Guideline

WHO consolidated guidelines on tuberculosis: module 1: prevention: tuberculosis preventive treatment, 2nd ed

Year of Publication

2024

Issuing Institution

World Health Organization

Links

WHO IRIS

Recommendations

21 included recommendations

Adults and adolescents living with HIV who are unlikely to have TB disease on an appropriate clinical evaluation or according to national guidelines should receive TB preventive treatment as part of a comprehensive package of HIV care. Treatment should also be given to those on antiretroviral treatment, to pregnant women and to those who have previously been treated for TB, irrespective of the degree of immunosuppression and even if testing for TB infection is unavailable

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

High

Infants aged < 12 months living with HIV who are in contact with a person with TB and who are unlikely to have TB disease on an appropriate clinical evaluation or according to national guidelines should receive TB preventive treatment.

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

Children aged ≥ 12 months living with HIV who are considered unlikely to have TB disease on an appropriate clinical evaluation or according to national guidelines should be offered TB preventive treatment as part of a comprehensive package of HIV prevention and care if they live in a setting with high TB transmission, regardless of contact with TB

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low

All children living with HIV who have successfully completed treatment for TB disease may receive TB preventive treatment.

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Low

Children aged < 5 years who are household contacts of people with bacteriologically confirmed pulmonary TB and who are found not to have TB disease on an appropriate clinical evaluation or according to national guidelines should be given TB preventive treatment even if testing for TB infection is unavailable

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

High

Children aged ≥ 5 years, adolescents and adults who are household contacts of people with bacteriologically confirmed pulmonary TB who are found not to have TB disease on an appropriate clinical evaluation or according to national guidelines may be given TB preventive treatment.

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Low

People who are initiating anti-tumour-necrosis factor treatment, or receiving dialysis, preparing for an organ or haematological transplant or have silicosis should be systematically tested and treated for TB infection.

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Very low

Systematic testing and treatment for TB infection may be considered for prisoners, health workers, immigrants from countries with a higher TB burden, homeless people and people who use drugs

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

Adults and adolescents living with HIV should be screened for TB according to a clinical algorithm. Those who do not report any of the symptoms of current cough, fever, weight loss or night sweats are unlikely to have TB disease. Those who report any of these symptoms may have TB, should be evaluated for TB disease and other diseases and should be offered TB preventive treatment if TB disease is excluded, regardless of their antiretroviral treatment status

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

Among adults and adolescents living with HIV, chest X-ray may be used to screen for TB disease

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Moderate

Among adults and adolescents living with HIV, C-reactive protein with a cut-off of > 5 mg/L may be used to screen for TB disease

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Low

Among adults and adolescents living with HIV, molecular WHO-recommended rapid diagnostic tests may be used to screen for TB disease

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Moderate

Infants and children living with HIV who have poor weight gain, fever or current cough or who have a history of contact with a person with TB should be evaluated for TB and other diseases that cause such symptoms. If TB disease is excluded after an appropriate clinical evaluation or according to national guidelines, these children should be offered TB preventive treatment, regardless of their age

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low

Among HIV-negative household contacts aged ≥ 5 years and other risk groups, the absence of any symptoms of TB and the absence of abnormal chest radiographic findings may be used to rule out TB disease before TB preventive treatment

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

Among individuals aged 15 years and older in populations in which TB screening is recommended, systematic screening for TB disease may be conducted using a symptom screen, chest X-ray or molecular WHO-recommended rapid diagnostic tests, alone or in combination

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

Among individuals younger than 15 years who are close contacts of someone with TB, systematic screening for TB disease should be conducted using a symptom screen including any one of cough, fever or poor weight gain; or chest radiography; or both

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

Either a tuberculin skin test (TST) or interferon-γ release assay (IGRA) can be used to test for TB infection.

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Very low

Mycobacterium tuberculosis antigen-based skin tests (TBSTs) may be used to test for TB infection.

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

The following TB preventive treatment options are recommended 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

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

The following alternative TB preventive treatment options may be used regardless of HIV status: a 1-month regimen of daily rifapentine plus isoniazid or 4 months of daily rifampicin.

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Low

In contacts exposed to multidrug- or rifampicin-resistant tuberculosis, 6 months of daily levofloxacin should be used as TB preventive treatment

Status

Updated

Recommended in favor

Strong

Certainty of evidence

Moderate