low

Health care facility level: The panel recommends that IPC activities using multimodal strategies should be
implemented to improve practices and reduce HAIs and AMR.

ART should be started in any child with active TB disease as soon as possible and within 8
weeks following the initiation of antituberculosis treatment regardless of the CD4 cell count
and clinical stage.

• Ventilation (i.e. natural and/or mechanical).
• Upper-room ultraviolet germicidal irradiation.

• Protective equipment (particulate respirator masks that meet or exceed N95 standards
set by the CDC/NIOSH or the FFP2 standards that are CE certified) should be provided
for health workers caring for patients with infectious TB (suspected or confirmed).

• A triage system should be in place to identify people suspected of having TB and minimize
diagnostic delays with rapid diagnostics e.g. Xpert MTB/RIF.
• Separate people with suspected or confirmed TB
• Ensure cough etiquette and respiratory hygiene
• Minimize the time spent in health-care facilities (e.g. through community-based approaches).

All children living with HIV, after successful completion of treatment for TB, should receive IPT for an additional 6 months.

In children living with HIV who are less than 12 months of age, only those who have contact
with a TB case and who are evaluated for TB (using investigations) should receive 6 months of
IPT if the evaluation shows no TB disease.

Children living with HIV who do not have poor weight gain, fever or current cough are unlikely
to have active TB. Children living with HIV who have poor weight gain, fever or current cough
or contact history with a TB case may have TB and should be evaluated for TB and other
conditions. If the evaluation shows no TB, they should be offered IPT preventive therapy
regardless of their age.

LF-LAM should not be used as a screening test for active TB.

LF-LAM may be used to assist in the diagnosis of active TB in adult inpatients living with
HIV, with signs and symptoms of TB (pulmonary and/or extrapulmonary), who have a CD4
cell count less than or equal to 100 cells/mm3
or people living with HIV who are seriously
ill regardless of CD4 count or with unknown CD4 count.