4.5 Illustrative algorithm combinations

To aid understanding of how the different algorithms interlink to provide a final diagnosis for a patient, illustrative scenarios are presented in Fig. 4.7 to Fig. 4.9.Three scenarios are provided, with two simulated pathways in each. The scenarios are based on three epidemiological settings: high TB/HIV, high Hr-TB and high MDR/RR-TB. These examples are for illustrative purposes only - they do not represent a specific recommendation. There could be many alternative combinations that could achieve the same outcome; the choice to use one test instead of another would depend on factors such as availability, ease of use, in-country product support and costs.

Scenario 1: High TB/HIV setting

Scenario 2: High Hr-TB setting

Scenario 3: High MDR/RR-TB setting

DST: drug-susceptibility testing; INH: isoniazid; LF-LAM: lateral flow lipoarabinomannan assay; MC-aNAAT: moderate complexity automated NAAT; MTBC: Mycobacterium tuberculosis complex bacteria; NAAT: nucleic acid amplification test; RIF: rifampicin; SL-LPA: line-probe assay for second-line drugs; TB: tuberculosis. Model algorithm number shown in shaded circles.

Hr-TB: isoniazid-resistant, rifampicin-susceptible tuberculosis; INH: isoniazid; LC-aNAAT: low complexity automated NAAT; MC-aNAAT: moderate complexity automated NAAT; MTBC: Mycobacterium tuberculosis complex bacteria; NAAT: nucleic acid amplification test; TB: tuberculosis. Model algorithm number shown in shaded circles.

HC-rNAAT: high complexity reverse hybridization NAAT; LC-aNAAT: low complexity automated NAAT; LFX: levofloxacin; MC-aNAAT: moderate complexity automated NAAT; MTBC: Mycobacterium tuberculosis complex bacteria; NAAT: nucleic acid amplification test; PZA: pyrazinamide; RIF: rifampicin; SL-LPA: line-probe assay for second-line drugs; TB: tuberculosis. Model algorithm number shown in shaded circles.

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