Consolidated Guidelines

Background

Tuberculosis (TB) remains a threat to global public health and is one of the topmost infectious causes of death in the world. In 2022, an estimated 10.6 million people developed TB, and 1.3 million died from the disease. About 410,000 new cases of multidrug-resistant¹ or rifampicin-resistant tuberculosis (MDR/RR-TB) were estimated to occur in 2022. While all of these would have been eligible for a second-line TB treatment regimen, only 175,650 enrolments on treatment were reported by countries in the same year.

1. Global tuberculosis report 2023. Geneva: World Health Organization; 2023 (https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2023, accessed 8 November 2023).
2. Framework for collaborative action on tuberculosis and comorbidities. Geneva: World Health Organization; 2022 (https://iris.who.int/handle/10665/361989, accessed 31 August 2023).
3. The end TB strategy.

Table A2.1 summarizes changes to recommendations published in the 2012 WHO policy on collaborative TB/HIV activities (1). The 2012 policy contained (i) WHO recommendations, which were formulated using the GRADE approach, and (ii) operational recommendations not assessed using the GRADE methodology, which were developed during consultation with key stakeholders.

Definitions of actions for changes to recommendations developed using the GRADE approach are as follows.

The formulation of WHO recommendations is based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Once evidence has been synthesized through a systematic review approach, evidence reviewers use the GRADE methodology to categorize the quality of the evidence into four levels: high, moderate, low or very low (see Table A1.1). The starting point for rating the quality of evidence is always the study design, whereby evidence from RCTs is rated as high quality, while evidence from non-randomized or observational studies is rated as low quality.

Research gaps related to HIV-associated TB were identified during the respective GDG meetings and are listed below. Further research gaps, some of which may have already been addressed, can be found in Priority research questions for TB/HIV in HIV-prevalent and resource-limited settings (134).