NATIONAL TUBERCULOSIS CONTROL PROGRAM MANUAL …

1 NATIONAL TUBERCULOSIS CONTROL PROGRAMMANUAL OF PROCEDURES 6th editionNational TUBERCULOSIS CONTROL PROGRAM MANUAL of Procedures 6th editionCopyright 2020 Department of HealthAll Rights Printing, 2020 The mention (if any) of specific companies or of certain manufacturer s products does not imply that they are endorsed or recommended by the DOH in preference over others of a similar nature. Articles may be reproduced in full or in part for non-profit purposes without prior permission, provided credit is given to the Department of design and layout by Verzoliv Design HEALTHREPUBLIC PHILIPPINESOF THEOF**FLOREAT SALUBRITAS POPULID epartment of HealthSan Lazaro Compound, Rizal AvenueSta.

2 Cruz, Manila, 1003 PhilippinesTelephone No: (+632) 743-8301 to 23 Website: acknowledges the contribution of the following partners in the development of this publication: The Global Fund to Fight AIDS, TUBERCULOSIS and Malaria through the Philippine Business for Social Progress, United States Agency for International Development and its Implementing Partners, World Health Organization, Philippine Coalition Against TUBERCULOSIS , professional societies, other government agencies, local government units, and patient OF CONTENTSList of Tables, Figures and Annexes viAbbreviations ixForeword xiiPreface xiiiCHAPTER 1.

3 PATIENT-CENTERED TUBERCULOSIS CARE 1 INTRODUCTION 2 OBJECTIVE 2 DEFINITION OF TERMS 2 POLICIES 3 PROCEDURES 3A. Respecting patient autonomy and supporting self-efficacy 3B. Maximize physical comfort, safety and wellness 3C. Provide psycho-emotional support and protection from social isolation and discrimination 4D. Financial assistance to DS-TB and DR-TB patients to support diagnosis and treatment adherence 5 CHAPTER 2.

4 SCREENING AND DIAGNOSIS OF TUBERCULOSIS 7 INTRODUCTION 8 OBJECTIVE 8 Section Systematic screening 9 DEFINITION OF TERMS 9 POLICIES 10 PROCEDURES 10A. Systemic screening in health facilities (intensified case finding) 10B. Active case finding in targeted community, workplace and congregate settings 13C. Screening among health-care workers 15D. Contact tracing 16ivNATIONAL TUBERCULOSIS CONTROL PROGRAM : MANUAL OF PROCEDURES 6TH EDITION Section Diagnosis of TUBERCULOSIS disease 18 DEFINITION OF TERMS 18 POLICIES 19 PROCEDURES 20A.

5 Collection and transport of sputum specimens 20B. Procedure for Xpert MTB/RIF 22C. Procedure for smear microscopy 22D. Decision on diagnosis based on laboratory results 23E. Decision on further testing based on result of Xpert MTB/RIF 26 CHAPTER 3. TREATMENT OF TUBERCULOSIS 31 INTRODUCTION 32 OBJECTIVES 32 DEFINITION OF TERMS 32 Section Treatment of drug-susceptible TUBERCULOSIS 34 POLICIES 34 PROCEDURES 34A.

6 Initiation of treatment 34B. Approach to TB patients initiated treatment by a provider outside a DOTS facility 38C. TB treatment in HIV co-infection 38D. Monitoring treatment 39E. Management of patients who interrupted treatment 41F. Assigning treatment outcome 42 Section Treatment of drug-resistant TUBERCULOSIS 43 POLICIES 43 PROCEDURES 44A.

7 Education, counselling and support to patients and family members prior to treatment 44B. Pretreatment evaluation 44C. Assigning the appropriate DR-TB treatment regimen 45D. MDR-TB and RR-TB treatment in HIV co-infected 50E. MDR-TB and RR-TB treatment in children 54F. Initiation of treatment 55G. Monitoring treatment 55vCHAPTER 4. TUBERCULOSIS PREVENTIVE TREATMENTH. Active drug safety monitoring and management (aDSM) 59I. Modification of treatment regimen 60J. Assigning treatment outcome 61K. Post treatment follow-up 62 CHAPTER 4. TUBERCULOSIS PREVENTIVE TREATMENT 65 INTRODUCTION 66 OBJECTIVE 66 DEFINITION OF TERMS 66 POLICIES 67 PROCEDURES 67A.

8 Identification of individuals eligible for TB preventive treatment 67B. Excluding active TB prior to initiation of TPT 69C. Initiation of treatment 71D. Treatment considerations in special population 74E. Monitoring treatment 75F. Assigning treatment outcome 77 CHAPTER 5. RECORDING AND REPORTING 79 INTRODUCTION 80 OBJECTIVES 80 DEFINITION OF TERMS 80 POLICIES 80 PROCEDURES 81A.

9 Setting-up TB recording and reporting system 81B. Recording 82C. Records and data management 83D. Use of ITIS 84E. Reporting 85F. Data sharing 86G. NTP Forms 86 ANNEXES 89viNATIONAL TUBERCULOSIS CONTROL PROGRAM : MANUAL OF PROCEDURES 6TH EDITION LIST OF FIGURESFig. 1. Systematic screening for pulmonary PTB in adults 15 years old with unknown HIV infection status in health facilities 12 Fig. 2. Systematic screening for the diagnosis of active PTB disease in PLHIV 12 Fig. 3. Screening for PTB in targeted community, workplace and congregate settings 15 Fig.

10 4. Screening among health-care workers 16 Fig. 5. Approach to diagnosis of TB in children (< 15 years old) 24 Fig. 6. Chest X-ray findings strongly suggestive of PTB in children and adolescents 25 Fig. 7. Diagnosis and clinical application of Xpert/MTB RIF 27 Fig. 8. Assignment of DR-TB treatment regimens and revision of the regimen upon receipt of LPA and phenotypic DST results 49 Fig. 9. LTBI algorithm in adults and children with HIV 5 years old 69 Fig. 10. LTBI algorithm in children with HIV aged 1 4 years 70 Fig. 11. LTBI algorithm in HIV-negative child contacts < 5 years old 70 Fig. 12. LTBI algorithm in HIV-negative at-risk individuals 5 years old 71 LIST OF TABLES, FIGURES AND ANNEXESLIST OF TABLEST able 1.