providing care for people living with HIV

The guidelines are aimed at health-care
workers providing care for people living with
HIV, policy-makers and health programme
managers working in the field of HIV /AIDS
and TB. These guidelines are also intended for
governments, nongovernmental organizations,
donors and patient support groups that address
HIV and TB.
What is the best combination of signs, symptoms
and diagnostic procedures (e.g. smear
microscopy, radiography, serum-based tests such
as interferon-gamma release assays [IGRA]) that
can be used as screening tools to determine
the eligibility for treatment of latent TB infection
(LTBI)?
2. What is the optimal duration and drug regimen
(e.g. INH, rifampicin, etc.) for treatment of LTBI to
reduce the risk of developing TB among people
living with HIV?
3. What is the optimal time to start considering
initiation of IPT (i.e. should immune status be
considered and should IPT be started with ART)?
4. Should secondary treatment of LTBI be provided
for people living with HIV to prevent reinfection or
recurrence of TB after successful completion of
TB treatment?
5. Does treatment for LTBI among people living with
HIV lead to significant development of monoresistance
against the drug(s) used for LTBI
treatment?
6. Will low adherence rates to treatment for LTBI be
a barrier to the implementation of LTBI treatment
among people living with HIV?
7. Is the provision of treatment for LTBI costeffective?
8. Is the use of tuberculin skin test (TST) feasible in
resource-limited settings?
The guidelines include evidence-based
recommendations for adults, children and infants, the
summary and grading of evidence, implementation
issues and key research gaps. In contrast to the
1998 WHO/UNAIDS Policy, these new guidelines
reconceptualize ICF and the provision of IPT as
integral and interlinked components of quality care
for people living with HIV. The revised guidelines
recommend the use of an evidence-based, simplified
TB screening algorithm that relies on four clinical
symptoms to identify those eligible for either IPT or
further diagnostic work-up for TB or other diseases.
Although a subject of another set of WHO guidelines,
screening for TB also allows for improved infection
control measures to prevent nosocomial transmission.
These guidelines also include recommendations for
people living with HIV who are pregnant, on ART and
have completed TB treatment. The guidelines will
be reviewed and updated in five years according to
WHO procedure.[13]