Latent tuberculosis infection in focus: Evaluating public concerns, treatment perceptions, and awareness in King Sabatha Dalindyebo Local Municipality, Eastern Cape, South Africa.

Latent tuberculosis infection (LTBI) remains an under-recognized component of tuberculosis (TB) prevention in South Africa despite its potential to progress to active disease and contribute to ongoing transmission. This study assessed community awareness, perceptions of LTBI treatment, and perceived barriers to screening and care among adults in the King Sabata Dalindyebo Local Municipality, Eastern Cape, South Africa. A community-based cross-sectional survey was conducted using a structured interviewer-administered questionnaire assessing LTBI awareness, perceived risk of progression, understanding of the consequences of untreated LTBI, attitudes towards screening and treatment, and perceived barriers to care. Data were analysed using descriptive statistics, chi-square tests, correlation analysis, and multivariable logistic regression to identify independent predictors of LTBI knowledge. LTBI awareness varied significantly across age groups, with the highest awareness observed among participants aged 20-29 years and lower awareness among older adults. Although concern about progression to active TB was high, knowledge of the consequences of untreated LTBI and uptake of preventive treatment remained limited. Lack of awareness was the most frequently reported barrier to LTBI screening and treatment, followed by fear of medication side effects and stigma. Greater knowledge of LTBI was associated with fewer informational barriers, while lower educational attainment independently predicted poor LTBI knowledge. These findings demonstrate important gaps between awareness, perceived risk, and engagement in preventive care. Strengthening community education, improving access to LTBI information, and addressing informational barriers may enhance screening uptake and preventive treatment in rural, high-burden communities, thereby supporting tuberculosis elimination efforts in South Africa.