Interventions for Tuberculosis

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Age Cohort: Pregnancy and newborn

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Advocay for TB Health Education on TB to pregnanct women/families/communities Distribution of IEC materials Social behaviour change and communication (SBCC) Education on good hygiene parctices eg Promotion of cough etiquette, General public education on TB symptoms, cough etiquette, TB treatment and actions to take after contact with a suspected TB case Advise to Pregnant women to avoid contact with people with persistent cough General public education on good nutrition Promotion of multi-sectoral approach in improving housing and saniation to combat TB community Health workers training on TB including prevention measures	Community Health workers training on TB including prevention measures Isolation for TB confirmed cases Pregnant women to avoid contacts with persons with TB Sceening for TB TB active case finding TB contact tracing TB awreness creation TB notification		Directly Observed Therapy (DOTs) to promote adherence to medication Referral of pregnant women with persistent cough to next level for investigation Referral of people living with a suspected case of TB for investigation and possible preventive treatment	Home based rehabilitation Physical exercises/Physiotherapy	Counselling Linkage to TB support groups Psycho-social and psychological support Spiritual support
Primary Care
Nutritional advice for pregnant women	BCG vaccination at birth HIV counselling and Testing for all Pregnant women Pregnant women to avoid contact with people with persistent cough Investigate pregnant women with persistent cough for TB		Physical and clinical examination Direct Observed Therapy (DOT) to promote adherence to medication TB drugs refill Sputum collection and specimen referral to labortaories within hospitals Sputum smear -acid stain and culture of sputum Monitoring of TB complications
Referral Facility: General
Nutritional advice for pregnant women Promotion of multi-sectotral approach in addressing improving housing and sanitation to combat TB	BCG vaccination at birth Advise pregnant women to avoid contact with people with persistent cough Investigate pregnant women with persistent cough for TB		Physical and clinical examination Confirmation of diagnosis using acid fast stain and culture of sputum Treatment of confirmed TB cases with anti TB medication using Direct Observed Therapy (DOT) Treatment with anti-TB medication Direct Observed Therapy (DOT) to promote adherence to medication Managment of TB/HIV co-infection Initiation of co-trimoxazole preventive therpay for TB/HIV co-ifection ART therapy for TB/HIV co-infection TB drugs refill Management of Multi -drug resistance TB Sputum smear /Stain and culture of sputum TB skin test HIV Counseling and Testing for confirmed TB cases Monitoring of TB complications
Referral Facility: Specialist
Promotion of multi-sectotral approach in addressing improving housing and sanitation to combat TB	BCG vaccination at birth Advise pregnant women to avoid contact with people with persistent cough Investigate pregnant women with persistent cough for TB		Physical and clinical examination Treatment with anti-TB medication Direct Observed Therapy (DOT) to promote adherence to medication Managment of TB/HIV co-infection Initiation of co-trimoxazole preventive therpay for TB/HIV co-ifection ART therapy for TB/HIV co-infection TB drugs refill Monitoring of TB complications Management of Multi -drug resistance TB Sputum smear /Stain and culture of sputum TB skin test HIV Counseling and Testing for confirmed TB cases

Age Cohort: < 5 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Social and behavioural change communication for parents Promote cough etiquette and cough hygiene	BCG vaccination Contact tracing, screening and management TB Prevention Therapy (TPT) Isolation of confirmed or presumptive adult TB cases	Recognition of tuberculosis signs and symptoms	Directly Observed Therapy (DOTs) Referral of presumptive TB TB drugs refill Trace and follow defaulters	Home-based self-management rehabilitation	Psychosocial support Linkage with support groups
Primary Care
Promote cough etiquette and cough hygiene Promote strong TB Infection control measures	Triage people with presumptive TB for “fast-track” or separation Ensure rapid diagnosis and initiation of treatment Improve room ventilation Protect health care workers	Contact history Physical examination Anthropometric measurement AFB microscopy Rapid molecular test Chest radiography	Directly Observed Therapy (DOTs) Trace and follow defaulters Referral of people with adverse reactions and complications	Breathing exercise	Psychosocial support Linkage with support groups
Referral Facility: General
Promote cough etiquette and cough hygiene Promote strong TB Infection control measures	Strong TB Infection control measures Triage people with presumptive TB for “fast-track” or separation Ensure rapid diagnosis and initiation of treatment Improve room ventilation Protect health care workers	Contact history Physical examination Anthropometric measurement AFB microscopy Tuberculin skin test Rapid molecular test HIV testing Chest radiography Ultrasound	Directly Observed Therapy (DOTs) Manage adverse reactions and complications	Breathing exercise	Psychosocial support Linkage with support groups
Referral Facility: Specialist
Promote cough etiquette and cough hygiene Promote strong TB Infection control measures	Strong TB Infection control measures Triage people with presumptive TB for “fast-track” or separation Ensure rapid diagnosis and initiation of treatment Improve room ventilation Protect health care workers	Contact history Physical examination Anthropometric measurement Tuberculin skin test (TST) Interferon gamma release assay HIV testing Rapid molecular diagnostic tests Chest radiography Ultrasound Fluid analysis Drug sensitivity test (DST) CT scan MRI Fine-needle aspiration Biopsy of tissues	Direct Observed Therapy (DOT) Manage severe adverse infections and complications Anti TB medication Anti MDR/XDR TB Intensive care as clinically indicated	Breathing exercise	Psychosocial support Linkage with support groups

Age Cohort: 5 - 11 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Social and behavioural change communication for parents School health education Promote cough etiquette and cough hygiene	Contact tracing, screening and management TB Prevention Therapy (TPT) Isolation of confirmed or presumptive adult TB cases	Recognition of tuberculosis signs and symptoms	Directly Observed Therapy (DOTs) Self-administrative therapy (SAT) to those with good adherence Referral of people with presumptive TB to next level Referral of people living HIV for regular screening and possible TPT * TB drugs refill for SAT Trace and follow up of defaulters	Home-based self-management rehabilitation	Psychosocial support Linkage with support groups
Primary Care
Promote cough etiquette and cough hygiene Promote strong TB Infection control measures	Triage people with presumptive TB for “fast-track” or separation Ensure rapid diagnosis and initiation of treatment Improve room ventilation Protect health care workers	Contact history Physical examination Anthropometric measurement AFB microscopy Gene/Xpert Chest radiography	Directly Observed Therapy (DOTs) Self-administrative therapy (SAT) to those with good adherence Referral of people living HIV for regular screening and possible TPT * TB drugs refill for SAT Trace and follow up of defaulters Referral of people with adverse reactions and complications	Breathing exercise	Psychosocial support Linkage with support groups
Referral Facility: General
Promote cough etiquette and cough hygiene Promote strong TB Infection control measures	Strong TB Infection control measures Triage people with presumptive TB for “fast-track” or separation Ensure rapid diagnosis and initiation of treatment Improve room ventilation Protect health care workers	Contact history Physical examination Anthropometric measurement AFB microscopy Tuberculin skin test Gene/Xpert HIV testing Chest radiography Ultrasound	Directly Observed Therapy (DOTs) Self-administrative therapy (SAT) to those with good adherence ART therapy for TB/HIV co-infection Referral of people living HIV for regular screening and possible TPT * TB drugs refill for SAT Trace and follow up of defaulters Referral of people with adverse reactions and complications	Breathing exercise	Psychosocial support Linkage with support groups
Referral Facility: Specialist
Promote cough etiquette and cough hygiene Promote strong TB Infection control measures	Strong TB Infection control measures Triage people with presumptive TB for “fast-track” or separation Ensure rapid diagnosis and initiation of treatment Improve room ventilation Protect health care workers	Contact history Physical examination Anthropometric measurement Tuberculin skin test (TST) Blood tests e.g. (interferon gamma release assay) HIV testing Gene/Xpert or other molecular diagnostic tests Chest radiography Ultrasound Fluid analysis Sputum culture Drug sensitivity test (DST) Computerized tomography (CT) scan Magnetic resonance imaging (MRI) Fine-needle aspiration Biopsy of tissues	Direct Observed Therapy (DOT) Self-administered treatment (SAT) Management of severe adverse infections and complications Management of TB/HIV co-infection ART therapy for TB/HIV co-infection MDR/XDR TB diagnosis and management Nutritional support and supplement ICU care as clinically indicated Linkage to non-medical social support	Breathing exercise	Psychosocial support Linkage with support groups

Age Cohort: 12 - 24 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Contact tracing, screening and management Isolation of confirmed or presumptive TB cases Casefinding campaign in the community to increase case detection	Institute the following measures in homes where there is a suspected or confirmed TB case Adequate ventilation Education on cough etiquette Isolation of confirmed or suspected case if feasibleAdvise confirmed or suspected case to spend as much time outdoors Spend as little time as possible on public transport while smear positive Spend as little time as possible in crowded places when smear positive Sputum collection and transportation for TB suspects Isolation of confirmed TB patients at community level if possible Screening for TB at the community level Active TB case finding TB contacts tracing Referral of contacts of a confirmed TB case who have symptoms to next level for preventive treatment Referral of contacts of confirmed TB case who are HIV positive to next level for preventive treatment.	Recognition of tuberculosis signs and symptoms	Directly Observed Therapy (DOTs) Referral of people with presumptive TB to next level Referral of people living HIV for regular screening and possible TPT * Trace and follow up of defaulters Primary level Family & community based DOTS	Home-based self-management rehabilitation	Psychosocial support Linkage with support groups
Primary Care
Promote cough etiquette and cough hygiene Promote strong TB Infection control measures	Triage people with presumptive TB for “fast-track” or separation Ensure rapid diagnosis and initiation of treatment Improve room ventilation Protect health care workers	Contact history Physical examination Anthropometric measurement AFB microscopy Rapid molecular diagnostic tests Chest radiography	Directly Observed Therapy (DOTs) Self-administrative therapy (SAT) to those with good adherence Referral of people living HIV for regular screening and possible TPT * TB drugs refill for SAT Trace and follow up of defaulters Referral of people with adverse reactions and complications Diagnosis using Xpert MTB/RIF	Breathing exercise	Psychosocial support Linkage with support group
Referral Facility: General
Promote cough etiquette and cough hygiene Promote strong TB Infection control measures	Strong TB Infection control measures Triage people with presumptive TB for “fast-track” or separation Ensure rapid diagnosis and initiation of treatment Improve room ventilation Protect health care workers	Contact history Physical examination Anthropometric measurement AFB microscopy Tuberculin skin test Rapid molecular diagnostic tests HIV testing Chest radiography Ultrasound	Directly Observed Therapy (DOTs) Self-administrative therapy (SAT) to those with good adherence ART therapy for TB/HIV co-infection Referral of people living HIV for regular screening and possible TPT * TB drugs refill for SAT Trace and follow up of defaulters Manage adverse reactions and complications Diagnosis using Xpert MTB/RIF	Breathing exercise	Psychosocial support Linkage with support groups
Referral Facility: Specialist
Advocacy for TB Distribution of IEC materials on TB Health education to communities on TB Promote use of personal protective equipment (PPE) Universal precaution for TB (eg. cough etiquette, Train health workers on TB	Strong TB Infection control measures Triage people with presumptive TB for “fast-track” or separation Rapid diagnosis and initiation of treatment Improve room ventilation Protect health care workers	Contact history Physical examination Anthropometric measurement Tuberculin skin test (TST) Interferon gamma release assay HIV testing Rapid molecular diagnostic tests Chest radiography Ultrasound Fluid analysis Sputum culture Drug sensitivity test (DST) Line probe assay (LPA) Computed tomography (CT) Magnetic resonance imaging (MRI) Fine-needle aspiration Biopsy of tissues	Direct Observed Therapy (DOT) Self-administered treatment (SAT) Manage severe adverse infections Manage complications Manage HIV co-infection Manage MDR/XDR TB Nutritional support and supplement Intensive care as clinically indicated Linkage to non-medical social support	Breathing exercise	Psychosocial support Linkage to support groups

Age Cohort: 25 - 59 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Social and behavioural change communication Promote cough etiquette and cough hygiene Create awareness on Tuberculosis risk factors and prevention methods Social and behavioural change communication on tuberculosis Mass media to raise awareness on tuberculosis and its prevention Promote infection prevention control for TB	Contact tracing, screening and management Isolation of confirmed or presumptive TB cases		Directly Observed Therapy (DOTs) Referral of people with presumptive TB to next level Referral of people living HIV for regular screening and possible TPT * Trace and follow up of defaulters Directly Observed Therapy (DOTs) by family/community/CHAs to promote adherence Self administrative therapy (SAT) to those with good adherence Referral of presumptive TB cases to next level Referral of people living HIV for regular screening and possible TPT * TB drugs refill Trace and follow up of defaulters	Home-based self-management rehabilitation	Psychosocial support Linkage with support groups
Primary Care
Promote cough etiquette and cough hygiene Promote strong TB Infection control measures	Triage people with presumptive TB for “fast-track” or separation Ensure rapid diagnosis and initiation of treatment Improve room ventilation Protect health care workers TB preventive therapy	Contact history Physical examination AFB microscopy Gene/Xpert Chest radiography	Physical and clinical examination Confirmation of diagnosis using Chest X-ray and acid fast stain and culture of sputum Treatment of confirmed TB cases with anti TB medication using Direct Observed Therapy (DOT ) Direct Observed Therapy (DOT) to promote adherence to medication TB drugs refill Sputum collection and specimen referral to labortaories within hospitals Sputum smear -acid stain and culture of sputum Monitoring of TB complications Diagnosis confirmation using AFB, Directly Observed Therapy (DOTs) by family/community/CHAs to promote adherence Self administrative therapy (SAT) to those with good adherence Referral of people with presumptive TB to next level Referral of people living with HIV for regular TB screening B Preventive Therapy TB drugs refill Trace and follow up of defaulters	Breathing exercise	Psychosocial support Linkage with support groups
Referral Facility: General
Promote cough etiquette and cough hygiene Promote strong TB Infection control measures	Strong TB Infection control measures Triage people with presumptive TB for “fast-track” or separation Ensure rapid diagnosis and initiation of treatment Improve room ventilation Protect health care workers TB preventive therapy	Contact history Physical examination AFB microscopy Tuberculin skin test Gene/Xpert HIV testing Chest radiography Ultrasound	Directly Observed Therapy (DOTs) Self-administrative therapy (SAT) to those with good adherence ART therapy for TB/HIV co-infection Referral of people living HIV for regular screening and possible TPT * TB drugs refill for SAT Trace and follow up of defaulters Manage adverse reactions and complications Diagnosis confirmation using chest x-ray, AFB, GeneXpert Directly Observed Therapy (DOTs) by family/community/CHAs to promote adherence Self administrative therapy (SAT) to those with good adherence Referral of people with presumptive TB to next level Referral of people living HIV for regular screening and possible TPT * TB drugs refill Trace and follow up of defaulters Linkage to non-medical social support	Breathing exercise	Psychosocial support Linkage with support groups
Referral Facility: Specialist
Promote cough etiquette and cough hygiene Promote strong TB Infection control measures	Strong TB Infection control measures Triage people with presumptive TB for “fast-track” or separation Ensure rapid diagnosis and initiation of treatment Improve room ventilation Protect health care workers TB preventive therapy	History Physical examination Tuberculin skin test (TST) Interferon gamma release assay test HIV testing Molecular diagnostic tests Chest radiography Ultrasound Fluid analysis Sputum culture Drug sensitivity test (DST) Line probe assay (LPA) Computed tomography (CT) Magnetic resonance imaging (MRI) Fine-needle aspiration Biopsy of tissues	Direct Observed Therapy (DOT) Self-administered treatment (SAT) Management of severe adverse infections and complications Management of TB/HIV co-infection ART therapy for TB/HIV co-infection MDR/XDR TB management Nutritional support and supplement Management of complication Linkage to non-medical social support	Breathing exercise	Psychosocial support Linkage with support groups

Age Cohort: 60+ years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Social and behavioural change communication Promote cough etiquette and cough hygiene Create awareness on Tuberculosis risk factors and prevention methods Social and behavioural change communication on tuberculosis Mass media to raise awareness on tuberculosis and its prevention Promote infection prevention control for TB	Contact tracing, screening and management TB Prevention Therapy (TPT) Isolation of confirmed or presumptive TB cases	Recognition of tuberculosis signs and symptoms Sputum transportation	Referral of people with presumptive TB to next level Referral of people living HIV for regular screening and possible TPT Direct observation of patients Trace and follow up of defaulters	Home-based self-management rehabilitation	Psychosocial support Linkage with support groups
Primary Care
Promote cough etiquette and cough hygiene Promote strong TB Infection control measures	Triage people with presumptive TB for “fast-track” or separation Ensure rapid diagnosis and initiation of treatment Improve room ventilation Protect health care workers	History Physical examination AFB microscopy POC Molecular diagnostic tests Chest radiography	Directly Observed Therapy (DOTs) Self-administrative therapy (SAT) to those with good adherence Referral of people living HIV for regular screening and possible TPT * TB drugs refill for SAT Trace and follow up of defaulters Referral of people with adverse reactions and complications	Breathing exercise	Psychosocial support Linkage with support groups
Referral Facility: General
Promote cough etiquette and cough hygiene Promote strong TB Infection control measures	Strong TB Infection control measures Triage people with presumptive TB for “fast-track” or separation Ensure rapid diagnosis and initiation of treatment Improve room ventilation Protect health care workers	History Physical examination AFB microscopy Tuberculin skin test POC Molecular diagnostic tests HIV testing Chest radiography Ultrasound	Directly Observed Therapy (DOTs) Self-administrative therapy (SAT) to those with good adherence ART therapy for TB/HIV co-infection Referral of people living HIV for regular screening and possible TPT * TB drugs refill for SAT Trace and follow up of defaulters Referral of people with adverse reactions and complications	Breathing exercise	Psychosocial support Linkage with support groups
Referral Facility: Specialist
Promote cough etiquette and cough hygiene Promote strong TB Infection control measures	Strong TB Infection control measures Triage people with presumptive TB for “fast-track” or separation Ensure rapid diagnosis and initiation of treatment Improve room ventilation Protect health care workers	History Physical examination Tuberculin skin test (TST) Interferon gamma release assay test HIV testing Molecular diagnostic tests Chest radiography Ultrasound Fluid analysis Sputum culture Drug sensitivity test (DST) Computed tomography (CT) Magnetic resonance imaging (MRI) Fine-needle aspiration Biopsy of tissues	Direct Observed Therapy (DOT) Self-administered treatment (SAT) Management of severe adverse infections and complications Management of TB/HIV co-infection ART therapy for TB/HIV co-infection MDR/XDR TB diagnosis and management Nutritional support and supplement Management of complication Linkage to non-medical social support	Breathing exercise	Psychosocial support Linkage with support groups