From Tuberculosis › Chapter 16: Treatment of latent tuberculosis infection · Médecins Sans Frontières, Current online edition, 2026
Introductory guidance on identifying and treating latent TB infection to reduce progression to active disease.
- Issuer
- Médecins Sans Frontières
- Edition
- Current online edition, 2026
- Audience
- Clinicians treating tuberculosis in humanitarian and resource-limited settings
- Reviewed
- 23 Oct 2026 · GMJ
What this guideline says
GMJ summary
This introductory section from the MSF tuberculosis guideline defines latent tuberculosis infection (LTBI) as a state of persistent immune response to M. tuberculosis antigens with no evidence of clinically manifest active tuberculosis, per WHO definitions. It establishes that identification and treatment of LTBI can reduce TB morbidity, mortality and transmission.
The central message is that LTBI treatment aims to reduce the risk of progression to active TB and must only be initiated after active TB has been ruled out through appropriate evaluation. Detection of LTBI can be performed using tuberculin skin test (TST) or interferon-gamma release assay (IGRA). If signs or symptoms of active TB develop during LTBI treatment, specimens should be taken for diagnosis and drug resistance detection (Xpert MTB/RIF, Xpert MTB/XDR, culture and DST), and TB treatment initiated according to results.
Key points
For clinicians — doses and thresholds as stated in the guideline
- LTBI is defined as persistent immune response to M. tuberculosis antigens with no evidence of clinically manifest active TB
- Identify LTBI using tuberculin skin test (TST) or interferon-gamma release assay (IGRA)
- Active TB must be ruled out by appropriate evaluation before initiating LTBI treatment
- If signs/symptoms of active TB develop during LTBI treatment, obtain specimens for Xpert MTB/RIF, Xpert MTB/XDR, culture and drug susceptibility testing
- Initiate TB treatment according to drug resistance testing results if active TB is diagnosed during LTBI treatment
From the guideline
Verbatim
“The goal of LTBI treatment is to reduce the risk of progression to active TB. It must be initiated only once active TB has been ruled out by appropriate evaluation.”
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
As Chair of the Public Health Institute of Georgia, I recognise that latent TB infection management remains an underutilised prevention strategy in our region, despite Georgia's moderate TB burden and pockets of high transmission. The critical recommendation for Georgian clinicians is the absolute requirement to rule out active TB before initiating preventive treatment—a step that demands access to quality chest radiography and clinical assessment at primary care level. The main implementation challenge will be ensuring that TST or IGRA testing, molecular diagnostics for active case detection, and preventive treatment regimens are available and affordable within our universal health coverage programme, particularly in rural areas where TB prevalence may be higher but diagnostic capacity limited.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 23 Oct 2026
Applicability
Georgia and the South Caucasus
This guidance is directly relevant for Georgia and the South Caucasus, where TB remains a public health concern with ongoing transmission. National TB programmes in the region will need to establish systems for LTBI screening among high-risk populations, ensure access to both TST and IGRA testing, and develop protocols for ruling out active TB before initiating preventive treatment. Programmes should integrate LTBI services into primary health care and ensure availability of molecular diagnostics (Xpert MTB/RIF, Xpert MTB/XDR) and culture facilities for monitoring patients on preventive treatment who develop symptoms.
Questions this guideline answers
Quick answers
What is latent tuberculosis infection?
LTBI is a state of persistent immune response to M. tuberculosis antigens with no evidence of clinically manifest active tuberculosis.
How do you detect LTBI?
LTBI can be detected using the tuberculin skin test (TST) or interferon-gamma release assay (IGRA).
What must be done before starting LTBI treatment?
Active TB must be ruled out by appropriate evaluation before initiating LTBI treatment.
What should be done if a patient develops TB symptoms during LTBI treatment?
Take specimens for diagnosis and detection of drug resistance (Xpert MTB/RIF, Xpert MTB/XDR, culture and DST), then initiate TB treatment according to the results.
Related on GMJ
Interconnected resources
Dictionary of Public Health
Conditions A–Z
GMJ News coverage
ASF accreditation standards
Same guideline
- Latent tuberculosis infection treatment regimens — MSF TuberculosisChapter 16: Treatment of latent tuberculosis infection
- BCG vaccination for staff exposed to tuberculosis — MSF TuberculosisChapter 15: Follow-up of staff exposed to tuberculosis
- Preventive measures at patients' homes — MSF TuberculosisChapter 14: Infection prevention and control
- Respiratory protection measures in health facilities — MSF TuberculosisChapter 14: Infection prevention and control
- Environmental Measures in Health Facilities — MSF TuberculosisChapter 14: Infection prevention and control
- Administrative measures in health facilities — MSF TuberculosisChapter 14: Infection prevention and control
Other guidelines on this topic
- Latent tuberculosis infection treatment regimens — MSF Tuberculosis
- BCG vaccination for staff exposed to tuberculosis — MSF Tuberculosis
- Preventive measures at patients' homes — MSF Tuberculosis
- Respiratory protection measures in health facilities — MSF Tuberculosis
- Environmental Measures in Health Facilities — MSF Tuberculosis
- Issuer
- Médecins Sans Frontières
- Guideline
- Tuberculosis
- Chapter
- Chapter 16: Treatment of latent tuberculosis infection
- Type
- Clinical guideline (chapter)
- Edition
- Current online edition, 2026
- Status
- Current
- Published
- 2026-10-14
- Scope
- Chapter 16, Section 16.1
- Audience
- Clinicians treating tuberculosis in humanitarian and resource-limited settings
- Record history
- Created 23 Oct 2026 · updated 23 Oct 2026 · next check Apr 2027
Médecins Sans Frontières. 16.1 Introduction. In: Tuberculosis. Paris: MSF; 2026 Oct 14.GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
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