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Table Of Contents

ACKNOWLEDGEMENTS
1 Introduction
1.3 Challenges to TB control
2 The National Tuberculosis Programme
2.1 Mission, strategic objectives and targets for TB control
2.2 The structure of The National TB Programme
2.2.1 Core activities at the national level
2.2.2 Core activities at the provincial level
2.2.3 Core activities at the district level
2.2.4 Core activities at the PHC facility level
2.2.5 Core activities at the community level
Transmission and Pathogenesis of TB
3.1 Transmission of tuberculosis
3.2 Pathogenesis of tuberculosis
3.3 Primary infection
3.4 Post-primary TB / Secondary TB
4 Diagnosis of TB
4.1 Symptoms and signs of TB
4.2 How is the diagnosis of tuberculosis confirmed?
4.2.1 Smear and culture evaluation of a TB suspect pre-treatment
4.2.2 Sputum smears
4.2.3 Sputum culture and drug susceptibility testing
4.2.4 Chest x-rays
4.2.5 Tuberculin skin test
4.3 The seriously ill TB-suspect
4.4 Algorithm for TB diagnosis in a new case
4.5 Algorithm for TB diagnosis in high risk TB suspects and re- treatment cases
5 TB Case Definitions
5.1 Why case definitions?
5.2 Why match treatment to standardised category?
5.3 What determines case definitions?
5.3.1 Site of TB disease - pulmonary or extra-pulmonary
5.3.2 Bacteriology - sputum smear and culture result
5.3.3 Severity of disease
5.3.4 History of previous treatment
5.4 Recording treatment outcomes with smear-positive TB
6 Extra-Pulmonary Tuberculosis
6.1 TB meningitis
6.1.1 Clinical presentation and management
6.2 Disseminated / miliary TB
6.2.1 Clinical features
6.2.2 Diagnosis
6.3 Tuberculous lymphadenopathy
6.3.1 Clinical features
6.3.2 Diagnosis
6.4 Tuberculous serous effusions
6.4.1 Tuberculous pleural effusion
6.4.2 Tuberculous pericardial effusion
6.4.3 Peritoneal Tuberculosis
6.4.3.1 Clinical features
6.5 Tuberculous empyema
6.6 Tuberculosis of the spine
6.6.1 Clinical features
6.6.2 Diagnosis
7 Principles of TB Treatment
7.1 The essential TB drugs
7.2 Fixed dose combination tablets
7.3 Standard treatment regimens for adults (8 years and older)
7.3.1 New Cases
7.3.2 Retreatment cases
7.4 Standard treatment regimen dosages
7.5 Side-effects of TB drugs and their management
7.5.1 Isoniazid (H)
7.5.2 Rifampicin (R)
7.5.3 Streptomycin (S)
7.5.4 Ethambutol (E)
7.5.5 Pyrazinamide (Z)
7.5.6 Pyridoxine
7.6 Symptom-based approach to the management of side-effects
8 Monitoring the Response to Treatment
8.1 Monitoring the response of new cases
8.1.1 New smear-positive cases
8.1.2 New smear-negative, culture-positive cases
8.2 Monitoring the response of retreatment cases
8.2.1 Retreatment smear-positive cases
8.2.2 Retreatment smear-negative, culture-positive cases
8.3 Monitoring the response of EPTB and smear-negative, culture-negative cases
8.4 Monitoring algorithm for new PTB adults
8.5 Monitoring algorithm for retreatment PTB adults
9 Adherence to Treatment
9.1 Adherence
9.2 What is directly observed treatment (DOT)?
9.3 Applying DOT to fit clients' needs
9.3.1 Clinic DOT
9.3.2 Workplace DOT
9.3.3 Community DOT
9.3.4 The role of family / friends
9.4 Strategies for good adherence
9.4.1 Education and adherence counselling
9.5.2 Managing treatment interruption
10 Treatment Regimens in Special Circumstances
10.1 Pregnant women
10.2 Breastfeeding women
10.3 Women using contraceptives
10.4 Liver disorders
10.5 Established chronic liver disease
10.6 Acute hepatitis
10.7 Renal failure
11 TB in Children
11.1 Tuberculous infection
11.1.1 Diagnosis of tuberculous infection
11.1.2 Contact screening
11.1.3 Management of children with tuberculous infection
11.1.4 Algorithm for screening a child with documented TB exposure
11.1.5 A baby born to a mother with tuberculosis
11.2 TB disease
11.3 Clinical presentation of TB
11.4 Diagnosis of TB
11.4.1 Chest x-rays
11.4.2 Smear and culture
11.4.3 Diagnosis of extra-pulmonary TB
11.4.4 Diagnosis of lymph node TB
11.4.5 Diagnosis of TB meningitis
11.5 Management of a child with TB
11.5.1 Directly observed treatment short course
11.5.2 Regimen 3: 2(RHZ) / 4 (RH)
11.5.3 Regimens 1 and 2
11.5.4 Use of steroids in children with TB
11.5.5 Response to therapy
11.5.6 Immune reconstitution inflammatory syndrome (IRIS)
11.5.7 A child who deteriorates on TB treatment
11.5.7 Adverse events
11.6 MDR-TB in children
11.7 TB and HIV co-infection in children
11.7.1 TB diagnosis in HIV positive children
11.7.2 TB treatment
11.7.3 General HIV care for co-infected children
11.7.4 Cotrimoxazole prophylaxis
11.7.5 Antiretroviral therapy
12.1 Introduction
12.2 TB preventive therapy
12.2.1 Eligibility for TB preventive therapy
12.2.2 When and how to start TB preventive therapy
12.3 Diagnosis of TB in HIV positive clients
12.3.1 Diagnosis of pulmonary tuberculosis
12.3.2 Extra-pulmonary tuberculosis
12.3.3 TB recurrence
12.3.4 Multi-drug resistant TB
12.4 Treatment of TB in HIV positive clients
12.4.1 Response to treatment
12.4.2 Side effects to TB drugs
12.4.3 Case fatality
12.5 Diagnosis of HIV in TB clients
12.6 HIV care for co-infected adult TB clients
12.7 Cotrimoxazole prophylaxis
12.8 Antiretroviral therapy and TB
12.8.1 Drug interactions
12.8.2 Client develops TB while on antiretroviral therapy
12.8.3 Client presents with TB before commencing antiretroviral therapy
12.8.4 Immune reconstitution inflammatory syndrome (IRIS)
12.8.5 Counselling of co-infected clients
13 MDR and XDR-Tuberculosis
13.1 Factors contributing to MDR-TB
13.1.1 Poor management of drug supply
13.1.2 Poor client management
13.1.3 Client-related factors
13.2 The PHC role in MDR-TB management
13.3 Preventing MDR-TB
13.4 Early diagnosis of MDR-TB
13.5 Management Of MDR-TB
13.6 MDR-TB Contact Management
13.7 Treating Mono and Poly-Resistance
13.8 XDR-TB
14 Non-Tuberculosis Mycobacteria
14.1 Epidemiology and pathogenesis
14.2 Clinical manifestations
14.3 Bacteriology
14.4 Management of NTM
15 Admission and Discharge Criteria for TB Clients
15.1 Introduction
15.2 Admission criteria to TB hospitals
15.3 Essential elements of in-patient care in TB hospitals
15.3.1 Clinical management
15.4 Criteria for referral from TB hospitals to district / regional hospitals
15.5 Discharge criteria from TB hospitals to PHC clinics
15.6 Discharge process
16 Infection Control
16.1 Administrative control and appropriate work practices
16.2 Environmental control measures
16.3 Personal respiratory protection
16.4 Protection of health care personnel
17 Monitoring and Evaluation
17.1 Monitoring
17.2 Evaluation
17.3 Surveillance
17.4 Standard tools used in The National TB Control Programme
17.4.1 The electronic TB register
17.5 Standard reports
17.6 Information flow
17.7 Using monitoring and evaluation as a management tool
17.8 Programme monitoring indicators
17.8.1 Case finding indicators
17.8.2 Case holding indicators
17.8.4 TB treatment outcome indicators - new smear-positive cases
17.8.5 TB Treatment outcome indicators - retreatment smear-positive cases
17.8.6 Programme management indicators
17.9 TB, HIV and STI integrated audit tool (TB programme components)
References
Annexure 1: Tuberculin Skin Testing
Annexure 2: Essential Tuberculosis Drugs
1 Isoniazid
2 Rifampicin
3 Pyrazinamide
4 Streptomycin
5 Ethambutol
Annexure 3: Clinically Significant Drug Interactions
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TB Guidelines 2009

TB Guidelines 2009

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Published by: juniorebinda on Aug 12, 2011
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