Questions and answers: the 2013 revision of the WHO definitions and reporting framework for tuberculosis
These answers are meant to help national TB programmes to classify and report on TB patients and to guide programme monitoring using the 2013 revision of the definitions and reporting framework for tuberculosis. They are not intended to determine individual case management or treatment options which are the topic of other WHO guidelines (see related links). MDR-TB = multidrug-resistant TB The new definitions will first be used by WHO in its 2014 round of global data collection, relating to TB cases registered in 2013, treatment outcomes of TB patients notified in 2012 and treatment outcomes of RR-TB/MDR-TB patients who started second-line treatment in 2011. Detailed guidance on how to report under the new framework will be provided within the WHO global TB data collection system. National TB programmes which have not changed their TB recording and reporting systems by the time the 2014 data collection round is launched will still be able to report to WHO. The most important change is that diagnosis using Xpert MTB/RIF and other WHO-endorsed molecular tests are included in a new definition of bacteriologically confirmed case. Other changes include: Countries should adhere closely to the revised definitions of cases and treatment outcomes. This permits global comparisons which countries can find helpful to track progress. However, the forms, registers and reports in the revised framework document are intended to serve as examples and demonstrate how a minimum dataset should be compiled. National TB programmes may modify the forms, registers and reports to suit their needs, but the minimum dataset submitted to WHO should follow the same definitions, in order to be comparable between countries. National TB programmes using aggregate quarterly reporting systems to pass data up from basic management units to sub-national and national levels from paper-based registers may wish to include indicators other than the ones shown in the revised framework document. However any addition to the quarterly reports, especially extra disaggregation, increases the reporting burden on TB staff, because manual counting and checking is time-consuming and prone to errors, so national TB programmes need to judge whether the extra burden is justified by the benefit gained or not. National TB programmes using national case-based databases in which individual case records can be regularly updated (for example web-based or mobile-app-based systems) do not usually need to submit quarterly reports since case finding and treatment outcome reports can be generated automatically on demand. Disaggregated reports using variables already in the database can also be generated easily without placing an additional reporting burden on frontline TB staff. However, if a national TB programme wishes to monitor variables not already in the database it would need to update its system accordingly. This would place an extra data entry burden on TB staff and the national TB programme will need to judge whether the extra burden is justified or not. The basic management unit TB register functions as both an epidemiological tool and a management tool. It should therefore contain the records of all patients diagnosed with TB and eligible for TB treatment, including those diagnosed with RR-TB or MDR-TB, regardless of whether treatment was actually started. Patients who died or were lost before treatment start should be notified as they are important to include for surveillance purposes and, from a public health perspective, may have contacts that require tracing and follow up. If they are never recorded, it is not possible to discern true burden or good management. Yes. The final treatment outcome would be Lost to follow-up. Yes. The final treatment outcome would be Died. Yes. The final treatment outcome would be Died. There is no standard definition, and TB programmes apply different definitions and different thresholds for investigation. Presumptive TB refers to a patient who presents with symptoms or signs suggestive of TB disease (previously known as a TB suspect) and where bacteriological investigation is recommended. The registers in the framework document are limited to the ones that are needed to generate the standard case finding and treatment outcome indicators and reports. National TB programmes may wish to keep a list of patients who are investigated for TB (e.g. sputum smear, culture, Xpert MTB/RIF, chest X-ray) as a managerial tool, but this is outside the scope of the reporting framework. Likewise a list of TB patients undergoing testing for RR-/MDR-TB may be useful for follow-up purposes in the clinics. However, note that patients may undergo repeat investigations and therefore lists of patients investigated for TB often include duplicate entries for the same patient. Suggested formats for registers of people investigated for TB will be published in 2014 by WHO in manuals for TB screening in risk groups and for contact investigation. The reporting of drug susceptibility testing and Xpert TB/RIF testing for patients at risk of MDR-TB (such as those who failed first-line treatment) will be included in the detection indicators in the Companion handbook, as an update to the previous MDR-TB indicators document. The clinician has to interpret these contradictory results and decide whether this is actually a TB case requiring registration and treatment, taking into consideration all other available evidence about the patient and also the reliability of test results. Xpert MTB/RIF is more specific than smear microscopy. Smear positive but Xpert MTB/RIF negative results may be observed if a sample contained strains of MOTT (mycobacterium other than tuberculosis) but no strains of mycobacterium tuberculosis. For reporting purposes, the individual is classified according to the best available information at the time of reporting. If an individual is considered to be a TB case but there is no positive bacteriological result, the case is classified as clinically diagnosed (this includes patients with negative bacteriology as well as those with no bacteriological result, or those with only histopathology features suggestive of TB). If a positive bacteriological result (by smear, culture or Xpert MTB/RIF) becomes available at a later stage then the case is reclassified as bacteriologically confirmed. If the reclassification occurs after the basic management unit quarterly case registration report has already been sent, and the national TB programme does not have a mechanism to accept updated reports, then there will be a discrepancy between data at national and local levels. This is to be expected with one-off quarterly reporting. Ideally, there should be a mechanism to accept updated reports to avoid such discrepancies. Similar discrepancies would occur if the national TB programme has a national case-based electronic system, but where records are entered once and rarely updated. However, a national TB programme with a national case-based database in which individual case records can be regularly updated does not need quarterly reporting since case finding reports can be generated on demand. Such automated reports will therefore always use the most recent patient classification available in the database. The terms are very similar. The term bacteriologically confirmed has been introduced to make it clearer that TB in patients was ascertained using bacteriological tests which now also include Xpert MTB/RIF. Histopathology does not detect or identify bacteria and hence, by definition, cannot be a method for bacteriological confirmation. These cases may be included with pulmonary TB for the purpose of reporting, given the high degree of infectiousness associated with many of them. "Chronic" is an ill-defined term which is generally applied to patients who have received repeated inadequate treatments, who still have active TB disease and are considered incurable by health staff (see the Companion handbook). National TB programmes may keep a list of such cases until they can be tested for drug-susceptibility (most of them are expected to have drug resistant TB) and placed on adequate drug regimens. If second-line treatment is started the patients will need to be re-registered in the basic management unit TB register and in the second-line TB treatment register to record the new treatment episode. The definition of these previously treated patient categories has been expanded to capture cases that are clinically diagnosed and not confirmed bacteriologically because in some countries such patients may represent a large proportion of previously treated cases. Most of these cases were previously classified as Other retreatment cases (see 4th edition treatment guidelines). Retreatment cases with pulmonary TB, which typically represent the majority of retreatment cases, should also be disaggregated by bacteriological status in the basic management unit quarterly report on TB case registration(p31 of the 2013 framework). Cases in the first group are known to have been treated with anti-TB drugs before and therefore may be at higher risk of having acquired drug resistance. They should therefore be enumerated with the retreatment cases even if their previous treatment outcome is unknown. TB/HIV data should be included in the quarterly report on TB case registration because it helps assess promptness in detection of HIV positive TB cases and also the prompt initiation of co-trimoxazole preventative therapy and antiretroviral therapy, although the data may be preliminary and incomplete. Having preliminary data also helps the programme to compare with the National Aids Programme to ensure that both programmes agree on the number of HIV-positive TB patients on antiretroviral therapy. The finalised TB/HIV data set should be available one year later when compiling the TB treatment outcomes report, so national TB programmes are able to update their preliminary TB/HIV numbers. This is a change from the 2006 version of the reporting framework where antiretroviral therapy and co-trimoxazole preventive therapy coverage was reported only in the treatment outcome report. Note that national TB programmes with national case-based databases in which individual case records can be regularly updated do not need quarterly reporting since case finding and treatment outcome reports can be generated on demand. Such automated reports will therefore always use the most recent TB/HIV data available in the database. TB is the leading cause of death among people living with HIV, therefore it is especially important to assess the effectiveness of the treatment of HIV-positive TB cases. Disaggregating treatment outcome reports by HIV status had already been recommended in the 2006 revision of the case definition and reporting framework. The only change in the 2013 revision is that the additional disaggregation by smear status has been removed to simplify reporting (many HIV-positive TB patients will not be sputum smear positive). If rifampicin resistance or MDR is detected in a patient and the patient is put on second-line treatment before the end of first-line treatment and before a treatment outcome for first-line treatment had been determined then the patient is removed from the main TB treatment outcome cohort (see diagram C.1 on p38 of the 2013 framework). However, if the patient is put on second-line treatment after the end of first-line treatment or after a treatment outcome of treatment failed has been assigned, the patient is retained in the main treatment outcome cohort. This mechanism allows national TB programmes to distinguish between treatment outcomes for cases on first line treatment and for cases on second line treatment. Assigning a treatment failure outcome for patients with RR-/MDR-TB who are placed immediately on an adequate second-line regimen is not logical since patients are being provided with appropriate treatment. Such patients will usually get a final treatment outcome much later than TB patients on 6-8 month first-line regimens, and these are shown in the combined annual treatment outcomes report (see pp34-36 of the 2013 framework). The overall success rate of patients registered and treated in a given year can be estimated when two successive annual combined outcomes reports are available, usually 2 years later. National TB programmes may wish to record the number of patients moved to the second-line treatment register and removed from the main TB treatment cohort on the basic management unit treatment outcome quarterly report (see figure 1 below as a possible adaptation). This would allow programmes to reconcile the cohort size with the number of patients originally registered. Figure 1: A possible adaptation to block 1 of the quarterly report on TB treatment outcomes in the basic management unit (p33 of the 2013 framework) allowing the person who generates the report to reconcile the cohort size with the number of TB patients originally registered. It depends on what happened first, the regimen change or the assignment of treatment outcome: If rifampicin resistance or MDR is detected in a patient and the patient is put on second-line treatment before the end of first-line treatment and before a treatment outcome for first-line treatment had been determined then the patient is removed from the standard treatment outcome cohort (see diagram C.1 on p38 of the 2013 framework). However, if the patient is put on second-line treatment after the end of first-line treatment or after a treatment outcome has been assigned, then the patient is kept in the standard treatment outcome cohort, along with the recorded outcome. Transferred out means that the patient was transferred to another unit and the final treatment outcome was not received from the destination unit. This was not a meaningful outcome because the reporting unit was often not able to determine the final treatment outcome. Therefore such cases are now classified as not evaluated. Staff should be encouraged to seek treatment outcome data on patients that have transferred out. National TB programmes may wish to monitor the number of transferred out cases if they find it useful. For example, it may be used to help identify areas with high level of cross-referrals between basic management units and population movement between countries and where special coordination systems should be set up (see, for example, The Minimum Package for Cross-Border TB Control and Care in the WHO European Region: a Wolfheze Consensus Statement). However, when reporting to WHO, those transferred out cases should be included in the not evaluated category. The definition of the “cured” outcome is that in a bacteriologically confirmed patient sputum smear should be negative in the last month of treatment and on at least one previous occasion. Therefore the answers are:
a) Patient outcome is cured. No. The patient must complete the full course of second-line treatment before a treatment outcome can be assigned. Cured requires that treatment was completed as recommended by the national policy without evidence of failure and that three or more consecutive cultures taken at least 30 days apart are negative after the intensive phase. If two or more anti-TB drugs are changed in the regimen because a drug susceptibility testing result showed that the patient had XDR-TB, the outcome should be treatment failed. The change applies to any two drugs, regardless of the class of those anti-TB drugs. If a treatment generates too many adverse reactions and the regimen needs to be modified significantly then it is considered to have failed because it is doing more harm than good. In contrast, if a regimen change is imposed for other programmatic reasons (e.g. drug stock-out) then it is not considered a failure. No. There should be evidence of additional resistance to fluoroquinolones or second line injectable drugs using quality assured tests resulting in a permanent regimen change of at least two anti-TB drugs to be classified as failure. Amplification to Group 4 drugs is not enough given that drug susceptibility testing to these agents is not reliable. The TB treatment card need not change much from the one proposed in the 2006 revision of definitions and reporting framework. For example, extra space may be needed for recording the results of Xpert MTB/RIF testing at month 0 (see, for example, the top of p12 of the 2013 framework ). However, the treatment card for MDR-TB treatment has been revised and is included in the companion handbook. National TB programmes may choose to have two forms for different levels if they find it more useful. The key point is that the definitions should remain the same and the key variables for each diagnostic test must be captured. Yes. The variables shown in the upper half of the "Request for examination of biological specimen for TB" form (p11 of the 2013 framework) allows countries to assess adherence to the diagnostic algorithms most likely to be implemented. For instance, the form allows laboratories to identify cases with HIV infection or previously treated TB patients who have been tested with Xpert MTB/RIF. The grading scales shown on pages 11, 17, 21 and 25 of the 2013 framework were for the most frequent methods used for field diagnosis. However, it is important to adapt the grading on the forms to the grading used in a specific setting, for instance if using Bright Field with 1000x magnification or Fluorescence Microscopy with 200x or 400x magnification, as described in the GLI handbook. Use the "Media used (liquid or solid)" column In the culture results section of the laboratory request form (p12 of the 2013 framework). There is no dedicated column for media used in the suggested laboratory register culture, Xpert MTB/RIF and drug susceptibility testing (pp27-29 of the 2013 framework) . However, as the country customization notes (p26 of the 2013 framework) indicate, laboratories may wish to add a separate column to indicate details of the test (solid media drug susceptibility testing, liquid media drug susceptibility testing; direct line probe assay; indirect line probe assay) so that they may compile reports based on test type. All patients, including new cases found to have rifampicin resistance at the time of TB diagnosis, should be entered in the basic management unit TB register even if first-line treatment has not been attempted. If they initially start treatment for MDR-TB, the column “Moved to second-line treatment register” should be ticked and the patient entered also in the second-line treatment register. See also diagram C3.A on p40 of the 2013 framework. A hospital may refer patients to a TB treatment facility near their residence where they will start TB treatment and be entered in that treatment facility's TB register (but not as transfer in). If the hospital itself provides TB treatment, the hospital should keep its own TB register and compile its own quarterly reports to send to higher levels. If the hospital initially registers the patient in its TB register before the patient is referred to another facility then the patient should be registered as transferred out in the hospital TB register and as transfer in in the facility register. The TB coordinator should ensure close coordination between hospital and other TB treatment facilities to ensure patients are followed up and properly recorded and reported and not double counted in treatment cohorts. Yes, national TB programmes can customize their reports to add these extra disaggregations if they need them (for instance to compare with previous years), but see also How can we adapt the framework to suit our needs?. The age and sex distribution was changed to have a complete understanding of age/sex distribution of all new and relapse cases. This is especially important for assessing the burden of childhood TB cases, many of which are likely to be clinically diagnosed and/or extrapulmonary cases. National TB programmes can customize their reports to add these extra disaggregations if they need them, but see also How can we adapt the framework to suit our needs?. In countries using paper-based case registration with quarterly reporting of aggregates using WHO-recommended (non customized) forms, the contribution of different tests (direct microscopy, culture, Xpert MTB/RIF) to confirmation of TB diagnosis may be assessed through a survey based on a sample of patient cards. Such a survey may provide further details on the sequence of tests used to confirm TB diagnosis and on the yield of testing algorithms in use. Countries using electronic case-based recording and reporting in which details of diagnostic tests are captured will be able to disaggregate cases by types of tests and document the yield of testing algorithms in use.
Yes, this is already proposed as one possible country customization (see bottom of p30 in the 2013 framework). For patients with presumptive TB the laboratory diagnostic technique and results could be disaggregated by test type (smear, culture, Xpert MTB/RIF) if national TB programmes need this information. This is to minimise the number of indicators that the programme has to report upon; new cases and relapse cases are all new episodes of TB. National TB programmes can customize their reports to show separate treatment outcomes for new cases and relapse cases if they need them, but see also How can we adapt the framework to suit our needs?. All TB cases should be treated, not just pulmonary smear-positive TB cases, and therefore the treatment outcomes for all TB patients should be monitored. WHO has been requesting data on treatment outcomes for extrapulmonary cases for some time. The main change is that outcomes for all TB cases (new and relapse, pulmonary and extrapulmonary) are aggregated and then disaggregating only by diagnosis type (bacteriologically confirmed or clinically diagnosed). National TB programmes may choose to compile pulmonary and extrapulmonary outcomes separately in their quarterly reports, if they need them, but see also How can we adapt the framework to suit our needs?. Polydrug-resistant TB patients who do not have rifampicin resistance do not require an MDR-TB regimen. They may be treated using first-line drugs with the addition of second-line drugs depending on the resistance pattern(see the companion handbook). The second-line treatment outcome monitoring as defined in the WHO guidelines is only intended for cases with laboratory confirmed RR-/MDR-TB. Other forms of drug-resistant TB should be included in the quarterly report on TB treatment outcomes in the basic management unit and may also be analysed separately if there is particular interest. Data on TB in health workers is typically available from occupational health programmes. All persons who are diagnosed with RR-/MDR-TB should be placed on second-line treatment as soon as possible. The second-line TB treatment register is a treatment register unlike the basic management unit TB register which is an epidemiological tool (i.e. a tool to measure the numbers of all forms of TB cases notified within the jurisdiction of a basic management unit). It follows the cohort of patients actually started on treatment because in many countries more cases were being diagnosed than were started on treatment. National TB programmes may wish to keep a separate "waiting list" of all diagnosed RR-/MDR-TB cases that have not started treatment. WHO recommends the reporting of indicators for 6-monthly enrolment to assess how start of treatment relates to the detection of MDR-TB (see also Multidrug-resistant tuberculosis indicators and the companion handbook). To simplify recording we recommend that MDR-TB cases whose treatment fails are not re-registered during the same calendar year. However, in programmes that differentiate MDR from XDR cohorts, MDR-TB patients found to have XDR-TB at any time in the course of their second-line TB treatment are excluded from the non-XDR MDR-TB cohort and included in the XDR-TB treatment cohort. WHO recommends that RR-TB cases be treated using an MDR-TB regimen since the large majority of rifampicin-resistant strains are also resistant to isoniazid (see the companion handbook). The combined treatment outcomes report (p36 of the 2013 framework) monitors the outcome of all confirmed RR-TB and MDR-TB patients treated using an MDR-TB regimen. National TB programmes may choose to monitor outcomes for RR-TB and MDR-TB separately in their quarterly reports if they need them (especially if RR-TB patients are not treated with a full MDR-TB regimen), but see also How can we adapt the framework to suit our needs?. The case notification rate is the number of new episodes of TB (regardless of TB site or method of diagnosis) per 100 000 population registered in a particular year and notified to the national health authorities. New and relapse cases are new episodes of TB detected in a given year, while treatment after default or treatment after failure are continuation of cases already registered previously and so should not be included again in the calculation of case notification rate. Health staff should carefully elicit a patient’s previous history of TB treatment as this has important implications for registration, for choice of treatment regimen and for eligibility for MDR-testing. Indicators for MDR-TB are defined in Multidrug-resistant tuberculosis indicators and updates are included in the companion handbook. Similar indicators are being developed by WHO for drug-susceptible TB during 2014. Given that first-line TB treatment with 6-8 months regimens has now been scaled up globally, calculating the conversion rate (the proportion of new smear-positive TB patients with a negative smear at 2 and 3 months) is no longer recommended. It is more useful for national TB programmes to monitor final outcomes via the quarterly treatment outcome reports. A smear-negative patient who is Xpert MTB/RIF positive at the time of diagnosis is considered bacteriologically positive and there is no need to have a second sputum smear result for categorization. Only smear and culture should be used to assess follow up in cases with TB confirmed by Xpert MTB/RIF. This is because molecular tests, including Xpert MTB/RIF, are not suitable for patient monitoring as these tests also detect DNA from non-viable bacilli (see p18 of Rapid Implementation of the Xpert MTB/RIF diagnostic test).
RR-TB = rifampicin-resistant TB
XDR-TB = extensively drug-resistant TBGeneral questions
When will WHO start collecting data according to the 2013 revision?
What is different from the previous definitions and standard reports?
How strictly should we follow the new forms, registers and reports? Why is adherence to the definitions important?
How can we adapt the framework to suit our needs?
Aggregate quarterly reporting systems
National case-based databases
Who to include in the TB register
Why should all TB cases be included in the basic management unit TB register, not just those starting treatment?
Should patients who never started TB treatment be notified and included in the treatment outcome cohort?
Should patients who died before starting TB treatment be notified and included in the treatment outcome cohort?
Should TB cases identified only through post mortem examinations be notified and included in the treatment outcome cohort?
Presumptive TB / MDR-TB
Is there a standard definition of presumptive TB?
Why is there no register of presumptive TB cases in the framework document?
Why is there no quarterly report monitoring the coverage of Xpert TB/RIF testing in groups at high risk of having MDR-TB?
Case definitions
How do you classify a patient found to be smear positive but negative by Xpert MTB/RIF?
How do you classify a TB case if there is no bacteriological test result available? What if a positive bacteriological test result becomes available at a later stage?
How does the term bacteriologically confirmed TB case differ from definite TB case used in the past?
Why are cases diagnosed by histopathology alone not considered to be bacteriologically confirmed?
Is laryngeal TB classified as pulmonary?
How should "chronic" TB cases be included in the framework?
Why do patients classified as relapse, treatment after failure or treatment after loss to follow up now also include patients with no bacteriological confirmation?
What is the purpose of distinguishing between cases previously treated for more than one month but with treatment outcome unknown and cases with unknown treatment history?
TB/HIV
Why do I have to report TB/HIV activities in both the quarterly report on TB case registration as well as the quarterly report on TB treatment outcomes?
Why are treatment outcomes for all HIV-positive patients listed separately in the quarterly report on treatment outcomes?
Outcomes for patients treated for drug-susceptible TB
Why are cases that are diagnosed with RR-/MDR-TB during the course of their first-line regimen and subsequently placed on second-line treatment no longer registered as treatment failures in the basic management unit TB register? And how can we now assess the outcome of the total cohort of patients notified in a given period?
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If a patient started first-line treatment and was discovered to be RR- or MDR-TB at around 5 or 6 months, what is the cut-off time to distinguish between recording treatment failure or switching to second-line treatment and removing that patient from the main treatment outcome cohort?
Why is transfer out no longer an outcome, and is now included under not evaluated?
What is the treatment outcome for a new bacteriologically confirmed patient with drug-susceptible TB who has completed the course of anti-TB treatment and who had negative sputum smear results taken at (a) 2 and 6 months, (b) 2 and 5 months, c) only 2 months, d) only 6 months?
b) Patient outcome is treatment completed.
c) Patient outcome is treatment completed.
d) Patient outcome is treatment completed.
Outcomes for patients treated using second-line drugs
If an RR-TB/MDR-TB patient has three negative cultures spaced 30 days apart immediately after completing the intensive phase of second-line treatment, can the patient already be classified as cured?
What would be the treatment outcome for a patient on second-line treatment whose treatment regimen is changed because the patient is found to have XDR-TB?
One reason for assigning the outcome of treatment failed for second line treatment is the need for permanent regimen change of at least two anti-TB drugs. Do those two anti-TB drugs need to be one fluoroquinolone and one second-line injectable drug or can they be also Group 4 or Group 5 drugs?
Why does the definition of treatment failed for second-line treatment also include cases who had a permanent regimen change as a result of adverse drug reactions?
Is amplification of resistance to Group 4 drugs enough to assign an outcome of treatment failed?
Form design
Has the TB treatment card changed? Where can I find a template for it? Is it the same for RR-/MDR-TB?
Would it not be more practical to have two separate rather than a single request form for smear, Xpert MTB/RIF, culture and drug susceptibility testing: one for diagnosis of TB at the basic management unit level, including smear and/or Xpert MTB/RIF, and one for the national reference laboratory including also culture and drug susceptibility testing?
Should the laboratory request form include information that permits monitoring of adherence to national policies on use of WHO-approved rapid diagnostics such as Xpert MTB/RIF algorithms?
Why is the grading of sputum smear microscopy (0, scanty, 1+,2+,3+) defined in the request form and the registers only for "normal" bright field (BF) microscope with 1000x magnification, when there is increasing use of fluorescence (FM) microscopes which has a different grading scheme?
How do I denote culture positive results on the laboratory request form and the laboratory register when using liquid culture?
Laboratory request form
Laboratory register
Registration and reporting
How do I register patients diagnosed with RR-/MDR-TB?
A significant number of patients diagnosed in tertiary care hospitals are not registered for treatment there but are referred to a health facility close to patients’ homes for TB treatment. Do these patients need to be registered where diagnosis is made or where they start treatment?
The quarterly report on TB case registration compiles the age and sex distribution for all new and relapse cases ( bacteriologically confirmed or clinically diagnosed, pulmonary and extrapulmonary), not just new smear-positive cases as in the previous revision. Can countries customize their quarterly reports by having the age and sex distribution for pulmonary and extrapulmonary cases separately or for bacteriologically confirmed and clinically diagnosed separately?
Bacteriologically confirmed cases include sputum smear-positive cases, culture-positive cases and Xpert TB/RIF-positive cases. How will it be possible to monitor the contribution of Xpert MTB/RIF to the bacteriological confirmation of TB cases and to compare notification rates of bacteriologically-confirmed cases between facilities using smear microscopy, facilities using Xpert MTB/RIF and facilities using a mixture of the two methods?
The quarterly report on TB case registration does not distinguish cases detected by Xpert MTB/RIF from other forms of bacteriological classification? Can Block 3 be modified to show these data?
Why are new cases and relapses (if bacteriologically confirmed) assessed together in the treatment outcome quarterly report, when they are separated in the case registration quarterly report?
Why does treatment outcome monitoring include extrapulmonary cases?
Why are outcomes for polydrug-resistant TB cases not reported separately?
WHO asks countries to report the number of health care workers diagnosed with TB. How can this number be collected?
Registers and reports (patients treated using second-line drugs)
Why does the second-line TB treatment register only contain patients started on treatment and not all diagnosed RR-/MDR-TB cases, including patients who are lost or die before treatment starts? And would it not be useful to have a quarterly report of MDR-TB case finding?
Should I re-register MDR-TB patients whose second-line treatment failed and who re-start another second-line treatment episode?
Why are outcomes of second-line treatment of MDR-TB and RR-TB patients merged together?
Indicators
Why are only new or relapse cases considered in the calculation of the case notification rate?
Where can I find the indicators for RR-/MDR-TB? Are there similar ones for drug-susceptible TB?
How do we calculate the conversion rate? Do we include patients who were smear negative at diagnosis but bacteriologically confirmed with technologies like Xpert MTB/RIF in our analysis or do we need a second smear result for categorization?
