in_the_evidence

In previously treated patients, if the specimen obtained at the end of the intensive phase (month 3) is smear-positive, sputum culture and drug susceptibility
testing (DST) should be performed.

In new patients, if the specimen obtained at the end of month 3 is smear-positive,
sputum culture and drug susceptibility testing (DST) should be performed.

In new patients, if the specimen obtained at the end of the intensive phase
(month 2) is smear-positive, sputum smear microscopy should be obtained at
the end of the third month.

For smear-positive pulmonary TB patients treated with first-line drugs, sputum
smear microscopy may be performed at completion of the intensive phase of
treatment.

It is recommended that TB patients who are living with HIV should receive at least
the same duration of TB treatment as HIV-negative TB patients.

If a daily continuation phase is not possible for these patients, three times
weekly dosing during the continuation phase is an acceptable alternative.

New patients with pulmonary TB should receive a regimen containing 6 months
of rifampicin: 2HRZE/4HR.

Priority should be given to achieving adequate ACH using ventilation systems. However, in some settings it is not possible
to achieve adequate ventilation; for example, because of climatic changes (e.g. in winter or during the night) or building
structure, or because transmission of TB would pose a high risk of morbidity and mortality (e.g. in MDR-TB wards). In such
cases, a complementary option is to use upper room or shielded ultraviolet germicidal irradiation (UVGI) devices. This environmental control does not provide fresh air or directional airflow.

Well-designed, maintained and operated fans (mixed-mode ventilation) can help to obtain adequate dilution when natural
ventilation alone cannot provide sufficient ventilation rates.
In some settings, mechanical ventilation (with or without climate control) will be needed. This may be the case, for example,
where natural or mixed-mode ventilation systems cannot be implemented effectively, or where such systems are inadequate given local conditions (e.g. building structure, climate, regulations, culture, cost and outdoor air quality).

In existing healthcare facilities that have natural ventilation, when possible, effective ventilation should be achieved by
proper operation and maintenance on a regular schedule. Simple natural ventilation may be optimized by maximizing the
size of the opening of windows and locating them on opposing walls.