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5.2 Tools for screening for TB
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Consolidated Guidelines
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Module 1: Prevention
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Module 1: TB Preventive Treatment
- Acknowledgements
- Abbreviations and acronyms
- Definitions
- Executive summary
- Introduction
- 1. Recommendations
- 2. Monitoring and evaluation
- 3. Research gaps
- 4. References
- Annex 1. Recommendations in the WHO consolidated guidelines on tuberculosis: tuberculosis preventive treatment, second edition (2024) and in the previous edition (2020)
- Annex 2. Methods and expert panels
- Annex 3. GRADE summary of evidence tables
- Annex 4. GRADE evidence-to-decision tables
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Annex 5. Summary of unpublished studies (PICO 10)
- A5.1 Summary of TB CHAMP and V-QUIN clinical trials
- A5.2 Use of fluoroquinolones for TB preventive treatment in contacts of persons with MDR-/RR-TB: A systematic review
- A5.3 Assessing fluoroquinolone (levofloxacin) acceptability among contacts of MDR-TB patients: a qualitative study10
- A5.4 A survey to explore the programmatic feasibility of levofloxacin (Lfx) TPT for MDR-TB contacts11
- Module 1: TB infection prevention and control
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Module 1: TB Preventive Treatment
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Module 2: Screening
- Acknowledgements
- Abbreviations and acronyms
- Definitions
- Executive summary
- 1. Introduction
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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
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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
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3.3 Tools for screening for TB disease among people living with HIV
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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
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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
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Module 3: Diagnosis
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Module 3: Rapid diagnostics for tuberculosis detection
- Acknowledgements
- Abbreviations and acronyms
- Definitions
- Executive summary
- 1. Introduction
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2. Recommendations
- 2.1 Initial diagnostic tests for diagnosis of TB with drug-resistance detection
- 2.2. Initial diagnostic tests for diagnosis of TB without drug-resistance detection
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2.3 Follow-on diagnostic tests for detection of additional drug-resistance after TB confirmation
- Low complexity automated NAATs for detection of resistance to isoniazid and second-line anti-TB agents
- First-line LPAs
- Performance of SL-LPA on sputum specimens and culture isolates
- High complexity reverse hybridization-based NAATs for detection of pyrazinamide resistance
- Targeted next-generation sequencing
- Research gaps
- References
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Annexes
- Annex 1: Guideline development methods
- Annex 2: Conflict of interest assessment for Guideline Development Group and External Review Group members
- Annex 3: Guideline development group members
- Web Annex A. List of studies included in systematic review
- Web Annex B. GRADE profiles
- Web Annex C. Evidence to decision tables
- Web Annex D. Evidence synthesis and analysis
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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
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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
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Module 4: Treatment
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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
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Module 4: Drug-resistant tuberculosis treatment
- Abbreviations and acronyms
- Acknowledgements
- Definitions
- Executive summary
- Introduction
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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 MDR/RR-TB
- Section 4. Regimen for rifampicin-susceptible, isoniazid-resistant TB (Hr-TB)
- Section 5. Monitoring patient response to MDR/RR-TB treatment using culture
- Section 6. Starting antiretroviral therapy in patients on MDR/RR-TB regimens
- Section 7. Surgery for patients on MDR/RR-TB treatment
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Research gaps
- Section 1. The 6-month BPaLM regimen for treatment of MDR/RR-TB or pre-XDR-TB
- Section 2. The 9-month all-oral regimen for MDR/RR-TB
- Section 3. Longer regimens for MDR/RR-TB
- Section 4. Regimens for rifampicin-susceptible, isoniazid-resistant TB (Hr-TB)
- Section 5. Monitoring patient response to MDR/RR-TB treatment using culture
- Section 6. Starting antiretroviral therapy in patients on MDR/RR-TB regimens
- Section 7. Surgery for patients on MDR/RR-TB treatment
- References
- Annex 1. Supplementary table
- Annex 2. Trial population in ZeNix and TB-PRACTECAL trials
- Web Annexes
- Module 4: Tuberculosis care and support
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Module 4: Drug-susceptible tuberculosis treatment
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Module 5: Children and adolescents
- Acknowledgements
- Abbreviations
- Definitions
- Executive summary
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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
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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
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Module 6: Comorbidities
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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
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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
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2. Statements and Recommendations
- 2.1 Statement #1
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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
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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
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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
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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
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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
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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
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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
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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)
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Module 6: Nutritional care and support for TB patients
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Module 1: Prevention
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Manuais Operacionais
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Module 1: Prevention
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Module 1: TB preventive treatment
- Acknowledgements
- Abbreviations and acronyms
- Definitions
- 1. Introduction
- 2. Identifying populations for TB preventive treatment
- 3. Screening for TB and ruling out TB disease before TB preventive treatment
- 4. Testing for TB infection
- 5. TB preventive treatment
- 6. Safety and management of adverse drug reactions in TB preventive treatment
- 7. Supporting people in adhering to and completing TB preventive treatment
- 8. Monitoring and evaluation
- 9. Ethics and TB preventive treatment
- References
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Annexes
- Annex 1. Investment case for TB screening and preventive treatment
- Annex 2. Messages for different stakeholders
- Annex 3. Coordination mechanisms to support PMTPT
- Annex 4. Costing considerations for PMTPT
- Annex 5. Checklist for PMTPT components in reviews of national programmes
- Annex 6. Variables to be collected for TB contact evaluation
- Web annexes
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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
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Module 1: Infection prevention and control
- Acknowledgements
- Abbreviations and acronyms
- Definitions
- 1. Introduction
- 2. Administrative controls
- 3. Environmental controls
- 4. Respiratory protection
- 5. TB IPC in special situations
- 6. Monitoring and evaluation
- References
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Annexes
- Annex 1. Data elements for monitoring implementation of tuberculosis infection prevention and control
- Annex 2. Facility tuberculosis risk assessment tool
- Annex 3. Example of an outline of facility tuberculosis infection prevention and control plan
- Annex 4. Health care worker tuberculosis screening form
- Annex 5. Health care worker TB screening register
- Annex 6. Sample posters for health education
- Annex 7. How to choose upper-room germicidal ultraviolet light fixtures
- Annex 8. Choosing a radiometer for measurement of ultraviolet C irradiation
- Annex 9. Checklist for the review of programmatic implementation of tuberculosis infection prevention and control
- Annex 10. Country example: education messages for tuberculosis and for tuberculosis infection prevention and control
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Module 1: TB preventive treatment
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Módulo 2: Rastreamento Rastreamento sistemático da tuberculose doença
- Agradecimentos
- Siglas e Abreviaturas
- Definições
- Capítulo 1. Introdução
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Capítulo 2. As seis etapas do ciclo de planejamento e implementação
- 2.1 Introdução
- 2.2 Avaliação da situação
- 2.3 Definição de metas e objetivos específicos
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2.4 Identificação e priorização de grupos de risco
- 2.4.1 Potenciais benefícios para indivíduos
- 2.4.2 Potenciais riscos e malefícios para indivíduos
- 2.4.3 Potencial impacto sobre a prevalência e a transmissão
- 2.4.4 Potencial rendimento total de casos verdadeiros de TB
- 2.4.5 Número necessário para rastrear para detectar uma pessoa com TB
- 2.4.6 Análises de custo-efetividade e custo-benefício
- 2.5 Seleção de algoritmos de rastreamento e diagnóstico
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2.6 Planejamento, orçamentação e implementação
- 2.6.1 Requisitos para planejamento, recursos humanos, produtos básicos e orçamento
- 2.6.2 Seleção de um modelo de programa de rastreamento
- 2.6.3 Considerações éticas
- 2.6.4 Envolvimento das partes interessadas e organizações parceiras e definição de funções
- 2.6.5 Mobilização de recursos
- 2.6.6 Teste-piloto
- 2.7 Monitoramento, avaliação e modificação do programa
- Capítulo 3. Ferramentas e algoritmos de rastreamento
- Capítulo 4. Implementação de tecnologias CAD em um novo contexto
- Capítulo 5. Rastreamento da tuberculose doença em adultos e adolescentes vivendo com HIV/aids
- Capítulo 6. Rastreamento da tuberculose doença em crianças
- Referências
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Anexo 1 Algoritmos de rastreamento para a população em geral e grupos de alto risco (excluindo pessoas vivendo com HIV/aids)
- A.1.1 ‒ Rastreamento com tosse
- A.1.2 ‒ Rastreamento paralelo com tosse e radiografia de tórax
- A.1.3 ‒ Rastreamento seriado positivo sequencial com tosse e radiografia de tórax
- A.1.4 ‒ Rastreamento seriado negativo sequencial com tosse e radiografia de tórax
- A.1.5 ‒ Rastreamento com qualquer sintoma de TB
- A.1.6 ‒ Rastreamento paralelo com qualquer sintoma de TB e radiografia de tórax
- A.1.7 ‒ Rastreamento seriado positivo sequencial com qualquer sintoma de TB e radiografia de tórax
- A.1.8 ‒ Rastreamento seriado negativo sequencial com qualquer sintoma de TB e radiografia de tórax
- A.1.9 ‒ Rastreamento com radiografia de tórax
- A.1.10 ‒ Rastreamento com TDRm
- Anexo 2 Comparação de desempenho dos algoritmos de rastreamento para a população em geral e grupos de alto risco (excluindo pessoas vivendo com HIV/aids)
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Anexo 3 Algoritmos de rastreamento para adultos e adolescentes vivendo com HIV/aids
- A.3.1 ‒ Algoritmo de rastreamento único com investigação de quatro sintomas
- A.3.2 ‒ Algoritmo de rastreamento único com PCR
- A.3.3 ‒ Algoritmo de rastreamento único com radiografia de tórax
- A.3.4 ‒ Algoritmo de rastreamento paralelo com investigação de quatro sintomas e PCR
- A.3.5 ‒ Algoritmo de rastreamento positivo sequencial com investigação de quatro sintomas e PCR
- A.3.6 ‒ Algoritmo de rastreamento negativo sequencial com investigação de quatro sintomas e PCR
- A.3.7 ‒ Algoritmo de rastreamento paralelo com investigação de quatro sintomas e radiografia de tórax
- A.3.8 ‒ Algoritmo de rastreamento positivo sequencial com investigação de quatro sintomas e radiografia de tórax
- A.3.9 ‒ Algoritmo de rastreamento negativo sequencial com investigação de quatro sintomas e radiografia de tórax
- A.3.10 ‒ Algoritmo de rastreamento único com TDRm para pacientes clínicos internados em ambientes com prevalência de TB > 10%
- A.3.11 ‒ Algoritmo de rastreamento único com TDRm para pessoas vivendo com HIV/aids
- Anexo 4 Comparação de desempenho dos algoritmos de rastreamento em adultos e adolescentes vivendo com HIV /aids
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Anexo 5 Algoritmos de rastreamento para crianças
- A.5.1 ‒ Rastreamento com sintomas
- A.5.2 ‒ Rastreamento com radiografia de tórax
- A.5.3 ‒ Rastreamento paralelo com sintomas e radiografia de tórax
- A.5.4 ‒ Rastreamento seriado positivo sequencial com sintomas e radiografia de tórax
- A.5.5 ‒ Rastreamento seriado negativo sequencial com sintomas e radiografia de tórax
- A.5.6 ‒ Rastreamento com sintomas (para crianças menores de 10 anos vivendo com HIV/aids)
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Module 3: Diagnosis
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Module 3: Rapid diagnostics for tuberculosis detection
- Acknowledgements
- Abbreviations and acronyms
- 1. Introduction
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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
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3. Implementing a new diagnostic test
- 3.1 Placement of diagnostic tests in the tiered laboratory network
- 3.2 Pretest probability and test accuracy considerations
- 3.3 Epidemiologic considerations
- 3.4 Multi-disease platform considerations
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3.5 Steps and processes for implementing a new diagnostic test
- 3.5.1 Area 1 – Policies, budgeting and planning
- 3.5.2 Area 2 – Regulatory issues
- 3.5.3 Area 3 – Equipment
- 3.5.4 Area 4 – Supply chain
- 3.5.5 Area 5 – Procedures
- 3.5.6 Area 6 – Digital data
- 3.5.7 Area 7 – Quality assurance, control and assessment
- 3.5.8 Area 8 – Recording and reporting
- 3.5.9 Area 9 – Human resource training and competency assessment
- 3.5.10 Area 10 – Monitoring and evaluation
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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 people with RR-TB or MDR-TB
- 4.4 Algorithm 4 – mWRD as the initial or follow-on test to detect Hr-TB
- 4.5 Illustrative algorithm combinations
- 6.References
- Annex 1. Budgetary considerations for implementing a new diagnostic test
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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
- Annex 3. Implementation of next-generation sequencing technologies
- Annex 4. Conflict of interest assessment
- Annex 5. Additional resources
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Módulo 3: Diagnóstico Testes para detecção de tuberculose infecção
- Agradecimentos
- Siglas e Abreviaturas
- 1. Introdução
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2. Testes para detecção de TB infecção e modelo de algoritmo
- 2.1 Quem deve fazer o teste para detecção de TB infecção?
- 2.2 Risco de doença em pessoas com resultado positivo no teste para detecção de TB infecção
- 2.3 Quais são as vantagens e desvantagens da testagem para detecção de TB infecção?
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2.4 Quando a testagem para detecção de TB infecção não é recomendada?
- 2.4.1 Testes anteriores positivos para TB infecção
- 2.4.2 Vacinas ou doenças virais concomitantes ou recentes
- 2.4.3 Investigação clínica de adultos para diagnosticar a TB doença ou monitorar a resposta ao tratamento
- 2.4.4 História de reações alérgicas à PT ou TBST (mas o IGRA pode ser usado)
- 2.4.5 Challenges with blood collection in young children when using IGRAs (but TBST may be used)
- 2.5 Algoritmo de modelo integrado e centrado na pessoa
- 3. Testes para detecção de TB infecção recomendados pela OMS
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4. Considerações programáticas para a implementação de testes para detecção de TB infecção
- 4.1 Considerações gerais: cascata de cuidados integrados e centrados na pessoa da TB infecção
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4.2 Etapas para a implementação programática de testagem para detecção de TB infecção
- 4.2.1 Área 1: Políticas, orçamento e planejamento
- 4.2.2 Área 2: Aprovação regulatória e importação de produtos
- 4.2.3 Área 3: Equipamento e materiais
- 4.2.4 Área 4: Sensibilização, capacitação e avaliação de competências de recursos humanos
- 4.2.5 Área 5: Cadeia de abastecimento
- 4.2.6 Área 6: Procedimentos
- 4.2.7 Área 7: Dados digitais
- 4.2.8 Área 8: GQ, CQ e avaliação da qualidade
- 4.2.9 Área 9: Registro e comunicação
- 4.2.10 Área 10: Monitoramento e avaliação
- Referências
- Anexo 1. Testes cutâneos para detecção de TB infecção - descrição detalhada
- Anexo 2. Ensaios de liberação de interferon-gama - descrição detalhada
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Module 3: Rapid diagnostics for tuberculosis detection
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Módulo 4: Tratamento
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Módulo 4: Tratamento Tratamento da tuberculose sensível
- Agradecimentos
- Siglas
- Definições
- Resumo executivo
- Principais recomendações da OMS sobre a TB-S
- 1. Introdução
- 2. Considerações essenciais no tratamento da TB-S
- 3. Tratamento da TB-S com o esquema de 6 meses
- 4. Tratamento da TB-S com o esquema de 4 meses 2HPMZ/2HåPM
- 5. Tratamento da TB-S com o esquema de 4 meses 2RHZ(E)/2RH
- 6. Tratamento da TB-S em pessoas vivendo com HIV/aids
- 7. Tratamento da TB extrapulmonar
- 8. Tratamento da TB-S em situações especiais
- 9. Monitoramento da resposta ao tratamento
- 10. Definição dos desfechos
- Referências
- Anexo. Posologia dos medicamentos, por faixa de peso, para tratamento da TB-S
- Anexos on-line
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Module 4: Drug-resistant tuberculosis treatment, 2022 update
- Abbreviations
- Acknowledgements
- 1. Introduction
- 2. Commonly used terms and key definitions in DR-TB treatment
- 3. Key considerations in DR-TB treatment
- 4. The 6-month bedaquiline, pretomanid, linezolid and moxifloxacin (BPaLM) regimen
- 5. The 9-month all-oral regimen
- 6. The longer regimens
- 7. Regimen for rifampicin susceptible and isoniazid resistant TB
- 8. Adjuncts to MDR-TB treatment
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9. Programmatic implementation of MDR-TB regimens
- 9.1 Policy and operational documents
- 9.2 National MDR-TB expert committee or technical working group
- 9.3 Electronic recording and reporting
- 9.4 Estimates (epidemiological and logistics)
- 9.5 Management of the supply chain and storage conditions for pharmaceuticals
- 9.6 Preparation for the introduction of new treatment regimens
- 10. Treatment outcome definitions
- References
- Annex
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Módulo 4: Tratamento Atenção e apoio ao tratamento da tuberculose
- Agradecimentos
- Siglas
- Definições
- 1. Introdução
- 2. Abordagem centrada nas pessoas
- 3. Intervenções de atenção e suporte para facilitar a adesão ao tratamento da TB
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4. Educação em saúde e aconselhamento para pessoas afetadas pela tuberculose
- 4.1 Princípios orientadores para educação em saúde e aconselhamento
- 4.2 Habilidades de comunicação efetiva para oferecer educação em saúde e aconselhamento
- 4.3 Aconselhamento para fornecer informações sobre TB e as responsabilidades das pessoas e comunidades afetadas
- 4.4 Aconselhamento para fornecer informações sobre o tratamento da TB e assegurar a adesão ao tratamento
- 4.5 Aconselhamento para fornecer apoio psicológico
- 4.6 Aconselhamento sobre atenção e suporte nutricional
- 4.7 Aconselhamento no final do tratamento da TB e sobre cuidados paliativos
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5 Modelos de atenção para todos os pacientes com TB
- 5.1 Modelos de atenção para todos os pacientes com TB
- 5.2 Modelos de atenção descentralizada, integrada e centrada na família à TB para crianças e adolescentes
- 5.3 Modelos de prestação de serviços para pessoas com TB, HIV e comorbidades
- 5.4 Envolvimento do setor privado no tratamento da TB
- 5.5 TB e emergências de saúde
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6. Cuidados paliativos
- 6.1 O que são cuidados paliativos?
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6.2 Planejamento e implementação de cuidados paliativos para pessoas afetadas pela TB
- 6.2.1 Integração dos cuidados paliativos aos programas nacionais de tuberculose
- 6.2.2 Pacote essencial de cuidados paliativos para pessoas afetadas pela TB
- 6.2.3 Oxigênio para alívio de dispneia leve
- 6.2.4 Morfina para alívio seguro de dispneia crônica ou refratária
- 6.2.5 Trabalho em equipe para a prestação de cuidados paliativos
- 6.2.6 Manejo de transtornos por uso de substâncias psicoativas e outras comorbidades
- 6.2.7 Monitoramento e avaliação dos cuidados paliativos para pessoas afetadas pela TB
- 6.2.8 Economia de custos com a integração dos cuidados paliativos aos programas de TB
- 6.3 Cuidados de fim de vida para pessoas com TB
- Referências
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Módulo 4: Tratamento Tratamento da tuberculose sensível
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Module 5: Children and adolescents
- Acknowledgments
- Abbreviations
- Definitions
- 1. Introduction
- 2. TB screening and contact investigation
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3. Prevention of TB in children and adolescents
- 3.1 Introduction
- 3.2 BCG vaccination
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3.3 TB preventive treatment
- 3.3.1. Introduction
- 3.3.2. Target groups for TB preventive treatment
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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
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4. TB diagnostic approaches for children and adolescents
- 4.1 Introduction
- 4.2 Diagnosing TB in children and adolescents
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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
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5. Treatment of drug-susceptible and drug-resistant pulmonary and extrapulmonary TB in children and adolescents
- 5.1 Introduction
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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 drug susceptible pulmonary TB in children
- 5.2.4. Implementation considerations
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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
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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
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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
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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
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6. Models of TB care for children and adolescents
- 6.1 Introduction
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6.2 Decentralized, family-centred, integrated TB services
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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
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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
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7. Special situations
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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
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Module 6: Comorbidities
- Introduction
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Mental health conditions and substance use disorders
- Acknowledgements
- Abbreviations
- Definitions
- 1. Mental health conditions and substance use disorders: background and rationale
- 2. People-centred care for mental health conditions and substance use disorders in people affected by TB
- 3. Identifying and managing care for mental health conditions and substance use disorders in people affected by TB
- 4. Special considerations
- References
- Annex. WHO resources for mental and substance use disorders
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HIV
- Acknowledgements
- Abbreviations and acronyms
- Definitions
- 1. Background and rationale
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2. Establish and strengthen collaboration across health programmes and across sectors for delivering people-centred services for HIV-associated TB
- 2.1 Strengthen governance and accountability for TB/HIV collaborative activities
- 2.2 Conduct an analysis of access to quality services for TB and HIV
- 2.3 Coordinate planning and resource mobilization for collaborative action
- 2.4 Implement and scale up people-centred services for HIV-associated TB
- 2.5 Strengthen monitoring, evaluation and research
- 3. Reduce the burden of TB among people living with HIV
- 4. Reduce the burden of HIV among people with TB
- References
- Annex 1. Monitoring and evaluation of collaborative TB/HIV activities
- Annex 2. Methods for algorithms for diagnosis of TB in people living with HIV
- Annex 3. Checklist for TB infection prevention and control
- Annex 4. Package of care for advanced HIV disease
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Module 1: Prevention
- Training Catalogue
- TB Drug Dosage Finder