Worry About Latent TB Isn’t Leading to Treatment

Latent tuberculosis infection, or LTBI, is a hidden part of the TB problem: people carry the bacteria without symptoms but can develop active TB later. In South Africa, where TB is common, LTBI has received far less attention than active disease, even though treating LTBI can prevent future illness. To illuminate how communities understand and respond to this hidden risk, researcher Lindiwe Modest Faye and colleagues carried out a community survey in the King Sabatha Dalindyebo Local Municipality, Eastern Cape. The team focused on adults living in this high-burden rural area and used a structured questionnaire to measure basic knowledge of LTBI, how worried people were about progression to active TB, what consequences they believed could follow untreated LTBI, and what barriers they faced when it came to treatment. By asking about both feelings and facts, the study aimed to see whether concern translated into accurate knowledge and into action — getting preventive treatment. The work highlights questions about where information gaps and barriers exist in a hard-hit, rural South African setting.

The study used a cross-sectional, community-based design and analyzed responses with descriptive statistics, chi-square tests, and Pearson correlation, presenting results by age and other demographic subgroups. Awareness of LTBI varied by age: the highest awareness was reported among 20–29-year-olds (52.7%; 95% CI: 44.7–60.7; p = 0.5625) and the lowest among those aged 50–59 (15.8%; 95% CI: 5.5–37.6; p = 0.0044). Belief that LTBI requires treatment was strongest in people under 20 (66.7%) and in the 20–29 group (62.3%; 95% CI: 54.2–69.8; p = 0.0036), yet actual treatment uptake was low across every age band, peaking at 14.8% (95% CI: 5.9–32.5; p = 0.0003) among 30–39-year-olds. Concern that LTBI could progress to active TB was common (75.1%; 95% CI: 69.3–80.1; p < 0.0001), but only 38.3% correctly identified the full consequences of untreated LTBI (p = 0.0012). The most-cited barrier to care was lack of awareness (62.4%; 95% CI: 56.2–68.3; p < 0.0001). Correlation analysis showed a weak but significant link between understanding consequences and fewer informational barriers (r = 0.186; 95% CI: 0.064–0.307; p = 0.0035), while emotional concern did not align significantly with accurate knowledge or behavior.

Together, these findings point to a striking mismatch: people are often worried about latent TB, but that worry does not reliably lead to correct knowledge or to getting preventive treatment. The study suggests that concern alone is not enough; accurate information and accessible care are necessary to turn awareness into action. For communities like King Sabatha Dalindyebo, the authors conclude that improving community education, tackling stigma that may deter people from seeking care, and tailoring messages to different age groups are important steps. Age-sensitive messaging could address the low awareness seen in older adults while reinforcing treatment benefits for younger groups who already feel treatment is necessary. By closing information gaps and lowering barriers — especially the informational barrier identified as most common — health programs can better engage people living with LTBI and reduce the number who progress to active TB, supporting broader TB prevention goals in rural South Africa.