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

Classification of early tuberculosis states to guide research for improved care and prevention: an international Delphi consensus exercise. Coussens, A. K, Zaidi, S. M A, Allwood, B. W, Dewan, P. K, Gray, G., Kohli, M., Kredo, T., Marais, B. J, Marks, G. B, 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, Alland, D., Behr, M. A, Beko, B. B, Burhan, E., Churchyard, G., Cobelens, F., Denholm, J. T, Dinkele, R., Ellner, J. J, Fatima, R., Haigh, K. A, Hatherill, M., Horton, K. C, Kendall, E. A, Khan, P. Y, MacPherson, P., Malherbe, S. T, Mave, V., Mendelsohn, S. C, Musvosvi, M., Nemes, E., Penn-Nicholson, A., Ramamurthy, D., Rangaka, M. X, Sahu, S., Schwalb, A., Shah, D. K, Sheerin, D., Simon, D., Steyn, A. J C, Anh, N. T., Walzl, G., Weller, C. L, Williams, C. M., Wong, E. B, Wood, R., Xie, Y. L, & Yi, S. The Lancet Respiratory Medicine, Elsevier, mar, 2024.

Paper doi abstract bibtex

Summary 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.

@article{Coussens2024,
abstract = {Summary 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.},
author = {Coussens, Anna K and Zaidi, Syed M A and Allwood, Brian W and Dewan, Puneet K and Gray, Glenda and Kohli, Mikashmi and Kredo, Tamara and Marais, Ben J and Marks, Guy B and Martinez, Leo and Ruhwald, Morten and Scriba, Thomas J and Seddon, James A and Tisile, Phumeza and Warner, Digby F and Wilkinson, Robert J and Esmail, Hanif and Houben, Rein M G J and Alland, David and Behr, Marcel A and Beko, Busisiwe B and Burhan, Erlina and Churchyard, Gavin and Cobelens, Frank and Denholm, Justin T and Dinkele, Ryan and Ellner, Jerrold J and Fatima, Razia and Haigh, Kate A and Hatherill, Mark and Horton, Katherine C and Kendall, Emily A and Khan, Palwasha Y and MacPherson, Peter and Malherbe, Stephanus T and Mave, Vidya and Mendelsohn, Simon C and Musvosvi, Munyaradzi and Nemes, Elisa and Penn-Nicholson, Adam and Ramamurthy, Dharanidharan and Rangaka, Molebogeng X and Sahu, Suvanand and Schwalb, Alvaro and Shah, Divya K and Sheerin, Dylan and Simon, Donald and Steyn, Adrie J C and Anh, Nguyen Thu and Walzl, Gerhard and Weller, Charlotte L and Williams, Caroline ML and Wong, Emily B and Wood, Robin and Xie, Yingda L and Yi, Siyan},
doi = {10.1016/S2213-2600(24)00028-6},
file = {:C$\backslash$:/Users/01462563/OneDrive - University of Cape Town/Documents/CIDRI-Africa papers and outputs/Coussens et al - 2024 - ICE-TB position paper.pdf:pdf},
issn = {2213-2600},
journal = {The Lancet Respiratory Medicine},
keywords = {fund{\_}ack,perspective},
mendeley-tags = {fund{\_}ack,perspective},
month = {mar},
pages = {10.1016/S2213--2600(24)00028--6},
publisher = {Elsevier},
title = {{Classification of early tuberculosis states to guide research for improved care and prevention: an international Delphi consensus exercise}},
url = {http://www.thelancet.com/article/S2213260024000286/fulltext http://www.thelancet.com/article/S2213260024000286/abstract https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(24)00028-6/abstract},
year = {2024}
}

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