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INDEX-TB Guidelines - Guidelines on extra-pulmonary tuberculosis for India
Indian Council of Medical Research (ICMR), Global Health Advocates, Cochrane Infectious Diseases Group
World Health Organisation (WHO)
(2016)
C1
The main objective of these guidelines is to provide guidance on up-to-date, uniform, evidence-informed practices for suspecting, diagnosing and managing various forms of extra-pulmonary tuberculosis (EPTB) at all levels of healthcare delivery. They can then contribute to the National Programme to i
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mprove detection, care and outcomes in EPTB; to help the programme with initiation of treatment, adherence and completion whilst minimizing drug toxicity and overtreatment; and contribute to practices that minimize the development of drug resistance.
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5 May 2021
This Information Note is intended to assist national TB programmes and health personnel worldwide to maintain essential tuberculosis (TB) services during the COVID-19 pandemic and in the
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recovery phase. It is important that recent progress made in TB prevention and care is not reversed by COVID-19. The WHO Global TB Programme, along with WHO regional and country offices, developed this note in response to questions received from Member States and other partners since the start of the pandemic. The note includes references to other published WHO information products relevant to TB practitioners. WHO continues to monitor the situation closely for any changes that may influence this note and will issue updates should any factors change.
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The Compendium of data and evidence-related tools for use in TB planning and programming was developed as a companion document to the People-centred framework for tuberculosis programme p
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lanning and prioritization – user guide, published by the World Health Organization (WHO) in 2019. The compendium is intended to support implementation of the people-centred framework user guide. It can also be used independently to inform decisions taken by national tuberculosis (TB) programmes about the implementation of the tools included in this document.
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The purpose of this guide is to provide updated clinical guidance on TB/HIV, with an emphasis on diagnostic aspects—including new techniques—as well as current treatment, while maintaining a pub
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lic health approach. By compiling and consolidating the latest World Health Organization recommendations on the subject into a single guide, the aim is to create a reference and consultation document that is frequently used, and that unifies and standardizes the comprehensive management of TB/HIV co-infection in healthcare facilities based on the principle of “two diseases, one patient.” It also seeks to support the updating of national standards and guidelines on co-infection and to complement the coordinated work that must exist between TB and HIV prevention and control programs at all levels, within the framework of the twelve internationally recommended TB/HIV collaborative activities.
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Social Stigma associated with COVID-19
recommended
A guide to preventing and addressing social stigma.
Social stigma in the context of health is the negative association between a person or group of people who share certain characteristics and a specific disease. In an outbreak, this may mean
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people are labelled, stereotyped, discriminated against, treated separately, and/or experience loss of status because of a perceived link with a disease.
Different Languages are available
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The guide is organized into the major types of toxicities, the associated symp-toms, possible offending medications, and the suggested nursing assessments and interventions. Some symptoms (e.g. nausea) may be associated with a num-ber of
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underlying causes and may be mild, or a symptom of a more serious medical situation requiring urgent attention. The pathophysiology for medica-tion-related fatigue and hypersalivation are unclear and these symptoms are not grouped under a specific type of toxicity. Additional information (comments) are provided for each toxicity to highlight relevant clinical information that may assist in management of side effects. Medications more strongly associated with the side effect appear in bold text. The appendices include tools nurses can use to more thoroughly assess patient complaints of pain, depression and neuropathy.
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In the context of the coronavirus disease (COVID-19) pandemic response, WHO identifies young people as a priority target audience with specific concerns, experiences and behaviours. This policy brie
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f provides relevant insights from behavioural evidence and a set of behavioural considerations for those promoting COVID-19 preventive behaviours among young people. Designers of programmes and initiatives targeting youth may find it helpful to refer to the youth-specific barriers and drivers identified in this policy brief and to prioritize these for testing when planning initiatives targeted at young people.
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The National Tuberculosis Programme (NTP) of Rwanda (known as TB & ORD Division/IHDPC/RBC) is preparing to write their next National Strategic Plan and for this reason Rwanda was selected as a country to received technical assistance (TA) to conduct
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an assessment of their surveillance system using the surveillance checklist as input for the new strategy. This TA was provided under the USAID TBCARE I Core project on Monitoring and Evaluation, Operational Research and Surveillance (C7.08) developed a surveillance checklist with the objectives to assess a national surveillance system’s ability to accurately measure TB cases and deaths and to identify gaps in national surveillance systems that need to be addressed in order to improve TB surveillance.
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In 2016 CRS leveraged the robust infrastructure of its large, multi-sectoral orphans and vulnerable children (OVC) program in Nigeria by expanding the program's core mandate to include community childhood TB casefinding,
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with a focus on highly vulnerable children and their caregivers
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The outbreak of COVID-19 comes with unpredictable primary and secondary impacts on vulnerable and food-insecure populations across the world. Mortality and morbidity appear to be most acute for elderly
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people, and those with underlying health conditions. At the same time, the widely anticipated economic downturn could have a more devastating effect on the world’s poor than the virus itself
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The guide presents a structured framework covering assessment and planning, service delivery models, integration with broader health and social services, monitoring, and sustainability. It emphasizes community leadership, human rights, equitable acc
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ess and adaptation to local contexts, including closed settings. Practical tools are included to support implementation and accelerate progress towards global targets for controlling HIV and eliminating viral hepatitis epidemics.
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Following review of the latest evidence, WHO recommends that TB-LAMP can be used as a replacement for microscopy for the diagnosis of pulmonary TB in adults
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with signs and symptoms of TB. It can also be considered as a follow-on test to microscopy in adults with signs and symptoms of pulmonary TB, especially when further testing of sputum smear-negative specimens is necessary.
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The target audience for this training course is non-clinicians such as Home Based Carers, Community Caregivers, Youth Care Workers, Peer educators, Community Health Workers etc. primarily those who will be providing adherence counselling to clients with
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HIV, TB, Hypertension and Diabetes. This group of non-clinicians play a vital role in helping to reduce the workload of nursing staff. Amongst others, non- clinicians educate clients and provide emotional support in a manner that makes each client feel like they are receiving focused, individual attention. Non-clinicians are often in close contact with communities and, therefore, able to understand and play a role in alleviating health service barriers in the community.
Facility managers may also be part of the target audience in order to ensure that they understand the components of the minimum package of interventions to support linkage, adherence and retention in care.
Further, their attendance seeks to ensure that non-clinicians receive necessary assistance and support when they have to implement what they have learned back into their workplaces.
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The global burden of disease due to mental disorders continues to rise, especially in low- and middle-income countries (LMIC). In addition to causing a large proportion of morbidity, mental disorders – especially severe mental disorders (SMD) – are linked
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with poorer health outcomes and increased mortality. SMD are defined as a group of conditions that include moderate to severe depression, bipolar disorder, and schizophrenia and other psychotic disorders. People with SMD have a two to three times higher average mortality compared to the general population, which translates to a 10-20 year reduction in life expectancy. While people with SMD do have higher rates of death due to unnatural causes (accidents, homicide, or suicide) than the general population, the
majority of deaths amongst people with SMD are attributable to physical health conditions, both
non-communicable and communicable.
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In 2022, WHO published the Consolidated guidelines on HIV, viral hepatitis and STI prevention, diagnosis, treatment and care for key populations. These guidelines outline a public health response to HIV, viral hepatitis and sexually transmitted infections (STIs) for 5 key populations (men who have s
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ex with men, sex workers, people in prisons and other closed settings, people who inject drugs and trans and gender diverse people).
In this policy brief, we give an update on those parts of the guidelines related to hepatitis C diagnosis and treatment for key populations.
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Tropical Medicine and Infectious Disease 2017, 2(4), 50
This is a cross-sectional analysis of baseline data in a longitudinal study on asymptomatic, LF antigen-positive and -negative young people in Myanmar. Rapid field screening was used to id ... entify antigen-positive cases and a group of antigen-negative controls of similar age and gender were invited to continue in the study. ... Results demonstrate that sub-clinical changes associated with infection can be detected in asymptomatic cases. Further exploration of these low-cost devices in clinical and research settings on filariasis-related lymphedema are warranted.
https://doi.org/10.3390/tropicalmed2040050 more
This is a cross-sectional analysis of baseline data in a longitudinal study on asymptomatic, LF antigen-positive and -negative young people in Myanmar. Rapid field screening was used to id ... entify antigen-positive cases and a group of antigen-negative controls of similar age and gender were invited to continue in the study. ... Results demonstrate that sub-clinical changes associated with infection can be detected in asymptomatic cases. Further exploration of these low-cost devices in clinical and research settings on filariasis-related lymphedema are warranted.
https://doi.org/10.3390/tropicalmed2040050 more
The manual is written for clinicians working at the district hospital (first-level referral care) who diagnose and manage sick adolescents and adults in resource constrained settings. It aims to support clinical reasoning, and to provide an effective clinical approach and protocols for the managemen
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t of common and serious or potentially life-threatening conditions at district hospitals. The target audience thus includes doctors, clinical officers, health officers, and senior nurse practitioners. It has been designed to be applicable in both high and low HIV prevalence settings.
Volume 2 provides a symptom-based approach to clinical care for acute and subacute conditions (including mental health). It provides short summaries of the management of diseases that affect multiple systems of the body, focusing on communicable diseases. It also includes the chronic or long-term management of HIV, TB, alcohol, and substance use disorders.
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The WHO Global strategy on human resources for health: workforce 2030 encourages development partners and global health initiatives to leverage their support to health systems in countries to sustainably strengthen the health workforce. To assess the impact of these investments, a methodology was de
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veloped and pilot tested by WHO.
The impact assessment tool (consisting of an MS Excel calculator with two subsets) supports users to:
• assess and quantify the health impact of HRH investments made in the context of HIV, tuberculosis (TB) and malaria programmes through their modelled effect on health service coverage of these three diseases; and
• provide aggregate indicative estimates of the range of health workers required to attain high coverage of selected health services.
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The present Consolidated guidelines include a comprehensive set of WHO recommendations for the treatment and care of DR-TB, derived from these WHO guidelines documents. The consolidated guidelines include policy recommendations on treatment regimens
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for isoniazid-resistant TB (Hr-TB) and MDR/RR-TB, including longer and shorter regimens, culture monitoring of patients on treatment, the timing of antiretroviral therapy (ART) in MDR/RR-TB patients infected with the human immunodeficiency virus (HIV), use of surgery for patients receiving MDR-TB treatment, and optimal models of patient support and care.
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