1.
MINISTRY OF HEALTH
REPUBLIC OF KENYA
INTEGRATED GUIDELINE FOR
TUBERCULOSIS, LEPROSY AND
LUNG DISEASE
2021

2.
MINISTRY OF HEALTH
REPUBLIC OF KENYA
INTEGRATED GUIDELINE FOR
TUBERCULOSIS, LEPROSY AND
LUNG DISEASE
2021

3.
Integrated Guideline for Tuberculosis,
Leprosy and Lung Disease | 2021
ii
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part, provided the source is acknowledged. It may not be sold or used for commercial purposes.
Published by:
Ministry of Health
Afya House, Cathedral Road
PO Box 30016 Nairobi 00100
http:/
/www.health.go.ke

4.
Integrated Guideline for Tuberculosis,
Leprosy and Lung Disease | 2021
iii
Table of Contents
List of Abbreviations...................................................................................................................................................................ix
Foreword ..........................................................................................................................................................................................xiii
Acknowledgement....................................................................................................................................................................xiv
CHAPTER 1: INTRODUCTION TO THE INTEGRATED GUIDELINE FOR TUBERCULOSIS,
LEPROSY AND LUNG DISEASE..........................................................................................1
1.2 Introduction...........................................................................................................................................................................1
1.1.2 Tuberculosis..........................................................................................................................................................2
1.1.2 Leprosy.....................................................................................................................................................................2
1.1.3 Lung Health...........................................................................................................................................................2
1.2 Strategic Focus..................................................................................................................................................................3
1.3 Diagnosis and Case Finding....................................................................................................................................3
1.4 Integrated Care Provision .........................................................................................................................................3
1.5 Nutrition Status Assessment...................................................................................................................................4
1.6 Advocacy & Communication .................................................................................................................................4
1.7 Recording & Reporting................................................................................................................................................4
1.8 Scope of the guidelines..............................................................................................................................................4
1.9 Target audience ...............................................................................................................................................................5
CHAPTER 2: APPROACHES TO FINDING PEOPLE WITH TUBERCULOSIS................................7
2.1. Introduction..........................................................................................................................................................................7
2.2. Setting......................................................................................................................................................................................8
2.3. Facility Based Active Case Finding (FB-ACF)..............................................................................................8
2.4. Contact Management................................................................................................................................................16
2.5. Community Outreaches............................................................................................................................................21
CHAPTER 3: MANAGEMENT OF DRUG SUSCEPTIBLE TUBERCULOSIS (DSTB) IN ADULTS. 25
3.1 Introduction....................................................................................................................................................................... 25
3.2 Classification of Tuberculosis...............................................................................................................................26
3.3 Diagnosis of Tuberculosis....................................................................................................................................... 27
3.4 Baseline Work Up for Newly Diagnosed Tuberculosis......................................................................31
3.5 Role of Chest x-ray (CXR) in Tuberculosis Screening and Diagnosis......................................31
3.6 Diagnosis of Extrapulmonary TB.......................................................................................................................36
3.7 Treatment of Drug Susceptible Tuberculosis..........................................................................................39
3.8 Special Considerations in the Management of TB..............................................................................44
3.9 TB Treatment Outcome Definitions.................................................................................................................45
3.10 Complications of Pulmonary Tuberculosis................................................................................................45
3.11 Treatment Preparation, Initiation and Follow Up.................................................................................. 47

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Integrated Guideline for Tuberculosis,
Leprosy and Lung Disease | 2021
iv
3.12 Treatment Response Follow-up for Bacteriologically Confirmed TB...................................49
3.13 Treatment Interruption...............................................................................................................................................51
3.14 Common Adverse Effects of First Line Anti-Tuberculous Drugs..............................................53
3.15 Dietary Considerations for Persons on First Line Anti-TB Medicines....................................55
CHAPTER 4: TUBERCULOSIS IN CHILDREN ..................................................................................... 57
4.1 Introduction.......................................................................................................................................................................58
4.2 Diagnosis of TB in children....................................................................................................................................59
4.3 Treatment of Drug Sensitive Tuberculosis in Children..................................................................... 73
4.5 TB and HIV Co-infection in Children..............................................................................................................84
4.6 Prevention of TB in Children.................................................................................................................................89
4.7 Child Nutrition and TB...............................................................................................................................................92
4.8 TB in Special Circumstances in Childhood...............................................................................................96
CHAPTER 5: LABORATORY DIAGNOSIS OF TB..................................................................................99
5.1 Introduction.......................................................................................................................................................................99
5.2 Laboratory Diagnosis of TB................................................................................................................................100
5.3 Specimen Collection................................................................................................................................................101
5.4 Laboratory Request form......................................................................................................................................104
5.5 Transport and Packaging......................................................................................................................................105
5.6 Laboratory Testing.....................................................................................................................................................107
5.7 Test Turnaround Time...............................................................................................................................................112
5.8 External Quality Assessment.............................................................................................................................118
5.9 Laboratory Infection Prevention Control...................................................................................................118
CHAPTER 6: TUBERCULOSIS IN SPECIAL CONDITIONS.........................