conditional

Triage of people with TB signs and
symptoms, or with TB disease, is
recommended to reduce M. tuberculosis
transmission to health workers, persons
attending health care facilities or other
persons in settings with a high risk
of transmission.

Xpert MTB/RIF may be used as a replacement test for usual practice (including conventional
microscopy, culture or histopathology) for testing specific non-respiratory specimens (lymph
nodes and other tissues) from patients suspected of having extrapulmonary TB.

All children living with HIV, after successful completion of treatment for TB, should receive IPT for an additional 6 months.

Adults and adolescents living with HIV who have an unknown or positive tuberculin skin test
status and among whom active TB disease has been safely ruled out should receive at least
36 months of IPT. IPT should be given to such individuals regardless of whether or not they
are receiving ART. IPT should also be given irrespective of the degree of immunosuppression,
history of previous TB treatment, and pregnancy.

LF-LAM may be used to assist in the diagnosis of active TB in adult inpatients living with
HIV, with signs and symptoms of TB (pulmonary and/or extrapulmonary), who have a CD4
cell count less than or equal to 100 cells/mm3
or people living with HIV who are seriously
ill regardless of CD4 count or with unknown CD4 count.

The following treatment administration options may be offered to patients on TB treatment:
a) Community- or home-based DOT is recommended over health facility-based DOT or
unsupervised treatment;
b) DOT administered by trained lay providers or health-care workers is recommended over DOT
administered by family members or unsupervised treatment;
c) Video-observed treatment (VOT) may replace DOT when the video communication technology is available, and it can be appropriately organized and operated by health-care providers and patients.

One or more of the following treatment adherence interventions (complementary and not
mutually exclusive) may be offered to patients on TB treatment or to health-care providers:
a) tracers and/or digital medication monitor;
b) material support to the patient;
c) psychological support to the patient;
d) staff education.

Amikacin may be included in the treatment of MDR/RR-TB patients aged 18 years or more on
longer regimens when susceptibility has been demonstrated and adequate measures to monitor
for adverse reactions can be ensured. If amikacin is not available, streptomycin may replace
amikacin under the same conditions.