Feedback
In patients with presumptive or confirmed DS-TB, there are several regimens that can be used based on current WHO policy. The 6-month regimen has become the standard of care all over the world but efforts have been made to develop effective shorter regimens to treat DS-TB. Several trials were designed to assess whether a shorter treatment regimen can remain highly effective and raise no additional safety concerns.
Risk groups include groups at high risk of exposure to TB or of progression to TB disease or who have limited access to TB services. The following risk groups should always be systematically screened for TB:
The cost of screening, especially as an outreach activity, can be high. The opportunity cost must be considered and compared with other means for improving early TB detection, such as improving the patient-initiated pathway to TB diagnosis (see 2.1.1). The efficiency of a screening programme can be increased by collaboration with other health and social programmes.
The epidemiology of TB in each setting and the social and the health-system contexts will inform decisions on a TB screening strategy, including how risk groups are prioritized, which screening approach to choose and whether screening of specific risk groups is feasible. Therefore, before embarking on detailed planning, a baseline assessment of the following features should be undertaken:
Tuberculosis (TB) is a major yet preventable airborne infectious disease. About one fourth of the world’s population is infected with TB bacilli, the vast majority of whom have no disease (1, 2). In 2019, an estimated 10 million new TB cases emerged worldwide, and more than 1.4 million people died of TB, making it the leading single infectious disease cause of death that year (2). Of the estimated 10 million people who fell ill with TB in 2019, TB was not diagnosed in an estimated 2.9 million, and they were not enrolled in quality-assured TB treatment (2).
It is both important and feasible for NTPs to ascertain cure at the end of treatment. The notion of relapse-free cure or sustained treatment success after the end of treatment is critical; however, it is beyond the means of routine programmatic monitoring and is feasible only under operational research conditions (e.g. in special cohorts, in patients undergoing rehabilitation and during follow-up for post-TB lung disease).
Response to treatment in pulmonary TB patients is also monitored by bacteriological sputum smear examination and culture. For pulmonary DS-TB, the most important evidence of improvement is conversion of the sputum culture to negative. For extrapulmonary TB, sputum smears and cultures are only performed during the monitoring period if the patient develops pulmonary signs, or in the rare situation when materials valid for microbiological examinations are collected from the extrapulmonary site.
Isoniazid, rifampicin or pyrazinamide may cause hepatotoxicity. In the management of TB in patients with chronic liver disease (CLD), experts recommend monitoring aminotransferases (i.e. alanine aminotransferase [ALT] and aspartate aminotransferase [AST]) on a weekly basis initially, and fortnightly after the second month of treatment. In cases where aminotransferase are five or more times higher than the upper limit of normal (with or without symptoms), or three or more times higher in the presence of symptoms or jaundice (i.e.
mWRDs are now also recommended for screening people living with HIV. (See 3.1.4 for a full description of their use in screening). A positive mWRD screen result in a person with HIV must be followed by further diagnostic evaluation to confirm or rule out TB.
