Advancing Tuberculosis Management in APAC: Overcoming Diagnostic Challenges

This is a verbatim transcript of an interview conducted with Prof Erlina Burhan in July 2026. The transcript has been lightly edited for clarity.

Introduction

My name is Erlina Burhan. I am a pulmonologist and also a pulmonary infectious disease consultant at Persahabatan Hospital, Jakarta, Indonesia. and I am also a professor of respiratory medicine at the Faculty of Medicine, Universitas Indonesia. For more than two decades, my work has focused on tuberculosis, from clinical management research to policy development. I have been involved in several international clinical trials on tuberculosis (TB) treatment, shorter regimen and TB faxing. I also serve on the Board of Directors of the Union and the Stop TB Partnership.

How can expanding the focus beyond active TB to include systematic identification and management of latent TB Infection (LTBI) help improve patient outcomes and support regional elimination goals? 

TB elimination cannot be achieved by focusing only on active disease. The much larger reservoir is latent TB infection, or LTBI, where individuals are infected but remain asymptomatic and may develop active TB later in life. In many high-burden countries across Asia-Pacific countries, a substantial proportion of the population is estimated to carry latent infection. Without identifying and managing these individuals, transmission will continue across generations. Although many countries have introduced LTBI policies, implementation remains inconsistent. Screening is often limited to selected populations, and access to diagnostic testing and preventive therapy remains variable. This is why robust diagnostic frameworks are essential. Accurate identification of people who will benefit from preventive therapy enables us to catch before disease develops.

Beyond the traditionally recognised risk group of close contacts, which patient populations in the APAC region require greater attention for testing for latent TB , and how does this impact diagnostic requirements?

Traditionally, we focus on household contacts, and I think they remain an important priority. However, our understanding of TB risk has evolved. Greater attention should also be given to children under 5, people living with HIV, patients preparing for immunosuppressive therapies such as biologic agents or organ transplantation, and patients receiving dialysis, also healthcare workers in high-exposure settings, and now increasingly, individuals with diabetes mellitus, and do not forget, people with uncontrolled comorbidities, such as hypertension, hronic kidney diseases – due to the weakened immunity, they are at risk of developing active TB. While countries may prioritise these groups differently based on epidemiology and resources, one principle remains consistent: the more vulnerable the patient, the greater the need for highly accurate diagnostic tests. High specificity becomes important because unnecessary preventive treatment can expose patients to an avoidable risk, while missed infections represent missed opportunities for prevention.

In balancing clinical accuracy with field realities, how do practical operational factors influence the choice of LTBI testing?

Clinical performance is important, but implementation determines real-world impact. Many patients in resource-constrained settings face practical barriers such as transportation costs, time away from work, and multiple visits to healthcare facilities. Every additional visit increases the risk of loss to follow-up. This is why operational considerations matter when selecting diagnostic tools. Tests that can simplify the diagnostic pathway, reduce patient visits, and provide efficient laboratory workflows have important advantages beyond their analytical performance. And remember, accurate tests can offer clinicians a better understanding of their patients’ status.

What would be your word of advice for clinicians combating tuberculosis across the Asia Pacific region?

TB elimination starts with finding the right patients at the right time. When diagnosis is timely, accurate, and linked to effective care, we improve individual outcomes, reduce transmission, and move much closer to achieving TB elimination across the Asia-Pacific region.

The views and opinions expressed by Prof Erlina Burhan are his own views and opinions. Roche disclaims all liability in relation to these views and opinions.