TABLE 2

Summary of the World Health Organization standards for HIV infection and other comorbid conditions, tuberculosis (TB) in children, monitoring and evaluation activities, and supportive approaches to the management of TB patients

Standards for HIV infection and other comorbid conditions
 19) HIV testing should be routinely offered to all patients with presumptive TB and those who have been diagnosed with TB [3, 28].
 20) Persons living with HIV should be screened for TB by using a clinical algorithm [3].
 21) ART and routine CPT should be initiated among all TB patients living with HIV, regardless of their CD4 cell count [3].
 22) A thorough assessment should be conducted to evaluate comorbid conditions and other factors that could affect the response to or
 outcome of TB treatment. Particular attention should be given to diseases or conditions known to affect treatment outcomes, such as
 diabetes mellitus, drug and alcohol abuse, undernutrition and tobacco smoking [3].
Standards for managing TB in children
 23) The diagnosis of TB in children relies on the thorough assessment of all evidence derived from a careful history (including history of TB
 contacts and symptoms consistent with TB), clinical examination (including growth assessment), a TST, CXR (if available), bacteriological
 confirmation whenever possible, investigations for suspected pulmonary TB and suspected EPTB, and HIV testing. Whenever possible, the
 Xpert MTB/RIF Ultra assay should be used as the initial diagnostic test in children suspected of having any form of TB [29].
 24) The principles of treating TB in children are the same as for treating TB in adults: first-line treatment of drug-sensitive TB consists of a
 2-month intensive phase with isoniazid, rifampicin, pyrazinamide and, depending on the setting and type of disease, ethambutol, followed
 by a continuation phase with isoniazid and rifampicin for ≥4 months; however, the dose of first-line anti-TB agents differs from that
 administered in adults [3].
 25) In settings where TB is highly endemic or where there is a high risk of exposure to TB, a single dose of BCG vaccine should be given to
 all infants; however, HIV-positive children should not be given BCG vaccine. After considering local factors, BCG vaccine should be given
 to all infants except those who are HIV-positive for whom BCG is contraindicated [3].
 26) All children younger than 5 years and HIV-positive children of any age should be included in contact screening and management efforts,
 with the aim of identifying undiagnosed TB disease and providing preventive therapy for contacts without TB disease that are susceptible
 to developing disease following exposure to a contact with active TB disease [3].
Standard for monitoring and evaluation
 27) All providers must report both new and re-treatment TB cases and their treatment outcomes to national public health authorities in
 conformance with applicable legal requirements and policies; TB mortality should be monitored by using standard cause-of-death data
 from vital registration systems [3, 30].
Standards for supportive approaches to TB patient management
 28) Digital technologies can be adapted to increase the effectiveness or efficiency of different components of TB programmes [3, 24].
 29) Promptly identify persons with TB symptoms (triage); provide an adequately ventilated waiting area for them; educate them about cough
 etiquette and respiratory hygiene; ensure they are prioritised for TB testing; and separate infectious patients [3].
 30) A patient-centred approach to treatment should be developed to promote adherence, improve quality of life and relieve suffering. This
 approach should be based on the patient's needs and on mutual respect between the patient and the provider [3, 24].
 31) Prior to starting TB treatment, each patient's need for support should be assessed, and interventions to encourage adherence to
 treatment be offered to improve outcomes [3, 24].
 32) Before starting TB treatment, all patients should be assessed to determine the risk of treatment interruption and appropriate options for
 treatment administration should be offered to each patient. Community- or home-based DOT is recommended over health facility-based
 DOT or unsupervised treatment; and DOT administered by trained lay providers or healthcare workers is recommended over DOT
 administered by family members. Video-observed treatment may replace DOT when the technology is available, and can be organised and
 operated by healthcare providers and patients [3, 24].
 33) All forms of suffering associated with TB should be addressed by ensuring that patients have proper access to care, and to the
 management of adverse reactions to treatment, management of psychological distress, means to prevent and mitigate stigma and
 discrimination; and by providing access to social protection mechanisms to reduce indirect costs [3].

ART: antiretroviral therapy; CPT: co-trimoxazole preventive therapy; TST: tuberculin skin test; CXR: chest radiography; EPTB: extrapulmonary tuberculosis; BCG: bacille Calmette–Guérin; DOT: directly observed therapy.