Who Operational Handbook On Tuberculosis Module 1

Infection prevention and control activities are amongst the key components envisaged by the End TB Strategy to curb the tuberculosis (TB) burden worldwide. This handbook provides practical advice on how to implement the WHO recommendations on TB infection prevention and control within the clinical and programmatic management of TB, using a public health approach. The guidance emphasizes the importance of building integrated, well-coordinated, multisectoral actions across all levels of health care and other settings where there is a high risk of M. tuberculosis transmission. It shares best practices and experiences and provides checklists and job aids to support the implementation and monitoring of actions to cut transmissions, and promotes an implementation hierarchy of interventions across all settings as an integrated package. The target audience for the handbook includes policy-makers at national and subnational level; programme managers for TB, HIV and noncommunicable disease programmes; managers and clinicians at inpatient and outpatient health care facilities; managers at various congregate settings; occupational health officials; engineers; medical practitioners; frontline health care workers; and other key stakeholders in the public and private sectors.

With the availability of new emerging evidence on the treatment of drug resistant TB (DR-TB), the WHO has recently updated the DR-TB treatment guidelines by convening a guideline development group meeting in 2019 and then by releasing the WHO Consolidated Guidelines on Tuberculosis, Module 4: Treatment - Drug-Resistant Tuberculosis Treatment in June 2020. These guidelines include a comprehensive set of WHO recommendations, grouping all new and existing recommendations on the treatment and care of DR-TB in one document. The consolidated guidelines are complemented by an operational handbook which is designed to assist with implementation of the WHO recommendations by Member States, technical partners and others who are involved in the management of patients with DR-TB. The WHO Operational Handbook on Tuberculosis, Module 4: Treatment - Drug-Resistant Tuberculosis Treatment provides practical guidance on how to put in place the recommendations at the scale needed to achieve national and global impact. The strategies described in the operational handbook are based on the latest WHO recommendations which were formulated by Guideline Development Groups using the GRADE approach. In many cases however, the recommendations in their current form lacked sufficient clinical and programmatic detail, which is important for implementation. This operational handbook complements the guidelines with practical advice based on best practices and knowledge from the fields such as pharmacokinetics, pharmacodynamics, microbiology, pharmacovigilance and clinical and programmatic management.

This handbook is the companion implementation guide to the 2021 WHO consolidated guidelines on tuberculosis: Module 2: Screening. Systematic screening for tuberculosis disease. This handbook is part of a modular series of practical guides meant for the implementers of various aspects of the programmatic management TB. The operational handbook discusses six essential steps in designing and implementing a TB screening programme: assessing the situation, setting goals and specific objectives, identifying and prioritizing risk groups, choosing algorithms for screening and diagnosis, planning, budgeting and implementing, and monitoring, evaluating and modifying the programme. The handbook also contains various algorithm options for screening in different populations including: 10 possible screening algorithms for the general population and high-risk groups, 11 algorithms for adults and adolescents ≥10 years living with HIV, and 6 algorithms for children (5 for child contacts an 1 for children 10 years living with HIV). brIn addition, WHO links to 2 web-based tools to assist with planning and implementation of screening activities: 1) iScreenTBCAD for TB detection which helps countries with calibrating CAD technologies for new settings.

The aim of this operational handbook is to provide practical guidance on the implementation of the World Health Organization (WHO) policy recommendations on the prevention and management of TB in children and adolescents under programmatic circumstances and at different levels of the health system. The practical guidance aims to inform the development or revision of national policies and related implementation guidance (e.g. handbooks, standard operating procedures) on the management of TB in children and adolescents. This handbook can also help countries adequately plan for the uptake of interventions to better address the specific needs of children and adolescents with or at risk of TB. It can contribute to national efforts to build capacity among national and subnational programme managers and among health workers at all levels of the health care system. The target audience for this handbook includes NTPs and other child health programmes that provide care for children with or at risk of TB, including maternal, newborn, child and adolescent health programmes, HIV services, and PHC programmes. The handbook also targets paediatricians and other health care workers (HCWs) in the public and private sectors, school health services, civil society and community-based organizations, and health care educators.

BACKGROUND: Tuberculosis (TB) strains with drug resistance (DR-TB) are more difficult to treat than drug-susceptible ones, and threaten global progress towards the targets set by the End TB Strategy of the World Health Organization (WHO). WHO estimates that about half a million cases of multi-drug or rifampicin resistant (MDR/RR-TB) are estimated to occur each year. However, only one third were estimated to have accessed effective treatment and of those, just over half had a successful treatment outcome. Therefore, there is a pressing need for evidence-based policy recommendations on the treatment and care of patients with DR-TB, based on the most recent and comprehensive evidence available. In this regard, the WHO Consolidated Guidelines on Tuberculosis, Module 4: Treatment - Drug-Resistant Tuberculosis Treatment fulfills the mandate of WHO to inform health care professionals in Member States on how to improve treatment and care for patients with DR-TB. The 2020 recommendations on drug resistant TB treatment are contained in the second module to be released under the rubric of WHO Consolidated Guidelines on Tuberculosis (Module 4: Treatment). The WHO Consolidated Guidelines on Tuberculosis will group all TB recommendations in one document and will be complemented by matching modules of a consolidated operational handbook. The operational handbook will provide practical advice on how to put in place the recommendations at the scale needed to achieve national and global impact. OVERVIEW: Between 2011 and 2019, WHO has developed and issued evidence-based policy recommendations on the treatment and care of patients with DR-TB. These policy recommendations have been presented in several WHO documents and their associated annexes, including the WHO Consolidated Guidelines on Drug Resistant Tuberculosis Treatment, issued by WHO in March 2019. The policy recommendations in each of these guidelines have been developed by WHO-convened Guideline Development Groups, using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach to summarize the evidence, and formulate policy recommendations and accompanying remarks. The present WHO Consolidated Guidelines on Tuberculosis, Module 4: Treatment - Drug-Resistant Tuberculosis Treatment includes a comprehensive set of WHO recommendations for the treatment and care of DR-TB. The document includes two new recommendations, one on the composition of shorter regimens and one on the use of the BPaL regimen (i.e. bedaquiline, pretomanid and linezolid). In addition, the consolidated guidelines include existing recommendations on treatment regimens for isoniazid-resistant TB and MDR/RR-TB, including longer 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), the use of surgery for patients receiving MDR-TB treatment, and optimal models of patient support and care. The guidelines are to be used primarily in national TB programmes, or their equivalents in Ministries of Health, and for other policy-makers and technical organizations working on TB and infectious diseases in public and private sectors and in the community.