18.6
Routine TB screening (intensified case finding)
Clinical HIV Guidelines, 5th Edition, 2022. Chapter 18, Continuing ART.
Clinical description
- Screen all patients at each visit for signs of active TB using 4 standard screening questions
o Cough of any duration o Fever o Night sweats o Weight loss / failure to thrive / malnutrition
- Children: in addition to the above, ask about the following signs. Investigate for TB if any are
present:
o Unresolved pneumonia o Frequent hospitalization/ illness o TB contact Continuing ART
- Classify screening outcome as follows:
o TB not suspected if none of the 4 signs are positive. In this case, the patient is very unlikely to have active TB.
o TB presumptive if one or several of the 4 signs are positive.
- Thoroughly investigate further (full clinical exam, sputum for Xpert, chest x-ray, fine
needle aspirate, TB urine Lam if indicated, FASH, etc.)
- Interrupt TPT until active TB has been ruled out
o TB confirmed if the patient has a current confirmed episode of TB (clinical or lab diagnosis).
- Always confirm if the patient is currently taking and adherent to TB treatment –
initiate TB treatment without delay or provide intensive adherence support.
- Classify on TB treatment or not on treatment.
Check doses against the printed guideline and your clinical judgement before treating a patient. Spotted an error? Report it from the contact links below.
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