Programmatic management of Tuberculosis preventive therapy: past, present, future

Background: Tuberculosis infection (TBI) is an emerging public health priority, involving about one fourth of the world population. Since persons with TBI are the reservoir for tuberculosis (TB), stopping progression to active disease by preventive treatment is one of the main interventions needed to achieve TB elimination. As of today, the proportion of people with TBI receiving treatment is minimal, at global level, mostly because current international policies recommend systematic testing and treatment for less than 2% of infected people. PRESENT: : facts and gaps: The programmatic management of TB preventive treatment (PMTPT) involves a set of cascading interventions whose effectiveness is limited by the poor predictivity of diagnostic tests, the length and the potential toxicity of treatment, and the suboptimal prioritisation within global policies. Partly because of this, competing priorities and lack of adequate funding are significant barriers for scale up, particularly in low- and middle-income countries. Monitoring and evaluation: To date there is no universal system of monitoring and evaluation for the PMTPT elements and just a few countries use standard recording and reporting tools, contributing to leaving TBI a neglected condition. Conclusions: Better financed research and resources reallocation are essential steps to progress towards TB elimination worldwide.