OpiniãoThe Global TB Programme (GTB) of the World Health Organization (WHO) has been combining all current recommendations into one overall set of consolidated guidelines on TB. The guidelines contain recommendations regarding all areas related to the programmatic management of TB (e.g. screening, preventive treatment, diagnostics, the treatment of drug-susceptible and drug-resistant TB, patient care and support). The consolidated guidelines contain modules specific to each programmatic area.
The consolidated WHO evidence-based guidelines for the treatment of drug-resistant TB (4), for the treatment of drug-susceptible TB (DS-TB) (5), and for the management of tuberculosis in children and adolescents (3) were published in 2020 and 2022. The recommendations on tuberculosis care and support contained in these guidelines were developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method for assessment of the quality of evidence.
People-centred care is an important element of the End TB Strategy which recommends treatment and patient support for all people with TB. Several interventions to support patients in their adherence to TB treatment have been implemented by national TB programmes for many years (e.g. treatment support with observation of medicine intake and social support), while others have been introduced recently (e.g. digital health interventions such as SMS messages, telephone calls or other reminders, and video-supported treatment, or VST). These interventions and models of care have been assessed using the GRADE method and WHO has issued guidelines with evidence-based recommendations for a variety of interventions for TB care and support. This module presents all WHO’s recommendations on TB care and support that are either newly developed or are existing recommendations that have been published previously in other WHO guidelines that applied the GRADE approach.
Structure of the document
The Recommendations part of this document has three main sections on elements of TB care and support. The elements covered are:
1. Care and support interventions for all people with TB.
2. Models of care for people with drug-resistant TB.
3. Models of care for children and adolescents exposed to TB or with TB disease.
Each section starts with the current WHO recommendations for that element. It then gives information on the evidence used to inform the recommendations, summarizes the analyses that were carried out on the basis of the evidence, and describes considerations for specific subgroups, for monitoring and evaluation and for implementation. Research gaps that were identified for each of the sections are presented at the end of the document; online annexes provide more details on the methods, the Guideline Development Groups (GDGs), the reports of systematic reviews and data analyses, evidence profiles, unpublished data and statistical analysis plans. Each section reflects discussions held at GDG meetings. Additional information on the implementation of patient care interventions is presented in the relevant submodule of the WHO operational handbook on TB care and support which is, a separate document that is designed to aid implementation efforts.