in_the_evidence

• A triage system should be in place to identify people suspected of having TB and minimize
diagnostic delays with rapid diagnostics e.g. Xpert MTB/RIF.
• Separate people with suspected or confirmed TB
• Ensure cough etiquette and respiratory hygiene
• Minimize the time spent in health-care facilities (e.g. through community-based approaches).

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

TB treatment should be initiated first, followed by ART as soon as possible within the first 8
weeks of treatment.

In children living with HIV who are less than 12 months of age, only those who have contact
with a TB case and who are evaluated for TB (using investigations) should receive 6 months of
IPT if the evaluation shows no TB disease.

Children living with HIV who are more than 12 months of age and who are unlikely to have
active TB on symptom-based screening and have no contact with a TB case should receive 6
months of IPT (10 mg/kg/day) as part of a comprehensive package of HIV prevention and care.

Children living with HIV who do not have poor weight gain, fever or current cough are unlikely
to have active TB. Children living with HIV who have poor weight gain, fever or current cough
or contact history with a TB case may have TB and should be evaluated for TB and other
conditions. If the evaluation shows no TB, they should be offered IPT preventive therapy
regardless of their age.

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.

Adults and adolescents living with HIV who have an unknown or positive tuberculin skin test
(TST) status and are unlikely to have active TB should receive at least 6 months of IPT as part
of a comprehensive package of HIV care. IPT should be given to such individuals regardless of
the degree of immunosuppression and also to those on ART, those who have previously been
treated for TB and pregnant women.

Adults and adolescents living with HIV should be screened with a clinical algorithm; those who
do not report any one of the symptoms of current cough, fever, weight loss or night sweats
are unlikely to have active TB and should be offered IPT.

TB patients with known positive HIV status and TB patients living in HIV-prevalent settings
should receive at least 6 months of a rifampicin-containing treatment regimen. The
optimal dosing frequency is daily during the intensive and continuation phases.