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  • TB Infection

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    • TB Infection (or previously known as Latent TB infection) is a stage in between uninfected and having active TB. In this stage the person has no symptoms and can only be identified using laboratory tests.

    • The vast majority of infected people may never develop TB disease. However, to achieve TB elimination, it is important to treat TB infection in people at risk of developing active TB disease.

    • It is a state of persistent immune response to stimulation by Mycobacterium tuberculosis antigens with no evidence of clinically manifested active TB.

    • There is no single acceptable/reliable test for direct identification of Mycobacterium tuberculosis infection in humans. Tuberculin Skin Test (TST) and Interferon-gamma release assay (IGRA) are commonly used tests for identifying TB infection.

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  • Testing for TB Infection

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    For TB infection, there are two recommended tests which can be used to identify such patients.

    Tuberculin Skin Test (TST)

    The skin test is done by injecting a small amount (0.5 ml) of TB antigens into the top layer of skin on your inner forearm. If one has ever been exposed to TB bacteria (Mycobacterium tuberculosis), there will be a reaction indicated by the development of a firm red bump (induration) >= 10 mm at the site within 2 days.

    Tuberculin Skin Test

    Figure: Tuberculin Skin Test

     

    Interferon-gamma release assay (IGRA)

    IGRA is a Blood test. If one has been exposed to TB bacteria, the white blood cell in the blood will release a substance called gamma interferon when the cells are exposed to specific TB antigens.

    Interferon-gamma release assay (IGRA)

    Figure: Interferon-gamma release assay (IGRA)

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  • TB Preventive Therapy

    Content

    TPT treatment options recommended under NTEP include:

    • 3-month weekly Isoniazid and Rifapentine (3HP)
    • 6-months daily isoniazid (6H)

     

    Table 1: TPT Options for Target Population; Source: (Guidelines for Programmatic Management of Tuberculosis Preventive Treatment)

    Table 2: TPT dosage based on age and weight band recommended by NTEP; Source: Guidelines for Programmatic Management of Tuberculosis Preventive Treatment

     

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    Assessment

    Question   Answer 1   Answer 2   Answer 3   Answer 4   Correct answer   Correct explanation   Page id   Part of Pre-test   Part of Post-test  
    TPT options recommended under NTEP include which of the following?   3-month weekly Isoniazid and Rifapentine (3HP)   Rifampicin 6-months daily isoniazid (6H) 1 and 3 4 TPT options recommended under NTEP include 3-month weekly Isoniazid and Rifapentine (3HP) and 6-months daily isoniazid (6H).   Yes Yes

  • TB Preventive Treatment [TPT]: Treatment Adherence for Contacts of DR-TB Index Patients

    Content

    Adherence to the Tuberculosis Preventive Treatment (TPT) course and treatment completion are important determinants of clinical benefit, both at individual and population levels.

    • Develop a personal adherence plan with the support of the family member, caregiver or health worker as per the treatment regimen being provided.
    • Treatment support and adherence monitoring will be like that of the index patient. 
    • Give first preference to the family member to be the treatment provider in consultation with the person. 
    • Use of digital platforms (tele/ video calls, 99DOTS/ MERM), counting empty blisters, refill monitoring etc., to strengthen adherence monitoring. 
    • Irregular or inadequate treatment reduces the protective efficacy of TPT regimen.
    • Poor adherence or early cessation of TPT can potentially increase the risk of the individual developing TB including Drug-resistant Tuberculosis (DR-TB) (although not supported by existing evidence from research settings).
    • It is known that the efficacy of TPT is greatest if at least 80% of the doses are taken within the duration of the regimen. The total number of doses taken is also a key determinant of the extent of TB prevention. 

    The criteria for completion of TPT among DR-TB contacts have been given in the table below.

     

    Table: Criteria for completion of TPT among DR-TB contacts; Source: Guidelines for PMDT in India, 2021.

    DOSES

    TOTAL DURATION IN MONTHS

    EXPECTED NO. OF DOSES

    80% OF RECOMMENDED DOSES (DAYS)

    EXTENDED TIME FOR TREATMENT COMPLETION (DAYS) (TREATMENT DURATION + 33% ADDITIONAL TIME)

    6Lfx (daily)

    6

    180

    144

    239

    4R (daily)

    4

    120

    96

    160

     

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