The pooled IPD from longitudinal cohort studies showed a lower risk of death and a higher likelihood of cure and resolution of TB signs and symptoms in patients using ART compared with those not using ART (low-quality evidence). There is very low quality evidence for other outcomes that were considered critical or important for decision-making (for example, severe adverse effects from secondline drugs for DR-TB, occurrence of sputum smear or culture conversion, interactions of ART with antituberculosis drugs and default from treatment). Available data did not allow assessment for a number of other outcomes of interest, namely, avoiding the acquisition of additional drug resistance, preventing TB transmission, sustaining relapse-free cure, establishing the optimal duration of MDR-TB treatment, avoiding unnecessary MDR-TB treatment, reducing cost and improving population access to appropriate care.
6.3 Summary of findings
Book navigation
-
Consolidated Guidelines
-
Module 1: Prevention
- Module 1: TB preventive treatment
- Module 1: TB infection prevention and control
-
Module 2: Screening
- Acknowledgements
- Abbreviations and acronyms
- Definitions
- Executive summary
- 1. Introduction
-
2. Recommendations for systematic screening for TB disease in targeted populations
- 2.1 Systematic screening for TB disease among the general population
- 2.2 Systematic screening for TB disease among people with structural risk factors for TB
- 2.3 Systematic screening for TB disease among people living with HIV
- 2.4 Systematic screening for TB disease among household and other close contacts of individuals with TB disease
- 2.5 Systematic screening for TB disease in prisons and other penitentiary institutions
- 2.6 Systematic screening for TB disease among miners and others exposed to silica dust
- 2.7 Systematic screening for TB disease among people attending health care services who have clinical risk factors for TB
-
3. Recommendations for tools for systematic screening for TB disease
- 3.1 Tools for screening for TB disease among the general population and high-risk groups
- 3.2 Use of computer-aided detection software for automated reading of digital chest radiographs
-
3.3 Tools for screening for TB disease among people living with HIV
-
3.3.1 Summary of the evidence and rationale
- 3.3.1.1 WHO-recommended four-symptom screen
- 3.3.1.2 C-reactive protein
- 3.3.1.3 Chest radiography
- 3.3.1.4 Molecular WHO-recommended rapid diagnostic tests for medical inpatients living with HIV in settings with a high TB burden
- 3.3.1.5 Molecular WHO-recommended rapid diagnostic tests for all other people living with HIV
- 3.3.2 Implementation considerations for all tools for screening people living with HIV
-
3.3.1 Summary of the evidence and rationale
- 3.4 Tools for systematic screening for TB disease among children and adolescents
- 4. Monitoring and evaluation
- 5. Research gaps
- 6. References
- Supplementary Table
- Web annexes
-
Module 3: Diagnosis
-
Module 3: Rapid diagnostics for tuberculosis detection
- Acknowledgements
- Abbreviations and acronyms
- Definitions
- Executive summary
- 1.Introduction
- 2. Recommendations
-
Annexes
- Annex 1: Guideline development methods
- Annex 2: Conflict of interest assessment for Guideline Development Group and External Review Group members
- Web Annex 1. List of studies included in systematic reviews
- Web Annex 2. GRADE profiles
- Web Annex 3. Evidence-to-decision tables
- Web Annex 4. Evidence synthesis and analysis
-
Module 3: Tests for TB infection
- Acknowledgements
- Abbreviations and acronyms
- Executive summary
- 1. Use of Mycobacterium tuberculosis antigen-based skin tests for the diagnosis of TB infection
- 2. Use of the TST and IGRAs for the diagnosis of TB infection
- 3. Use of the TST and IGRAs for the diagnosis of TB disease
- References
- Annex 1. Summary of changes between the 2011–2020 guidance and the 2022 update
- Annex 2. GDG processes and decision-making
- Annex 3. Conflict of interest assessment for Guideline Development Group and External Review Group members
-
Web annexes
- Web Annex A. Accuracy of Mycobacterium tuberculosis antigen-based skin tests: a systematic review and meta-analysis
- Web Annex B. Safety of Mycobacterium tuberculosis antigen-based skin tests: a systematic review and meta-analysis
- Web Annex C. GRADE profiles of Mycobacterium tuberculosis antigen-based skin tests
- Web Annex D. Cost–effectiveness of Mycobacterium tuberculosis antigen-based skin tests: a systematic review
- Web Annex E. Modelling for economic evidence for the use of Mycobacterium tuberculosis antigen-based skin tests
- Web Annex F. Qualitative evidence for the use of Mycobacterium tuberculosis antigen-based skin tests
- Web Annex G. Mycobacterium tuberculosis antigen-based skin tests: evidence-to-decision table
- Web Annex H. Use of tuberculin skin test or interferon gamma release assays for identifying individuals at greatest risk of progression to active TB
- Web Annex I. Diagnostic accuracy of interferon gamma release assays for evaluation of patients with pulmonary TB
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Module 3: Rapid diagnostics for tuberculosis detection
-
Module 4: Treatment
-
Module 4: Drug-resistant tuberculosis treatment
- Acknowledgements
- Abbreviations and acronyms
- Definitions
- Executive summary
- Introduction
-
Recommendations
- Section 1. The 6-month bedaquiline, pretomanid, linezolid and moxifloxacin (BPaLM) regimen for MDR/RR-TB (NEW)
- Section 2. The 9-month all-oral regimen for MDR/RR-TB (NEW)
- Section 3. Longer regimens for multidrug- or rifampicin-resistant tuberculosis
- Section 4. The bedaquiline, pretomanid and linezolid (BPaL) regimen for multidrug-resistant tuberculosis with additional fluoroquinolone resistance
- Section 5. Monitoring patient response to MDR-TB treatment using culture
- Section 6. Starting antiretroviral therapy in patients on second-line antituberculosis regimens
- Section 7. Surgery for patients on MDR-TB treatment
- Section 8. Care and support for patients with MDR/RR-TB
-
Research gaps
- Section 1. Regimens for isoniazid-resistant TB
- Section 2. Shorter all-oral bedaquiline-containing regimen for MDR/RR-TB
- Section 3. Longer regimens for MDR /RR-TB
- Section 4. The BPaL regimen for MDR-TB with additional fluoroquinolone resistance
- Section 5. Monitoring patient response to MDR-TB treatment using culture
- Section 6: Starting antiretroviral therapy in patients on secondline antituberculosis regimens
- Section 7. Surgery for patients on MDR-TB treatment
- Section 8. Care and support for patients with MDR-TB
- References
- Supplementary Table
- Online annexes
-
Module 4: Drug-susceptible tuberculosis treatment
- Acknowledgements
- List of abbreviations
- Definitions
- Executive summary
- Introduction
- Objectives
- Methods used to update the guidelines
- Recommendations
- Research priorities
- References
- Annex. Summary of changes in policy on DS-TB treatment since 2010 and mapping of recommendations in consolidated DS-TB guidelines
- Web Annexes
- Module 4: Tuberculosis care and support
-
Module 4: Drug-resistant tuberculosis treatment
-
Module 5: Management of tuberculosis in children and adolescents
- Acknowledgements
- Abbreviations
- Definitions
- Executive summary
-
1. Introduction
- 1.1. Background
- 1.2. Rationale for the development of the 2022 consolidated guidelines
- 1.3. Objectives of the 2022 consolidated guidelines
- 1.4. Target audience
- 1.5. WHO recommendations relevant to the management of TB in children and adolescents
- 1.6. Scope of the guideline update
- 1.7. Publication, dissemination, evaluation and expiry
- 1.8. Document structure
- 2. TB screening and contact investigation
- 3. Prevention of TB
-
4. Diagnostic approaches for TB in children and adolescents
- 4.1. The use of the Xpert MTB/RIF Ultra assay in gastric aspirate and stool specimens for the diagnosis of pulmonary TB and rifampicin resistance
- 4.2. Treatment decision algorithms for the diagnosis of pulmonary TB in children aged below 10 years of age
- 4.3. Consolidated recommendations on TB diagnostics and diagnostic approaches relevant to children and adolescents
- 5. Treatment of TB disease in children and adolescents
- 6. Models of TB care for case detection and provision of TPT in children and adolescents
- 7. Special situations
- 8. Research priorities
- 9. References
- Annex 1. WHO recommendations incorporated in the guidelines on the management of TB in children and adolescents
- Annex 2. Supplementary table
-
Module 6: Management of tuberculosis and comorbidities
-
Module 6: Nutritional care and support for TB patients
- Acknowledgements
- Financial support
- Abbreviations
- Executive summary
- 1. Scope and purpose
- 2. Background
- 3. Guideline development process
- 4. Summary of the evidence
- 5. Key principles
- 6. Recommendations
- 7. Dissemination, adaptation and implementation
- 8. Plans for updating the guideline
- References
- Annex 1 GRADE summary of findings tables
- Annex 2 Summary of the Nutrition Guidance Advisory Group’s considerations for determining the strength of the recommendation
- Annex 3 Questions in population, intervention, control, outcomes (PICO) format
- Annex 4 WHO Steering Committee for Nutrition Guidelines Development 2010–2011
- Annex 5 Nutrition Guidance Advisory Group – nutrition in the life-course 2010–2011, WHO Secretariat and external resource experts
- Annex 6 External experts’ and stakeholders’ panel
-
Module 6: Joint WHO/ILO policy guidelines on improving health worker access to prevention, treatment and care services for HIV and TB
- Abbreviations, Acronyms and Selected Definitions
- Executive Summary
- 1. Introduction
-
2. Statements and Recommendations
- 2.1 Statement #1
-
2.2 Statement #2
- 2.2.1 Introduce new, or reinforce existing, policies that prevent discrimination against health workers with HIV or TB, and adopt interventions aimed at stigma reduction among colleagues and supervisors.
- 2.2.2 Key References and Supporting WHO Guidelines
- 2.2.3 Table 4: Recommendation for Statement 2
- 2.3 Statement #3
- 2.4 Statement #4
-
2.5 Statement #5
- 2.5.1 In conjunction with health workers’ representatives, develop and implement programmes for regular, free, voluntary, and confidential counselling and testing for HIV and TB, including addressing sexual and reproductive health issues, as well as intensified case finding in the families of health workers with TB.
- 2.5.2 Key References and Supporting WHO Guidelines
- 2.5.3 Table 7: Recommendation for Statement 5
-
2.6 Statement #6
- 2.6.1 Develop and implement training programmes for pre-service, in-service and continuing education on TB and HIV prevention, treatment and care services, integrating with existing programmes and including managers and worker representatives as well as health workers.
- 2.6.2 Key References and Supporting WHO Guidelines
- 2.6.3 Table 8: Recommendation for Statement 6
-
2.7 Statement #7
- 2.7.1 Disseminate policies in the form of guidelines and codes of practices for application at the level of health facilities, and ensure provision of budgets for the training and material inputs to make them operational.
- 2.7.2 Key References and Supporting WHO Guidelines
- 2.7.3 Table 9: Recommendation for Statement 7
- 2.8 Statement #8
- 2.9 Statement #9
-
2.10 Statement #10
- 2.10.1 Provide universal availability of free and timely PEP to all health care providers, for both occupational and non-occupational exposures, with appropriate training of counsellors and information on the benefits and risks provided to all staff.
- 2.10.2 Key References and Supporting WHO Guidelines
- 2.10.3 Table 14: Recommendation for Statement 10
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2.11 Statement #11
- 2.11.1 Provide free HIV and TB treatment for health workers in need, facilitating the delivery of these services in a non-stigmatizing, gendersensitive, confidential, and convenient setting even where there is no staff clinic, and/or the health worker’s own facility does not offer ART.
- 2.11.2 Key References and Supporting WHO Guidelines
- 2.11.3 Table 15: Recommendation for Statement 11
-
2.12 Statement #12
- 2.12.1 In the context of preventing co-morbidity, provide universal availability of a comprehensive package of prevention and care for all HIV positive health workers, including IPT and CTX prophylaxis, with appropriate information on the benefits and risks
- 2.12.2 Key References and Supporting WHO Guidelines
- 2.12.3 Table 16: Recommendation for Statement 12
-
2.13 Statement #13
- 2.13.1 Establish schemes for reasonable accommodation and compensation, including, as appropriate, paid leave, early retirement benefits and death benefits in the event of occupationally-acquired disease.
- 2.13.2 Key References and Supporting WHO Guidelines
- 2.13.3 Table 17: Recommendation for Statement 13
-
2.14 Statement #14
- 2.14.1 Develop and implement mechanisms for monitoring the availability of these TREAT policy guidelines at the national level, as well as the dissemination of these policies and their application in the healthcare setting.
- 2.14.2 Key References and Supporting ILO and WHO Guidelines
- 2.14.3 Table 18: Recommendation for Statement 14
- 3. Integrating framework and implementation plan
- References
- Annex 1: WHO and other international guidelines referenced
- Annex 2: Follow-up and implementation; an Extract from the Report: International consultation policy guidelines on improving health workers' access to prevention, treatment and care services for HIV and TB 14-16 September 2009, WHO/Geneva (pp 41-46)
-
Module 6: Nutritional care and support for TB patients
-
Module 1: Prevention
-
Operational Handbooks
-
Module 1: Prevention
-
Module 1: TB preventive treatment
- Acknowledgements
- Abbreviations & acronyms
- Definitions
- Chapter 2. Identification of populations for TB preventive treatment
- Chapter 3. Ruling out TB disease before TB preventive treatment
- Chapter 4. Testing for TB infection
- Chapter 5. TB preventive treatment
- Chapter 6. Safety, management of adverse reactions and other drug-related issues in TB preventive treatment
- Chapter 7. Adherence to TB preventive treatment
- Chapter 8. Monitoring and evaluation test
- Chapter 9. Ethics and TB preventive treatment
-
Annexes
- Annex 1. List of key messages
- Annex 2. Coordination mechanisms to support PMTPT
- Annex 3. Costing considerations for programmatic management of TB preventive treatment
- Annex 4. Planning checklist for PMTPT
- Annex 5. Answers to frequently asked questions on TST
- Annex 6. Answers to frequently asked questions on IGRAs
- References
-
Module 1: TB laboratory biosafety
- Executive summary
- Participants in the guideline development process
- Abbreviations
- Introduction
- 1. Risk assessment and the classification of tb laboratories
- 2. Essential biosafety measures for tb laboratories
- 3. Low-risk tb laboratories
- 4. Moderate-risk tb laboratories
- 5. High-risk tb laboratories (tb-containment laboratories)
- 6. Safety equipment
- 7. Personal protective equipment and clothing
- 8. Plans for emergency preparedness and response
- 9. References
- 10. Annex
-
Module 1: TB preventive treatment
-
Module 2: Screening
- Acknowledgements
- Abbreviations and acronyms
- Definitions
- Chapter 1. Introduction
-
Chapter 2. The six steps in the planning and implementation cycle
- 2.1 Introduction
- 2.2 Assessing the situation
- 2.3 Setting goals and specific objectives
-
2.4 Identifying and prioritizing risk groups
- 2.4.1 Potential benefits for the individual
- 2.4.2 Potential risks and harms for the individual
- 2.4.3 Potential impact on prevalence and transmission
- 2.4.4 Potential total yield of true TB cases
- 2.4.5 Number needed to screen to detect a person with TB
- 2.4.6 Cost–effectiveness and cost–benefit analyses
- 2.5 Choosing algorithms for screening and diagnosis
- 2.6 Planning, budgeting and implementing
- 2.7 Monitoring, evaluating and modifying the programme
- Chapter 3. Screening tools and algorithms
- Chapter 4. Implementation of CAD technologies in a new setting
- Chapter 5. Screening for tuberculosis disease among adults and adolescents living with HIV
- Chapter 6. Screening for tuberculosis disease in children
- References
-
Annex 1 Screening algorithms for the general population and high-risk groups (not including people living with HIV)
- A.1.1 – Screening with cough
- A.1.2 – Parallel screening with cough and CXR
- A.1.3 – Sequential positive serial screening with cough and CXR
- A.1.4 – Sequential negative serial screening with cough and CXR
- A.1.5 – Screening with any TB symptom
- A.1.6 – Parallel screening with any TB symptom and CXR
- A.1.7 – Sequential positive serial screening with any TB symptom and CXR
- A.1.8 – Sequential negative serial screening with any TB symptom and CXR
- A.1.9 – Screening with CXR
- A.1.10 – Screening with mWRD
- Annex 2 Comparative performance of algorithms for the general population and high-risk groups (not including people living with HIV)
-
Annex 3 Screening algorithms for adults and adolescents living with HIV
- A.3.2 – CRP single screening algorithm
- A.3.3 – CXR single screening algorithm
- A.3.4 – Parallel screening algorithm with W4SS and CRP
- A.3.5 – Sequential positive screening algorithm with W4SS and CRP
- A.3.6 – Sequential negative screening algorithm with W4SS and CRP
- A.3.7 – Parallel screening algorithm with W4SS and CXR
- A.3.8 – Sequential positive screening algorithm with W4SS and CXR
- A.3.9 – Sequential negative screening algorithm with W4SS and CXR
- A.3.10 – mWRD single screening algorithm for medical inpatients in settings with TB prevalence > 10%
- A.3.11 – mWRD single screening algorithm for people living with HIV
- Annex 4 Comparative performance of algorithms for adults and adolescents living with HIV
-
Annex 5 Screening algorithms for children
- A.5.1 – Screening with symptoms
- A.5.2 – Screening with CXR
- A.5.3 – Parallel screening with symptoms and CXR
- A.5.4 – Sequential positive serial screening with symptoms and CXR
- A.5.5 – Sequential negative serial screening with symptoms and CXR
- A.5.6 – Screening with symptoms (for children living with HIV < 10 years)
-
Module 3: Diagnosis
-
Module 3: Tests for tuberculosis infection
- Acknowledgements
- Abbreviations and acronyms
- 1. Introduction
- 2. Testing for TB infection and a model algorithm
- 3. WHO-recommended tests for TB infection
-
4. Programmatic considerations for implementing TB infection tests
- 4.1 General considerations: integrated and person-centred TB infection cascade of care
-
4.2 Steps for programmatic implementation of testing for TB infection
- 4.2.1 Area 1 – Policies, budgeting and planning
- 4.2.2 Area 2 – Regulatory approval and importation of products
- 4.2.3 Area 3 – Equipment and materials
- 4.2.4 Area 4 – Human resource sensitization, training and competency assessment
- 4.2.5 Area 5 – Supply chain
- 4.2.6 Area 6 – Procedures
- 4.2.8 Area 8 – QA, QC and quality assessment
- 4.2.9 Area 9 – Recording and reporting
- 4.2.10 Area 10 – Monitoring and evaluation
- References
- Annex 1. Skin tests for tuberculosis infection – detailed description
- Annex 2. Interferon-gamma release assays – detailed description
-
Module 3: Rapid diagnostics for tuberculosis detection
- Acknowledgements
- Abbreviations
- 1. Introduction
-
2. Diagnostic tests with WHO recommendations
- 2.1 Conventional diagnostic tests for the diagnosis of TB
- 2.2 Initial tests for diagnosis of TB with drug-resistance detection
- 2.3 Initial tests for diagnosis of TB without drug-resistance detection
- 2.4 Follow-on diagnostic tests for detection of additional drug resistance
- 2.5 Tests WHO recommends against using
- 2.6 Phenotypic and genotypic DST
- 3. Implementing a new diagnostic test
-
4. Model algorithms
- 4.1 Algorithm 1 – mWRD as the initial diagnostic test for TB
- 4.2 Algorithm 2 – LF-LAM testing to aid in the diagnosis of TB among PLHIV
- 4.3 Algorithm 3 – DST for second-line drugs for RR-TB or MDR-TB patients
- 4.4 Algorithm 4 – mWRD as the initial or follow-on test to detect Hr-TB
- 4.5 Illustrative algorithm combinations
- 5. Suggested reading
- 6.References
- Annex 1: Budgetary considerations for implementing a new diagnostic test
-
Annex 2: Information sheets on the newly recommended products
- A2.1 Information sheet: Practical considerations for implementation of the Abbott RealTime MTB and Abbott RealTime MTB RIF/INH tests
- A2.2 Information sheet: Practical considerations for implementation of the BD MAX MDR-TB test
- A2.3 Information sheet: Practical considerations for implementation of the Roche cobas MTB and cobas MTB-RIF/INH assays
- A2.4 Information sheet: Practical considerations for implementation of the Bruker-Hain Lifesciences FluoroType MTB and FluoroType MTBDR
- A2.5 Information sheet: Practical considerations for implementation of the Cepheid Xpert MTB/XDR test
- A2.6 Information sheet: Practical considerations for implementation of the Nipro Genoscholar PZA-TB II assay
-
Module 3: Tests for tuberculosis infection
-
Module 4: Treatment
-
Module 4: Drug-resistant tuberculosis treatment
- Acknowledgements
- Abbreviations and acronyms
- 1. Introduction
- 2. Commonly used terms and key definitions in drug-resistant TB treatment
- 3. Key considerations in drugresistant TB treatment
- 4. Regimen for rifampicin-susceptible and isoniazid-resistant TB
- 5. The shorter all-oral bedaquiline-containing regimen for MDR/RR-TB
-
6. Longer regimens for MDR/RR-TB
- 6.1 Eligibility
- 6.2 Medicines used in longer MDR-TB treatment regimens
- 6.3 Composition of the longer MDR-TB regimens
- 6.4 Prolonged use of bedaquiline and concurrent use of bedaquiline and delamanid
- 6.5 Dosage of the longer MDR-TB regimen components
- 6.6 Duration of the longer MDR-TB regimens
- 6.7 Key subgroups
- 6.8 Treatment monitoring
- 7. The bedaquiline, pretomanid and linezolid (BPaL) regimen for MDR-TB with additional fluoroquinolone resistance
- 8. Adjuncts to MDR-TB treatment
- 9. Patient support to enable adherence to treatment
- 10. Programmatic implementation of MDR-TB regimens
- References
- Annex I: Dosage by weight band for medicines used in multidrug-resistant TB regimens, adults and children
-
Module 4: Drug-susceptible tuberculosis treatment
- Acknowledgements
- Abbreviations and acronyms
- Definitions
- Executive summary
- Key WHO recommendations on DS-TB
- 1. Introduction
- 2. Key considerations in DS-TB treatment
- 3. Treatment of DS-TB using the 6-month regimen
- 4. Treatment of DS-TB using the 4-month 2HPMZ/2HPM regimen
- 5. Treatment of DS-TB using the 4-month 2HRZ(E)/2HR regimen
- 6. Treatment of DS-TB in PLHIV
- 7. Treatment of extrapulmonary TB
- 8. Treatment of DS-TB in special situations
- 9. Monitoring treatment response
- 10. Outcome definitions
- Annex. Dosages of anti-TB medicines by weight band for treatment of DS-TB
- References
- Web annexes
-
Module 4: Tuberculosis care and support
- Acknowledgements
- Abbreviations
- Definitions
- 1. Introduction
- 2. People-centred approach
- 3. Care and support interventions to enable TB treatment adherence
-
4. Health education and counselling for people affected with tuberculosis
- 4.1. Guiding principles for health education and counselling
- 4.2. Effective communication skills to provide health education and counselling
- 4.3. Counselling to provide information about TB and the responsibilities of affected individuals and communities
- 4.4. Counselling to provide information about TB treatment and to ensure adherence to treatment
- 4.5. Counselling to provide psychological support
- 4.6. Counselling on nutritional care and support
- 4.7. Counselling at the end of TB treatment and on palliative care
- 5. Models of care for TB services
-
6. Palliative care
- 6.1 What is palliative care?
-
6.2. Planning and implementing palliative care for people affected by TB
- 6.2.1 Integration of palliative care into national tuberculosis programmes
- 6.2.2 Essential package of palliative care for people affected by TB
- 6.2.3 Oxygen for relief of mild dyspnoea
- 6.2.4 Morphine for safe relief of chronic or refractory dyspnoea
- 6.2.5 Palliative care teamwork
- 6.2.6 Management of substance use disorders and other comorbidities
- 6.2.7 Monitoring and evaluation of palliative care for people affected by TB
- 6.2.8 Cost savings from palliative care integration into TB programmes
- 6.3. End-of-life care for people with TB
- References
-
Module 4: Drug-resistant tuberculosis treatment
-
Module 5: Management of tuberculosis in children and adolescents
- Acknowledgments
- Abbreviations
- Definitions
- 1. Introduction
- 2. TB screening and contact investigation
-
3. Prevention of TB in children and adolescents
- 3.1 Introduction
- 3.2 BCG vaccination
-
3.3 TB preventive treatment
- 3.3.1. Introduction
- 3.3.2. Target groups for TB preventive treatment
-
3.3.3. Ruling out TB disease before starting TB preventive treatment
- 3.3.3.1. HIV-negative household and close contacts of a person with pulmonary TB: infants and children aged under 5 years
- 3.3.3.2. HIV-negative household and close contacts of a person with pulmonary TB: children and adolescents aged 5 years and over
- 3.3.3.3. Children and adolescents living with HIV
- 3.3.4. Testing for TB infection
- 3.3.5. Options for TB preventive treatment regimens: drug-susceptible TB
- 3.3.6. Options for TB preventive treatment regimens: drug-resistant TB
- 3.3.7. Follow-up of children and adolescents on TB preventive treatment
- 3.3.8. Adherence to TB preventive treatment
- 3.3.9. Other issues related to TB preventive treatment in children and adolescents
- 3.4 TB infection prevention and control
- Key messages
-
4. TB diagnostic approaches for children and adolescents
- 4.1 Introduction
- 4.2 Diagnosing TB in children and adolescents
-
4.3 Diagnostic approaches: pulmonary TB
- 4.3.1. Typical symptoms of pulmonary TB
- 4.3.2. History of TB contact
- 4.3.3. Clinical examination
- 4.3.4. Atypical clinical presentations of children with pulmonary TB
- 4.3.5. Bacteriological confirmation
- 4.3.6. Testing for TB infection
- 4.3.7. Role of chest X-ray
- 4.3.8. HIV testing
- 4.3.9. Integrated treatment decision algorithms for pulmonary TB in children
- 4.4 Diagnostic approaches: extrapulmonary TB
- 4.5 Disease severity
- 4.6 Diagnostic approaches: drug-resistant TB
- Key messages
-
5. Treatment of drug-susceptible and drug-resistant pulmonary and extrapulmonary TB in children and adolescents
- 5.1 Introduction
-
5.2 Treatment of drug-susceptible TB in children and adolescents
- 5.2.1. Principles of TB management
- 5.2.2. Treatment of pulmonary TB in children and adolescents
- 5.2.3. Recommended regimens for treatment of drugsusceptible pulmonary TB in children
- 5.2.4. Implementation considerations
-
5.2.5. Subgroup considerations
- 5.2.5.1. Children with peripheral lymph node TB
- 5.2.5.2. Children and adolescents living with HIV
- 5.2.5.3. Children with severe acute malnutrition
- 5.2.5.4. Children with severe acute pneumonia
- 5.2.5.5. Infants aged under 3 months or weighing less than 3 kg
- 5.2.5.6. Children and adolescents treated for TB in past 2 years
- 5.2.5.7. Children and young adolescents with severe pulmonary TB
- 5.2.6. Treatment of drug-susceptible extrapulmonary TB in children and adolescents
-
5.2.7. Recommended dosing of first-line medicines in children
- 5.2.7.1. Recommended dosages for first-line TB medicines
- 5.2.7.2. Dosage tables and formulations for treatment of drug-susceptible TB in children and adolescents
- 5.2.7.3. Dosing table for the short intensive TB meningitis regimen
- 5.2.7.4. Dosing of first-line medicines in older children and adolescents over 25 kg (excluding the short intensive TB meningitis regimen)
- 5.2.7.5. Pyridoxine supplementation
- 5.2.8. Additional management considerations
- 5.2.9. Nutritional support
- 5.2.10. Management of adverse events from medicines used to treat drug-susceptible TB
- 5.2.11. Treatment adherence
- 5.2.12. Follow-up and monitoring of children and adolescents on TB treatment
- Key messages: treatment of DS-TB
-
5.3 Treatment of multidrug-resistant and rifampicin-resistant TB in children and adolescents
- 5.3.1. Identifying children who should be treated for multidrug-resistant and rifampicin-resistant TB
-
5.3.2. Multidrug-resistant and rifampicin-resistant TB treatment regimens for children and adolescents
- 5.3.2.1. Overview and approach to selecting a treatment regimen
- 5.3.2.2. Shorter all-oral bedaquiline-containing regimen for multidrug-resistant and rifampicin-resistant TB in children
- 5.3.2.3. Longer individualized regimens for children with multidrug-resistant and rifampicin-resistant TB who are not eligible for the standardized all-oral bedaquiline-containing regimen
- 5.3.2.4. Practical approach to designing individualized multidrug-resistant and rifampicin-resistant TB treatment regimens
- 5.3.2.5. Special considerations: TB meningitis
- 5.3.2.6. Special considerations: TB/HIV coinfection
- 5.3.3. Dosing and formulations of second-line TB medicines in children and young adolescents
- 5.3.4. Monitoring of children and adolescents on multidrugresistant and rifampicin-resistant TB treatment
- Key messages: treatment of DR-TB
- 5.4 Practical guidance for assessment and management of post-TB health in children and adolescents
-
6. Models of TB care for children and adolescents
- 6.1 Introduction
-
6.2 Decentralized, family-centred, integrated TB services
-
6.2.1. Implementation considerations
- 6.2.1.1. Stakeholder engagement
- 6.2.1.2. Regulatory framework and policy guidance
- 6.2.1.3. Health workforce
- 6.2.1.4. Treatment support
- 6.2.1.5. Recording and reporting
- 6.2.1.6. Access to diagnostic supplies and child-friendly formulations of TB medicines
- 6.2.1.7. Resource requirements
- 6.2.1.8. Opportunities for integration of TB services into other services
- 6.2.1.9. Socioeconomic impact of TB on children, adolescents and families
- 6.2.1.10. Examples of country experiences in development of family-centred, decentralized and integrated TB services for children and adolescents
-
6.2.1. Implementation considerations
- 6.3 Private-sector involvement in care for children and adolescents with TB
- 6.4 Differentiated TB service delivery
- 6.5 TB and health emergencies
- Key messages
-
7. Special situations
-
7.1 Management of TB in children and adolescents living with HIV
- 7.1.1. Introduction
- 7.1.2. TB screening in children and adolescents living with HIV
- 7.1.3. Prevention of TB in children and adolescents living with HIV
- 7.1.4. Diagnosis of TB in children and adolescents living with HIV
- 7.1.5. Treatment of TB in children and adolescents living with HIV
- 7.1.6. Co-trimoxazole preventive therapy
- 7.1.7. Antiretroviral therapy
- 7.1.8. Immune reconstitution inflammatory syndrome
- 7.2 TB in pregnancy and management of newborns of mothers with TB disease
- 7.3 Palliative care for children and adolescents with TB
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7.4 Care for adolescents with or at risk of TB
- 7.4.1. Physical and mental health
- 7.4.2. Connectedness and positive contribution to society
- 7.4.3. Safety and a supportive environment
- 7.4.4. Learning, competence, education, skills and employability
- 7.4.5. Agency and resilience
- 7.4.6. Substance abuse and late presentation to care
- 7.4.7. Poor adherence
- 7.4.8. Making TB services more adolescent-friendly
- 7.5 TB in children with severe acute pneumonia
- 7.6 Management of children with TB and malnutrition
- Key messages
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7.1 Management of TB in children and adolescents living with HIV
- 8. References
- Annex 1. Selected resources on child and adolescent TB
- Annex 2. Tuberculin skin testing: administration, reading and interpretation
- Annex 3. Sample collection methods
- Annex 4. Standard operating procedures for sample collection methods
- Annex 5. Treatment decision algorithms
- Annex 6. Dosing of medicines used in second-line multidrug-resistant TB regimens by weight band (below 46 kg)
- Annex 7. Overview of options for neurocognitive and functional testing at end of treatment for TB meningitis
- Module 6: Management of tuberculosis and comorbidities
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Module 1: Prevention
- Training Catalogue