Operational Handbooks

The patient-initiated pathway to TB diagnosis can be enhanced by:

The operational handbook is intended for personnel in national TB programmes and national HIV/ AIDS programmes, or their equivalents, and other relevant national health programmes in ministries of health; other relevant ministries working in public health and screening; other health policy-makers, implementing partners including technical and funding agencies, civil society and representatives of affected communities, clinicians and public health practitioners working on TB and HIV and infectious diseases in the public and private sectors.

Systematic screening for TB fulfils the classic screening criteria (8). The following key principles are to be considered in planning a TB screening initiative:

Note: Unless otherwise specified, the definitions listed below apply to the terms as used in this handbook. They may have different meanings in other contexts.

Active (TB) case-finding: Provider-initiated screening and testing in communities by mobile teams, often using mobile X-ray and rapid molecular tests. The term is sometimes used synonymously with “systematic screening”. It is referred to as “intensified case-finding” when conducted in health-care facilities and as “enhanced case-finding” when conducted in communities.

This operational handbook was prepared by Saskia den Boon and Cecily Miller, with input from Dennis Falzon and Matteo Zignol, under the overall direction of Tereza Kasaeva, Director, WHO Global Tuberculosis Programme. The WHO Global Tuberculosis Programme gratefully acknowledges the contributions of all experts and reviewers involved in the production of the latest update of the WHO guidelines on systematic screening for TB disease, on which this handbook is based, as well as other contributors listed below.

Modified all-oral shorter MDR-TB regimens (i.e. regimens that differ from the recommended 9-month shorter regimens) should only be implemented under “operational research conditions”. The main conditions are:

At present, there is little evidence to support modified all-oral shorter MDR-TB regimens that are designed using the hierarchy of TB medicines (Table 6.1). NTPs that intend to pilot such types of shorter MDR-TB regimens are advised to do so under operational research conditions.

The South African NTP implemented the 9-month all-oral MDR/RR-TB regimen as a standardized course of treatment, with little room for variation. Some changes to the prescribed regimen were considered acceptable in the South African context and may be appropriate in other settings (as described in Section 5.2).

Some patients who start treatment with the 9-month all-oral regimen are unable to continue or complete the course of treatment, and may have to restart or switch to a different regimen; for example, in the following situations: