GuidelinesOther guideline
Management of RR-TB and Other Co-Morbidities
This section has been included in this clinical guidance because it is essential. However, there is no update here. The information is based on existing clinical reference guide [11] . Co-morbid condition Management strategies Diabetes mellitus - Excellent glucose control (may need insulin). - Close monitoring of blood glucose and HbA1C. - Close monitoring for adverse events that may be
This section has been included in this clinical guidance because it is essential. However, there is no update here. The information is based on existing clinical reference guide [11].
| Co-morbid condition | Management strategies |
| Diabetes mellitus | - Excellent glucose control (may need insulin). - Close monitoring of blood glucose and HbA1C. - Close monitoring for adverse events that may be more common (i.e. peripheral neuropathy, renal failure). - Do not exceed a dose of 500 mg twice daily when using metformin with dolutegravir. |
| Hepatitis B | - Close monitoring of liver function. - Should initiate therapy with tenofovir and lamivudine/emtricitabine. |
| Hepatitis C | - Close monitoring of liver function. - Limited data on drug-drug interactions with directly acting agents (but data suggest there are no significant drug-drug interactions). - Delay treatment for hepatitis C until RR-TB treatment is complete, unless patient has unstable liver disease or develops worsening liver function during RR-TB treatment. |
| Substance use | - Routine and non-judgmental screening with WHO Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Refer to Annex in full guidance document. - Brief counselling intervention with motivational interviewing. - Should initiate RR-TB treatment even if there is not complete sobriety. - Enhanced adherence support. - Harm reduction counselling. - Referral to substance use treatment centre. - Pharmacotherapy-assisted treatment (i.e. naltrexone or acamprosate for alcohol use), opioid substitution therapy (methadone, suboxone) should be considered where appropriate and available. |
| People who are incarcerated | - Should have access to all medications and therapeutic innovations. - Enhanced counselling and adherence support, especially around time of release from prison or movement within the prison system. |
| Mobile populations | - Access to therapy regardless of province or country of origin. - Prioritize use of shorter regimen when possible. - Enhanced adherence support. |
| Renal failure | - Use renal dosing for medications that are renally cleared. - Avoid use of injectables. |
| Cigarette smoking | - Screen for active smoking at each visit. - Counselling to reduce or stop cigarette smoking. - Consider pharmacotherapy or nicotine replacement therapy. |
National Department of Health Clinical Management of Rifampicin-Resistant Tuberculosis, September 2023
Management of RR-TB and Other Co-Morbidities