Operational Handbooks

It is important to remember that: 1) decisions on the model of care for a particular situation should not be made in the belief that only one model serves the needs of all patients in a particular setting; and 2) in some settings, allowing community health-care workers to do more and different types of jobs to relieve staff shortages and to encourage more meaningful community participation may be important to allow services to be available to all patients.

6. Patients aged 12 years or older with pulmonary DS-TB may receive a 4-month regimen of isoniazid, rifapentine, moxifloxacin and pyrazinamide (2HPMZ/2HPM). (Conditional recommendation, moderate certainty of evidence) – new recommendation
7. In children and adolescents aged between 3 months and 16 years with non-severe TB (without suspicion or evidence of multidrug- or rifampicin- resistant TB [MDR/RR-TB]), a 4-month treatment regimen (2HRZ(E)/2HR) should be used. (Strong recommenda

Some patients may need to stay in hospital to receive treatment for TB. This is the case, for instance, if a patient has a severe form of DS-TB or DR-TB disease (e.g. meningitis, vertebral bone infection, pericarditis, miliary TB or severe TB lung disease with signs of respiratory distress/failure or sepsis), has serious comorbidities (e.g.

Decentralized care means care that is provided in smaller, ambulatory, non-specialized health-care centres closer to where a patient lives, often by community health workers or nurses, non-specialized doctors, community volunteers or TB treatment supporters. Care could occur at local centres (e.g. community centres), or at the patient’s home or workplace. Having treatment and care provided in decentralized health-care centres is a good way to improve access to treatment and increase the number of patients who receive regular, community-based treatment and support.

Although traditionally patients with DR-TB were hospitalized for portions of, and sometimes all of, their treatment, recommendations on this have changed. With the increasing use of all oral DR-TB treatment, patients with DR-TB should be treated whenever possible in an outpatient-based treatment programme similar to patients with DS-TB (60–62).

1. New patients with pulmonary TB should receive a regimen containing 6 months of rifampicin: 2HRZE/4HR. (Strong recommendation, high certainty of evidence)
2. Wherever feasible, the optimal dosing frequency for new patients with pulmonary TB is daily throughout the course of therapy.

As discussed in Chapter 6, assessment and relief of psychological, social and spiritual distress of patients and family caregivers are critical parts of palliative care for people affected by TB.

When patients learn that they are likely to die from their illness, they may experience any or all of the following emotions or thoughts in no particular order (56, 57):

Healthcare providers are trained to ‘advise’ and have an inherent desire to set things right for their patients. This rarely helps to bring a change in behaviour. Instead, the aim should be to explore people’s difficulties about changing their behaviour and help them find their own solutions. A therapeutic alliance (section 4.2.1) is important to understand the person’s point of view and identify the conflicts between how the person behaves and what he/she aims to achieve.