dot tb treatment in hiv who guidelines

The recommended treatment of TB disease in adults infected with HIV is a 6-month daily regimen consisting of: An intensive phase of isoniazid (INH), a rifamycin (see Drug Interactions below), pyrazinamide (PZA), and ethambutol (EMB) for the first 2 months.

Full Answer

Should HIV treatment be initiated during treatment for TB?

For persons with HIV who are not already on ART, treatment for HIV should be initiated during treatment for TB disease, rather than at the end, to improve outcomes among TB patients co-infected with HIV.

What is dot for TB treatment?

What is DOT? DOT means that a trained health care worker or other designated individual (excluding a family member) provides the prescribed TB drugs and watches the patient swallow every dose. Why use DOT?

What are the who treatment guidelines for tuberculosis (TB) (TB)?

(ii) Anti-retroviral therapy: The WHO guidelines for management of HIV-infected TB patients in resource- limited settings recommend a combination of two nucleoside reverse transcriptase inhibitors (NRTIs) along with one non-nucleoside reverse transcriptase inhibitor (NNRTI) for first line therapy.

What do we need to do to reduce HIV/TB deaths?

• We need to continue to advocate to have persons living with HIV included in new TB drug development To succeed in reducing HIV/TB deaths… from a treatment perspective We need to have the capability to start ART promptly (2-8 weeks) in all patients with HIV/TB

When should HIV patient start TB treatment?

The optimal timing to commence ART in HIV-infected patients with TB is within the first 8 weeks of starting antituberculous treatment and within the first 2 weeks for patients who have CD4 cell counts less than 50 cells/mm3. In resource-limited settings, NNRTI-based ART remains a first-line regimen.

Can TB and HIV be treated at the same time?

People with HIV/TB coinfection should be treated for both HIV and TB; however, when to start treatment and what medicines to take depends on a person's individual circumstances. Taking certain HIV and TB medicines at the same time can increase the risk of drug-drug interactions and side effects.

In which case of treatment DOTS is applicable?

National TB treatment guidelines strongly recommend using a patient-centered case management approach - including directly observed therapy ("DOT") - when treating persons with active TB disease.

What is the standard for treatment of TB in HIV infected persons?

Twelve weeks of once-weekly isonaizid and rifapentine (3HP), given by self-administered therapy or directly observed therapy, is the newest CDC-recommended treatment regimen for persons with latent TB infection and HIV and who are taking antiretroviral medications with acceptable drug-drug interactions with rifapentine ...

What medication are used for Category 3 in DOTS?

Objectives: To study the efficacy and safety of Category III DOTS treatment (intermittent thrice-weekly rifampicin [RMP], isoniazid [INH] and pyrazinamide for 2 months, followed by RMP and INH for 4 months) under India's Revised National Tuberculosis Control Programme in patients with uncomplicated small unilateral ...

Which drugs are given in DOTS?

DOTS involved treatment with a four drug regimen. These were isoniazid (INH), Rifampicin (Rif), Prazinamide (PZA) and Ethambutol (EMB) for 6-9 months.

How long is TB DOTS treatment?

A TB patient requires a daily treatment regimen that lasts for six to nine months. Patients are encouraged to go to TB clinics to take their medicines, under the care of a designated health worker.

What is FDC treatment?

An example of a fixed-dose combination (FDC) HIV drug is Atripla (a combination of efavirenz, emtricitabine, and tenofovir disoproxil fumarate). By reducing the number of pills a person must take each day, fixed-dose combination drugs can help improve adherence to an HIV treatment regimen.

What is DOT therapy?

Directly observed therapy (DOT) and other adherence promoting strategies should be used in all patients with HIV-related TB. The care for HIV-related TB should be provided by, or in consultation with, experts in management of both TB and HIV. The care for persons with HIV-related TB should include close attention to adherence to both regimens of TB and antiretroviral treatment, drug-drug interactions, paradoxical reaction or Immune Reconstitution Inflammatory Syndrome (IRIS), side effects for all drugs used, and the possibility of TB treatment failure or relapse.

When should antiretroviral therapy be initiated?

Anti-retroviral therapy should ideally be initiated within the first 2 weeks ...

How long does it take to take isonaizid and rifapentine?

Twelve weeks of once-weekly isonaizid and rifapentine (3HP), given by self-administered therapy or directly observed therapy, is the newest CDC-recommended treatment regimen for persons with latent TB infection and HIV and who are taking antiretroviral medications with acceptable drug-drug interactions with rifapentine.

What is the first step in HIV testing?

The first step is to ensure that people with HIV are tested for TB infection. If found to have TB infection, further tests are needed to rule out TB disease. The next step is to start treatment for latent TB infection or TB disease based on test results.

How long does HIV treatment last?

In the uncommon situation in which HIV-infected patients do NOT receive antiretroviral therapy during TB treatment, prolonging treatment to 9 months (extend continuation phase to 7 months) is recommended. Prolonging treatment to 9 months (extend continuation phase to 7 months) for HIV-infected patients with delayed response to therapy (e.g., ...

Can you take rifabutin with HIV?

Four months of daily rifampin is another treatment option. This regimen should not be used in people with HIV who are taking some combinations of antiretroviral therapy. In situations where rifampin cannot be used, sometimes another drug, rifabutin , may be substituted. For those taking antiretroviral medications with clinically significant drug ...

Is latent TB more likely to develop HIV?

Latent TB Infection and HIV. Someone with untreated latent TB infection and HIV infection is much more likely to develop TB disease during his or her lifetime than someone without HIV infection. There are several effective latent TB treatment regimens available for people with HIV.

Screening

In March 2021, WHO released the WHO consolidated guidelines on tuberculosis. Module 2: Screening – systematic screening for tuberculosis disease (1). These guidelines include 17 new and updated recommendations for the screening of TB disease.

Diagnosis

In July 2021, WHO released the WHO consolidated guidelines on tuberculosis. Module 3: Diagnosis – rapid diagnostics for tuberculosis detection 2021 update (3). Three new classes of nucleic acid amplification test (NAAT) are now endorsed by WHO:

Treatment

In April 2021, WHO convened a guideline development group (GDG) to review data from a trial conducted in 13 countries that compared 4-month rifapentine-based regimens with a standard 6-month regimen in people with drug-susceptible TB (6).

Comorbidities, vulnerable populations and people-centred care

In May to June 2021, WHO convened a GDG to review updated evidence on the management of TB in children and adolescents (aged 0–9 and 10–19 years, respectively). A rapid communication that summarizes the main updates to guidance on the management of TB in children and adolescents was released by WHO in August 2021 (8).

Other actions to support TB policy guidance

To exchange views on emerging areas where there is a need for global TB policy guidance, in March 2021, WHO convened a consultation on the translation of TB research into global policy guidelines, attended by scientists, public health experts, partners, civil society and countries (9).

Why do we need TB medicine?

TB medicines are used to prevent latent TB infection from advancing to TB disease and to treat TB disease. The choice of TB medicines and the length of treatment depend on whether a person has latent TB infection or TB disease. People with HIV/TB coinfection should be treated for both HIV and TB; however, when to start treatment ...

What to do if you have a coinfection with HIV?

If you have HIV/TB coinfection, talk to your health care provider about a treatment plan that works for you.

How does HIV medicine help?

HIV medicines protect the immune system and prevent HIV from advancing to AIDS . In people with HIV and latent TB infection, treatment with HIV and TB medicines reduces the chances that latent TB infection will advance to TB disease.

What is it called when a person with TB is inactive?

Once in the body, TB can be inactive or active. When the TB bacteria is inactive, this is called latent TB infection. When the TB bacteria is active, this is called TB disease.

What is TB in the body?

Tuberculosis (TB) is a disease caused by bacteria called Mycobacterium tuberculosis. The TB bacteria can spread from person to person through the air. Once in the body, TB can be inactive or active. Inactive TB is called latent TB infection. Active TB is called TB disease. TB usually affects the lungs, but it can affect any part of the body, ...

What is the cause of tuberculosis?

What is tuberculosis? Tuberculosis (TB) is a disease caused by bacteria called Mycobacterium tuberculosis. The TB bacteria can spread from person to person through the air. TB usually affects the lungs, but it can affect any part of the body, including the kidneys, spine, or brain. If not treated, TB can cause death.

Can you take TB and HIV at the same time?

People with HIV/TB coinfection should be treated for both HIV and TB; however, when to start treatment and what medicines to take depends on a person’s individual circumstances. Taking certain HIV and TB medicines at the same time can increase the risk of drug-drug interactions and side effects.

When should DOT be initiated?

DOT should be initiated when TB treatment starts. Do not allow the patient to try self-administering medications and missing doses before providing DOT. If the patient views DOT as a punitive measure, there is less chance of successfully completing therapy.

Who provides DOT?

A nurse or supervised outreach worker from the patient's county public health department normally provides DOT. In some situations, it works best for clinics, home care agencies, correctional facilities, treatment centers, schools, employers, and other facilities to provide DOT, under the guidance of the local health department.

Why do we need a dot?

DOT helps patients finish TB therapy as quickly as possible, without unnecessary gaps. DOT helps prevent TB from spreading to others. DOT decreases the risk of drug-resistance resulting from erratic or incomplete treatment. DOT decreases the chances of treatment failure and relapse.

Do home care agencies provide DOT?

DOT providers must remain objective. For complex regimens including IV/IM medications or twice daily dosing, home care agencies may provide DOT or share responsibilities with the local health department . If resources for providing DOT are limited, priority should be given to patients most at risk.

Screening

Diagnosis

Treatment

• In April 2021, WHO convened a guideline development group (GDG) to review data from a trial conducted in 13 countries that compared 4-month rifapentine-based regimens with a standard 6-month regimen in people with drug-susceptible TB (6). The GDG considereda 4-month regimen composed of rifapentine, isoniazid, pyrazinamide and moxifloxacin that met ...

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Comorbidities, Vulnerable Populations and People-Centred Care

Other Actions to Support TB Policy Guidance