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The recommendation in this section addresses one PICO question:
PICO question (DR-TB, 2016): Among patients on MDR-TB treatment, are the following two interventions (delay in start of treatment and elective surgery) likely to lead to cure and other outcomes?49
Notes:
The GDG 2018 assessed the individual contribution to patient outcomes of medicines used in longer MDR-TB regimens, using primarily the estimates of effect from the 2018 IPD meta-analysis and Trial 213 (delamanid) for PICO question 3–2018 (MDR/RR-TB, 2018) (see Web Annex 3 for the respective GRADE summaries of evidence for each medicine, and Web Annex 4 for the evidence-to-deci
The development of the current recommendations was made possible by the availability of a global Hr-TB IPD. As in other IPD analyses conducted to inform WHO treatment guidelines in recent years, the Hr-TB IPD analysis facilitated the comparison of different patient groups, some adjustment for covariates and better interpretation of the results (57). It is important for researchers and national programmes to continue contributing patient records to the Hr-TB IPD, to increase its value as a source of information for future treatment policy.
This section refers to recommendations on MDR/RR-TB treatment regimens that are of longer duration than the regimens described in Sections 1 and 2.
PICO questions
The recommendations in this section address PICO questions formulated in 2018 and 2019. The questions formulated in 2018 were as follows:
Further research is needed in the following areas:
Further research is needed in the following areas:
Further research is needed in the following areas:
In addition to summarizing the available evidence, the reviews undertaken for these consolidated guidelines revealed several gaps in current knowledge about critical areas in DR-TB treatment and care. The estimates of effect for patient studies were commonly assigned a low or very low certainty rating, which explains why most of the recommendations in these guidelines are conditional. Some gaps persist from those identified in previous TB treatment guidelines (11, 12).
