TB KaSPar
Feedback
Adults with extrapulmonary TB are eligible for the 6-month 2HRZE/4HR regimen, except for those with TB of the central nervous system, bone or joint, for which some expert groups suggest longer therapy (i.e. 9–12 months).
Children aged between 3 months and 16 years with extrapulmonary TB limited to peripheral lymph nodes (i.e. without involvement of other sites of disease) should be treated with the 4-month regimen (2HRZ(E)/2HR).
Extrapulmonary TB is active TB in organs other than the lungs. About 15% of the 7 million incident TB cases globally notified in 2018 were extrapulmonary TB; among WHO regions, prevalence ranged from 8% in the Western Pacific; to 15–17% in Africa, the Americas, Europe and South-East Asia; and to 24% in the Eastern Mediterranean (5).
There are no new monitoring and evaluation considerations beyond the current standard of care for People with HIV. In view of the subgroup considerations, NTPs may consider monitoring specifically for relapse in this group of TB patients. More details on treatment monitoring are given in Section 9.
There are no new implementation considerations beyond the current standards of care for People with HIV. NTPs need to work closely with HIV programmes to further expand HIV testing and ART coverage among TB patients. A particular exception highlighted in the recommendation on timing of the ART relates to situations when signs and symptoms of meningitis are present.
All People with HIV with DS-TB may be treated using the same duration of TB treatment as HIV-negative TB patients. There is much experience of treating these patients with the 6-month rifampicin-containing regimen 2HRZE/4HR (1, 36). The 4-month regimen with rifapentine and moxifloxacin has also been shown to perform well in patients who are also HIV-positive (1).
The recommendation on starting ART in TB patients has recently been expanded to include all patients, regardless of CD4 count. Although all three regimens (Table 2.1) can be initiated in People with HIV, the 6-month regimen is a preferred option in those with a CD4 count of less than 100 cells/mm³ .
Worldwide, a total of 375 963 cases of TB among People with HIV were notified in 2020, equivalent to 9% of the 4.2 million people diagnosed with TB who had an HIV-positive test result. Overall, the percentage of people diagnosed with TB who are HIV-positive has fallen globally over the past 10 years.
The coverage of ART among people diagnosed with TB and known to be HIV-positive was 88% in 2020, the same level as in 2019. By 2020, most people provided with TPT were living with HIV.
End-of-life care can be provided either in an inpatient setting (hospital or hospice) or in the home depending on: the preference of the patient; the willingness of the relatives and community to provide home care; the presence of a medical need for inpatient care; and the existing capacity for proper infection control in each setting (91, 122). Palliative home care combined with strict infection control may be preferred by many patients and may be less expensive than institutional care for health-care systems.
If suspension of DR-TB therapy is considered, there should be discussion with the entire clinical team – including the patient and all physicians, nurses and health workers or TB treatment supporters involved in the patient’s care. If the clinical team decides together that treatment should be suspended, a clear plan should be prepared for approaching the patient and the family. This process usually requires personal interaction with patient and family, ideally including home visits, and may take several weeks.