STANDARD OPERATING

PROCEDURES
TB Preventive Treatment: 3HR Regimen
Standard Operating Procedures TB Preventive Therapy: 3HR Regimen

CONTENTS

1. Purpose
2. Scope
3. Responsibility/Use of this SOP
4. Overview on 3HR
5. Implementation Procedures
5.1 Allocating 3HR Supply to Demonstration Sites
5.2 Conducting contact investigation
5.3 Identifying priority groups
5.4 Screening to Rule Out Active TB
5.5 Testing for TB Infection
5.6 Initiating Treatment for TB Infection
5.7 Monitoring of Treatment
6. Electronic Recording and Reporting
6.1 Recording
6.2 Reporting

ANNEXES

1. iNTP Demonstration Sites 3HR Allocation Table

2. List of Health Care Providers Trained with iNTP Module 2: 3HR Training
July 29 and 30, 2021 Batches
3. 3HR Allocation Table to Facilities Providing TB Services
4. Steps in Contact Investigation
5. TB Infection Cascade of Care
6. TST and IGRA Results Interpretation
7. TPT Treatment Initiation Algorithm
Figure 1: Algorithm for Children <5 y/o with HIV Negative or Unknown HIV Status Contacts of BC-TB (HH and
close contacts) and CD-TB cases
Figure 2: Algorithm for > 5 y/o with HIV Negative or Unknown HIV Status Contacts of BC-TB (HH and Close
Contacts)
Figure 3: Algorithm for Children 1-4 y/o with HIV Infection
Figure 4: Algorithm for > 5 y/o with HIV Infection
8. List of Preparations before starting 3HR
Table 1: Potential Adverse Events (AEs)
Table 2: Baseline Clinical Examinations
Table 3: Precautions
9. Electronic Recording and Reporting for the TPT: 3HR Implementation

Page 1 of 26
Standard Operating Procedures TB Preventive Therapy: 3HR Regimen

1 PURPOSE
This standard operating procedure (SOP) describes the procedure in the implementation of TB
Preventive Treatment using the 3-months of daily Isoniazid and Rifampicin (3HR)- a shorter oral TB
preventive treatment (TPT) course under the introducing New Tools Project (iNTP). The use of 3HR
will address barriers to TPT i.e., availability of fixed dose combinations to reduce pill burden, shorter
regimens, and child-friendly formulations. Further, it will ensure programmatic alignment of TPT
regimens for children < 15 years old regardless of HIV Status.

2 SCOPE
This SOP includes technical and operational protocol in allocating TPT courses to iNTP sites, conducting
contact investigation, identifying priority groups for TPT, screening to rule out active TB, testing for TB
infection, initiating treatment for TB infection, monitoring of treatment and its outcomes, recording, and
reporting, as well as other activities (e.g., use of VOT if available) to support treatment adherence and
success.

3 RESPONSIBILITY/USE OF THIS SOP

This procedure applies to the primary health care providers and all other healthcare workers who are
involved in contact investigation and provision of 3HR TPT.

4 OVERVIEW ON 3HR
Current efforts of finding missing cases of tuberculosis (TB) and treatment of active TB disease are
insufficient to achieve global and country targets in reducing TB burden by 2035, specifically reducing TB
incidence by 90%, mortality by 95%, and zero catastrophic cost. Globally, the rate of TB incidence needs
to accelerate to an average of 17% per year between 2025 and 2035. The only way to achieve this level
of decline in TB incidence is through introduction and rapid scale-up of new tools that can substantially
reduce the risk of developing active TB disease among approximately 1.7 billion people (equivalent to
around one-fourth of the world’s population) infected with TB. One of these tools is the provision of
short, effective and safe treatment for TB infection or TB preventive treatment (TPT).

In 2018, during the United Nations high level meeting on TB, member states committed to provide TPT
to at least 30 million people from 2018 to 2022 {6 million people living with HIV (PLHIV), 4 million
children below 5 years who are household contacts of patients with bacteriologically confirmed TB, and
20 million household contacts in older age groups}. The Updated Philippine Strategic TB Elimination Plan
(PhilSTEP1) 2020-2023 targets to provide TPT to at least 685,000 eligible individuals.

In 2020, the World Health Organization (WHO) recommended several TPT regimen options regardless
of HIV status including 6 or 9 months of daily isoniazid (6H or 9H), 3-months of weekly rifapentine plus
isoniazid (3HP), 1-month of daily rifapentine plus isoniazid (1HP), 4 months of daily rifampicin (4R) and 3

Page 2 of 26
Standard Operating Procedures TB Preventive Therapy: 3HR Regimen

months of daily isoniazid and rifampicin (3HR). The choice of regimen depends on availability of
appropriate formulations and considerations of age, safety, potential drug–drug interactions, and
adherence.

In collaboration with the Stop TB Partnership and the United States Agency for International
Development (USAID), the Philippines is one among six (6) countries under the Introducing New Tools
Project (iNTP) to receive a package of new tools to address the issues and challenges across the TB
continuum of care. In coordination with the National TB Control Program (NTP), these tools will be
introduced in six (6) selected sites in the country under programmatic conditions.
One of the new tools in the iNTP package to improve coverage of TPT is the 3 months daily isoniazid
and rifampicin regimen (3HR).

In the Philippines, 6 iNTP demonstration sites were identified to implement the 3HR regimen. These are
Bataan and Tarlac Provinces in Region III, Valenzuela City in NCR, Laguna Province in Region IV-A, Cebu
Province in Region VII and South Cotabato Province in Region XII.

5 IMPLEMENTATION PROCEDURES

5.1 Allocation of 3HR Supply for Demonstration Sites

5.1.1 iNTP-PMT prepares allocation table on all demonstration sites (Annex 1) based
on the site’s 2020 accomplishment on TB notification and with the following
assumptions: 4 household (HH) contacts per index BC-TB case, 1 child HH contact <5
years old per index CD-TB case, at least 70% of the HH contacts will complete the
screening procedures, at least 50% of those screened will be eligible for TPT, and with 3
months buffer. 78% were allotted for adults while 22% for children.
5.1.2 iNTP-PMT requests demonstration sites to identify public and private facilities with
trained staff to rollout 3HR (Annex 2)
5.1.3 PHO/CHO prepares distribution list detailing allocation of adult and
children's doses per facility and submits a copy to iNTP-PMT (Annex 3)

5.2 Conduct contact investigation

5.2.1 Contact Investigation is the important first step for TPT, an entry point for
systematic screening for active TB through identification of people with TB disease and
contacts of patients with TB who are eligible for TPT.
5.2.2. Contacts should be evaluated within 7 days from treatment initiation of the index
case and must follow the steps on effective contact investigation as shown on Annex 4.
5.2.3 TPT is offered to individuals who are at risk of developing active TB disease to
reduce that risk.

Page 3 of 26
Standard Operating Procedures TB Preventive Therapy: 3HR Regimen

5.3 Identifying priority groups

5.3.1 Household contacts, close contacts, PLHIV and other high risk clinical
groups (undergoing dialysis, preparing for organ/hematologic transplantation,
patients initiating anti-TNF or with silicosis) are people at-risk for TPT.
5.3.2 TPT Eligibility for At-risk Populations:

Household Contacts Close PLHIV

All HH Contacts of BC DS-
TB index
0-4 years old HH contacts of
CD DS-TB index
Contacts
At least 1 year old regardless of
All CC of BC whether a contact of a TB Case
DS-TB index or not
Less than 1 year old and a HH
contact of a known TB Case

5.3.3 Contacts of patients with known DR-TB have a high risk of infection
with drug-resistant organism and there is limited evidence on an optimal
approach for TPT on contacts of patients with DR-TB (no standard regimen).

5.4 Screening to Rule Out Active TB

5.4.1 ADULT: 4-symptom screening lasting 2 weeks or more with any

of the following symptoms: Cough; Unexplained weight loss;
Drenching night sweats; and unexplained fever.
5.4.2 PLHIV: 4-symptom screening regardless of duration with any of
the following symptoms: Cough; Unexplained weight loss; Drenching
night sweats; and unexplained fever.
5.4.3 CHILDREN: Symptom screening lasting for 2 weeks or more
with any of the following symptoms: Coughing/Wheezing; Unexplained
weight loss or failure to thrive; and unexplained fever. If the child is a
contact of a TB Case, also ask for the presence of fatigue, reduced
playfulness, decreased activity or anorexia.
5.4.4 If no sign and symptoms of TB, perform CXR except amongst
below 5 years of age contacts. Findings suggestive of TB should be
evaluated to rule out active TB Disease. Unavailability of CXR is not a
barrier to TPT as physicians may offer TPT later but should not contain
rifamycin.

5.5 Testing for TB Infection

5.5.1 WHO recommends either a Tuberculin Skin Test (TST) or Interferon-

Gamma Release Assay (IGRA) test to determine TB infection though neither
is considered as gold standard test.
5.5.2 TST or IGRA is not mandatory or required for all contacts prior to
initiation of TPT. Eligibility of Risk Groups for TPT using TST can be seen on

Page 4 of 26
Standard Operating Procedures TB Preventive Therapy: 3HR Regimen

the table below. For TST and IGRA result interpretation, please refer to
Annex 6.

TST NOT TST REQUIRED NOT

REQUIRED (Eligible ONLY if ELIGIBLE
(Eligible for TPT) positive) for TPT
<5 y/o, BC-TB index <5 y/o, CD-TB index ----------
HH
contacts
>5 y/o, BC-TB index, >5 y/o, BC-TB index, no >5 y/o, CD-TB
with TB risk* TB risk index

Close All ages, CD-TB

contacts ---------- All ages, BC-TB index index

Age <1 y/o

PLHIV Ages >1 y/o ---------- (If not contact
of a person with
TB)
•
Patients receiving
dialysis,
Other • Patients preparing
Risk ---------- for an organ or ----------
Groups hematological
transplantation
• Patients initiating
anti-TNF
treatment
• Patients with
silicosis
*TB Risk are those PLHIV, DM, smokers, with immune-suppressive medical
conditions, malnourished, with multiple people with TB in same household.

5.6 Initiating Treatment for TB Infection

5.6.1 TPT should be considered only after TB Disease is ruled out and after a
careful risk assessment of risk factor for TB Infection, positive test on TB
infection (if TST/IGRA is required) and potential toxicity of treatment. To
properly guide the health care providers, please see Annex 7 for the
algorithm of TPT Treatment initiation. (Figures 1-4)

Page 5 of 26
Standard Operating Procedures TB Preventive Therapy: 3HR Regimen

5.6.2 Preparations before starting 3HR Treatment includes counselling,

identifying potential adverse events, baseline clinical examination and
laboratory tests (if required), precautions for women of reproductive age and
for PLHIV. See Annex 8 for the List of Preparations before starting 3HR.
5.6.3 Provide the appropriate dosage for children and adults and use the
routine NTP TPT Treatment Card upon initiation of 3HR treatment regimen.
It is best to educate about TB infection and TPT and counsel on the
adherence plan.

Appropriate Dosage on 3HR Regimen

Children:
Weight 4-7 kg 8-11 kg 12-15 kg 16-24 kg > 25 kg
Band
HR Use adult
50/75mg 1 2 3 4 formulation
FDC

Adults:
Weight Band 25-37 kg 38-54 kg 55-70 kg > 70 kg
HR
75/150mg 2 3 4 5
FDC

5.7 Monitoring of Treatment

5.7.1 Conduct regular follow-ups and monitoring of AEs through

counselling, IECs and follow-up plan. Education and counseling
are crucial to capacitate and empower the clients to take
responsibility for their health. Remember that those with a
high risk of hepatotoxicity need monthly liver function
tests. Potential AEs and Management Strategies are as follows:

Adverse Event Suggested Management

• Advice to stay hydrated
• Give Paracetamol 500mg (adult) every 4 hours, as
Flu-like Signs and needed
Symptoms • If severe and not tolerated, consider switching to
the alternate regimen (6H)

Page 6 of 26
Standard Operating Procedures TB Preventive Therapy: 3HR Regimen

• Advice to stay hydrated

• Advice to avoid spicy and greasy foods
• Provide Oral Rehydration Solutions (ORS) if there
Nausea and is a mild dehydration
Vomiting • Give Metoclopramide 10mg (adult) every 8 hours
(TID), as needed
• If AST and/or ALT results are >3 but <5 times ULN
without signs and symptoms of hepatitis, continue
3HR and repeat ALT and AST weekly
Hepatotoxicity • If AST and/or ALT results are >3 times ULN with
signs and symptoms of hepatitis or if AST and/or
ALT >5 times ULN with or without signs of
hepatitis, stop 3HR and do not reintroduce

• Use Brief Peripheral Neuropathy Screening (BPNS)

to screen and assess the severity of Peripheral
Neuropathy
Peripheral • If mild: give 100-150 mg of Vit B6 to adults and
Neuropathy 50mg in children
• If not better or worsens with an increased Vit B6
dose: Stop 3HR and consider switching to 4R

• Give calamine lotion or topical steroid preparation

twice a day (BID) on the affected area
• Provide Chlorpheniramine 8mg BID or TID orally
Skin • Desensitize by starting with a low dose once
Hypersensitivity hypersensitivity reaction is resolved.
Reaction • If with Steven-Johnson Syndrome, consult with
regional TB MAC and/or specialist and follow their
advice.
• Do a drug rechallenge and:
o If due to Isoniazid – switch to 4R
o If due to Rifampicin – switch to 6H
• If with itchiness, generalized rashes, swelling of
nose tips or lips, with or without fever, withhold
3HR

Page 7 of 26
Standard Operating Procedures TB Preventive Therapy: 3HR Regimen

Orange-red • Reassure that it is just a staining from a drug in the

Discoloration of regimen and is harmless
Body Fluids (Tears, • Advise to continue 3HR
Saliva, Urine, Milk)

• Investigate for active TB disease or other diseases

Any Occurrence of and:
TB Signs and o If no active TB Disease, continue 3HR
Symptoms o If active TB Disease, stop 3HR provide
DS-TB or DR-TB treatment

5.7.2 Do not reintroduce 3HR if there is a major ADR requiring need to

discontinue 3HR.
5.7.3 Reporting of serious adverse events (SAEs) and adverse events of special
interest (AESIs) is highly encouraged. Use the Food and Drug Administration’s
(FDA) suspected adverse reaction form. Report can be sent via email to
pharmacovigilance@fda.gov.ph, adsm@doh.gov.ph, and
ntp.pharmacovigilance@gmail.com
5.7.4 Dispense a whole course of 3HR Supply to ensure continuous drug supply.
This can be delivered through treatment supporters such as barangay health
workers (BHWs), community volunteers, health facility staff, family members, or
to the client themselves assisted by digital adherence technology such as Video
Observed Treatment (VOT), 99DOTS and smart pill box.
5.7.5 Advised client to take the missed dose when remembered and continue
longer to make up for the required doses within the maximum extended
duration of the regimen that the client is taking. Extension of treatment
duration to make up for missed doses should not be more than 1 month.
5.7.6 Defining treatment outcomes are based on the client's treatment
adherence towards the whole treatment duration.

Outcome Definition
An individual who has completed the prescribed treatment
Completed duration and remains well or asymptomatic during the entire
period
Lost to An individual who interrupted TPT for 2 consecutive months
follow-up or more
Died Individual who dies for any reason during treatment
Failed An individual who developed active TB Disease anytime whilst
on TPT

Page 8 of 26
Standard Operating Procedures TB Preventive Therapy: 3HR Regimen

An individual who has been transferred to another health

facility with proper referral slip the continuation of TPT and
Not whose treatment outcome is not known; include here
Evaluated discontinued by a physician because the patient cannot tolerate
(e.g., severe ADRs) or those who refused to continue

6 RECORDING AND REPORTING

6.1 Recording
During the implementation, HCPs shall implement electronic recording through the ITIS
web version (Annex 9). ITIS Web shall serve as the primary recording and reporting
system throughout the duration of the project. Other digital platforms like ITIS Mobile
and the Care TB App can also be used for TPT notification once they are launched.

6.1.1. Log-in via https://itis.doh.gov.ph using your username and password.

6.1.2. Click Case Management then choose Add New Patient and add client for TPT.
Thereafter, make sure to add TB Record fill out all the information asked.
6.1.3. Add TST result (if done or available) and encode all diagnosis information
required. Also, remember to add patient’s contact in the contact investigation window.
6.1.4. Add treatment information and indicate 3HR under TPT regimen type.

*Note: Do not leave any blanks. Indicate “NA” if not applicable to patient or
patient is ineligible, “ND” if the patient is eligible but activity was not done,
“none” or “0’ if nothing, and “Unk” if unknown by health staff or patient,
accordingly.

6.2. Reporting

6.2.1. Quarterly reporting shall follow the guidelines as stipulated in NTP’s Manual of
Procedures.
6.2.2. Report 3 (Quarterly Report on TB and TB Preventive notification and Treatment)
and Report 5 (Quarterly Report on TB and TB Preventive Treatment Outcomes) shall
be accomplished and submitted every quarter.

Page 9 of 26
 Standard Operating Procedures TB Preventive Therapy: 3HR Regimen

Annex 1
iNTP Demonstration Sites 3HR Allocation Table

Region Province/ Final Equivalent Qty in Equivalent Qty in Date of

City Allocation Number of Tablets Number of Tablets Delivery
Patients Patients
(Adults) (Children)
Tarlac 3,974 3,100 1,041,600 874 293,664 Aug. 26,
Region 2021
III Bataan 2,430 1,896 637,056 534 179,424 Sept 01,
2021
NCR Valenzuela 2,144 1,672 561,792 472 158,592 Aug. 31,
2021
Region Laguna 8,288 6,464 2,171,904 1,824 612,864 Aug. 25,
IV-A 2021
Region Cebu 6,036 4,708 1,581,888 1,328 446,208 Sept. 02,
VII Province 2021
Region South 3,208 2,502 840,672 706 237,216 Sept. 13,
XII Cotabato 2021

Page 10 of 26
Standard Operating Procedures
Annex 2
List of Health Care Providers Trained with iNTP Module 2:
3HR Training
July 29 and 30, 2021 Batches
Name of Staff Name of Facility
Abigail Morales-Co Beng Valenzuela City Health Office
Alberto L. Guinto Valenzuela City Health Office
Alicia P. Antonio San Clemente RHU
Allen Ray P. Cruz Valenzuela Health Office
Benilda D. Evangelista Valenzuela Health Office
Benilinda Jane Cay-an Karuhatan Health Station
Cris Albert Pidot Ramos Rural Health Unit
Dave Renz Beltrano Valenzuela Health Office
Editha Marie Urbano Elysian Health Center
GEN. T. DE LEON 1 HEALTH
EDUARDO DALAGAN STATION
Edward Angelo Velasco Valenzuela Health Office
CENTRAL LUZON DOCTORS'
ELMAN HOWELL D. TAGUBA HOSPITAL
Engracia F. Almazan Pinalagad Health Center
Glodel De Lara Valenzuela Medical Center
Gubatan, Glenn Alfred Valenzuela Health Office
Hannah Joy Lumibao Valenzuela Health Office
Honeyvee R. Tan-Guzman Valenzuela Health Office
JANET ABUELA SAN AGUSTIN LINGUNAN 3S HEALTH CENTER
Jerome Senen Valenzuela Medical Center
Joan Alvarez Valenzuela Medical Center
Joan Leyson-Saligumba, MD 3S Maysan Health Stations
Joann Suba DOH CLCHD 3
John Philip Tiongco Valenzuela Health Office
Julie Ann Bautista Valenzuela Health Office
Juvy Anne Munsayac Valenzuela Health Office
Kaycelyn Alegre Valenzuela Medical Center
Leah B. Gato Valenzuela Medical Center
Maricel Abarico Valenzuela Health Office
Marie Joy M. Sebastian DOH-MM CHD
TB Preventive Therapy: 3HR Regimen
Name of Staff Name of Facility
Benny Maypa norala district hospital
Bhryan Bacasmas Batucan Borbon RHU
Brenda G. Paredes LGU - RHU1 Minglanilla
Camille P. Fugio DOH-CHD XII
Catherine C. Relator,RN Norala District Hospital
Catherine D. Cabatuan ALOGUINSAN RHU
Ceba Marie Bayno Badian District Hospital
CEBU PROVINCIAL HOSPITAL-
CHARIE MAE E. LOBITANA BOGO CITY
Charise R. Valendez Borbon Rural Health Unit
CEBU PROVINCIAL HOSPITAL-
CHARITY I. PILAPIL III BOGO CITY
Chelsea Daine Mariveles RHU SURALLAH
Christine Ann E. Castillo SANTA FE RURAL HEALTH UNIT
Isidro C. Kintanar Memorial
Christine Vismanos (ICKMH-Argao) Hospital-Argao
Clare Angelie Barbon San Fernando RHU
Consuelo A. Lu Consuelo A. Lu children 's clinic
Corazon Dotillos Borbon RHU
Corazon Vergara Borbon Rural Health Unit
Cresilda Cases DOH-CENTRAL VISAYAS
Cebu Provincial Hospital-Carcar
DAISY LOU C. ABARQUEZ, MD City
SOGOD DISTRICT HOSPITAL/
DEANNA MARIE B. TAMPUS,RN CEBU
Divina Inso PORO RHU
GEMMA SANCHEZ Santa Fe RHU
Dr.Jose Ma.V.Borromeo Memorial
Glendale Taguiam District Hospital
Gracel Rose S. Perez Cebu Provincial Health Office
GREGORIA MACIMILIANA T.
DIEZ BADIAN DISTRICT HOSPITAL
Gwen Aban Balamban Rural Health Unit 1
CEBU PROVINCIAL HOSPITAL-
GWYLLYN O. GULANE, MD BOGO CITY
Hazel Ramos PHO- South Cotabato
hilda s. tolentino ALOGUINSAN RHU
Page 11 of 26
Standard Operating Procedures
Marilou B. Lebardo
Valenzuela City Social Hygiene
Mark Anthony A. Manaois
Mark laureen salvio
Matty H. Torres
May Ronalee M. Mallari
Odielon Filomeno
Patricia Carmela De Vega
Paul Ryan G. Macanas
paula bianca celso
Robin Erick Pascual
Romella carag
Sharmaine Bataycan
Sharon Isturis
Tedjesse B Orlino
Venjieleen esquivel
Venus Agullo
Xylene Sangco
Zadel bonilla BSPT , RN
Glorie A.Occeño
David John D. Faustino
Edle Jay C Balunan
Elizabeth D. Constantino
Cherry Go-Frondarina
Ivy Rose De Guzman MABOLO HEALTH STATION
Jean Karen Reyes
Joshua James D. Reyes
Khristine G. Sy
Leah Dizon
Lemon Jane Baltazar
lilian lee partosa
Lombard Saligumba, MD Gen. T. De Leon Health Station
lovelina o. maderazo
MA EILEEN RAMONES-SIANGHIO,
MD
Ma. Lorraine Martin Bonilla
Maria Kristina Crisostomo Sanchez
Maria Ruth P Giron
Raquel E. Contreras
Rosalina B. Angeles
Rosanna De Vera
susan reyes
Tarlac PHO
Clinic
Valenzuela Health Office
Valenzuela Health Office
Valenzuela Health Office
DOH-MM CHD
Tagalag HC
DOH CLCHD 3
ugong 3s health station
Valenzuela Health Office
Bagbaguin Health Station
Valenzuela Health Office
Valenzuela Health Office
Valenzuela Medical Center
Concepcion health station
Valenzuela Medical Center
DOH-MM CHD
Valenzuela Health Office
Valenzuela Health Office
Valenzuela Health Office
Lawang Bato Health Center
Pasolo Health Station
Purok 4 HC
Valenzuela Health Office
Valenzuela Health Office
GTDL 3S health Center
Pasolo Health Station
Parada 3s Health Station
Valenzuela Health Office
Valenzuela Health Office
Valenzuela Medical Center
Valenzuela Health Office
Valenzuela Health Office
Valenzuela Health Office
Valenzuela Health Office
Isla Health Station
Valenzuela Health Office
Valenzuela Health Office
TB Preventive Therapy: 3HR Regimen
IRISH B. DURIMAN IPHO - SOUTH COTABATO
CEBU PROVINCIAL HEALTH
JANET T. RAMOS OFFICE
CEBU PROVINCIAL HOSPITAL-
JANYN VERGARA SARSONAS CARCAR CITY
Jasmen B. Pasco RHU BOLJOON
Jayne Pamela N. Te CPH-Carcar Cebu
Jennifer Estan Cebu Provincial Hospital Balamban
jennifer sayson ALOGUINSAN RHU
JERLAE COMETA LUCERO COMPOSTELA RHU
JOHN ARLO M. CODILLA IPHO- SOUTH COTABATO
John Lou Ducay SANTA FE RHU
Josiah Hans R. Samilin IPHO South Cotabato
Joverson S. Bejic Pinamungajan RHU
Kamlon J. Usman Jr. DOH Region 12 CHD
Cebu Provincial Health Office /
Kenver Aaron D. Sabornido PBSP
Kimverly Onajon IPHO South Cotabato
Lucille mae Potoy Carcar city health office
Lux Ann Lirazan Cebu Provincial Health Office
Daanbantayan District Hospital-
Lyka A. Sacapaño Cebu Province
MA. ANGELICA R. TOLOSA RHU SURALLAH
Ma. Arlene D. Castro Tuburan District Hospital
mae batoctoy Minglanilla District Hospital
Maria Caracena Barili Rural Health Unit 1
Maria Fe C.Managaytay RHU- Pinamungajan
Marian Melody S. Rabaca TUBURAN RHU
Marie Blanche A. Vazquez RHU Boljoon
Mark Anthony Sangre Balamban Rural Health Unit 2
Rural Health Unit of Compostela,
Mary Anne Q. Dungog Cebu
CEBU PROVINCIAL HOSPITAL -
Mary Grace Ypil DANAO
Mary Rose Therese C Cabillon Badian RHU
Melvin Saragena Alcoy rhu
Michelle Anne Recto Dagoy,MD Barili Rural Health Unit 1
Mitchell Tan Rural Health Unit II Dalaguete
Nanette L. Torralba Cebu Provincial Hospital-Danao
nathaniel b. alejado carcar city health office
Neillie Violon Aquino Minglanilla Rural Health Unit 1 IDots
Nelivit Mandal Verdida LGU-San Remigio
Philip Balogo Borbon RHU
Philip Ponce Liloan Rhu
Raiza Batomalaque Balamban Rural Health Unit 3
Renne B. Ciano RHU SANTANDER
Page 12 of 26
Standard Operating Procedures TB Preventive Therapy: 3HR Regimen

William R. Altobar Valenzuela Health Office Roda C. Camay San Remigio RHU I & II
ABIGAIL MONTEROLA SAN REMIGIO RHU Rodeliz K. Reyes Dumanjug Rural Health Unit
CEBU PROVINCIAL HOSPITAL-
Ace Climaco Balamban Rural Health Unit 3 RODELO THOMAS BALAGTAS JR. BOGO CITY
ailyn g. buenavista barili rhu Romelyn G. Tinga Bantayan District Hospital
Aimee Carumba RHU-2 Dalaguete Ronalyn Otarra Barili District Hospital
Aimee F. Apolinario RHU SANTANDER Roselyn S.Gako Dumanjug Rhu
Pilar Municipal Health Office And
Al Christy A. Catong Carcar City Health Office Steve Silagan Cuering Lying-In Clinic
Alcestis Donna Azul RHU San Fernando Thelma Arzadon-Lemente, RN. IPHO South Cotabato
Angiela May Cabinatan Cebu PHO Tomomi N. Abe, MD RHU Pinamungajan
Ann Lyka Liston Barili Rural Health Unit 1 VICK P. CABAHUG LILOAN RHU
Astrid Fariolen Santa Fe Rural Health Unit Vivian L. Awe RHU BOLJOON
BEN AMUS A. TAGALOG SOGOD DISTRICT HOSPITAL

Page 13 of 26
Standard Operating Procedures TB Preventive Therapy: 3HR Regimen

Annex 3
3HR Allocation Table to Facilities Providing TB Services

Page 14 of 26
Standard Operating Procedures
Steps in Contact Investigation
INTERVIEW: Once a case is
registered for treatment,
interview the index case and
explain the importance of
contact investigation
TEST: Test contacts for active
TB (Rapid TB Diagnostic Test)
or TB Infection (TST or IGRA -
not mandatory to all contacts)
depending on results of
symptom and/or CXR
Screening
PROVIDE: Provide results to
contacts and discuss
appropriate management
based on results
TB Preventive Therapy: 3HR Regimen
Annex 4
LIST AND RECORD: Ask for
the name of all HH and close REQUEST: Request index case
contacts, regardless of ag, and to interview HH and Close
list all of them in the DS-TB Contacts, and offer options on
Treatment Card and how they will be interviewed.
Presumptive Masterlist
OFFER: Offer CXR if available
to all contacts who are 5 years
INTERVIEW: Interview each
old and above. If not, perform
of the contacts for s/sx of TB
symptom screening including
those under 5 years of age
MANAGE: Perform baseline
COUNSEL: Counsel contacts
clinical evaluation and
prior to initiating TB
laboratory tests and provide
Treatment or TPT
appropriate management
UPDATE: Update patient
records, and facility forms and
registers
Page 15 of 26
Standard Operating Procedures TB Preventive Therapy: 3HR Regimen

Annex 5
TB Infection Cascade of Care

Page 16 of 26
Standard Operating Procedures TB Preventive Therapy: 3HR Regimen

Annex 6
TST and IGRA Results Interpretation

Type of Test Testing Method Lead Time Results

Positive:
At least 10mm
induration regardles
of BCG Vaccination
5 mm in
TST 0.1ml of PPD, ID 48-72 hours immunocompromise
route d children

Negative:
<9mm induration on
site

Positve: suggest that

TB infection is likely
Negative: suggest
IGRA In-vitro blood test 8-30 hours after TB infection is
using ELISA fresh blood unlikely
collection Indeterminate:
suggests for further
evaluation or repeat
testing

Page 17 of 26
Standard Operating Procedures TB Preventive Therapy: 3HR Regimen

Annex 7
TPT Treatment Initiation Algorithm
Figure 1: Algorithm for Children <5 y/o with HIV Negative or Unknown HIV Status
Contacts of BC-TB (HH and close contacts) and CD-TB cases

Page 18 of 26
Standard Operating Procedures TB Preventive Therapy: 3HR Regimen

Figure 2: Algorithm for > 5 y/o with HIV Negative or Unknown HIV Status Contacts of
BC-TB (HH and Close Contacts)

Page 19 of 26
Standard Operating Procedures TB Preventive Therapy: 3HR Regimen

Figure 3: Algorithm for Children 1-4 y/o with HIV Infection

Page 20 of 26
Standard Operating Procedures TB Preventive Therapy: 3HR Regimen

Figure 4: Algorithm for > 5 y/o with HIV Infection

Page 21 of 26
Standard Operating Procedures TB Preventive Therapy: 3HR Regimen

Annex 8
List of Preparations before starting 3HR

Table 1: Potential Adverse Events (AEs)

Suspected Culprit
Known AEs Rare AEs
Anti-TB Drugs

·Asymptomatic elevation of serum liver enzyme ·Convulsions

·Hepatitis ·Pellagra
Isoniazid ·Peripheral neuropathy ·Arthralgia
·Skin rash ·Anemia
·Sleepiness and lethargy ·Lupoid reactions
·Gastrointestinal reactions (abdominal pain, ·Osteomalacia
nausea, vomiting) ·Pseudomembranous colitis
·Hepatitis ·Pseudo adrenal crisis
Rifampicin
·Generalized cutaneous reactions ·Acute renal failure
·Thrombocytopenic purpura ·Shock
·Discoloration of body fluids ·Hemolytic anemia

Table 2: Baseline Clinical Examinations

Risk Factor for AE Action if Risk Factor is Present

Flu-like signs and symptoms:
Defer TPT until symptoms resolve
Fever, headache, runny nose, and joint pain
Increased risk of hepatotoxicity:
History of liver disease
Do a liver function test (AST and ALT)
Regular use of alcohol
Do not give TPT if AST and ALT are >3 times
Chronic liver disease
ULN
Pregnancy / Within 3 months postpartum
Age >60 years
Give pyridoxine (vitamin B6) prophylaxis.
Increased risk of peripheral neuropathy:
Adults and children >1 year old: 10 to 25 mg/day in
Malnourished
adults including pregnant and lactating women, and
Diabetes
people with other risk factors (depending on which
PLHIV
formulary is available)
Chronic alcoholic
For infants: 5 to 10 mg/day (including infants of
Renal insufficiency
lactating women who are taking isoniazid containing
Pregnancy and lactation
TPT regimen should receive vitamin B6 even if the
Infant
infant is not on TPT)

Page 22 of 26
Standard Operating Procedures TB Preventive Therapy: 3HR Regimen

Table 3: Precautions

1. Perform pregnancy when in doubt (missed period)

Women of 2. Ask if any contraceptive is being taken
Reproductive Age 3. Advise if receiving oral contraceptives containing ESTROGEN to
(14-54 y/o) take an oral contraceptive pill containing a higher dose of estrogen
(50 mcg) or use another form of contraception following a
consultation with a clinician
• Ask if PLHIV are on Anti-retroviral Therapy (ART) or not and
which ART drugs are being taken and adjust if required:

PLHIV ARTs Can Co-Administer with

3HR?
Efavirenz Yes
Protease inhibitors (Lopinavir, No, use 6H instead
Ritonavir) and Nevirapine
Raltegravir and Dolutegravir Yes, but increase dose

Page 23 of 26
Standard Operating Procedures TB Preventive Therapy: 3HR Regimen

Annex 9
Recording and Reporting Forms for the TPT: 3HR Implementation

Page 24 of 26
Standard Operating Procedures TB Preventive Therapy: 3HR Regimen

Page 25 of 26
Standard Operating Procedures TB Preventive Therapy: 3HR Regimen

Page 26 of 26