Testing and Treatment of Latent Tuberculosis Infection in the United States: A Clinical Guide for Health Care Providers and Public Health Programs
NSTC, under the auspices of NTCA, has released the updated third edition of Testing and Treatment of Latent Tuberculosis Infection in the United States: A Clinical Guide for Health Care Providers and Public Health Programs. This publication’s earlier editions were titled Testing and Treatment of Latent Tuberculosis Infection in the United States: Clinical Recommendations — A Guide for Health Care Providers and Public Health Programs.
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Led by NSTC members Drs. Marcos Burgos, Lisa Armitige, and Charlie Crane, a national group of TB experts updated these patient-centered and practical state-of-the-art recommendations on latent tuberculosis infection (LTBI) as a companion reference to support health care providers in implementing the 2020 “Guidelines for the Treatment of Latent Tuberculosis Infection: Recommendations from the National Tuberculosis Controllers Association and CDC.
The Testing and Treatment of Latent Tuberculosis Infection in the United States: A Clinical Guide for Health Care Providers and Public Health Programs is available for download at no charge. However, we ask that you register when you download a copy so that we can track interest in the publication. More importantly, this information will allow us to alert you when updates are released, as the document is a “living document” and will be updated as science or practice dictates.
The NSTC’s Clinical Recommendations
- Put the clinical advances of these guidelines into practical application in the broader context of the full process of patient care for LTBI—from screening and testing, to deciding whether and how to treat, and through to treatment completion
- Take a patient-centered approach
- Present current thinking among TB clinicians on clinically complicated situations
Audiences
Target audiences for this document include health care providers in public health departments, hospitals, congregate facilities, and private practices, including the following:
- Public health departments and TB programs
- Community clinics
- Hospitals
- Private medical practices
- Congregate facilities such as long-term care facilities, homeless shelters, correctional facilities
Contents
The recommendations provide a comprehensive reference on LTBI. The authors selected topics they considered essential to performing these tasks by considering knowledge and steps required for each task, patient care challenges and complexities they had encountered, and questions that they were frequently asked during consultations and trainings.
- Immunologic Tests for TB Infection
- When to Test for LTBI
- Pretreatment Clinical Evaluation
- Deciding Whether to Treat and Choosing a Regimen
- Considerations for Specific Populations
- Monitoring and Managing Treatment
- Nurse Case Management (brief overview)
Appendices include TB test interpretation, drugs used to treat LTBI, dosages for treatment regimens, collaborations between public health and community service providers, and directly observed therapy and video observed therapy.
Updates
The second edition was a collaboration of listed authors to perform a review of current literature and address comments put forth by end users of the first edition. The second edition updated information regarding LTBI treatment in pregnant persons, guidance from the American Academy of Pediatrics on use of IGRAs in children, TB screening before and during immunosuppressive therapies (with a table of specific biologics), LTBI treatment in kidney disease, and references throughout the document.
Additions to the second edition included guidance for patients traveling outside the United States, use of rifabutin monotherapy in patients with HIV, second round testing and follow up for children and recent contacts in contact investigations, and treatment of immunosuppressed close contacts. The second edition also clarified appropriate use of isoniazid in patients with baseline liver disease and when baseline laboratory testing is warranted.
The third edition addresses the use of the 1HP regimen in individuals with and without HIV.
This will be a living document, updated as the TB community learns more about LTBI testing and treatment. In selected topics, such as COVID-19-TB testing and nitrosamine concerns, where there are major and ongoing developments and anticipated new CDC or FDA recommendations, the document links to NTCA website pages that will be updated as needed.
Additional Resources for Testing and Treating LTBI
- Centers for Disease Control and Prevention: Latent Tuberculosis Infection Resources
- Guidelines for the Treatment of Latent Tuberculosis Infection: Recommendations from the National Tuberculosis Controllers Association and CDC, 2020
- NTCA Provider Guidance: Using the Isoniazid/Rifapentine Regimen to Treat Latent Tuberculosis Infection (LTBI)
- New Mexico Assessment Tool: New Mexico Flow Sheet for TB and LTBI
Disclaimer
The NSTC, a section of the NTCA, has developed this Clinical Guide to provide guidance for particular practice areas concerning latent tuberculosis screening, diagnosis, and treatment. This Clinical Guide is intended for use only as a tool to assist clinicians and health care professionals and should not be used to replace clinical judgment. For the full disclaimer, please see the inside cover of the publication.
