Operational Handbooks

Innovative rapid molecular tests to diagnose both pulmonary and extrapulmonary TB in all populations are strongly recommended over sputum smear microscopy and culture methods, because rapid tests can provide same day results (4). Some of the innovative tests also provide drug susceptibility results for rifampicin (R), isoniazid (H) and fluoroquinolones (FQ), allowing rapid confirmation of diagnosis, and timely and effective treatment allocation.

This operational handbook on the treatment of drug-susceptible tuberculosis (DS-TB) complements the World Health Organization (WHO) publication WHO consolidated guidelines on tuberculosis Module 4: Treatment – drug-susceptible tuberculosis treatment (1). It provides practical advice based on best practices and knowledge from fields such as pharmacokinetics, pharmacodynamics, microbiology, pharmacovigilance, and clinical and programmatic management.

10. In patients with tuberculous meningitis, an initial adjuvant corticosteroid therapy with dexamethasone or prednisolone tapered over 6–8 weeks should be used. (Strong recommendation, moderate certainty of evidence)
11. In patients with tuberculous pericarditis, an initial adjuvant corticosteroid therapy may be used. (Conditional recommendation, very low certainty of evidence)

Palliative care is the preventing and relieving of the suffering of people affected by TB during and after treatment and at the end-of-life.

Health emergencies, such as the COVID-19 pandemic, are associated with a disruption in health service delivery, either directly due to the focused attention given to the emergency or indirectly due to the actions taken to control the emergency.

The COVID-19 pandemic has reversed years of progress in providing essential TB services and reducing the disease burden of TB. There has been a large global drop in the number of people newly diagnosed with TB. Reduced access to TB diagnosis and treatment has resulted in an increase in the number of TB-related deaths.

In many high TB burden countries, the majority of people seek treatment from private providers not linked to the public health-care system (86). Private health-care providers are an entry point to TB care and treatment (86–88). However, people with TB may not have good-quality TB services if the NTP does not cooperate with the private sector. Health-care providers in the private sector may not be provided with information about TB or trained in the up-to-date guidance on TB diagnosis and treatment, including the use of child-friendly formulations.

Models of service delivery for people with TB and comorbidities range from the least integrated, where stand-alone disease-specific providers refer patients to the relevant specialist services for comorbidities, to the most integrated, where all services across the cascade of care for TB and key comorbidities are provided in a “one-stop-shop” by one health-care worker (83, 84). 10 Services may be provided at different levels of the health system, depending on the availability of comprehensive primary care and the degree of decentralization of the respective services.

8. It is recommended that TB patients who are living with HIV should receive at least the same duration of TB treatment as HIV-negative TB patients.  (Strong recommendation, high certainty of evidence)
9. Antiretroviral therapy (ART) should be started as soon as possible within 2 weeks of initiating TB treatment, regardless of CD4 cell count, among people living with HIV.

In high TB burden countries, the capacity to manage TB in children and adolescents is often centralized at the tertiary or secondary level of health care rather than being decentralized at the primary health care level where children and adolescents with TB or TB exposure commonly seek care (67, 68). Care at higher levels in the health system is often managed in a vertical, non-integrated way.