FeedbackSince the WHO policy on collaborative TB/HIV activities (10) was published in 2012, there have been remarkable scientific advances and consequently, updated WHO recommendations on screening, diagnosis, treatment and prevention of HIV-associated TB. These include:
- evidence on the overwhelming benefit of a combination of early ART and TPT in preventing TB and reducing morbidity and mortality among people living with HIV;
- the development of shorter rifamycin-based TPT regimens;
- C-reactive protein (CRP), chest X-ray (CXR) (including CAD software to interpret digital X-ray) and molecular WHO-recommended rapid diagnostic tests (mWRD) for TB screening among people living with HIV, in addition to the WHO-recommended four symptom screen (W4SS);
- the scale-up of molecular diagnostic tests to diagnose TB using a range of specimens, including non-sputum-based specimens such as urine or blood, recommended by WHO for the detection of both pulmonary and extra-pulmonary TB;
- LF-LAM to support in TB diagnosis;
- new antiretroviral therapy (ART) regimens as well as earlier start of ART after TB treatment initiation;
- new strategies for HIV testing;
- shorter TB treatment regimens;
- treatment support interventions and models of care that aim to make prevention and treatment more people-centred; and
- diagnosis and management of the most common infections in people with advanced HIV disease.
Based on this evidence, new WHO recommendations have been formulated, updated and published in WHO guidelines on TB (10, 11, 13-17, 21) and on HIV (21). The TB/HIV guidelines consolidate all WHO recommendations related to reducing the burden of TB among people living with HIV and to reducing the burden of HIV in people with TB.3
³ Recommendations are consolidated in the existing language of the source guideline. Since these recommendations were published, the use of language in relation to HIV and TB has evolved to ensure that the terminology used is non-stigmatizing, people-centred and human rights-based. The wording of recommendations will be updated appropriately during the next respective guideline development process.
