i gui

delin

es fo

r tes

ting

and

treat

men

t of l

aten

t tub

ercu

losis

infe

ctio

n. 2

010.

Join

t sta

tem

ent o

f the

Sa

udi T

hora

cic

Soci

ety,

the

Saud

i Soc

iety

of M

edic

al M

icro

biol

ogy

and

Infe

ctio

us D

iseas

es, t

he S

audi

As

soci

atio

n of

Pub

lic H

ealth

, and

the

Soci

ety

of F

amily

and

Com

mun

ity M

edic

ine.

Ann

Sau

di M

ed. 2

010

Jan-

Feb;

30(

1): 3

8–49

.Se

rbia

EUR

Low

tube

rcul

osis

burd

enGu

idel

ines

for e

xam

inin

g pe

rson

s in

cont

act w

ith tu

berc

ulos

is, la

tent

tube

rcul

osis

and

chem

opro

phyl

axis.

Pro

ject

“tu

berc

ulos

is co

ntro

l in S

erbi

a” [t

rans

late

d tit

le].

Belg

rade

: Min

istry

of H

ealth

; 201

1.

Seyc

helle

sAF

RLo

w tu

berc

ulos

is bu

rden

Natio

nal t

uber

culo

sis p

rogr

amm

e: cl

inica

l dia

gnos

is an

d m

anag

emen

t of t

uber

culo

sis, a

nd m

easu

res f

or it

s pr

even

tion

and

cont

rol.

Mon

t Fle

uri:

Com

mun

icab

le D

iseas

e Co

ntro

l Uni

t Sey

chel

les H

ospi

tal;

2013

. Si

ngap

ore

WPR

Low

tube

rcul

osis

burd

enA

guid

e on

infe

ctio

us d

iseas

es o

f pub

lic h

ealth

impo

rtan

ce in

Sin

gapo

re. S

inga

pore

: Min

istry

of H

ealth

; 201

1.

(. . .

cont

inue

d)

(con

tinue

s. . .

)

Ann Jagger et al.National policies on latent tuberculosisResearch

184F Bull World Health Organ 2018;96:173–184F| doi: http://dx.doi.org/10.2471/BLT.17.199414

Co

untr

y or t

errit

ory

WHO

regi

onCo

untr

y gro

upDa

ta so

urce

Sint

Maa

rten

(Dut

ch p

art)

AMR

Low

tube

rcul

osis

burd

enCa

ribbe

an g

uide

lines

for t

he p

reve

ntio

n, tr

eatm

ent,

care

and

cont

rol o

f tub

ercu

losis

and

HIV

/tub

ercu

losis

. W

ashi

ngto

n: C

arib

bean

HIV

/AID

S Re

gion

al Tr

aini

ng N

etw

ork;

201

0.

Spai

nEU

RLo

w tu

berc

ulos

is bu

rden

Guia

de

prac

tica

clin

ica so

bre

el d

iagn

ostic

o, e

l tra

tam

ient

o y l

a pr

even

cion

de

la tu

berc

ulos

is. G

uias

de

prac

tica

clin

ical e

n el

SNS

. Mad

rid: M

inist

erio

de

Sani

dad,

Pol

ica

Soci

al e

Igua

lidad

; 201

0.

Surin

ame

AMR

Low

tube

rcul

osis

burd

enCa

ribbe

an g

uide

lines

for t

he p

reve

ntio

n, tr

eatm

ent,

care

and

cont

rol o

f tub

ercu

losis

and

HIV

/tub

ercu

losis

. W

ashi

ngto

n: C

arib

bean

HIV

/AID

S Re

gion

al Tr

aini

ng N

etw

ork;

201

0.

Swed

enEU

RLo

w tu

berc

ulos

is bu

rden

Reko

mm

enda

tione

r för

pre

vent

iva

insa

tser

mot

tube

rkul

os: h

älso

kont

roll,

smitt

spår

ning

och

vacc

inat

ion.

St

ockh

olm

: Soc

ialst

yrel

sen;

201

2.Sw

itzer

land

EUR

Low

tube

rcul

osis

burd

enTu

berc

ulos

is in

Sw

itzer

land

. Ber

n: S

wiss

Fe

dera

l Offi

ce o

f Pub

lic H

ealth

; 201

2.Th

e fo

rmer

Yug

osla

v Re

publ

ic

of M

aced

onia

EUR

Low

tube

rcul

osis

burd

enD

iagn

osis

and

treat

men

t of l

aten

t tub

ercu

losis

infe

ctio

n. S

kopj

e: PH

I Ins

titut

e fo

r Lun

g D

iseas

e an

d Tu

berc

ulos

is; 2

009.

Tr

inid

ad a

nd To

bago

AMR

Low

tube

rcul

osis

burd

enCa

ribbe

an g

uide

lines

for t

he p

reve

ntio

n, tr

eatm

ent,

care

and

cont

rol o

f tub

ercu

losis

and

HIV

/tub

ercu

losis

. W

ashi

ngto

n: C

arib

bean

HIV

/AID

S Re

gion

al Tr

aini

ng N

etw

ork;

201

0.

Tuni

siaEM

RLo

w tu

berc

ulos

is bu

rden

Guid

e de

pris

e en

char

ge d

e la

turb

ecul

ose

en Tu

nisie

. Tun

is: D

irect

ion

des S

oins

de

Sant

é de

Bas

e, R

épub

lique

Tu

nisie

nne;

201

4;U

nite

d Ar

ab E

mira

tes

EMR

Low

tube

rcul

osis

burd

enM

anua

l of t

uber

culo

sis co

ntro

l. Ab

u D

habi

: Nat

iona

l Tub

ercu

losis

Con

trol P

rogr

amm

e; M

inist

ry o

f Hea

lth;

2010

. U

nite

d Ki

ngdo

mEU

RLo

w tu

berc

ulos

is bu

rden

Tube

rcul

osis.

NIC

E gu

idel

ines

[NG3

3]. L

ondo

n: N

atio

nal I

nstit

ute

for H

ealth

and

Car

e Ex

celle

nce;

201

6.

Briti

sh O

vers

eas T

errit

ory T

urks

an

d Ca

icos

Isla

nds

AMR

Low

tube

rcul

osis

burd

enCa

ribbe

an g

uide

lines

for t

he p

reve

ntio

n, tr

eatm

ent,

care

and

cont

rol o

f tub

ercu

losis

and

HIV

/tub

ercu

losis

. W

ashi

ngto

n: C

arib

bean

HIV

/AID

S Re

gion

al Tr

aini

ng N

etw

ork;

201

0.

Uni

ted

Stat

esAM

RLo

w tu

berc

ulos

is bu

rden

Late

nt tu

berc

ulos

is in

fect

ion:

a g

uide

for p

rimar

y car

e pr

ovid

ers.

Atla

nta:

Uni

ted

Stat

es C

ente

rs fo

r Dise

ase

Cont

rol a

nd P

reve

ntio

n; 2

013.

Uru

guay

AMR

Low

tube

rcul

osis

burd

enGu

ía N

acio

nal p

ara

el m

anej

o de

la Tu

berc

ulos

is. M

onte

vide

o: C

omisi

on H

onor

aria

par

a la

Luc

ha

Antit

uber

culo

sa y

Enf

erm

edad

es P

reva

lent

es; 2

016.

Uni

ted

Stat

es V

irgin

Isla

nds

AMR

Low

tube

rcul

osis

burd

enLa

tent

tube

rcul

osis

infe

ctio

n: a

gui

de fo

r prim

ary c

are

prov

ider

s. At

lant

a: U

nite

d St

ates

Cen

ters

for D

iseas

e Co

ntro

l and

Pre

vent

ion;

201

3.Ve

nezu

ela

(Bol

ivar

ian

Repu

blic

of

)AM

RLo

w tu

berc

ulos

is bu

rden

Dire

ctric

es p

ara

el d

espi

staj

e, di

agnó

stico

y tra

tam

ient

o de

la tu

berc

ulos

is en

pac

ient

es co

n in

dica

ción

de

tera

pias

bio

lógi

cas.

Cara

cas:

Min

ister

io d

el P

oder

Pop

ular

par

a la

Sal

ud, V

icem

inist

erio

de

Rede

s de

Salu

d Co

lect

iva

& D

irecc

ion

Gen

eral

de

Prog

ram

as d

e Sa

lud

Coor

dina

ción

Nac

iona

l de

Salu

d Re

spira

toria

; 201

0.

AFR:

Afri

can

Regi

on; A

IDS:

acq

uire

d im

mun

e de

ficie

ncy

synd

rom

e; A

MR:

Reg

ion

of th

e Am

eric

as; E

MR:

Eas

tern

Med

iterra

nean

Reg

ion;

EUR

: Eur

opea

n Re

gion

; HIV

: hum

an im

mun

odefi

cien

cy v

irus;

SEAR

: Sou

th-E

ast A

sia R

egio

n; TB

: tub

ercu

losis

; WHO

: W

orld

Hea

lth O

rgan

izatio

n; W

PR: W

este

rn P

acifi

c Re

gion

.

(. . .

cont

inue

d)