Screening and treatment practices for tuberculosis infection in Nordic, Baltic and Central European countries and Ukraine in 2023

Purpose: Throughout Europe, tuberculosis (TB) remains a public health concern, particularly among high-risk groups. Identifying at-risk populations for tuberculosis infection (TBI) testing and treatment is one of the tools to control the TB epidemic. This study aims to assess policies and practices in tuberculosis infection management across 10 countries in the Nordic, Baltic and Central European region, collaborating through the Northern Dimension Partnership in Public Health and Social Well-being network (NDPHS), and Ukraine. Methods: National data on TB epidemiology, management and policies were collected through an online questionnaire, followed by structured interviews with country representatives. Data were verified and meaningful similarities and differences were identified through follow-up contacts and working group discussions. Results: Among NDPHS countries, TB incidence ranged from 3 to 22 per 100,000 population in 2023, with multidrug resistance in 4.1% (441/10855) of cases. In NDPHS countries, Ukrainians accounted for 46.4% (189/407) of multidrug-resistant cases. While all countries screen for TBI among immunosuppressed patients and TB contacts, approaches to refugee screening and preventive treatment vary, 5 of 11 countries lacked access to rifapentine. Most countries did not utilize levofloxacin in the preventive treatment of multidrug-resistant TBI. Two countries reported having a national registry for TBI. Conclusion: Significant variation exists in TBI management across countries. Optimizing screening and treatment strategies directed at populations at risk is crucial for TB control in low-incidence countries. Cross-border coordination could be improved through alignment with international guidelines and by establishing an international registry for TBI.