The Ministry of Health and Child Care has released its updated Tuberculosis and leprosy management guidelines which comes with latest guidance on new diagnostics and shorter treatment regimens for TB.
By Staff Reporter
In this sixth edition, the Health and Child Care Ministry Permanent Secretary Dr Aspect Maunganidze said the pervious edition was done in 2016.
“The focus of TB prevention, care and control is to detect all TB cases early, particularly the bacteriologically positive cases, and provide them with effective treatment in a patient-centred manner, so as to reduce associated morbidity and mortality as well as the risk of development of drug resistance. Zimbabwe last updated the national TB management guidelines in 2016,” he said.
With treatment and diagnostics trends changing, the guidelines provide uniform guidance to all health workers in the public and private sector.
“Notably, the landscape has significantly shifted in recent years in the field of TB prevention and care, with existing guidelines no longer fit for purpose in providing the most up to date guidance in the care of TB patients. A range of new rapid molecular diagnostic tests have become increasingly available, including shorter treatment options for both drug susceptible and drug resistant TB, necessitating updating of these important guidelines. This document will provide standardized guidance to health care workers across all levels, in both the public and private sector in the care of TB clients,” Dr Maunganidze said.
In the guidelines, the Ministry of Health and Child Care acknowledges on the importance of adopting latest technologies used for chest x-rays.
“Findings from Prevalence surveys have zoomed a spotlight on subclinical TB, defined as “disease due to viable M. tuberculosis that does not cause clinical TB-related symptoms but causes other abnormalities that can be detected using existing radiologic or microbiologic assays” To date, very few interventions have attempted to identify and treat such individuals and more attention has been paid to reducing patient delays in care seeking after symptoms develop.
“It is plausible that subclinical TB could be potentially driving a substantial fraction of transmission at population level. More sensitive screening tools such as use of chest radiography to detect subclinical disease are increasingly becoming important as critical innovations if the global aspiration to end TB by 2030 is to be a reality,” reads the Guidelines.
The Health Ministry also noted how TB treatment regimens have been evolving.
“Finally, there has been a quantum leap in the development of new medicines for TB in recent years, which has seen the introduction of two completely new medicines, Bedaquiline and Delamanid, while a number of repurposed medicines including the fluoroquinolones, Linezolid and Clofazimine have found an increasingly important role in the treatment of especially Drug-resistant TB.
“There have also been changes in global TB indicators with WHO recommending that countries adopt a set of ten key indicators to monitor the national TB response to ensure alignment with the global End TB Strategy. Updating the national TB management guidelines is thus an imperative, to ensure global best practice is incorporated as standard of clinical care,” said the Ministry.
Zimbabwe was moved from the world’s top 30 list of countries heavily burdened by TB. It now has a double burden of TB/HIV and MDR-TB. According to the 2022 Global TB Report, TB estimated incidence of 190 /100,000 population was recorded in 2020 while treatment coverage was 54 percent in 2021, decreasing from 72 percent in 2019 (Global TB Report, 2022). An estimated 12,520 cases were missed in 2021. TB/HIV co-infection rate of 50 percent (Global TB Report, 2022), a drop from 54 percent in 2021. An Estimated Rifampicin of Resistant-TB was 1.7 percent among new and 28 percent among previously treated.
