1. Testing and Treatment of LTBI in the US: Practical Considerations
A Guide For Healthcare Providers (Companion Statement)
Charles M. Crane, MD, MPH
March 12, 2019

2. Sponsor National Society of TB Clinicians (NSTC)
One of 3 Sections within NTCA

3. Authorship Leadership Workgroup Charles M. Crane, Organizational Chair
Marcos Burgos, Chief Editor
Jennifer Kanouse, Copy Editor
Workgroup
Lisa Armitige, Pennan Barry, Robert Belknap, Benita Cook, Thomas Dobbs. Diana Fortune, Juliana Ferreira, Jennifer Flood, David Griffith, Carol Dukes Hamilton, Deborah Isaacs, John Jereb, Ron Karpick, Quratulain Kizilbash, Julie Low, Brenda Montoya, Diana Nilsen, Margaret Oxtoby, Barbara Seaworth, Wendy Thanassi, Dean Tsukayama, Lisa Villarroel

4. Disclosures
None

5. Learning Objective
Participants will be able to describe the companion statement being developed by NSTC for the testing and treatment of LTBI in the US.

6. Outline
Background
Process
Content
Conclusions

7. Background - 1
TB elimination requires more effective testing and treatment of LTBI in high risk groups
Revision of LTBI Guidelines in process
Limitations
Based on Highest Quality Evidence
GRADE criteria
RCTs limited by cost and time
Limited practical utility for providers
Expression of need for more practical document

8. Background - 2 NTCA decision to sponsor Companion Statement
Assigned to NSTC, Clinicians Section of NTCA
Target Audience
Public Health TB Programs
Healthcare Providers

9. Process - 1 Relationship with Guidelines Working Group
Parallel processes supported by NTCA
Hope of near simultaneous publication
Confidentiality Agreement
Workgroup Meetings
Scope of Statement
Writing Assignments
Sub-groups for each Section

10. Process - 3 First Draft Edits by Leadership Group Revisions by Authors
Second Draft
Series of Meetings to Discuss Content
Further edits by Authors and Leaders
Final Draft
Publication and Distribution by NTCA and State/local TB Programs
Electronic version a living document

11. Content - 1 Preface List of Abbreviations Section 1: Tests for LTBI
IGRAs
TST
Section 2: Whom to Test and Treat
General Considerations, principles
TB Risk Assessment based on CA model

12. Content - 2 Section 3: Considerations before starting LTBI Treatment
Confirmation of diagnosis of untreated LTBI
Evaluation for active TB
Risk of progression
Risk of adverse reactions
Likelihood of completion of treatment
Patient education
Selection of a regimen

13. Content - 3 Section 4: Treatment for LTBI (Regimens)
Rifapentine and isoniazid once weekly for 12 weeks (3HP)
Rifampin or rifabutin for 4 months (4R)
Isoniazid for 9 months (9H)

14. Content - 4
Section 5: Monitoring for and Management of Adverse Reactions
Monitoring for adherence, adverse reactions
Management of nonadherence
Management of adverse reactions
Role of the Nurse Case Manager
Role of the Healthcare Provider

15. Content - 5 Section 6: Considerations for Special Populations
Children
Pregnant, post-partem and breastfeeding women
Patients with co-morbidities
Patients with radiographic evidence of inactive TB (Class 4)
References

16. Content - 6 Appendix 1: Documentation Appendix 2: Drugs for LTBI
Appendix 3: Summary of Regimens
Appendix 4: Treatment by Private Providers
Education of private providers
Partnerships, MOUs,
Role of Health Department in monitoring treatment, DOT
Correctional Facilities, Drug Treatment Facilties, Renal Dialysis Facilities

17. Content - 7 Appendix 5: Definitions
Test characteristics and interpretation (sensitivity, specificity, PPV, NPV)
Recent TB infection

18. Conclusions Guidelines contain limitations based on their methodology
Companion Statement can be more effective for TB elimination
Current status
Next Steps
Discussion/questions?