While talking about tuberculosis (TB) it is important to understand the difference between TB infection and TB disease. Not everyone will develop active disease, but people with immunosuppressive condition, small children, and those recently exposed to TB are in the highest risk of falling ill. And we still have neither a diagnostic test to predict, who is likely to fall ill nor a vaccine to prevent it from happening. To better understand the situation, the NDPHS Expert Group on HIV, TB & AI is launching a study on LTBI in the region, covering both epidemiology and clinical management. Finnish Lung Health Association (Filha) will lead the study together with colleagues from Norway and Estonia.

Understanding LTBI epidemiology

The first part in the LTBI study is to examine epidemiology. In the Northern Dimension countries, varying socio-economic factors, healthcare infrastructure, and migration patterns contribute to the complexity of TB and LTBI prevalence. Screening and surveillance of LTBI are implemented with various intensiveness in Nordic Dimension countries. With this survey, we can identify high-risk populations and demographic trends associated with LTBI prevalence. This data can serve as the foundation for targeted intervention strategies.

Navigating drug-resistant strains

One of the most pressing hardships in LTBI management is the rise of drug-resistant tuberculosis strains. Certain Northern Dimension countries struggle with high rates of multidrug-resistant (MDR) and even extensively drug-resistant (XDR) TB. These strains highly complicate the treatment and evidence-based guidelines for treating contacts of such patients are still lacking. This study examines how ND countries currently deal with LTBI treatment of these contacts, which will form a basis for further discussions.

LTBI treatment practices in ND countries

The second part of the survey concentrates on the treatment options and practices conducted in LTBI treatment. Further, through country specific interviews it is possible to find existing good clinical practices to distribute and share with other ND countries.

Impact of Ukrainian Migration

Russia’s ongoing war in Ukraine has led to a significant influx of displaced individuals seeking refuge in European countries, including those within the Northern Dimension. This migration has had its implications for TB epidemiology as well, as displaced populations often face heightened risks of TB transmission due to overcrowded living conditions, limited access to healthcare, and disruptions in treatment continuity. Our study will examine the impact of Ukrainian migration on LTBI prevalence, and healthcare utilization, proposing policies to mitigate the associated risks. In this regard, Filha is planning to engage also Ukrainian TB specialists in this study.

The goal of the LTBI project

With TB eradication as the ultimate goal, a proactive and collaborative approach is essential in the management of LTBI. By conducting this comprehensive study that also addresses problems posed by drug-resistant TB strains and population migration, it is possible to develop common effective strategies to improve LTBI management and treatment outcomes in Nordic Dimension countries.

Read more about World TB Day 2024

Text: Mikko Vauhkonen, Member of the NDPHS Expert Group on HIV, TB, and Associated Infections, Finnish Lung Health Association (FILHA)