Guidelines on the Prevention and Control of Tuberculosis in Ireland

<strong>Guidelines</strong> on the Prevention and Control of Tuberculosis in Ireland 2010HSE/HPSC-xvdiseaseclinician (with a chest X-ray) for a medical assessment to rule out TB disease or LTBI.However, an occupational medicine consultant may wish to treat these patients if appropriateprotocols, audit of care and resources are in place (section 9.1).9.4 Irish HCWs or HCWs from low incidence countries (< 40 cases of TB per 100,000 per year) with apositive TST (Mantoux test) defined as ≥15mm should be referred to a respiratory or infectiousdisease clinician (with a chest X-ray) for a medical assessment to rule out TB disease or LTBI.However, an occupational medicine consultant may wish to treat these patients if appropriateprotocols, audit of care and resources are in place (section 9.1).9.5 All new entrants to Ireland who originate from a country with a high incidence of tuberculosis (≥40cases per 100,000 population per year) and will be spending at least three months in Ireland shouldbe provided with an opportunity to be screened for TB (section 9.2).9.6 An expanded programme of screening for TB including voluntary screening for HIV in new entrantsshould be established. The committee believes that this should be part of a broader healthscreening programme to improve the health of new entrants to Ireland (section 9.2).9.7 A programme of screening for TB in prisoners should be provided (section 9.3).9.8 Prisoners should receive chemotherapeutic treatment for active disease or LTBI by DOT, as highrates of treatment failure have been observed in this population. Patients undergoing any formof TB treatment should be assigned a key worker (a health professional) to promote compliance,monitor treatment effectiveness and the occurrence of adverse events (section 9.3).9.9 Prison medical services should liaise with community TB services to ensure the continuation of DOTafter release from prison (section 9.3).9.10 An opportunistic active case finding strategy is advised among homeless individuals. Screening bychest X-ray is recommended. TST and IGRA are believed to be less useful, as people may movebefore test reading /results are available (section 9.4).9.11 Nomination of a key worker for homeless patients receiving treatment and the provision of DOTare considered an optimal strategy for treatment completion (section 9.4).10 Tuberculosis and HIV Infection10.1 Cases of TB/HIV should always be managed by physicians with expertise in treating both TB andHIV (chapter 10).10.2 A high index of suspicion should be maintained for TB in all HIV-infected individuals (section 10.1).10.3 In HIV-infected individuals, routine screening for TB is advisable. HIV-infected children should bescreened annually for TB, beginning at age three to 12 months (section 10.5).10.4 All TB cases should be offered HIV testing (section 10.4).10.5 The recommended treatment regimens for LTBI in adults who are HIV positive are: (i) isoniazidfor an optimum duration of nine months or (ii) rifampicin for four months or (iii) a combination ofrifampicin and isoniazid for four months (section 10.7).10.6 The recommended treatment regimens for LTBI in children who are HIV positive are: (i) isoniazid fora minimum of six months with an optimum duration of nine months or (ii) rifampicin for six monthsor (ii) a combination of rifampicin and isoniazid for four months (section 10.7).10.7 DOT is recommended for the treatment of all HIV-infected TB cases (section 10.7).