Evidence-based guidance is needed on (i) how tuberculosis (TB) infectiousness evolves in response to effective treatment and (ii) how the TB infection risk can be minimized to help countries to implement community-based, outpatient-based care while reducing TB-related suffering and improving TB treatment outcomes. This document aims to 1) review the available evidence on how TB infectiousness evolves in response to effective treatment and which factors can lower or boost infectiousness; 2) present policy options on the infectiousness of TB patients relevant to the WHO European Region; 3) define the limitations in the available evidence and 4) provide recommendations for further research. The document aims to target all professionals dealing with TB (e.g. TB specialists, pulmonologists, infectious disease specialists, primary health care professionals, and other clinical and public health professionals), as well as health staff working insettings where TB transmission may occur.

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