Republic ofthe Philippines Department of Health OFFICE OF THE SECRETARY June 14, 2019 DEPARTMENT MEMORANDUM No. 2019- TO: MINISTER OF _HEALTH-_BANGSAMORO AUTONOMOUS REGION IN MUSLIM MINDANAO AND ALL DIRECTORS OF NTERS FOR HEALTH DEVELOPMENT SUBJECT: Guidelines _on Expanded Eligibility for Latent_TB Infection (LTBN ‘Treatmei ‘The country tas committed to treat 1.2 million individuals for later TB Infection (LTBI) during the PhilSTEP1 period (2017-2022). However, only 4,893 mostly child household contacts of TB cases were given LTBI treatment in 2018.Last year, the World Health Organization issued the “Updated and consolidated guidelines for programmatic management of LTBI” with new recommendations, including new indications for LTBI treatment. The NTP Manual of Procedures is currently being revised to reflect this and ‘other major recommendations. {As advanced implementation of the revised NTP MOP, all health facilities shall offer {TBI treatment to the following eligible high-risk groups even without Tuberculin Skin Test Persons living with HIV 2.Children less than 5 years old who are houschold contacts of a bacteriologically-confirmed TB case 3.Household contacts of a bacteriologically confirmed-TB case who are more than 5 years old AND with any of the following other risk factors for tuberculosis: DM, smoker, immune- compromised, malnourished, with two or more active TB cases in the household ‘The above groups can be given Isoniazid preventive therapy (IPT) for 6 months at standard recommended dosage as long. as active TB is ruled out by Chest X-ray. If Chest X-ray is not accessible, do symptom screening for any TB symptoms and physician can give IPT based on the informed decision of the patient. In addition, IPT may also be given to the following groups once active TB is ruled out AND there is a positive tuberculin skin test: Children less than 5 years old who are household contacts of a clinically-diagnosed TB case 2.Household contacts of a bacteriologically confirmed-TB case who are more than 5 years old AND with no other TB risk factors, as enumerated above : 3.Close contacts of Bacteriologically-confirmed ‘TB (outside the household) 4.0ther risk groups (ongoing dialysis, for organ/hematologic transplant, initiating anti-TNF treatment, silicosis) For compliance. By Authority of the Secretary of Health: RNA C. CABOTAJH, MD, MPH, CESO IIT Undersecretary of Healt! THRTEE TST TAS CORT REST ARIE, NH CTT RTS @ TET ET THO TT TOR TTT TET Doct Lie: 11-9902, 71-9503 Fax 78-182 e UR. hip doh gon ph ei ae Soh 6 ph