Roles of the PCACs and NCAC
Each province should have a provincial clinical advisory committee (PCAC), or similar arrangement, through which formal input can be sought on the management of persons with RR-TB [11] . The PCACs can be consulted at any time, and they should provide input on the management of patients in the following situations: Initial regimen choice in more complicated patients (i.e. those in whom a choice be
Each province should have a provincial clinical advisory committee (PCAC), or similar arrangement, through which formal input can be sought on the management of persons with RR-TB [11]. The PCACs can be consulted at any time, and they should provide input on the management of patients in the following situations:
- Initial regimen choice in more complicated patients (i.e. those in whom a choice between the short and long regimens is not clear).
- Failed XDR-TB
- Treatment regimen design for children, especially if being managed in primary care
- Toxicity management, especially when consideration of discontinuation of any of the following medications is being considered: linezolid, bedaquiline, levofloxacin/moxifloxacin, clofazimine and/or delamanid.
- End-of-life care.
- INH mono-resistant TB if detected after month 2 of DS-TB treatment.
- CNS RR-TB.
- Initial and subsequent rescue regimen for persons who are not responding to therapy.
- Discordant DST results.
There is also a national clinical advisory committee (NCAC) that can provide formal input on more complicated patients. The NCAC can be consulted at any time and may provide input of the management of patients in the following situations:
- Patients in whom RR-TB treatment has failed.
- Management of children with complicated RR-TB.
- CNS RR-TB that is fluoroquinolone-resistant.
RR-TB during pregnancy – note that pregnant women with RR-TB can be initiated on treatment by providers without NCAC approval but these cases should still be presented to the NCAC so that this cohort can be more formally monitored on a national level [11]
National Department of Health Clinical Management of Rifampicin-Resistant Tuberculosis, September 2023
Roles of the PCACs and NCAC