WHO policy on collaborative TB/HIV activities : guidelines for national programmes and other stakeholders

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Recommendations

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WHO policy on collaborative TB/HIV activities : guidelines for national programmes and other stakeholders

Recommendations

Routine HIV testing should be offered to all people with presumptive and diagnosed TB

Adults and adolescents living with HIV should be screened with a clinical algorithm; those who do not report any one of the symptoms of current cough, fever, weight loss or night sweats are unlikely to have active TB and should be offered isoniazid preventive therapy (IPT)

TB patients with known positive HIV status and TB patients living in HIV-prevalent settings should receive at least 6 months of a rifampicin-containing treatment regimen. The optimal dosing frequency is daily during the intensive and continuation phases

Children living with HIV who are more than 12 months of age and who are unlikely to have active TB on symptom-based screening and have no contact with a TB case should receive 6 months of isoniazid preventive therapy (IPT) (10 mg/kg/day) as part of a comprehensive package of HIV prevention and care

In children living with HIV who are less than 12 months of age, only those who have contact with a TB case and who are evaluated for TB (using investigations) should receive 6 months of isoniazid preventive therapy (IPT) if the evaluation shows no TB disease

All children living with HIV, after successful completion of treatment for TB, should receive isoniazid preventive therapy (IPT) for an additional 6 months

Tuberculin skin test (TST) is not a requirement for initiating isoniazid preventive therapy (IPT) in people living with HIV.

People living with HIV who have a positive tuberculin skin test (TST) benefit more from isoniazid preventive therapy (IPT); TST can be used where feasible to identify such individuals.

Providing isoniazid preventive therapy (IPT) to people living with HIV does not increase the risk of developing isoniazid (INH)-resistant TB. Therefore, concerns regarding the development of INH resistance should not be a barrier to providing IPT.

Children living with HIV who do not have poor weight gain, fever or current cough are unlikely to have active TB.

Adults and adolescents living with HIV and screened with a clinical algorithm for TB, and who report any one of the symptoms of current cough, fever, weight loss or night sweats may have active TB and should be evaluated for TB and other diseases.

All people living with HIV with CD4 counts of ≤350 cells/mm3 irrespective of the WHO clinical stage should start ART

Routine HIV testing should be offered to all people with presumptive and diagnosed TB

Routine co-trimoxazole prophylaxis should be administered to all HIV-infected people with active TB disease regardless of CD4 cell counts.

TB treatment should be initiated first, followed by ART as soon as possible within the first 8 weeks of treatment

ART should be started in any child with active TB disease as soon as possible and within 8 weeks following the initiation of antituberculosis treatment regardless of the CD4 cell count and clinical stage

Efavirenz should be used as the preferred non-nucleoside reverse transcriptase inhibitor in patients starting ART while on antituberculosis treatment

TB patients with known positive HIV status and TB patients living in HIV-prevalent settings should receive at least 6 months of rifampicin treatment regimen (strong recommendation, high quality of evidence). The optimal dosing frequency is daily during the intensive and continuation phases

It is recommended that TB patients who are living with HIV should receive at least the same duration of TB treatment as HIV-negative TB patients