TY - JOUR
T1 - Treatment of latent infection to achieve tuberculosis elimination in low-incidence countries
AU - Campbell, Jonathon R.
AU - Dowdy, David
AU - Schwartzman, Kevin
N1 - Publisher Copyright:
© 2019 Campbell et al.
PY - 2019/6
Y1 - 2019/6
N2 - Tuberculosis (TB) persists in the United States, Canada, and other high-income, low-incidence countries largely because of ongoing reactivation of latent TB infection (LTBI). • TB elimination in low-incidence countries, defined as an annual incidence of ≤1 case per million, will require extensive screening and treatment of LTBI, including in people for whom the harms of LTBI treatment outweigh the likely benefits: for example, older foreign-born individuals with no recent travel/exposure. Ongoing migration from higher-incidence countries, as well as pockets of transmission in vulnerable subgroups such as prisoners, homeless persons, and drug users, will also continue to pose challenges for TB elimination. • Policymakers in low-incidence countries face a choice between a utilitarian approach that tolerates individual net harm to advance public health goals and a patient-centered approach that values shared decision-making but will predictably result in failure to achieve TB elimination. • While TB elimination is an important aspirational vision, the ethical implications of this goal—namely the implicit requirement to offer LTBI screening and treatment to individuals who are more likely to experience harm than good—merit careful reflection.
AB - Tuberculosis (TB) persists in the United States, Canada, and other high-income, low-incidence countries largely because of ongoing reactivation of latent TB infection (LTBI). • TB elimination in low-incidence countries, defined as an annual incidence of ≤1 case per million, will require extensive screening and treatment of LTBI, including in people for whom the harms of LTBI treatment outweigh the likely benefits: for example, older foreign-born individuals with no recent travel/exposure. Ongoing migration from higher-incidence countries, as well as pockets of transmission in vulnerable subgroups such as prisoners, homeless persons, and drug users, will also continue to pose challenges for TB elimination. • Policymakers in low-incidence countries face a choice between a utilitarian approach that tolerates individual net harm to advance public health goals and a patient-centered approach that values shared decision-making but will predictably result in failure to achieve TB elimination. • While TB elimination is an important aspirational vision, the ethical implications of this goal—namely the implicit requirement to offer LTBI screening and treatment to individuals who are more likely to experience harm than good—merit careful reflection.
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U2 - 10.1371/journal.pmed.1002824
DO - 10.1371/journal.pmed.1002824
M3 - Article
C2 - 31170161
AN - SCOPUS:85067503024
VL - 16
JO - PLoS Medicine
JF - PLoS Medicine
SN - 1549-1277
IS - 6
M1 - e1002824
ER -