40 Questions
How often should symptom-based screening be done for PLHIV?
At every visit and at the time of diagnosis
What is the duration of TB signs and symptoms in PLHIV?
Any duration, not necessarily two weeks
What is the first step in identifying presumptive TB in PLHIV?
Identify TB signs and symptoms
What is the purpose of asking about previous history of treatment and exposure to TB cases in presumptive TB?
To determine the risk for DR-TB
What is the next step after identifying a presumptive TB case in PLHIV?
Record the patient in Form 1 and follow the diagnostic algorithm
What is recorded on a monthly basis in Form 1?
The total number of clients who underwent chest X-ray screening
Who should be screened for TB using symptoms and chest X-ray?
Household and close contacts of all ages of a diagnosed TB case
What is the purpose of Fig. 2 in the context of TB screening and diagnosis?
To outline the steps for screening and diagnosis of TB in PLHIV
What is the definition of a presumptive DR-TB case?
A TB case with a history of previous treatment and close contacts of a known DR-TB case
What is the primary consideration for screening strategies?
All of the above
What is the purpose of asking about the four cardinal signs/symptoms in patients consulting the health facility for other reasons?
To determine if the patient has a presumptive TB
What is the first step in screening for pulmonary TB (PTB) in adults ≥ 15 years old?
Record the patient's demographic and contact information in a register of consults
What is a presumptive TB?
A patient who has any of the four cardinal signs/symptoms lasting for at least two weeks
Where can screening for TB be done?
In health facilities, in communities or congregate settings, and among health workers and TB contacts
What is the purpose of systematic screening in health facilities?
To ensure that all patients visiting the health facility are screened for TB
What is the purpose of asking about the cardinal signs and symptoms in Fig. 1?
To identify patients who have a presumptive TB
What is the recommended frequency for chest X-ray screening?
Once a year
What is the primary consideration for chest X-ray screening in resource-limited settings?
Presence of TB risk factors
What is the requirement for pregnant women undergoing chest X-ray screening?
A written consent and abdominal protective shield
What percentage of bacteriologically confirmed pulmonary TB cases would have been missed by screening using symptoms alone?
One-third to two-thirds
Which of the following is NOT a TB risk factor?
Hypertension
What should be requested for chest X-ray screening?
Posteroanterior (PA) view
What should be brought for comparison during chest X-ray screening?
Previous chest X-rays
What should be done if a chest X-ray is not available for high-risk patients with signs and symptoms lasting less than two weeks?
The physician may decide whether to consider the patient a presumptive TB case
What is the recommended frequency of chest X-ray screening for adults in high-risk settings?
Annually
What is the recommended approach for children in high-risk settings?
Symptom screening only
What should be considered when planning chest X-ray screening in high-risk settings?
Availability of sufficient supply, including Xpert cartridges and drugs
Why is Xpert MTB/RIF preferred over smear microscopy in ACF?
Because Xpert MTB/RIF is more sensitive than smear microscopy
What should be done for patients with chest X-ray findings suggestive of TB?
Collect sputum for an Xpert MTB/RIF test
What should be done for pregnant women during chest X-ray screening?
Use a protective shield and obtain written consent
What should be asked about for patients identified as presumptive TB?
Both their previous history of treatment and exposure to a TB case
What should be done after identifying patients as presumptive TB?
Record the patient in Form 1
What is the initial step in evaluating household contacts of diagnosed DR-TB cases?
Screen with signs and symptoms and chest X-ray
What is the frequency of follow-up contacts for household contacts of DR-TB cases?
Every six months for two years
What is the recommended test for DR-TB contacts without signs and symptoms or with chest X-ray findings not suggestive of TB?
Symptom screening
What is the recommended frequency of chest X-ray for household contacts of DR-TB cases?
Every year
What is the purpose of educating household contacts about TB signs and symptoms?
To advise them to return to the health facility if signs and symptoms develop
What is the recommended action for household contacts with signs and symptoms or a positive chest X-ray result?
Refer to Xpert MTB/RIF testing
What is the alternative to chest X-ray screening if it is not feasible?
Xpert MTB/RIF testing
What is the recommended frequency of Xpert MTB/RIF testing if chest X-ray is not available?
Every year
Study Notes
Screening for TB
- Household and close contacts of all ages of a diagnosed TB case should be screened for TB using symptoms and chest X-ray.
Systematic Screening in Health Facilities
- Systematic screening in health facilities involves screening all clients visiting the facility, regardless of the reason for consultation.
- If the patient consults due to any of the four cardinal signs/symptoms (cough, unexplained fever, unexplained weight loss, and night sweats), follow the guidelines.
- If the patient consults for other reasons, ask about the four cardinal signs/symptoms.
- Steps involved in screening for pulmonary TB (PTB) in adults ≥ 15 years old:
- Record the patient's demographic and contact information.
- Ask about the four cardinal signs/symptoms.
- If any of the signs/symptoms are present for at least two weeks, identify as a presumptive TB.
- If not, offer chest X-ray screening if one has not been conducted in the past year.
Chest X-ray Screening
- A chest X-ray posteroanterior (PA) upright view should be requested, and previous chest X-rays should be brought for comparison.
- Written consent should be taken from pregnant women, and an abdominal protective shield should be used.
- If resources are limited, prioritize those with TB risk factors (e.g., contacts of TB patients, people living with HIV, elderly, diabetics, smokers, etc.).
Risk Factors
- TB risk factors include:
- Contacts of TB patients
- Those with a history of previous TB treatment
- People living with HIV
- Elderly (> 60 years old)
- Diabetics
- Smokers
- Health-care workers
- Urban and rural poor
- Those with other immune-suppressive medical conditions
Presumptive TB Case
- If a patient has chest X-ray findings suggestive of TB, identify as a presumptive TB.
- If a patient has TB signs and symptoms and/or a chest X-ray suggestive of TB, identify as a presumptive TB.
Screening for PLHIV
- Screening for PLHIV should be done at the time of diagnosis of HIV/AIDS and annually, thereafter.
- Symptom-based screening should be done at every visit.
- Signs and symptoms for PLHIV can be of any duration, not necessarily two weeks.
Presumptive DR-TB Case
- Ask about previous history of treatment and exposure to TB cases to determine the risk for DR-TB.
- Presumptive DR-TB cases are those with previous history of TB treatment, close contacts of a known DR-TB case, or a non-converter of DS-TB regimen.
Follow-up Contacts
- Follow-up contacts every six months for the next two years.
- Do symptom screening every six months and chest X-ray annually.
- If it is not feasible to do a chest X-ray, directly do Xpert MTB/RIF test annually.
Screening Household Contacts of DR-TB Cases
- Evaluate all household contacts of diagnosed DR-TB cases by screening with signs and symptoms and chest X-ray.
- Those with signs and symptoms or a positive chest X-ray result should be identified as presumptive TB.
- Refer all household contacts identified as presumptive TB to Xpert MTB/RIF testing.
- Follow-up contacts every six months for the next two years.
This quiz covers the procedures for screening household and close contacts of a diagnosed TB case, including considerations for specimen transport and laboratory capacity. Learn about the strategies for effective TB diagnosis and treatment.
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