Глава 6. Скрининг на туберкулез среди детей

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• Прикладные пособия
  • Модуль 1. Профилактика
    • Модуль 1. Профилактика: профилактическое лечение туберкулеза
      • Выражение признательности
      • Аббревиатуры и акронимы
      • Определения
      • Глава 1. Введение и описание подхода
      • Глава 2. Выявление групп населения, нуждающихся в профилактическом лечении ТБ
      • Глава 3. Меры по исключению заболевания ТБ как предварительное условие для назначения профилактического лечения ТБ
      • Глава 4. Тестирование на туберкулезную инфекцию
      • Глава 5. Профилактическое лечение ТБ
        • Глава 5.1 Рекомендуемые дозировки препаратов при ПЛТ
      • Глава 6. Безопасность, купирование побочных реакций и решение других вопросов, связанных с приемом препаратов в рамках профилактического лечения ТБ
        • Глава 6.1 Меры, принимаемые в связи с нежелательными явлениями
      • Глава 7. Соблюдение режима профилактического лечения ТБ
        • Глава 7.1 Процедуры, направленные на удержание в системе медико-санитарной помощи людей, получающих ПЛТ
      • Глава 8. Мониторинг и оценка
      • Глава 9. Этика и профилактическое лечение ТБ
      • Приложения
        • Приложение 1. Перечень ключевых тезисов
        • Приложение 2. Координационные механизмы поддержки ПВ ПЛТ
        • Приложение 3. Финансовые аспекты программного ведения профилактического лечения ТБ
        • Приложение 4. Контрольный перечень вопросов при планировании ПВ ПЛТ
        • Приложение 5. Ответы на часто задаваемые вопросы о ТКП
        • Приложение 6. Ответы на часто задаваемые вопросы об IGRA
      • Библиография
    • Module 1: TB laboratory biosafety
      • Executive summary
      • Participants in the guideline development process
      • Abbreviations
        • Definitions of terms
      • Introduction
      • 1. Risk assessment and the classification of tb laboratories
        • 1.1 Risk assessment for tb laboratories: what is it?
        • 1.2 Hazard identification
        • 1.3 Determining risks
        • 1.4 Monitoring risks and mitigation measures
        • 1.5 Employee occupational health programme
        • 1.6 Classification of tb laboratories
      • 2. Essential biosafety measures for tb laboratories
        • 2.1 Codes of practice
          • 2.1.1 Laboratory access
          • 2.1.2 Responsibilities of the laboratory manager
          • 2.1.3 Personal protective equipment
          • 2.1.4 Procedures
          • 2.1.5 Work areas
        • 2.2 Equipment
        • 2.3 Design and facilities
        • 2.4 Training
        • 2.5 Waste handling
          • 2.5.1 Incineration
          • 2.5.2 Autoclaving
          • 2.5.3 Disinfection
        • 2.6 Disposal procedures for contaminated materials
          • 2.6.1 Broken glass and glass slides
          • 2.6.2 Contaminated or potentially infectious materials for disposal
      • 3. Low-risk tb laboratories
        • 3.1 Factors that increase the risk of infection
        • 3.2 Specific features and essential minimum biosafety measures
      • 4. Moderate-risk tb laboratories
        • 4.1 Factors that increase the risk of infection
        • 4.2 Specific features and essential minimum biosafety measures
      • 5. High-risk tb laboratories (tb-containment laboratories)
        • 5.1 Factors that increase the risk of infection
        • 5.2 Specific features and required biosafety measures
      • 6. Safety equipment
        • 6.1 Biological safety cabinets
          • 6.1.1 Selecting a biological safety cabinet for a TB laboratory
          • 6.1.2 Class I biological safety cabinets
          • 6.1.3 Class II type A2 biological safety cabinets
          • 6.1.4 Thimble connections
          • 6.1.5 Using biological safety cabinets in the laboratory
        • 6.2 Centrifuges with safety buckets
        • 6.3 Autoclaves
      • 7. Personal protective equipment and clothing
        • 7.1 Laboratory gowns
        • 7.2 Respirators
          • 7.2.1 Fitting a respirator
          • 7.2.2 Removing a respirator
        • 7.3 Gloves
          • 7.3.1 Removing gloves
      • 8. Plans for emergency preparedness and response
        • 8.1 Emergency preparedness plan
        • 8.2 Emergency response procedures for tb laboratories
          • 8.2.1 Infectious spills (outside a biological safety cabinet)
          • 8.2.2 Infectious spills (contained within a biological safety cabinet)
          • 8.2.3 Breakage of tubes inside sealed buckets (safety cups)
        • 8.3 Spill clean-up kit
      • 9. References
      • 10. Annex
        • Annex 1: Meeting participants
        • Annex 2: Declarations of interest
        • Annex 3: Peer review panel
    • 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
      • 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
  • Модуль 2: Скрининг : Систематический скрининг на туберкулез
    • Выражение благодарности
    • Сокращения и акронимы
    • Определения
    • Глава 1. Введение
      • 1.1 Обоснование для систематического скрининга на туберкулез
      • 1.2 Принципы скрининга на туберкулез
      • 1.3 Задачи данного практического справочника
      • 1.4 Целевая аудитория данного практического справочника
    • Глава 2. Шесть этапов цикла планирования и реализации
      • 2.1 Введение
        • 2.1.1 Более широкое использование диагностики ТБ по инициативе пациента
        • 2.1.2 Скрининг по инициативе медицинских учреждений для диагностики ТБ
      • 2.2 Оценка ситуации
        • 2.2.1 Проводимые мероприятия в области скрининга и информационно-разъяснительная работа
        • 2.2.2 Социальный контекст
        • 2.2.3 Эпидемиология ТБ
        • 2.2.4 Национальные программы борьбы с туберкулезом и система здравоохранения в целом
        • 2.2.5 Охват услугами здравоохранения и доступ к медицинскому обслуживанию
        • 2.2.6 Защита от стигматизации, дискриминации и вреда
      • 2.3 Постановка целей и конкретных задач
      • 2.4 Определение и приоритизация групп риска
        • 2.4.1 Потенциальная польза для человека
        • 2.4.2 Потенциальные риски и вред для человека
        • 2.4.3 Потенциальное влияние на распространенность и передачу инфекции
        • 2.4.4 Потенциальная общая результативность относительно количества достоверных случаев ТБ
        • 2.4.5 Количество лиц, подлежащих скринингу, для выявления одного случая ТБ
        • 2.4.6 Анализ экономической эффективности и рентабельности
      • 2.5 Выбор алгоритмов скрининга и диагностики
      • 2.6 Планирование, составление бюджета и внедрение
        • 2.6.1 Требования к планированию, кадровым ресурсам, материалам и составлению бюджета
        • 2.6.2 Выбор модели программы скрининга
        • 2.6.3 Этические аспекты
        • 2.6.4 Вовлечение заинтересованных сторон и партнерских организаций и определение ролей
        • 2.6.5 Мобилизация ресурсов
        • 2.6.6 Пилотные испытания
      • 2.7 Мониторинг, оценка и изменение программы
        • 2.7.1 Разработка плана для мониторинга и оценки
        • 2.7.2 Предлагаемые индикаторы
        • 2.7.3 Процедуры учета и отчетности
        • 2.7.4 Программные оценки
        • 2.7.5 Мониторинг временных тенденций для повторного скрининга и изменения приоритетов
    • Глава 3. Инструменты и алгоритмы скрининга
      • 3.1 Инструменты скрининга
        • 3.1.1 Скрининг симптомов
        • 3.1.2 Скрининг с помощью РГК
        • 3.1.3 Технологии КД для скрининга и медицинской сортировки
        • 3.1.4 Молекулярный быстрый диагностический тест, рекомендованный ВОЗ для скрининга
        • 3.1.5 Тестирование на наличие туберкулезной инфекции
      • 3.2 Алгоритмы скрининга
        • 3.2.1 Основные характеристики алгоритмов скрининга и диагностики ТБ
        • 3.2.2 Варианты алгоритмов скрининга и диагностики
        • 3.2.3 Выбор алгоритма для программы скрининга
      • 3.3 Инструмент для скрининга на туберкулез
    • Глава 4. Использование технологий КД в новых условиях
      • 4.1 Рекомендации по выбору и использованию КД для скрининга в рамках программ по борьбе с туберкулезом
      • 4.2 Набор инструментов для калибровки оборудования для КД
      • 4.3 Онлайн-инструмент для калибровки оборудования для КД для применения в новых условиях
    • Глава 5. Скрининг на туберкулез среди взрослых и подростков, живущих с ВИЧ
      • 5.1 Введение
      • 5.2 Инструменты скрининга
        • 5.2.1 Рекомендуемый ВОЗ скрининг четырех клинических симптомов ТБ
        • 5.2.2 С-реактивный белок (СРБ)
        • 5.2.3 Рентгенограмма грудной клетки
        • 5.2.4 Рекомендованные ВОЗ молекулярные быстрые диагностические тесты
      • 5.3 Рекомендации по использованию всех инструментов скрининга
      • 5.4 Алгоритмы скрининга
    • Глава 6. Скрининг на туберкулез среди детей
      • 6.1 Введение
      • 6.2 Скрининг детей, находившихся в контакте с больным ТБ
        • 6.2.1 Скрининг симптомов
        • 6.2.2 РГК
        • 6.2.3 Рекомендованные ВОЗ молекулярные быстрые диагностические тесты
        • 6.2.4 Тестирование на наличие туберкулезной инфекции
        • 6.2.5 Рекомендации по внедрению
      • 6.3 Скрининг среди детей, живущих с ВИЧ
        • 6.3.1 Скрининг на наличие симптомов и скрининг среди лиц, находившихся в контакте с больным ТБ
        • 6.3.2 Прочие скрининговые тесты
        • 6.3.3 Рекомендации по внедрению
      • 6.4 Алгоритмы скрининга
    • Библиография
    • Приложение 1. Алгоритмы скрининга среди населения в целом и в группах высокого риска (не включая людей, живущих с ВИЧ)
      • Рис. A.1.1 – Скрининг на наличие кашля
      • Рис. A.1.2 – Параллельный скрининг на наличие кашля и на основе РГК
      • Рис. A.1.3 – Последовательный скрининг при положительном результате на наличие кашля и на основе РГК
      • Рис. A.1.4 — Последовательный скрининг при отрицательном результате на наличие кашля и на основе РГК
      • Рис. A.1.5 — Скрининг на наличие любых симптомов туберкулеза
      • Рис. A.1.6 — Параллельный скрининг на наличие любых симптомов туберкулеза и на основе РГК
      • Рис. A.1.7 — Последовательный скрининг при положительном результате на наличие любого симптома и на основе РГК
      • Рис. A.1.8 — Последовательный скрининг при отрицательном результате на наличие любого симптома и на основе РГК
      • Рис. A.1.9 — Скрининг на основе РГК
      • Рис. A.1.10 — Скрининг на основе мБДТ
    • Приложение 2. Сравнительная эффективность алгоритмов при применении среди населения в целом и групп высокого риска (за исключением людей, живущих с ВИЧ)
    • Приложение 3. Алгоритмы скрининга для взрослых и подростков, живущих с ВИЧ
      • Рис. A.3.1 — Алгоритм скрининга с использованием только W4SS
      • Рис. A.3.2 — Алгоритм скрининга с использованием только теста на СРБ
      • Рис. A.3.3 — Алгоритм скрининга с использованием только РГК
      • Рис. A.3.4 — Алгоритм параллельного скрининга с использованием W4SS и теста на СРБ
      • Рис. A.3.5 — Алгоритм последовательного скрининга при положительном результате теста с использованием W4SS и теста на СРБ
      • Рис. A.3.6 — Алгоритм последовательного скрининга при отрицательном результате теста с использованием W4SS и теста на СРБ
      • Рис. A.3.7 — Алгоритм параллельного скрининга с использованием W4SS и РГК
      • Рис. A.3.8 — Алгоритм последовательного скрининга при положительном результате теста с использованием W4SS и РГК
      • Рис. A.3.9 — Алгоритм последовательного скрининга при отрицательном результате теста с использованием W4SS и РГК
      • Рис. A.3.10 — Алгоритм скрининга с использованием только мБДТ среди пациентов, находящихся в стационаре, в условиях распространенности ТБ > 10 %
      • Рис. A.3.11 — Алгоритм скрининга с использованием только мБДТ среди людей, живущих с ВИЧ
    • Приложение 4. Сравнительная эффективность алгоритмов скрининга для взрослых и подростков, живущих с ВИЧ
    • Приложение 5. Алгоритмы скрининга среди детей
      • Рис. A.5.1 — Скрининг на наличие симптомов
      • Рис. A.5.2 — Скрининг на основе РГК
      • Рис. A.5.3 — Параллельный скрининг на наличие симптомов и на основе РГК
      • Рис. A.5.4 — Последовательный скрининг при положительном результате на наличие симптомов и на основе РГК
      • Рис. A.5.5 — Последовательный скрининг при отрицательном результате на наличие симптомов и на основе РГК
      • Рис. A.5.6 — Скрининг на наличие симптомов (для детей с ВИЧ в возрасте < 10 лет)
  • Module 3: Diagnosis
    • Module 3: Rapid diagnostics for tuberculosis detection
      • Acknowledgements
      • Abbreviations
        • Abbreviations of TB agents
      • 1. Introduction
        • 1.1 Background
        • 1.2 About this guide
        • 1.3 Target audience
      • 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
          • 2.2.1 Xpert MTB/RIF assay
          • 2.2.2 Xpert MTB/RIF Ultra assay
          • 2.2.3 Truenat MTB, MTB Plus and MTB-RIF Dx assays
          • 2.2.4 Moderate complexity automated NAATs
        • 2.3 Initial tests for diagnosis of TB without drug-resistance detection
          • 2.3.1 TB-LAMP assay
          • 2.3.2 Urine LF-LAM
        • 2.4 Follow-on diagnostic tests for detection of additional drug resistance
          • 2.4.1 Low complexity automated NAATs for detection of resistance to INH and second-line anti-TB drugs
          • 2.4.2 LPAs
          • 2.4.3 High complexity reverse hybridization NAAT
        • 2.5 Tests WHO recommends against using
          • 2.5.1 Ubicación de las pruebas diagnósticas en la estructura escalonada de la red de laboratorios de TB
          • 2.5.2 Consideraciones relativas a la precisión al escoger una prueba diagnóstica, 2.5.3 Pasos y procedimientos para implementar una nueva prueba diagnóstica
        • 2.6 Phenotypic and genotypic DST
      • 3. Implementing a new diagnostic test
        • 3.1 Placement of diagnostic tests in the tiered laboratory network
          • 3.1.1 Peripheral level
          • 3.1.2 Intermediate level
          • 3.1.3 Central level
          • 3.1.4 Structure of network and testing packages
        • 3.2 Pretest probability and test accuracy considerations
        • 3.3 Epidemiologic considerations
        • 3.4 Multi-disease platform considerations
        • 3.5 Steps and processes for implementing a new diagnostic test
      • 4. Model algorithms
        • 4.1 Algorithm 1 – mWRD as the initial diagnostic test for TB
          • 4.1.1 Decision pathway for 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 People with HIV
          • 4.2.1 Decision pathway for Algorithm 2 – LF-LAM testing to aid in the diagnosis of TB among People with HIV
        • 4.3 Algorithm 3 – DST for second-line drugs for RR-TB or MDR-TB patients
          • 4.3.1 Decision pathway for 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
          • 4.4.1 Decision pathway for Algorithm 4
        • 4.5 Illustrative algorithm combinations
          • 4.5.1 Implementing a new diagnostic algorithm
      • 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
      • Acknowledgements
      • Abbreviations and acronyms
      • 1. Introduction
        • 1.1 Rationale for TB infection testing
        • 1.2 TB infection tests that are currently recommended by WHO
        • 1.3 The TB infection cascade of care
        • 1.4 About this operational handbook
        • 1.5 Target audience
      • 2. Testing for TB infection and a model algorithm
        • 2.1 Who should be tested for TB infection?
        • 2.2 Risk of disease in those with positive tests for TB infection
        • 2.3 What are the advantages and disadvantages of testing for TB infection?
        • 2.4 When is TB infection testing not advised?
          • 2.4.1 Prior positive TB infection tests
          • 2.4.2 Concomitant or recent vaccines or viral illnesses
          • 2.4.3 Clinical work-up of adults to diagnose TB disease or monitoring of the response to treatment
          • 2.4.4 History of TST or TBST allergic reactions (but IGRAs may be used)
          • 2.4.5 Challenges with blood collection in young children when using IGRAs (but TBST may be used)
        • 2.5 An integrated and person-centred model algorithm
      • 3. WHO-recommended tests for TB infection
        • 3.1 TB infection skin test using tuberculin (TST)
          • 3.1.1 Interpretation of TST – criteria for a positive TST
        • 3.2 TB infection skin tests using M. tuberculosis-specific antigen
          • 3.2.1 Cy-Tb
          • 3.2.2 Diaskintest
          • 3.2.3 C-TST
          • 3.2.4 Interpretation of TBST – criteria for a positive TBST
        • 3.3 Steps and processes for skin testing
          • 3.3.1 Materials and supplies needed
          • 3.3.2 Personnel needed
          • 3.3.3 Training and quality control
          • 3.3.4 Overview of test procedures and management
        • 3.4 Interferon-gamma release assays
          • 3.4.1 ELISA-based QFT-Plus
          • 3.4.2 ELISA-based WANTAI TB-IGRA
          • 3.4.3 ELISPOT-based T-SPOT.TB
      • 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
          • 4.2.7 Area 7 – Digital data
          • 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
        • A1.1 – Test administration
        • A1.2 – Reading of TST or TBST result
        • References for Annex 1
      • Annex 2. Interferon-gamma release assays – detailed description
        • A2.1 QFT-Plus – step by step
        • A2.2 WANTAI TB-IGRA – step by step
        • A2.3 T-SPOT.TB – step by step
        • References for Annex 2
  • Модуль 4: Лечение
    • Модуль 4: Лечение лекарственно-чувствительного туберкулеза
      • Выражение признательности
      • Аббревиатуры и акронимы
      • Определения
      • Резюме
      • Ключевые рекомендации ВОЗ по ЛЧ-ТБ
        • Лечение ЛЧ-ТБ по 6-месячной схеме
        • Лечение ЛЧ-ТБ по 4-месячным схемам
        • Лечение ЛЧ-ТБ и антиретровирусная терапия у людей, живущих с ВИЧ
        • Использование адъювантных стероидов в лечении туберкулезного менингита и перикардита
      • 1. Введение
      • 2. Основные особенности лечения ЛЧ-ТБ
        • 2.1 Диагностика ТБ и тестирование на лекарственную чувствительность
        • 2.2 Уход и поддержка при лечении ТБ
        • 2.3 Варианты лечения ЛЧ-ТБ
      • 3. Лечение ЛЧ-ТБ по 6-месячной схеме
        • 3.1 Критерии получения
        • 3.2 Состав и продолжительность схемы 2HRZE/4HR
        • 3.3 Практические соображения
        • 3.4 Подгруппы
        • 3.5 Мониторинг лечения
      • 4. Лечение ЛЧ-ТБ по 4-месячной схеме 2HPMZ/2HPM
        • 4.1 Критерии получения
        • 4.2 Состав и продолжительность схемы лечения
        • 4.3 Практические соображения
        • 4.4 Подгруппы
        • 4.5 Мониторинг лечения
      • 5. Лечение ЛЧ-ТБ по 4-месячной схеме 2HRZ(E)/2HR
        • 5.1 Критерии получения
        • 5.2 Состав и продолжительность схемы лечения
        • 5.3 Практические соображения
        • 5.4 Подгруппы
        • 5.5 Мониторинг лечения
      • 6. Лечение ЛЧ-ТБ у ЛЖВ
        • 6.1 Критерии получения
        • 6.2 Состав и продолжительность схемы лечения
        • 6.3 Практические соображения
        • 6.4 Мониторинг лечения
      • 7. Лечение внелегочного ТБ
        • 7.1 Критерии получения
        • 7.2 Состав и продолжительность схемы лечения
        • 7.3 Использование адъювантных стероидов при лечении туберкулезного менингита и перикардита
        • 7.4 Практические соображения
      • 8. Лечение ЛЧ-ТБ в особых ситуациях
        • 8.1 Диабет
        • 8.2 Беременность
        • 8.3 Пожилые люди
        • 8.4 Хроническая почечная недостаточность
        • 8.5 Хронические заболевания печени
      • 9. Мониторинг ответа на лечение
        • 9.1 Клиническое обследование
        • 9.2 Рентгенография органов грудной клетки
        • 9.3 Микроскопия мазка и посев
        • 9.4 Оценка состояния пациентов при подозрении на неэффективность лечения
      • 10. Определения результатов (исходов) лечения
        • 10.1 Определения результатов лечения
        • 10.2 Практические соображения
      • Библиография
      • Приложение. Дозировки противотуберкулезных препаратов для лечения ЛЧ-ТБ в зависимости от веса пациентов
      • Веб-приложения
    • Module 4: Drug-resistant tuberculosis treatment, 2022 update
      • Acknowledgements
      • Abbreviations
      • 1. Introduction
      • 2. Commonly used terms and key definitions in DR-TB treatment
      • 3. Key considerations in DR-TB treatment
        • 3.1 Access to DST
        • 3.2 Safety monitoring and management, provision of patient support and management of comorbidities
        • 3.3 Regimen options in the treatment of DR-TB
      • 4. The 6-month bedaquiline, pretomanid, linezolid and moxifloxacin (BPaLM) regimen
        • 4.1 Eligibility
        • 4.2 Composition and duration of the regimen
          • 4.2.1 BPaLM regimen
          • 4.2.2 BPaL regimen
          • 4.2.3 Duration of treatment
          • 4.2.4 Linezolid dosing in the BPaLM/BPaL regimen
          • 4.2.5 Modification of treatment
          • 4.2.6 Discontinuation of the regimen
          • 4.2.7 Pregnancy during treatment
        • 4.3 Key subgroups
          • 4.3.1 Children
          • 4.3.2 People with HIV
          • 4.3.3 Pulmonary TB
          • 4.3.4 Extrapulmonary TB
          • 4.3.5 Pregnant and breastfeeding women
        • 4.4 Implementation considerations
          • 4.4.1 DST
          • 4.4.2 Treatment support
          • 4.4.3 Contact tracing of household contacts
          • 4.4.4 Infection control
          • 4.4.5 Cost–effectiveness analysis
      • 5. The 9-month all-oral regimen
        • 5.1 Eligibility
          • 5.1.1 Assessment of extent and severity of TB disease
          • 5.1.2 DST results
          • 5.1.3 Haematological assessment
        • 5.2 Composition and duration of the regimen
          • 5.2.1 Ethionamide variation
          • 5.2.2 Linezolid variation
          • 5.2.3 Choice of fluoroquinolone
          • 5.2.4 Drug dosage and frequency
          • 5.2.5 Regimen modifications
          • 5.2.6 Switching between treatment regimens
        • 5.3 Key subgroups
          • 5.3.1 People with HIV
          • 5.3.2 Children
          • 5.3.3 Pregnant and breastfeeding women
          • 5.3.4 Extensive TB disease
          • 5.3.5 Extrapulmonary TB
        • 5.4 Implementation considerations and treatment in special situations
          • 5.4.1 DST results
          • 5.4.2 Patient subgroups
        • 5.5 Treatment monitoring
          • 5.5.1 Monitoring treatment response and outcome assignment
          • 5.5.2 Monitoring safety
          • 5.5.3 Modification or discontinuation of treatment
        • 5.6 Using modified all-oral shorter MDR-TB regimens under operational research
          • 5.6.1 Operational research conditions
      • 6. The longer regimens
        • 6.1 Eligibility
        • 6.2 Composition and duration of the regimens
          • 6.2.1 Choice of components for the longer MDR-TB regimens
          • 6.2.2 Medicines used in longer MDR-TB treatment regimens
          • 6.2.3 Duration of the regimen
        • 6.3 Key subgroups
          • 6.3.1 People with HIV
          • 6.3.2 Children
          • 6.3.3 Pregnant and lactating women
          • 6.3.4 Patients with diabetes mellitus
          • 6.3.5 Patients with extrapulmonary TB
        • 6.4 Implementation considerations and treatment in special situations
          • 6.4.1 Extensive DR-TB disease
          • 6.4.2 Severe extrapulmonary TB
          • 6.4.3 DR-TB in different patient groups
        • 6.5 Treatment monitoring
          • 6.5.1 Monitoring treatment response and outcome assignment
          • 6.5.2 Monitoring safety
      • 7. Regimen for rifampicin susceptible and isoniazid resistant TB
        • 7.1 Eligibility
        • 7.2 Composition and duration of the regimen
        • 7.3 Considerations for implementation
        • 7.4 Treatment monitoring
      • 8. Adjuncts to MDR-TB treatment
        • 8.1 Surgery in the treatment of MDR/XDR-TB
        • 8.2 Применение кортикостероидов
        • 8.3 Treatment of MDR/RR-TB patients with HIV
      • 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
        • 10.1 Treatment outcome definitions
        • 10.2 Considerations for implementation
      • References
      • Annex
    • 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
        • 3.1. Social support in TB management
          • 3.1.1 Informational and educational support
          • 3.1.2 Psychological and emotional support
          • 3.1.3 Material support
          • 3.1.4 Companionship support
        • 3.2. Treatment administration and digital adherence technologies
          • 3.2.1 Treatment support
          • 3.2.2 Digital adherence technologies
        • 3.3. Selecting a suitable package of care and support for a patient
      • 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
          • 4.2.1 Forming a therapeutic alliance
          • 4.2.2 Active listening
          • 4.2.3 Using non-verbal communication
          • 4.2.4 Asking questions
          • 4.2.5 Providing information
        • 4.3. Counselling to provide information about TB and the responsibilities of affected individuals and communities
          • 4.3.1 What information must be provided?
          • 4.3.2 How should this information be provided?
        • 4.4. Counselling to provide information about TB treatment and to ensure adherence to treatment
          • 4.4.1 Counselling to provide information about TB treatment
          • 4.4.2 Counselling to ensure adherence to treatment
        • 4.5. Counselling to provide psychological support
          • 4.5.1 Basic psychological support
          • 4.5.2 Strengthen social support
          • 4.5.3 Problem-solving technique
          • 4.5.4 Provide support to the caregivers
          • 4.5.5 Refer to mental health services
        • 4.6. Counselling on nutritional care and support
          • 4.6.1 Treat the underlying cause
          • 4.6.2 Educate the person
          • 4.6.3 Assess ‘readiness’ of the person to change diet/lifestyle
          • 4.6.4 Motivate the person
          • 4.6.5 Rewarding desired behaviour (in children)
        • 4.7. Counselling at the end of TB treatment and on palliative care
          • 4.7.1 Counselling at the end of TB treatment and post-TB treatment
          • 4.7.2 Counselling on palliative care
      • 5. Models of care for TB services
        • 5.1. Models of care for all TB patients
          • 5.1.1 Outpatient model of TB treatment: decentralized care
          • 5.1.2 Inpatient model of TB treatment and care
          • 5.1.3 Deciding on the best-suited model for a situation
        • 5.2. Decentralized and integrated family-centred models of TB care for children and adolescents
        • 5.3. Models of service delivery for people with TB, HIV and comorbidities
        • 5.4. Private-sector involvement in TB care
        • 5.5. TB and health emergencies
      • 6. Palliative care
        • 6.1 What is palliative care?
          • 6.1.1 Why is palliative care an essential part of comprehensive TB care?
          • 6.1.2 When and where should palliative care be provided for people with TB?
          • 6.1.3 Who should provide palliative care for people with TB?
          • 6.1.4 What is end-of-life care for people with TB?
        • 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
          • 6.3.1 When should suspension of TB treatment be considered?
          • 6.3.2 Important considerations in suspending TB treatment
          • 6.3.3 Decision-making about suspension of TB treatment
          • 6.3.4 Providing end-of-life care for people with TB
      • References
  • Module 5: Children and adolescents
    • Acknowledgments
    • Abbreviations
    • Definitions
    • 1. Introduction
      • 1.1 Background
      • 1.2 Children and adolescents as a key vulnerable population
      • 1.3 Rationale and objectives of this operational handbook
      • 1.4. Preferences of end-users regarding content and structure of this operational handbook
      • 1.5. Structure of the operational handbook
      • 1.6 Target audience
    • 2. TB screening and contact investigation
      • 2.1 Introduction
      • 2.2 Contact investigation
        • 2.2.1 Prioritizing household contacts
        • 2.2.2 Planning and budgeting to implement or strengthen household contact investigation
        • 2.2.3 Key implementation steps in contact investigation
        • 2.2.4 Examples of facility- and community-based approaches for TB contact investigation
      • 2.3 TB screening approaches in children and adolescents
        • 2.3.1. Screening child contacts of people with bacteriologically confirmed TB
          • 2.3.1.1. Symptom screening
          • 2.3.1.2. Chest X-ray
          • 2.3.1.3. Molecular WHO-recommended rapid diagnostic tests
          • 2.3.1.4. Tests for TB infection
        • 2.3.2. Considerations for implementation of screening of child close contacts
      • 2.4 Screening children and adolescents living with HIV
        • 2.4.1. Screening for symptoms and contact
        • 2.4.2. Other screening tests
        • 2.4.3. Considerations for implementation
        • 2.4.4. Screening of adolescents living with HIV
      • Key messages
    • 3. Prevention of TB in children and adolescents
      • 3.1 Introduction
      • 3.2 BCG vaccination
        • 3.2.1. Recommendations from the WHO BCG position paper
          • 3.2.1.1. Children living with HIV and neonates
          • 3.2.1.2. Administering BCG
          • 3.2.1.3. Contraindications for BCG
          • 3.2.1.4. Adverse reactions
      • 3.3 TB preventive treatment
        • 3.3.1. Introduction
        • 3.3.2. Target groups for TB preventive treatment
          • 3.3.2.1. Children and adolescents living with HIV
          • 3.3.2.2. Child and adolescent household contacts
        • 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
          • 3.3.4.1. Tuberculin skin testing
          • 3.3.4.2. Interferon-gamma release assay
        • 3.3.5. Options for TB preventive treatment regimens: drug-susceptible TB
          • 3.3.5.1. Implementation considerations
          • 3.3.5.2. Dosages
        • 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
          • 3.3.8.1. Special considerations for adherence in children
        • 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
          • 4.3.5.1. Sample types
          • 4.3.5.2. WHO-recommended rapid diagnostic tests
          • 4.3.5.3. Molecular WHO-recommended rapid diagnostic tests for TB
          • 4.3.5.4. Antigen detection in a lateral flow format (biomarker-based detection)
          • 4.3.5.5. Repeat testing with molecular WHO-recommended rapid diagnostic tests
        • 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
          • 4.3.9.1. Algoritmo A (para entornos con radiografía de tórax) y algoritmo B (para entornos sin radiografía de tórax)
          • 4.3.9.2. Uso de los algoritmos integrados de decisión sobre el tratamiento
      • 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 drug susceptible pulmonary TB in children
        • 5.2.4. Implementation considerations
          • 5.2.4.1. Assessing eligibility for the 4-month regimen
          • 5.2.4.2. Inclusion of ethambutol in the intensive phase of treatment
          • 5.2.4.3. Implementation considerations for the isoniazid, rifapentine, moxifloxacin and pyrazinamide regimen
          • 5.2.4.4. Dosing frequency
        • 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
          • 5.2.6.1. Treatment of TB meningitis and osteoarticular TB
          • 5.2.6.2. Implementation considerations: treatment of TB meningitis
        • 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
          • 5.2.8.1. Indications for referral and hospitalization
          • 5.2.8.2. Indications for adjuvant therapy
        • 5.2.9. Nutritional support
        • 5.2.10. Management of adverse events from medicines used to treat drug-susceptible TB
          • 5.2.10.1. Hepatotoxicity
          • 5.2.10.2. Peripheral neuropathy
          • 5.2.10.3. Optic neuritis
          • 5.2.10.4. Overview of common adverse events and their management
        • 5.2.11. Treatment adherence
        • 5.2.12. Follow-up and monitoring of children and adolescents on TB treatment
          • 5.2.12.1. Follow-up after treatment completion
          • 5.2.12.2. Treatment interruption
          • 5.2.12.3. Treatment failure
          • 5.2.12.4. Children and adolescents requiring retreatment for TB
          • 5.2.12.5. Registration of TB treatment in children and adolescents
      • 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
          • 5.3.3.1. Dosing
          • 5.3.3.2. Formulations
        • 5.3.4. Monitoring of children and adolescents on multidrugresistant and rifampicin-resistant TB treatment
          • 5.3.4.1. Monitoring response to treatment
          • 5.3.4.2. Monitoring for adverse effects
      • Key messages: treatment of DR-TB
      • 5.4 Practical guidance for assessment and management of post-TB health in children and adolescents
        • 5.4.1. Post-TB health
        • 5.4.2. Post-TB meningitis in children and adolescents
        • 5.4.3. Post-TB lung disease in children and adolescents
        • 5.4.4. Post-TB osteoarticular disease in children and adolescents
        • 5.4.5. Post-TB health-related quality of life
    • 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
      • 6.3 Private-sector involvement in care for children and adolescents with TB
        • 6.3.1. Background
        • 6.3.2. Rationale
        • 6.3.3. Benefits of involving the private sector in TB care
        • 6.3.4. Implementation considerations
      • 6.4 Differentiated TB service delivery
        • 6.4.1. Background
        • 6.4.2. Rationale
        • 6.4.3. Implementation considerations
      • 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
          • 7.1.7.1. Timing of antiretroviral therapy
          • 7.1.7.2. Choice of antiretroviral therapy regimen
          • 7.1.7.3. Adjustments to antiretroviral therapy regimens with TB treatment
          • 7.1.7.4. TPT in children and adolescents living with HIV on antiretroviral therapy
        • 7.1.8. Immune reconstitution inflammatory syndrome
      • 7.2 TB in pregnancy and management of newborns of mothers with TB disease
        • 7.2.1. Screening for TB in pregnant women living with HIV
        • 7.2.2. Congenital and neonatal TB
          • 7.2.2.1. Management of congenital and neonatal TB
        • 7.2.3. Management of asymptomatic neonates of mothers with TB
      • 7.3 Palliative care for children and adolescents with TB
        • 7.3.1. Introduction
        • 7.3.2. Palliative care for people with TB
        • 7.3.3. Palliative care for children and adolescents with TB
      • 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
        • 7.6.1. Introduction
        • 7.6.2. Diagnosis and treatment of TB in children with malnutrition
        • 7.6.3. Nutritional care for children and adolescents with TB
      • Key messages
    • 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: Comorbidities
    • 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
      • 3.1 Depression
      • 3.2 Anxiety
      • 3.3 Psychoses
      • 3.4 Substance use disorders
      • 3.5 Suicidal behaviours
    • 4. Special considerations
      • 4.1 Stigma
      • 4.2 Palliative care
      • 4.3 Homelessness
      • 4.4 Multimorbidity and TB-associated disabilities
    • References
    • Annex WHO resources for mental and substance use disorders
• Сводное руководство
  • Module 1: Prevention
    • Module 1: TB preventive treatment
      • Acknowledgements
      • Abbreviations & acronyms
      • Definitions
      • Executive summary
      • Introduction
        • 1. Background
        • 2. Rationale
        • 3. Scope of the current update
        • 4. Target audience
      • 1. Recommendations
        • 1.1. Identification of populations for testing of latent tuberculosis infection and TB preventive treatment
        • 1.2. Ruling out active tuberculosis disease
        • 1.3. Testing for latent tuberculosis infection
        • 1.4. Tuberculosis preventive treatment options
      • 2. Monitoring and evaluation
      • 3. Research gaps
      • 4. References
      • Supplementary Table
      • Online annexes
        • ANNEX 1. Methods and Expert Panels
        • ANNEX 2 GRADE summary of evidence tables (for new recommendations in 2018 & 2019 guidelines updates)
        • ANNEX 3 GRADE evidence-to-decision tables
    • Module 1: TB infection prevention and control
      • Abbreviations
      • Glossary
      • Acknowledgements
      • Declarations of interest
      • How to use these guidelines
      • Executive summary
        • Guideline development methods
        • Summary of recommendations
      • 1. Introduction
        • Scope of the guidelines
        • Objective
        • Target audience
      • 2. Recommendations
        • 2.1. Administrative controls
        • 2.2. Environmental controls
        • 2.3 Respiratory protection
      • 3. Core components of IPC programmes
      • 4. Methods
        • 4.1. Preparation for evidence assessment
        • 4.2. Evidence retrieval, quality assessment and grading of the evidence
        • 4.3. Formulation of the recommendations
        • 4.4. Guideline Development Group decision-making
        • 4.5. Guideline preparation, peer-review and content presentation
      • 5. Research priorities
      • 6. Publication, dissemination and implementation
      • References
      • Annexes
        • Annex 1 – List of participants to the Guideline Development Group meeting
        • Annex 2 – Summary of declarations of interest and management
        • Annex 3 – Risk of acquiring tuberculosis infection, progression to active disease and the effect of treatment on infectiousness
      • Online annexes
        • Annex 4 – GRADE evidence summary tables
        • Annex 5 – GRADE evidence-to-decision tables
        • Annex 6 – Results of the systematic reviews on the development of these guidelines
  • Модуль 2: Скрининг : Систематический скрининг на туберкулез
    • Выражение признательности
    • Сокращения и акронимы
    • Определения
    • Резюме
    • 1. Введение
      • 1.1 Общие сведения
      • 1.2 Определение и задачи систематического скрининга на туберкулез
      • 1.3 Объем обновления 2021 г.
      • 1.4 Обоснование обновления Руководства
      • 1.5 Задачи обновления Руководства
      • 1.6 Целевая аудитория
    • 2. Рекомендации по систематическому скринингу на туберкулез в целевых группах населения
      • 2.1 Систематический скрининг на туберкулез среди населения в целом
        • 2.1.1 Резюме доказательств и обоснование
        • 2.1.2 Рекомендация по реализации
      • 2.2 Систематический скрининг на туберкулез среди людей со структурными факторами риска заражения ТБ
        • 2.2.1 Резюме доказательств и обоснование
        • 2.2.2 Рекомендация по реализации
      • 2.3 Систематический скрининг на туберкулез среди людей, живущих с ВИЧ
        • 2.3.1 Резюме доказательств и обоснование
        • 2.3.2 Рекомендация по реализации
      • 2.4 Систематический скрининг на туберкулез среди лиц, имевших контакт в рамках домохозяйства или иной близкий контакт с больными ТБ
        • 2.4.1 Резюме доказательств и обоснование
        • 2.4.2 Рекомендация по реализации
        • 2.4.3 Рекомендации относительно подгрупп
      • 2.5 Систематический скрининг на туберкулез следует проводить в тюрьмах и прочих местах лишения свободы
        • 2.5.1 Резюме доказательств и обоснование
        • 2.5.2 Рекомендация по реализации
      • 2.6 Систематический скрининг на туберкулез среди горняков и других лиц, подвергающихся воздействию кварцевой пыли
        • 2.6.1 Резюме доказательств и обоснование
        • 2.6.2 Рекомендация по реализации
      • 2.7 Систематический скрининг на туберкулез среди людей, посещающих медицинские учреждения, у которых есть клинические факторы риска ТБ
        • 2.7.1 Резюме доказательств и обоснование
        • 2.7.2 Рекомендации по реализации
    • 3. Рекомендации по инструментам для систематического скрининга на туберкулез
      • 3.1 Инструменты для скрининга на ТБ среди населения в целом и групп высокого риска
        • 3.1.1 Резюме доказательств и обоснование
        • 3.1.2 Рекомендация по реализации для всех инструментов
      • 3.2 Использование программного обеспечения компьютерной диагностики для автоматического считывания цифровых рентгенограмм грудной клетки
        • 3.2.1 Резюме доказательств и обоснование
        • 3.2.2 Рекомендация по реализации
      • 3.3 Инструменты для скрининга на туберкулез среди людей, живущих с ВИЧ
        • 3.3.1 Резюме доказательств и обоснование
          • 3.3.1.1 Рекомендованный ВОЗ скрининг четырех клинических симптомов туберкулеза
          • 3.3.1.2 С-реактивный белок
          • 3.3.1.3 Рентгенография грудной клетки
          • 3.3.1.4 Рекомендованные ВОЗ молекулярные быстрые диагностические тесты для проходящих стационарное лечение пациентов, живущих с ВИЧ, в условиях высокого бремени ТБ
          • 3.3.1.5 Рекомендованные ВОЗ молекулярные быстрые диагностические тесты для всех прочих людей, живущих с ВИЧ
        • 3.3.2 Рекомендация по реализации всех инструментов для скрининга людей, живущих с ВИЧ
      • 3.4 Инструменты для систематического скрининга на туберкулез среди детей и подростков
        • 3.4.1 Резюме доказательств и обоснование
          • 3.4.1.1 Близкие контакты в возрасте до 15 лет
          • 3.4.1.2 Дети в возрасте до 10 лет, живущие с ВИЧ
        • 3.4.2 Рекомендация по скринингу детей и подростков
    • 4. Мониторинг и оценка
      • 4.1 Показатели
      • 4.2 Процедуры учета и отчетности
      • 4.3 Программные оценки
      • 4.4 Первоначальная калибровка для технологий компьютерной диагностики
    • 5. Пробелы в исследованиях
      • 5.1 Скрининг на туберкулез в целевых группах населения
        • 5.1.1 Население в целом и группы высокого риска
        • 5.1.2 Люди, живущие с ВИЧ
        • 5.1.3 Дети и подростки
      • 5.2 Инструменты для скрининга на туберкулез
        • 5.2.1 Компьютерная диагностика
        • 5.2.2 С-реактивный белок
        • 5.2.3 Алгоритмы скрининга
      • 5.3 Операционные исследования
    • 6. Библиография
    • Дополнительная таблица
    • Онлайн приложения (только на английском)
      • Web Annex A. Methods and Expert Panels
      • Web Annex B. GRADE Summary of Findings Tables
      • Web Annex C. GRADE Evidence to Decision Tables
  • Module 3: Diagnosis
    • Module 3: Rapid diagnostics for tuberculosis detection
      • Acknowledgements
      • Abbreviations and acronyms
      • 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
          • Lateral flow urine lipoarabinomannan assay
          • Loop-mediated isothermal amplification
        • 2.3. Follow on diagnostic tests for detection of additional drug-resistance
          • First-line LPAs
          • High complexity reverse hybridization-based NAATs for detection of pyrazinamide resistance
          • Low complexity automated NAATs for detection of resistance to isoniazid and second-line anti-TB agents
          • Second-line LPAs
      • Research gaps
      • References
      • 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
        • 1.1. Background
        • 1.2. Recommendation
        • 1.3. Test descriptions
        • 1.4. Evidence base
          • 1.4.1. Diagnostic accuracy
          • 1.4.2. Safety
          • 1.4.3. Cost and cost–effectiveness analysis
          • 1.4.4. User perspective
        • 1.5. Implementation considerations
        • 1.6. Monitoring and evaluation
        • 1.7. Research priorities
      • 2. Use of the TST and IGRAs for the diagnosis of TB infection
        • 2.1. Background
        • 2.2. Recommendation
        • 2.3. Test descriptions
        • 2.4. Evidence base
          • 2.4.1. PICO question
          • 2.4.2. Evidence on intervention effect
          • 2.4.3. Cost–effectiveness
          • 2.4.4. User perspective
        • 2.5. Implementation considerations
        • 2.6. Research priorities
      • 3. Use of the TST and IGRAs for the diagnosis of TB disease
        • 3.1. Background
        • 3.2. Recommendation
        • 3.3. Test descriptions
        • 3.4. Evidence base
          • 3.4.1. PICO questions
          • 3.4.2. Hierarchy of reference standards
          • 3.4.3. Studies search, selection and quality assessment
          • 3.4.4. Data synthesis and meta-analysis
          • 3.4.5. Use of IGRAs in the diagnosis of active TB
          • 3.4.6. Operational aspects of the use of IGRAs
        • 3.5. Research priorities
      • 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
  • Модуль 4: Лечение
    • Модуль 4: Лечение лекарственно-чувствительного туберкулеза
      • Выражение признательности
      • Список сокращений
      • Определения
      • Резюме
      • Введение
      • Цели
      • Методы, использованные в ходе подготовки обновленного руководства
        • Сфера охвата обновленного руководства
        • Достоверность фактических данных и обоснованность рекомендаций
        • Оценка и классификация фактических данных
        • Внешнее рецензирование
        • Публикация, распространение, применение, оценка и срок действия
      • Рекомендации
        • Лечение лекарственно-чувствительного туберкулеза по 6-месячной схеме
        • Лечение лекарственно-чувствительного ТБ по 4-месячным схемам
        • Лечение лекарственно-чувствительного ТБ и АРТ у людей, живущих с ВИЧ
        • Использование адъювантных стероидов в лечении туберкулезного менингита и перикардита
      • Приоритетные направления исследований
      • Библиография
      • Приложение. Резюме изменений в политике по лечению ЛЧ-ТБ с 2010 года и единый перечень рекомендаций из сводных руководств по лечению ЛЧ-ТБ
      • Веб-приложения (на английском языке)
    • 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)
          • 1.1 Recommendations
          • 1.2 Summary of evidence
          • 1.3 Evidence to recommendations: considerations
          • 1.4 Subgroup considerations
          • 1.5 Implementation considerations
          • 1.6 Monitoring and evaluation
        • Section 2. The 9-month all-oral regimen for MDR/RR-TB (NEW)
          • 2.1 Recommendation
          • 2.2 Summary of evidence
          • 2.3 Evidence to recommendations: considerations
          • 2.4 Subgroup considerations
          • 2.5 Implementation considerations
          • 2.6 Monitoring and evaluation
        • Section 3. Longer regimens for MDR/RR-TB
          • 3.1 Recommendations
          • 3.2 Justification and evidence
          • 3.3 Remarks
          • 3.4 Subgroup considerations
          • 3.5 Implementation considerations
          • 3.6 Monitoring and evaluation
        • Section 4. Regimen for rifampicin-susceptible, isoniazid-resistant TB (Hr-TB)
          • 4.1 Recommendations
          • 4.2 Justification and evidence
          • 4.3 Subgroup considerations
          • 4.4 Implementation considerations
          • 4.5 Monitoring and evaluation
        • Section 5. Monitoring patient response to MDR/RR-TB treatment using culture
          • 5.1 Recommendation
          • 5.2 Justification and evidence
          • 5.3 Subgroup considerations
          • 5.4 Implementation considerations
          • 5.5 Monitoring and evaluation
        • Section 6. Starting antiretroviral therapy in patients on MDR/RR-TB regimens
          • 6.1 Recommendation
          • 6.2 Justification and evidence
          • 6.3 Summary of findings
          • 6.4 Benefits
          • 6.5 Risks
          • 6.6 Values and preferences
        • Section 7. Surgery for patients on MDR/RR-TB treatment
          • 7.1 Recommendation
          • 7.2 Justification and evidence
          • 7.3 Subgroup considerations
          • 7.4 Implementation considerations
          • 7.5 Monitoring and evaluation
      • 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
      • Acknowledgements
      • List of abbreviations
      • Executive summary
      • Introduction
      • WHO policy recommendations
        • 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
      • Research priorities
      • References
      • Annexes
        • Annex 1. Experts involved in the development of the guidelines
        • Annex 2. PICO questions
      • Web Annexes
  • Module 5: 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
        • 1.6.1. PICO questions
        • 1.6.2. Questions contextuelles
      • 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
        • 4.1.1. Justification and evidence
        • 4.1.2. Subgroup considerations
        • 4.1.3. Implementation considerations
        • 4.1.4. Monitoring and evaluation
      • 4.2. Treatment decision algorithms for the diagnosis of pulmonary TB in children aged below 10 years of age
        • 4.2.1. Justification and evidence
        • 4.2.2. Subgroup considerations
        • 4.2.3. Implementation considerations
        • 4.2.4. Monitoring and evaluation
      • 4.3. Consolidated recommendations on TB diagnostics and diagnostic approaches relevant to children and adolescents
    • 5. Treatment of TB disease in children and adolescents
      • 5.1. Treatment shortening in children and adolescents with non-severe TB
        • 5.1.1. Justification and evidence
        • 5.1.2. Subgroup considerations
        • 5.1.3. Implementation considerations
        • 5.1.4. Monitoring and evaluation
      • 5.2. Treatment regimens for TB meningitis in children and adolescents
        • 5.2.1. Justification and evidence
        • 5.2.2. Subgroup considerations
        • 5.2.3. Implementation considerations
        • 5.2.4. Monitoring and evaluation
      • 5.3. Treatment of multi-drug and rifampicin resistant TB in children
        • 5.3.1. The use of bedaquiline in children with MDR/RR-TB aged below 6 years
        • 5.3.2. The use of delamanid in children with MDR/RR-TB aged below 3 years
      • 5.4. Consolidated recommendations on TB treatment for children and adolescents
    • 6. Models of TB care for case detection and provision of TPT in children and adolescents
      • 6.1. Decentralized and family-centred, integrated models of care to deliver child and adolescent TB services
        • 6.1.1. Justification and evidence
        • 6.1.2. Subgroup considerations
        • 6.1.3. Implementation considerations
        • 6.1.4. Monitoring and evaluation
      • 6.2. Consolidated recommendations on models of TB care relevant to 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: 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
        • 1.1 Rationale and Objectives
          • 1.1.1 Target Audience and Scope:
        • 1.2 Policy Formulation Process
          • 1.2.1 Preliminary Review and Methodological Decisions
          • 1.2.2 Methods for the Corbett Study
          • 1.2.3 Methods for National Survey Conducted by the Guideline Group
          • 1.2.4 Methods for the Cochrane-Style Systematic Review
          • 1.2.5 Evidence Grading and Formulation of Recommendations
        • 1.3 Values
      • 2. Statements and Recommendations
        • 2.1 Statement #1
          • 2.1.1 Introduce new, or refine existing, national policies that ensure priority access for health workers and their families to services for the prevention, treatment and care for HIV and TB.
          • 2.1.2 Key References and Supporting WHO Guidelines
          • 2.1.3 Table 3: Recommendation for 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
          • 2.3.1 Develop or strengthen existing occupational health services for the entire health workforce so that access to HIV and TB prevention, treatment and care can be realized.
          • 2.3.2 Key References and Supporting WHO Guidelines
          • 2.3.3 Table 5: Recommendation for Statement 3
        • 2.4 Statement #4
          • 2.4.1 Develop or strengthen existing infection control programmes, especially with respect to TB infection control, and ensure integration with other workplace health and safety programmes.
          • 2.4.2 Key References and Supporting WHO Guidelines
          • 2.4.3 Table 6: Recommendation for 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
          • 2.8.1 Adapt and implement good practices in occupational health and the management of HIV and TB in the workplace from all sectors.
          • 2.8.2 Key References and Supporting WHO Guidelines
          • 2.8.3 Table 12: Recommendation for Statement 8
        • 2.9 Statement #9
          • 2.9.1 Establish and provide adequate financial resources for treatment, care and support programmes to prevent the occupational or non- occupational transmission of HIV and TB among health workers.
          • 2.9.2 Key References and Supporting WHO Guidelines
          • 2.9.3 Table 13: Recommendation for 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
        • 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
        • 3.1 Integrating Framework
        • 3.2 Implementation, Adaptation, Advocacy and Dissemination
      • 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)
• Каталог Обучения
• TB Drug Dosage Finder