in_the_evidence

LF-LAM should not be used as a screening test for active TB.

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.

Except as specifically described below for people with HIV infection with low CD4 counts or
who are seriously ill, urine lateral flow (LF)-LAM should not be used for the diagnosis of TB.

ART should be started in all TB patients living with HIV regardless of CD4 count.

All individuals with active TB should receive
(i) an assessment of their nutritional status
and (ii) appropriate counselling based on their
nutritional status at diagnosis and throughout
treatment.

Partners of known HIV-positive TB patients should be offered voluntary HIV testing and counselling
with mutual disclosure.

All health workers should be given appropriate information and encouraged to undergo TB diagnostic investigation if they
have signs and symptoms suggestive of TB (see rest of recommendation p. 12 of the guideline).

For patients with confirmed MDR/RR-TB, SL-LPA may be used as the initial test, instead of phenotypic culture-based DST, to detect resistance to the SLIDs.

For patients with confirmed MDR/RR-TB, SL-LPA may be used as the initial test, instead of phenotypic culture-based DST, to detect resistance to fluoroquinolones.

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.