Transcription of National Tuberculosis Management Guidelines
1 National Tuberculosis Management GuidelinesGovernment of Nepal Ministry of Health and Population Department of Health Services National Tuberculosis Centre Thimi, BhaktapurENDTB2019iiNATIONAL Tuberculosis Management Guidelines 2019 TABLE OF CONTENTS 1. INTRODUCTION AND INFORMATION ON THE National TB PROGRAM 12. BACKGROUND ON Tuberculosis BURDEN 93. GENERAL INFORMATION ABOUT Tuberculosis 114. Tuberculosis CLASSIFICATION AND DEFINITIONS 155. Tuberculosis CASE DETECTION AND DIAGNOSIS 186. TREATMENT OF Tuberculosis 337. DIAGNOSIS AND TREATMENT OF Tuberculosis IN CHILDREN 528. drug resistant /MDR TB Management 759. TB INFECTION CONTROL 7810.
2 Tuberculosis AND HIV 8311. Tuberculosis AND TOBACCO 8912. Tuberculosis AND DIABETES 9513. Management ASPECTS OF TB CONTROL PROGRAM 9914 MONITORING AND EVALUATION FOR TB CONTROL PROGRAM 101 ANNEXURESA nnex 1a: Procedure for obtaining clinical samples for bacteriological examination 108 Annex 1b: Job Aid for gastric aspiration 112 Annex 2: Recommended treatment regimens and dosages use of fixed dosed combined (FDC) drugs 113 Annex 3a: Guidance for dosing of INH preventive therapy 114 Annex 3b: Recommended Anti -TB drug dosages 114 Annex 4: Flow chart for Management of bacteriologically confirmed cases 115 Annex 5: Triple-layer packaging 116 Annex 6.
3 Recording and reporting forms 117ivNATIONAL Tuberculosis Management Guidelines 2019viNATIONAL Tuberculosis Management Guidelines 2019viiNATIONAL Tuberculosis Management Guidelines 2019 ACKNOWLEDGEMENTThe National TB Centre director (Dr. Sagar Rajbhandari) expresses my sincere gratitude to all the authors and reviewers of this guideline particularly to the World Health Organization and all the others who contributed in coming up with this comprehensive National Tuberculosis (TB) Management Guideline 20191. Dr. Bhim Singh Tinkari, Previous NTC Director2. Dr. Ashesh Dhungana, Chief Consultant Chest Physician, NTC3.
4 Dr. Sharad Kumar Sharma, Chief SMEAR section, NTC4. Mr. Anil Thapa, Previous Chief SMEAR section, NTC 5. Dr. Naveen Prakash Shah, Consultant Chest Physician, NTC6. Mr. Gokarna Raj Ghimire, Laboratory In-charge, NTC7. Mr. Pushpa Raj Joshi, Statistical officer, NTC8. Ms. Basundhara Sharma, Senior Public Health Officer, NTC9. Ms. Meera Hada, Medical Technologist, NTC10. Prof. Dr. Brajendra Srivastav, NAINS College of Medicine11. Dr. Suvesh Kumar Shrestha, Technical Specialist-TB, SCI12. Dr. Ashish Shrestha, National Consultant-TB, WHO13. Dr. Pramod Raj Bhattarai, Damien Foundation14. Dr. Bhawana Shrestha, Project Manager, NATA/GENETUP15.
5 Dr. Praveen Sanker, Laboratory Consultant, SCI-FIND16. Mr. Rajendra Basnet, SCI/NTC17. Mr. Ratna Bahadur Bhattarai, Monitoring and Evaluation Specialist- SCI/NTC18. Mr. Gokul Mishra, Liaison Officer, NTC/LSTM19. Mr. Bhagawan Maharjan, Microbiologist, GENETUP20. Mr. Nilaramba Adhikari, SCI/NTC21. Mr. Lok Raj Joshi, SCI/NTC22. Mr. Naval Kishor Shrestha, SCI/NTC23. Mr. Chitra Jung Shahi, DTLO, NTC24. Mr. Krishna Adhikari, Lab Technician Officer, NTC25. Ms. Kamala Devi Wagle, Public Health Nurse Officer, NTC26. Ms. Tara Sharma, NTC27. Ms. Anju Basnet, NTC28. Mr. Gopi Prasad Rupakheti, Kharidar/Supervisor, NTC29. Dr. Lungten Z.
6 Wangchuk, Scientist, Team -Lead, CDS, WHO, NepalviiiNATIONAL Tuberculosis Management Guidelines 2019ixNATIONAL Tuberculosis Management Guidelines 2019 ABBREVIATIONSAFB Acid-Fast BacillusAM AmikacinAIDS Acquired Immuno-Deficiency SyndromeART Anti-Retroviral TherapyBCG Bacillus Calmette-Guerin (vaccine)BMU Basic Management UnitBMI Body Mass IndexCat Treatment CategoryCNS Central Nervous SystemCPT Cotrimoxazole Preventive Therapy CSS Community System StrengtheningCFR Case Fatality RateCNR Case Notification RateCM CentimetreCXR Chest X-rayCSF Cerebrospinal FluidCM Capreomycin DC Disease ControlDOT Directly Observed TreatmentDOTS Directly Observed Treatment, Short Course, (TB Strategy)DRTB drug resistant TuberculosisDPT Diphtheria Preventative Therapy (DPT)
7 DST drug Susceptible TestDRS drug resistant SurveyE EthambutolEQA External Quality Assurance Eto Ethionamide EPTB (EP) Extra-pulmonary Tuberculosis EFV EfavirenzFDC Fixed Dose Combination FEFO First expiring, first outFoDST Fluoroquinolone drug Susceptible TuberculosisFNA Fine Needle AspirationFNAB Fine Needle Aspiration BiopsyFNAC Fine Needle Aspiration CytologyGA Gastric Aspirate H IsoniazidHC Health CentreHEO Health Extension OfficerHIV Human Immunodeficiency VirusHPF High Power Field ( 100x10 magnification)
8 HMIS Health Management Information SystemHSC Health Sub-CentreHRZE Isoniazid, Rifampicin, Pyrazinamide, EthambutolxNATIONAL Tuberculosis Management Guidelines 2019HR Isoniazid, RifampicinHRZELfx Isoniazid, Rifampicin, Pyrazinamide, Ethambutol, LevofloxacinH&Fq Isoniazid, Fluoroquinolone HCW Health Care WorkerINH IsoniazidIPT Isoniazid Preventive TherapyIDP Internally Displaced PeopleKM Kanamycin LPV/r Lopinavir RitonavirLIP Lymphocytic Interstitial PneumoniaLJ Lowenstein-Jensen MDR Multi- drug ResistantM & E Monitoring and EvaluationMTB Multi drug resistant TuberculosisMTB/RIF Multi drug resistant TB/Rifampicin ResistantMAM Moderate Acute MalnutritionMUAC Mid Upper Arm Circumference mg MilligramNTC National Tuberculosis ProgrammeNTP
9 National Tuberculosis ProgrammeNVP Nevirapine NRL National Reference Laboratory NG Nasogastric TubeOfx OfloxacinPMDT programmatic Management of drug resistant TuberculosisPICT Provider Initiated Counselling and TestingPTB Pulmonary TuberculosisPBC TB Pulmonary Bacteriological Confirmed TuberculosisPYZ PyrazinamidePLHIV People Living with HIVPAS Para Amino Salicylic AcidQMRL Quality Management in Reference LaboratoryR/RIF RifampicinRR/MDR Rifampicin resistant / Multi drug ResistantSDG Sustainable Development GoalSAM Severe Acute MalnutritionSL-LPA Second Line- Line Probe Assay SLD Second Line DrugSS-ve Sputum Smear NegativeSS+ve Sputum Smear PositiveSOP Standard Operation ProcedureTB TuberculosisTB/HIV Tuberculosis /Human Immune Virus TBM Tuberculosis MeningitisTWG Technical Working GroupUVGI Ultraviolet Germicidal IrradiationVCT Voluntary Counselling and Testing (for HIV/AIDS)
10 WHO World Health OrganizationW/A Weight for AgeXDRTB Extremely drug resistant Tuberculosis Z PyrazinamideINTRODUCTION AND INFORMATION ON THE National TB INTRODUCTIONThis guideline is to provide basic information about TB and its Management to all health workers in Nepal. Early detection, appropriate diagnosis and timely treatment of TB result in good treatment outcomes. Health workers need to be equipped with the right information on the diagnosis and treatment of TB. Poor Management of TB results in death and creates drug resistant (DR) TB which is very hard and costly to treat resulting in often poorer health workers in Nepal regardless of their involvement in TB services should be aware of TB, its transmission and prevention and its diagnosis and Management .
