positive

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.

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.

Xpert MTB/RIF should be used rather than conventional microscopy, culture and drug
susceptibility testing (DST) as the initial diagnostic test in adults and children suspected of
having HIV-associated TB or multidrug resistant TB.

The following options are recommended for the treatment of LTBI regardless of HIV status:
6 or 9 months of daily isoniazid, or a 3-month regimen of weekly rifapentine plus isoniazid,
or a 3-month regimen of daily isoniazid plus rifampicin.