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Prophylactic treatment is recommended for all those who test positive for tuberculosis
Last reviewed: 02.07.2025
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Preventive treatment for tuberculosis (TB) can prevent latent TB infections from progressing to fatal disease. Although TB infection is completely curable, there is no global consensus on which subgroups of people exposed to TB should be prioritized for preventive treatment, and whether the benefits of this treatment vary according to factors such as age or confirmed infection.
A new study led by a researcher at the Boston University School of Public Health (BUSPH) sheds light on this issue, showing that people with confirmed TB infection—meaning a positive skin or blood test—should be prioritized for treatment in low-prevalence settings, regardless of their age.
However, in high-burden settings, all exposed individuals should be considered for prophylactic treatment, even without confirmed infection, according to findings published in The Lancet Respiratory Medicine.
This strategy could help end the TB epidemic and support global efforts to reduce TB deaths by 95% by 2035 (compared to 2015 estimates). In 2022, there were more than 10 million active TB cases worldwide, resulting in 1.5 million deaths.
" TB affects tens of millions of people each year and has long-term consequences, even after recovery," said lead and corresponding author Dr. Leonardo Martinez, an associate professor of epidemiology at BUSPH. "Finding ways to optimize prevention is really important to combat the epidemic."
For the study, Dr. Martinez and colleagues conducted a comprehensive review and analysis to identify new TB cases among people who had been in close contact with diagnosed cases and compared the effectiveness of preventive treatment in these exposed individuals according to age, infection status, and TB burden in their setting.
Among 439,644 participants, the team found that TB preventive treatment was 49% effective among the 2,496 people who developed TB, but especially among those with a positive skin or blood test (for whom it was 80% effective).
Remarkably, the researchers found that TB preventive treatment was not effective for most people who had no signs of infection, except for children under 5 years old.
For those who had a positive skin or blood test, treatment effectiveness was comparable across all age groups—adults, children aged 5-17 years, and children under 5 years—and treatment was more effective among those in high-burden settings than in low-burden settings.
The team also estimated the number of people needed to be treated (NNT) to prevent one person from developing TB. Regardless of infection status, the NNT was lower in high-burden settings (29 to 43 people) compared with low-burden settings (213 to 455 people). Although people with negative blood or skin tests do not appear to benefit from preventive treatment, the researchers argue that the overall low NNT may justify prioritizing treatment of all exposed contacts in areas where testing for TB infection is unavailable.
"While it is critical to find and treat people who are spreading TB in the community, the threat of global TB will never end until people with latent TB are treated," said study co-author Dr. S. Robert Horsburgh, professor of global health. "The results of this study show how effective such treatment can be."