Classification of early tuberculosis states to guide research for improved care and prevention: an international Delphi consensus exercise

Coussens, A. K. et al. (2024) Classification of early tuberculosis states to guide research for improved care and prevention: an international Delphi consensus exercise. Lancet Respiratory Medicine, (doi: 10.1016/S2213-2600(24)00028-6) (PMID:38527485) (Early Online Publication)

Abstract

The current active–latent paradigm of tuberculosis largely neglects the documented spectrum of disease. Inconsistency with regard to definitions, terminology, and diagnostic criteria for different tuberculosis states has limited the progress in research and product development that are needed to achieve tuberculosis elimination. We aimed to develop a new framework of classification for tuberculosis that accommodates key disease states but is sufficiently simple to support pragmatic research and implementation. Through an international Delphi exercise that involved 71 participants representing a wide range of disciplines, sectors, income settings, and geographies, consensus was reached on a set of conceptual states, related terminology, and research gaps. The International Consensus for Early TB (ICE-TB) framework distinguishes disease from infection by the presence of macroscopic pathology and defines two subclinical and two clinical tuberculosis states on the basis of reported symptoms or signs of tuberculosis, further differentiated by likely infectiousness. The presence of viable Mycobacterium tuberculosis and an associated host response are prerequisites for all states of infection and disease. Our framework provides a clear direction for tuberculosis research, which will, in time, improve tuberculosis clinical care and elimination policies.

• Item Type: Articles
• Additional Information: Funding for the consensus meeting venue and accommodation for participants was provided by Wellcome (Grant Ref: 203135Z/16/Z). Funding for participants travel costs to attend the consensus meeting was provided by National Institutes of Health/RePORT RSA (Grant Ref:36 G-202211-69475) and the Bill and Melinda Gates Foundation (Grant Ref: UCT 35044). No funding was received for the writing of this paper. SZ was funded though the Commonwealth Scholarship Commission. The work was also supported by the Medical Research Council (Grant Ref: MR/V00476X/1) awarded to HE, the European Research Council (Starting Grant – Action Number 757699) awarded to RH and the National Health and Medical Research Council (Grant Ref: GNT2020750) awarded to AC.
• Status: Early Online Publication
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: MacPherson, Professor Peter
• Authors: Coussens, A. K., Zaidi, S. M.A., Allwood, B. A., Dewan, P. K., Gray, G., Kohli, M., Kredo, T., Marais, B. J., Marks, G., Martinez, L., Ruhwald, M., Scriba, T. J., Seddon, J. A., Tisile, P., Warner, D. F., Wilkinson, R. J., Esmail, H., Houben, R. M.G.J., and International Consensus for Early TB (ICE-TB) group,
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
• Journal Name: Lancet Respiratory Medicine
• Publisher: Elsevier
• ISSN: 2213-2600
• ISSN (Online): 2213-2619
• Published Online: 22 March 2024
• Copyright Holders: Copyright © 2024 Elsevier Ltd.
• First Published: First published in Lancet Respiratory Medicine 2024
• Publisher Policy: Reproduced in accordance with the publisher copyright policy