National Tuberculosis Management Guideline 2019, Nepal
Introduction (Ref. Page no. 1)
This guideline is to provide basic information about TB and its management to all health workers in Nepal. Early detection, appropriate diagnosis and timely treatment of TB result in good treatment outcomes. Health workers need to be equipped with the right information on the diagnosis and treatment of TB. Poor management of TB results in death and creates drug resistant (DR) TB which is very hard and costly to treat resulting in often poorer outcomes.
All health workers in Nepal regardless of their involvement in TB services should be aware of TB, its transmission and prevention and its diagnosis and management. Health workers managing TB patients need proper guidance in diagnosis and treatment of TB and it is for this purpose that this guideline is produced.
In developing this guideline, the National TB Program takes into consideration the emerging problems of TB/HIV and DR TB as well as other revisions including Latent TB infection made to TB management by World Health Organization. This guideline is therefore, an update from the 2012 General Manual (Third Edition).
Following are the major changes to TB management for Nepal;
- Only 2 sputum samples required for initial diagnosis of TB.
- Same-day diagnosis of TB by Microscopy (2 samples same day-1 hour apart)
- Only 1 sputum sample required for follow up examination.
- Even new presumptive TB cases should have access to GeneXpert diagnosis wherever it is possible
- Treatment is not extended at the end of the intensive phase, even though the sputum follow up examination result remains positive at the end of two months, continuation phase is commenced regardless of whether the sputum is positive or not.
- Streptomycin containing Category II regimen for retreatment cases will No Longer be used in Nepal
- TB suspect is changed to Presumptive TB : Previously treated patients’ definitions have been changed and are based on the outcome of their most recent course of treatment and are independent of bacteriological confirmation or site of disease.
- The treatment regimen for retreatment TB cases has been removed. All previously treated TB patients will receive new treatment regimen and will be screened for drug resistant TB.
- Recording and reporting forms have been edited to suit new definitions and change in the treatment regimen
- Global Tuberculosis Report 2019: Latest status of the tuberculosis epidemic
- Dissemination of Findings and Recommendations of Joint External Monitoring Mission(JEMM) of Nepal National Tuberculosis Program
- National Tuberculosis Programme Annual Report 2018
- National Strategic Plan for Tuberculosis Prevention, Care and Control 2016 – 2021
- NTP, Nepal: New TB Treatment Algorithm & Regimen (Updated)
- WHO announces landmark changes in MDR-TB treatment regimens
- TB Vaccine results announce a promising step towards ending the emergency
- 7 million people receive record levels of lifesaving TB treatment but 3 million still miss out
National Guideline on Drug Resistant TB Management 2019, Nepal