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3c87c161956d41819a69de0568a067ef | National-TB-Infection-Treatment-Guidelines_2023.pdf | Motivation for Health Goals in Treatment | The extent to which a person's behavior corresponds with agreed recommendations from a healthcare worker for taking medication, following a diet, and/or making lifestyle changes is crucial.
Adolescent: A person aged 15 to 19 years. | The extent to which a person's behaviour corresponds with agreed recommendations from a healthcare worker for taking medication, following a diet and/or making lifestyle changes Adolescent A person aged 15 to 19 years | ACCEPT | train |
bb07a905802e47e384b765e5bc590519 | National-TB-Infection-Treatment-Guidelines_2023.pdf | Clinic Appointment Planning | For practical purposes, children weighing >25 kg (typically eight to ten years of age) can be treated with adult doses of TB medications, including TB preventive treatment (TPT). Children weighing >25 kg can usually produce sputum for TB testing. For reporting purposes, children are defined as 0 to 14 years of age by W... | For practical purposes, children weighing >25kg (typically eight to ten years of age) can be treated with adult doses of TB medications including for TB preventive treatment (TPT). Children weighing >25kg can also usually produce sputum for TB testing. For reporting purposes, children are defined as 0 to 14 years of ag... | ACCEPT | train |
411dfaed68f040699ecd7f420be4e3ff | National-TB-Infection-Treatment-Guidelines_2023.pdf | Medication Management and Reminders | The periodic assessment of changes in targeted results attributed to the program intervention, or the analysis of inputs and activities to determine their contribution to results. | The periodic assessment of the change in targeted results that can be attributed to the programme intervention, or the analysis of inputs and activities to determine their contribution to results | ACCEPT | train |
89de0b5b3a794e19a9aa20e6dc26b8b6 | National-TB-Infection-Treatment-Guidelines_2023.pdf | Monitoring | The tracking of key elements of program performance (inputs, activities, and results) on a regular basis provides continuous information on progress towards achieving goals and alerts staff and managers to problems, offering an opportunity for early resolution. | The tracking of key elements of programme performance (inputs, activities and results) on a regular basis to provide continuous information on progress towards achieving goals, and alert staff and managers to problems, providing an opportunity for these to be resolved early | ACCEPT | train |
aa02f9f5070942a9bcd7f080695d2d6b | National-TB-Infection-Treatment-Guidelines_2023.pdf | Recent TB exposure | Contact with a person diagnosed with pulmonary TB in the last 12 months may include individuals from the same household or close contacts outside of the household setting, such as a care provider, colleague, teacher, family member, or friend. | Contact with a person diagnosed with pulmonary TB in the last 12 months. The person may be from the same household, or be a close contact outside of the household setting, e.g., a care provider, colleague, teacher, family member or friend | ACCEPT | train |
7517707c7e674c4480bfa52ac3c64c2b | National-TB-Infection-Treatment-Guidelines_2023.pdf | Significant TB exposure | Known exposure to a person (adult or adolescent) with pulmonary TB who shared the same enclosed space for one or more nights or for frequent or extended daytime periods during the three months before the index patient started their TB treatment. Significant TB exposure can occur in any setting, such as the household, w... | Known exposure to a person (adult or adolescent) with pulmonary TB who shared the same enclosed space for one or more nights or for frequent or extended daytime periods during the three months before the index patient starting their TB treatment. Significant TB exposure can occur in any setting, e.g., the household, wo... | ACCEPT | train |
b6e0f3d552ea4711be132ac01c641bef | National-TB-Infection-Treatment-Guidelines_2023.pdf | TB contact | All individuals (family members and others, regardless of age and HIV status) who have had a significant TB exposure—defined as sharing the same enclosed space or living arrangement with a TB index patient for one or more nights, or for frequent or extended daytime periods during the three months before the start of th... | All people (family members and other individuals; regardless of age and HIV status) who have had a 'significant TB exposure' -that is: shared the same enclosed space or shared living arrangement with a TB index patient for one or more nights or for frequent or extended daytime periods during three months before the sta... | ACCEPT | train |
bc18d7f0495043dfb397def4c04abeea | National-TB-Infection-Treatment-Guidelines_2023.pdf | TB exposed infants | Infants born to mothers diagnosed with TB, either before or after birth, or those with documented close TB exposure (e.g., from a caregiver, family member, or daycare provider). | Infants born to mothers who were diagnosed with TB before or after the baby was born, or other documented close TB exposure in the infant (e.g. another caregiver, family member, day care provider) | ACCEPT | train |
e9fb0982210548c6a88d03edfbeb4090 | National-TB-Infection-Treatment-Guidelines_2023.pdf | Rationale for expanded eligibility for TPT; TB test and treat approach | It is essential that TB preventive treatment (TPT) is scaled up to reduce the burden of TB in South Africa. Previously, TPT was offered only to individuals at the highest risk of progressing to TB disease after exposure, such as children younger than five years of age and all people living with HIV, regardless of age. ... | It is essential that TB preventive treatment (TPT) is scaled up to reduce the burden of TB in South Africa. Previously, TPT was offered only to people who were at the highest risk of progressing to TB disease after exposure (i.e., children younger than five years of age, and all people living with HIV, regardless of ag... | ACCEPT | train |
d906204d6dd64f8eab2ade2fcc591873 | National-TB-Infection-Treatment-Guidelines_2023.pdf | Rationale for expanded eligibility for TPT; A TB test and treat approach | Before disease can be ruled out, testing should be made available to all individuals prior to being offered TPT (refer to the section on children for exceptions as clinically relevant).
People who require TPT:
**TB Contacts:** All adults, adolescents, and children (including newborns and infants) exposed to TB requir... | before disease can be ruled out and should be made available to all people before being offered TPT (refer to the section on children for exceptions as clinically relevant). EXECUTIVE SUMMARY People who require TPT TB contacts: All adults, adolescents and children (including newborns or infants) exposed to TB require T... | ACCEPT | train |
77d3ce391eeb416cb0f221c19351fb74 | National-TB-Infection-Treatment-Guidelines_2023.pdf | Other high-risk groups | Inmates in correctional facilities remain a priority group for the treatment of TB infection because the confined indoor spaces they share with others often mean they meet the criteria for 'significant TB exposure.' Healthcare workers have a very high risk of TB and should be considered for treatment of TB infection wi... | Inmates in correctional facilities remain a priority group for treatment of TB infection because the confined indoor spaces they share with other people often practically mean they that meet the criteria of 'significant TB exposure'. Healthcare workers have a very high risk of TB and should be considered for treatment ... | ACCEPT | train |
9a49e33aa0f34629af9f1bc98397395c | National-TB-Infection-Treatment-Guidelines_2023.pdf | Choice of regimen | In South Africa, the current TPT options include isoniazid and rifapentine given once weekly for three months (3HP), daily rifampicin and isoniazid for three months (3RH), daily isoniazid for six months (6H), or daily isoniazid for 12 months (12H). Shorter treatment options should be offered where feasible and availabl... | In South Africa, the current TPT options include isoniazid and rifapentine given once weekly for three months (3HP), daily rifampicin and isoniazid for three months (3RH), daily isoniazid for six months (6H) or daily isoniazid for 12 months (12H). As a rule, shorter treatment options should be offered where feasible an... | ACCEPT | train |
621609e03baf4e5f98a1dda584627214 | National-TB-Infection-Treatment-Guidelines_2023.pdf | Children ≥25kg, adolescents and adults | Older children weighing ≥25 kg (typically eight years and older) can be offered 3HP if the regimen is available, as they can receive adult doses of TB medications. This includes children living with HIV who are on a dolutegravir-based regimen with a suppressed viral load (VL <1000 in the last six months). The guideline... | Older children weighing ≥25kg (typically eight years and older) can be offered 3HP if the regimen is available since they can receive adult doses of TB medications. These include children living with HIV, if they are on a dolutegravir-based regimen with a suppressed viral load (VL <1000 in the last six months). Accordi... | ACCEPT | train |
50ec88aa50ea49338dfaf7b804b7ad18 | National-TB-Infection-Treatment-Guidelines_2023.pdf | Children <25kg | 3RH is the preferred regimen for children under 25 kg not living with HIV. For children under 25 kg living with HIV and in infants/children born to pregnant women living with HIV, 6H is preferred over 3RH due to the risk of drug-drug interactions with ART and the potential for decreasing the effectiveness of prevention... | 3RH is the preferred regimen for children under 25kg not living with HIV. 6H is preferred (above 3RH) for children under 25kg living with HIV and in infants/ children born to pregnant women living with HIV, due to the risk of drug-drug interactions with ART and the potential for decreasing the effectiveness of preventi... | ACCEPT | train |
7257c05de6c44faeb6f3c906f2224f5f | National-TB-Infection-Treatment-Guidelines_2023.pdf | Monitoring and evaluation | It is important that programmatic assessments be conducted to determine whether TPT delivery targets are being met, using existing data collection tools. These include available electronic or other registers and cascade analysis. Such assessments should establish indicators and outcomes. Refer to Section 12 for more de... | It is important that programmatic assessments should be conducted to determine whether TPT delivery targets are being met, using existing data collection tools. These include available electronic or other registers, and cascade analysis. Such assessments should establish indicators and outcomes. Refer to Section 12 for... | ACCEPT | train |
de704d48072a4b76ac11e88f7fc9c6af | National-TB-Infection-Treatment-Guidelines_2023.pdf | Background | South Africa, along with 13 other countries, faces a significant triple burden of drug-susceptible TB (DS-TB), multidrug-resistant TB (MDR-TB), and TB co-infected with HIV (TB/HIV). It is among the top 30 high TB burden countries identified by the World Health Organization (WHO). The WHO estimated that in 2019, there w... | South Africa, with 13 other countries, carries the major triple burden of drug-susceptible TB (DS-TB), multidrug-resistant TB (MDR-TB) and TB co-infected with HIV (TB/HIV), and is among the top 30 high TB burden countries identified by the World Health Organization (WHO). The WHO estimated that, in 2019 there were 360 ... | ACCEPT | train |
0be43b91f14d4dfd9cb949ba5b52216f | National-TB-Infection-Treatment-Guidelines_2023.pdf | TB Preventive Treatment (TPT) | TPT is an effective and safe intervention to reduce the risk of developing TB disease for all age groups with TB exposure. It is also effective in reducing the risk of TB disease among people living with HIV (PLHIV) and those with silicosis, regardless of documented TB exposure. The guiding principle is that TPT should... | TPT is an effective and safe intervention to reduce the risk of developing TB disease for all age groups with TB exposure. TPT is also an effective intervention to reduce the risk of developing TB disease amongst PLHIV 14 and those with silicosis 15 , regardless of documented TB exposure. The overall guiding principle ... | ACCEPT | train |
d32b4f7487094fb6bf8aecae8429ca3d | National-TB-Infection-Treatment-Guidelines_2023.pdf | TB Preventive Treatment (TPT) | Tests for TB infection may be used in individual care settings at the clinician's discretion. TPT should be offered to all individuals after significant exposure to an adult or adolescent with active pulmonary TB disease (TB contacts) or if the individual is immunocompromised, regardless of known M. tuberculosis exposu... | or not. Tests of TB infection may be used in individual care settings at clinician discretion. TPT should be offered to all people after significant exposure to an adult or adolescent with active pulmonary TB disease (TB contacts) or if the individual is immunocompromised (regardless of known M.tb exposure). In the pas... | ACCEPT | train |
387a1ca74ac3452195a06225162596d7 | National-TB-Infection-Treatment-Guidelines_2023.pdf | Organisation Of The Guidelines | The guidelines are organized into sections by TPT patient type (Sections 4 to 9). Within each section, considerations are listed for (a) eligibility criteria that define the patient type in that section, and (b) management of TPT patients described in that section, including: (i) the TPT test and treat algorithm, (ii) ... | The guidelines are organised into sections by TPT patient type (Sections 4 to 9). Within each section, there are considerations listed for (a) eligibility criteria that define the patient type in that section, and (b) management of TPT patients described in that section including: (i) the TPT test and treat algorithm, ... | ACCEPT | train |
3b2627e810c34126a326f80274022331 | National-TB-Infection-Treatment-Guidelines_2023.pdf | Adult, Adolescent And Older Child Contacts | This group of potential TPT patients was previously called "household contacts." Significant TB exposure can occur both within and outside the household. Therefore, the term "household contact" is confusing and should no longer be used. Instead, these guidelines use the term "contacts" for those with significant TB exp... | This group of potential TPT patients were previously called "household contacts". Significant TB exposure can however occur both within and outside the household. Therefore, the term "household contact" is confusing and should no longer be used. Instead, these guidelines use the term "contacts" for "those with signific... | ACCEPT | train |
59747857046c4e979ed8e661ddff6dc7 | National-TB-Infection-Treatment-Guidelines_2023.pdf | TPT should be deferred or not offered if the individual | TPT should be deferred or not offered if the individual:
- Diagnosed with TB disease
- Has active liver disease (acute or chronic)
- Has symptoms and signs of severe peripheral neuropathy (consider rifampicin only [4R] regimen)
- Has a history of adverse reactions to any of the drugs used for TPT
- Drinks excessive alc... | • is diagnosed with TB disease • has active liver disease (acute or chronic) • has symptoms and signs of severe peripheral neuropathy (could consider rifampicin only [4R] regimen) • has a history of adverse reactions to any of the drugs (medications) used for TPT • drinks excessive alcohol, and is unwilling or unable t... | ACCEPT | train |
f7378df47aa14344aa89ce7dc690648b | National-TB-Infection-Treatment-Guidelines_2023.pdf | Evaluation for TB disease amongst adult, adolescent, and older child contacts | Evaluation for TB disease includes symptom screening, physical examination, and diagnostic testing, irrespective of reported symptoms. TB can be either bacteriologically confirmed or clinically diagnosed. Among adults, adolescents, and older children (≥25 kg), at least symptom screening and a sputum test are required p... | Evaluation for TB disease includes symptom screening, physical examination and diagnostic testing irrespective of reported symptoms. TB can either be bacteriologically confirmed or clinically diagnosed. Amongst adults, adolescents, and older children (≥25kg), at least symptom screening and a sputum test are required pr... | ACCEPT | train |
cda82c761d7e4c3caeeede44b7760594 | National-TB-Infection-Treatment-Guidelines_2023.pdf | Diagnostic tests for TB disease amongst adults, adolescents, and older children, regardless of the presence of symptoms | Diagnostic tests for TB disease amongst adults, adolescents, and older children, regardless of the presence of symptoms:
- a sputum sample for testing using Xpert
- If no sputum sample can be collected, a chest radiograph should be obtained to rule out TB disease.
- Tests for TB infection (TST/IGRA) are not required t... | • if no sputum sample can be collected, a chest radiograph should be obtained to rule out TB disease • tests of TB infection (TST/IGRA) are not a requirement to initiate TPT • most children ≥25kg can spontaneously expectorate sputum. If children cannot expectorate sputum and are well (no signs or symptoms), sputum test... | ACCEPT | train |
da911184bc9d4c3c9e37d424da871fcc | National-TB-Infection-Treatment-Guidelines_2023.pdf | TPT regimens for adult, adolescent, and older child (≥25kg) contacts | There are currently four potential regimens for this group: 3HP, 3RH, 6H, or 12H. The short course 3HP regimen should be prioritized if possible. This applies to adults, adolescents, and older children who are not living with HIV. If 3HP is not available for HIV-negative children ≥25 kg, adolescents, and adults, use 3R... | There are currently four potential regimens for this group: 3HP, 3RH, 6H or 12H. The short course 3HP regimen should be prioritised if possible. This applies to adults, adolescents and older children who are NOT living with HIV. If 3HP is not available for HIV-negative children ≥25kg, adolescents and adults, use 3RH. A... | ACCEPT | train |
587f628fa8134db8b43ecfbf4d41d5ee | National-TB-Infection-Treatment-Guidelines_2023.pdf | Recommended weekly dosages for the 3HP regimen for adult, adolescent, and child ≥25kg contacts not living with HIV | Recommended weekly dosages for the 3HP regimen for adults, adolescents, and children ≥25 kg contacts not living with HIV:
**Body Weight (kg)** | **Rifapentine (150 mg tablets, weekly)** | **Isoniazid (300 mg tablets, weekly)** | **Duration**
--- | --- | --- | ---
25-29.9 | 4 | 2 | 12 weeks (3 months)
30-49.9 | 6 | 3 |... | Recommended weekly dosages for the 3HP regimen for adult, adolescent, and child ≥25kg contacts not living with HIV Body weight (kg) Rifapentine Isoniazid Duration 150mg tablets (weekly) 300mg tablets (weekly) 25-29.9 4 2 12 weeks (3 months) 30 -49.9 6 3 12 weeks (3 months) >50 6 3 12 weeks (3 months) Note: If 3HP is no... | ACCEPT | train |
592822787d714504a8d6ed29f00bb989 | National-TB-Infection-Treatment-Guidelines_2023.pdf | Follow-Up and Monitoring During TB Treatment | Notify the patient to follow up for new symptoms or signs of TB. Provide adherence support, perform a weight check, make dose adjustments as needed, conduct safety monitoring, and register and notify for Xpert/u-LAM positive results or CXR suggestive of TB. | and notify patient Follow up for new symptoms or signs of TB, provide adherence support, weight check, do dose adjustment as needed, conduct safety monitoring and register and notify Xpert/u-LAM POSITIVE or CXR suggestive of TB | ACCEPT | train |
cb313952233d4222858d7fcca8b718c8 | National-TB-Infection-Treatment-Guidelines_2023.pdf | Child Contacts Children Weighing Less Than 25 Kilograms And Infants | Significant exposure is documented exposure to a person (adult or adolescent) with pulmonary TB who shared the same enclosed space for one or more nights (e.g., at home) or for frequent or extended daytime periods (e.g., at a school or crèche) during the three months before the index patient started TB treatment. | Significant exposure is known (documented) exposure to a person (adult or adolescent) with pulmonary TB who shared the same enclosed space for one or more nights (e.g. at home or similar) or for frequent or extended daytime periods (e.g. at a school, crèche or similar) during the three months before the index patient s... | ACCEPT | train |
ecb1eae08fc64ca4aead4e3e5bae27f1 | National-TB-Infection-Treatment-Guidelines_2023.pdf | TPT should be deferred or not offered if the child | TPT should be deferred or not offered if the child:
- Is diagnosed with TB disease.
- Has active liver disease (acute or chronic).
- Has symptoms and signs of severe peripheral neuropathy (a clinician may consider a rifampicin-only regimen on an individual basis).
- Has a history of adverse reactions to any medic... | • is diagnosed with TB disease • has active liver disease (acute or chronic) • has symptoms and signs of severe peripheral neuropathy (a clinician may consider a rifampicin only regimen on and individual basis) • has a history of adverse reactions to any medication used for TPT | ACCEPT | train |
a8e10c660dc94dadb4fbd19f89d3a744 | National-TB-Infection-Treatment-Guidelines_2023.pdf | Management of TPT in children weighing less than 25 kilograms | All children (HIV-negative and HIV-positive) with significant exposure to TB require TPT once TB disease has been excluded through clinical evaluation and testing. When an adult or adolescent patient is diagnosed with pulmonary TB disease, it is essential to conduct a thorough contact investigation to identify those wh... | All children (HIV-negative and HIV-positive) with significant exposure to TB require TPT once TB disease has been excluded through clinical evaluation and testing. When an adult or adolescent patient is diagnosed with pulmonary TB disease it is essential to conduct a thorough contact investigation to establish who had ... | ACCEPT | train |
d6bb661264b940cdb111d1fa25a8b07e | National-TB-Infection-Treatment-Guidelines_2023.pdf | Evaluation of child contacts | Evaluation for TB disease includes symptom screening, clinical examination, and diagnostic testing. These processes are similar for HIV-negative children and those living with HIV. TB testing strategies differ between older and younger children, as younger children typically cannot spontaneously expectorate sputum. Spu... | Evaluation for TB disease includes symptom screening, clinical examination and diagnostic testing. These are similar for HIV-negative children and in children living with HIV (see Figure 3 ). TB testing strategies are different in older children and younger children, who typically cannot spontaneously expectorate sputu... | ACCEPT | train |
cedcd8b5a21a452ea92b2621c56fa556 | National-TB-Infection-Treatment-Guidelines_2023.pdf | Diagnostic tests for TB disease amongst children -regardless of HIV status | In children who are TB contacts, refer to the latest National DR-TB Guidelines for the management of DR-TB exposure. | in children who are TB contacts • For the management of DR-TB exposure, refer to the latest National DR-TB Guidelines | ACCEPT | train |
46158b7f10774b17a86922d3da153a44 | National-TB-Infection-Treatment-Guidelines_2023.pdf | TPT regimens for children weighing less than 25 kilograms | There are three potential regimens for children: 3RH, 3HP, and 6H. The choice depends on the child's weight and HIV status or HIV exposure (maternal HIV) status:
- In HIV-negative children weighing less than 25 kg, the priority regimen is 3RH.
- In children living with HIV and on DTG (dolutegravir)-containing ART, th... | There are three potential regimens for children: 3RH, 3HP, and 6H. The choice depends on the child's weight, HIV status or HIV exposure (maternal HIV) status: • in HIV-negative children <25kg, the priority regimen is 3RH • in children living with HIV and on DTG (dolutegravir) containing ART, the preferred regimen is 6H... | ACCEPT | train |
600e331531ad45f18d9c7eb8b11ae331 | National-TB-Infection-Treatment-Guidelines_2023.pdf | Recommended daily dosages for 3RH in HIV-negative children <25kg | Child's Weight (kg) | RH (Daily) Fixed Dose Combinations | Duration
--- | --- | ---
2-2.9 | ½ tablet, 5 ml | 3 months
3-3.9 | ¾ tablet, 7.5 ml | 3 months
4-5.9 | 1 tablet, 10 ml | 3 months
6-7.9 | 1 ½ tablet, 15 ml | 3 months
8-11.9 | 2 tablets, 20 ml | 3 months
12-15.9 | 3 tablets, 30 ml | 3 months
16-... | Child's Weight (kg) RH (Daily) fixed dose combinations Duration 75/50 If dispersed in water 2-2.9 ½ tablet 5ml 3 months 3-3.9 ¾ tablet 7.5ml 4-5.9 1 tablet 10ml 6-7.9 1 ½ tablet 15ml 8-11.9 2 tablets 20ml 12-15.9 3 tablets 30ml 16-24.9 4 tablets 40ml ≥25 Use adult formulations and doses 5.3.2.2 Recommended daily dosage... | ACCEPT | train |
2c6c100b77f848ada97371188df11d99 | National-TB-Infection-Treatment-Guidelines_2023.pdf | Management of TPT in TB-exposed newborns (babies born to mothers diagnosed with pre-natal or peripartum TB or with other significant TB exposure) | Including TB testing for all, regardless of symptoms. TPT should not be deferred in a pregnant or breastfeeding woman with significant TB exposure, defined as sharing the same enclosed space with a person (adult or adolescent) known to have had pulmonary TB during the three months before this index patient started TB t... | including TB testing for all, regardless of symptoms. TPT should not be deferred in a pregnant or breastfeeding woman with significant TB exposure, defined as sharing the same enclosed space with a person (adult or adolescent) known to have had pulmonary TB during the three months before this index patient starting his... | ACCEPT | train |
281b2f016537461a9d4187f98baef0e3 | National-TB-Infection-Treatment-Guidelines_2023.pdf | TPT should be deferred or not offered if the pregnant woman | - Diagnosed with TB disease
- Has active liver disease (acute or chronic)
- Has symptoms and signs of severe peripheral neuropathy (consider rifampicin-only regimen)
- Has a history of adverse reactions to any medications used for TPT
- Makes excessive use of alcohol (unwilling or unable to scale down), defined as four... | • is diagnosed with TB disease • has active liver disease (acute or chronic) • has symptoms and signs of severe peripheral neuropathy (could consider rifampicin only regimen) • has a history of adverse reactions to any medications used for TPT • makes excessive use of alcohol (and is unwilling or unable to scale down),... | ACCEPT | train |
35f2e3e8a4364fe38c8f9c8b3dc7574a | National-TB-Infection-Treatment-Guidelines_2023.pdf | Management of TPT amongst HIVnegative and HIV-positive pregnant and breastfeeding women with TB exposure | When an adult or adolescent patient is diagnosed with pulmonary TB disease, thorough contact investigation is essential to identify individuals who may have had significant exposure to the index patient. For subsequent TB exposures, TB evaluation is again required, followed by either TPT or TB treatment as appropriate,... | When an adult or adolescent patient is diagnosed with pulmonary TB disease, thorough contact investigation is essential to establish who may have had a significant exposure to this index patient. For subsequent TB exposures, TB evaluation is again required followed by either TPT or TB treatment, as appropriate, i.e., T... | ACCEPT | train |
592273c0221c4ea5a955e3c6a331231c | National-TB-Infection-Treatment-Guidelines_2023.pdf | Evaluation for TB disease amongst pregnant and breastfeeding women | Evaluation for TB disease in pregnant women includes symptom screening, physical examination, and diagnostic testing. TB can be bacteriologically confirmed or clinically diagnosed. A minimum of symptom screening and a sputum test (regardless of symptom presence) are required prior to initiating TPT in a pregnant or bre... | Evaluation for TB disease in pregnant women includes symptom screening, physical examination, and diagnostic testing. TB can either be bacteriologically confirmed or clinically diagnosed. A minimum of symptom screening and a sputum test (regardless of the presence of symptoms) are required prior to initiating either TP... | ACCEPT | train |
7570072ba2964dfbb720397da4b717db | National-TB-Infection-Treatment-Guidelines_2023.pdf | TPT treatment options for pregnant and breastfeeding women | For HIV-negative pregnant and breastfeeding women, there are two regimen options: 3RH or 6H. For HIV-positive pregnant and breastfeeding women, there is one option: 12H. For all pregnant and breastfeeding women, pyridoxine (vitamin B6) 25 mg is added for the duration of TPT, irrespective of HIV status. | For HIV-negative pregnant and breastfeeding women there are two regimen options: 3RH or 6H. For HIV-positive pregnant and breastfeeding women there is one option: 12H. For ALL pregnant and breastfeeding women pyridoxine (vitamin B6) 25mg is added for the duration of TPT -irrespective of HIV status. | ACCEPT | train |
318a1aba21974bb7839bc7a11b5b78c7 | National-TB-Infection-Treatment-Guidelines_2023.pdf | People Living With Hiv (Plhiv) Adults, Adolescents, And Children Irrespective Of Age | All immunocompromised individuals have a significant risk of developing TB disease and require an initial TPT course, regardless of significant exposure, once TB disease has been excluded. This includes people of all ages living with HIV (adults, pregnant and breastfeeding women, adolescents, and children, including in... | All immunocompromised people have a significant risk for developing TB disease and require an initial TPT course, regardless of significant exposure, once TB disease has been excluded. This includes people of all ages living with HIV (adults, pregnant and breastfeeding women, adolescents, and children including infants... | ACCEPT | train |
2e285c9c9d2f456e828afc6dc577822a | National-TB-Infection-Treatment-Guidelines_2023.pdf | Who TPT should be offered to | TPT should be offered to all individuals on ART and to those newly diagnosed with HIV (adults, pregnant and breastfeeding women, adolescents, and children of all weights). These individuals should be evaluated for TB disease and offered TPT, regardless of TB exposure, once TB disease has been excluded. Prior completion... | TPT should be offered to all people on ART and people newly diagnosed with HIV (adults, pregnant and breastfeeding women, adolescents, and children of all weights) should be evaluated for TB disease and offered TPT, regardless of a TB exposure, once TB disease has been excluded. Prior completion of either TB treatment ... | ACCEPT | train |
55f12ef52fbf4fbf9c39045fb6885b6c | National-TB-Infection-Treatment-Guidelines_2023.pdf | TPT should be deferred or not offered if the individual living with HIV | - Is diagnosed with TB disease.
- Has active liver disease (acute or chronic).
- Has symptoms and signs of severe peripheral neuropathy (consider rifampicin-only regimen).
- Has a history of adverse reactions to any of the drugs used for TPT.
- Uses alcohol excessively (and is unwilling or unable to scale down)... | • is diagnosed with TB disease • has active liver disease (acute or chronic) • has symptoms and signs of severe peripheral neuropathy (could consider rifampicin only regimen) • has a history of adverse reactions to any of the drugs used for TPT • Uses alcohol excessively (and is unwilling or unable to scale down), defi... | ACCEPT | train |
43e435d9238d45fca5b048c40a4e6300 | National-TB-Infection-Treatment-Guidelines_2023.pdf | Management of TPT for PLHIV | If PLHIV (or their caregivers in the case of children) decline TPT (despite counseling), they should be counseled further regarding TB symptoms and offered TPT again at the next opportunity. If they develop symptoms suggestive of TB, they should be evaluated for TB disease and offered either TB treatment or TPT again i... | If PLHIV (or their caregivers in the case of children) decline TPT (despite counselling) then they should be counselled further regarding TB symptoms and should be offered TPT again at the next opportunity. If they develop symptoms suggestive of TB, they should be evaluated for TB disease and be offered either TB treat... | ACCEPT | train |
099074d379f14da5ae8a83295edde494 | National-TB-Infection-Treatment-Guidelines_2023.pdf | Symptom screening for TB disease amongst PLHIV (children <25kg) | - Current cough
- Poor weight gain, failure to thrive, or documented weight loss
- Fever or night sweats
- Lethargy or fatigue (decreased playfulness)
- Visible neck mass or swelling | • current cough • poor weight gain or failure to thrive or documented weight loss • fever or night sweats • lethargy/fatigue (decreased playfulness) • visible neck mass/swelling | ACCEPT | train |
5f8a5f0696904a078829de7ee2feeedd | National-TB-Infection-Treatment-Guidelines_2023.pdf | Diagnostic tests for TB disease amongst PLHIV (adults, adolescents, and children ≥25kg) | - A sputum sample should be obtained and tested using Xpert.
- If no sputum sample can be obtained, a chest radiograph should be performed to rule out TB disease.
- A urine sample can also be obtained from eligible individuals and tested using LF-LAM.
- Tests for TB infection (TST/IGRA) are not required to initiate ... | • a sputum sample should be obtained and tested using Xpert • if no sputum sample can be obtained, then a chest radiograph should be obtained to rule out TB disease • a urine sample can also be obtained from those who are eligible and tested using LF-LAM • test of TB infection (TST/IGRA) are not a requirement to initia... | ACCEPT | train |
ba8f376f5c854f81bd5f3b5b83596ac5 | National-TB-Infection-Treatment-Guidelines_2023.pdf | TPT regimens for PLHIV (adults, pregnant and breastfeeding women, adolescents, and children 25 kilograms or more) | For adults, adolescents, and children ≥25 kg living with HIV and initiating dolutegravir-containing ART, 12H is the preferred regimen. For those taking ART who are already virally suppressed (VL <50 copies/mL in the last six months) or those starting ART not containing dolutegravir, 3HP is preferred.
**7.3.2.1 Recomme... | For adults, adolescents and children ≥25kg living with HIV and initiating dolutegravir-containing ART, 12H is the preferred regimen. For those taking ART that are already virally suppressed (VL<50 copies/mL in the last six months) or those starting ART not containing Dolutegravir, 3HP is preferred. 7.3.2.1 Recommended ... | ACCEPT | train |
79637dce14d04e7c8ccf02b0b2973e34 | National-TB-Infection-Treatment-Guidelines_2023.pdf | TPT regimens for PLHIV (adults, pregnant and breastfeeding women, adolescents, and children 25 kilograms or more) | Signs of TB include providing adherence support, conducting weight checks, making dose adjustments as needed, performing safety monitoring, and registering and notifying for Xpert/u-LAM positive results or CXR suggestive of TB. | signs of TB, provide adherence support, weight check, do dose adjustment as needed, conduct safety monitoring and register and notify Xpert/u-LAM POSITIVE or CXR suggestive of TB | ACCEPT | train |
32b5c9612d07430ab0b2478fdf0c3504 | National-TB-Infection-Treatment-Guidelines_2023.pdf | Silicosis | People with confirmed silicosis have a significant risk of developing TB disease and require initial TPT regardless of exposure. After new TB exposure, a TB evaluation is again required, along with a decision to offer TPT or TB treatment (see Section 4). | People with confirmed silicosis have a significant risk for developing TB disease and require initial TPT regardless of significant exposure. After new TB exposure, TB evaluation is again required along with a decision to offer TPT or TB treatment (see Section 4). | ACCEPT | train |
0903af7e999a49ea9f19f32caaf46a98 | National-TB-Infection-Treatment-Guidelines_2023.pdf | Who TPT should be offered to | TPT should be offered to all individuals with confirmed silicosis, regardless of known significant exposure or prior TB treatment unrelated to silicosis. Individuals with silicosis who have completed TB treatment and have bacteriological proof of cure should be screened for TB symptoms and assessed for TPT eligibility ... | TPT should be offered to all people with confirmed silicosis regardless of whether they have a known significant exposure (regardless of prior TB treatment or TPT unrelated to silicosis). People with silicosis who have completed TB treatment and have bacteriological proof of cure should be screened for TB symptoms and ... | ACCEPT | train |
87bb96035f7546e68dce056432c04b66 | National-TB-Infection-Treatment-Guidelines_2023.pdf | Management of TPT for people with silicosis | If TPT is declined (despite counseling), re-counsel regarding TB symptoms and offer TPT again at the next opportunity. For symptoms suggestive of TB, reevaluate for TB disease and offer either TB treatment or TPT again if TB disease has been excluded. | If TPT is declined (despite counselling) re-counsel regarding TB symptoms and offer TPT again at the next opportunity. For symptoms suggestive of TB, reevaluate for TB disease and offer either TB treatment or TPT again, if TB disease has been excluded. | ACCEPT | train |
7f55bebfc2a94d2c8b6c2e6e663277d1 | National-TB-Infection-Treatment-Guidelines_2023.pdf | Evaluation for TB disease amongst silicosis | Evaluation for TB disease includes symptom screening, physical examination, and diagnostic testing, regardless of symptoms. TB can be either bacteriologically confirmed or clinically diagnosed. Among people with silicosis, a minimum of symptom screening and a sputum test are required prior to initiating TB treatment or... | Evaluation for TB disease includes symptom screening, physical examination, and diagnostic testing, regardless of symptoms. TB can either be bacteriologically confirmed or clinically diagnosed. Amongst people with silicosis a minimum of symptom screening and a sputum test are required prior to initiating either TB trea... | ACCEPT | train |
b851e2e9555b46679caac593e49e3f3d | National-TB-Infection-Treatment-Guidelines_2023.pdf | Testing for latent tuberculosis infection (LTBI) amongst adults with silicosis | Where available, the tuberculin skin test (TST) or interferon gamma release assay (IGRA) may be useful to distinguish silicosis from tuberculosis (TB) disease. | Where available, tuberculin skin test (TST) or interferon gamma release assay (IGRA) may be useful to distinguish silicosis from TB disease. | ACCEPT | train |
532e26340c2046a6801004322f8d80fa | National-TB-Infection-Treatment-Guidelines_2023.pdf | TPT regimens for adults with silicosis | There are currently three potential regimens for this group: 3HP, 3RH, or 12H. In general, the short course 3HP regimen should be prioritized where possible. Patients should also receive pyridoxine (vitamin B6) 25 mg for the duration of their TPT. | There are currently three potential regimens for this group: 3HP, 3RH or 12H. In general, the short course 3HP regimen should be prioritised where possible. Patients should also receive pyridoxine (vitamin B6) 25mg for the duration of their TPT. | ACCEPT | train |
e988a31f4b9645028442811fac9d2f24 | National-TB-Infection-Treatment-Guidelines_2023.pdf | Other High-Risk Groups | Additional specific TPT guidelines need to be developed for groups at increased risk of TB infection and/or progression to TB disease, such as:
1) Inmates in correctional facilities remain a priority for TPT because the confined indoor spaces they share with others often mean they meet the criteria for 'significant T... | Additional specific TPT guidelines need to be developed for groups at increased risk of TB infection and/or progression to TB disease, such as: 1) inmates in correctional facilities remain a priority for TPT because the confined indoor spaces they share with other people often mean they meet the criteria of 'significan... | ACCEPT | train |
581c3d3b8b6f48e4ad0acde210a8d3b0 | National-TB-Infection-Treatment-Guidelines_2023.pdf | Patient Categorisation And Treatment Outcomes | Patients treated for TB infection may be categorized as either new or previously treated. The treatment outcome possibilities are: completed, lost to follow-up, stopped, or died, as described in Table 2.
Table 2. Patient categories and treatment outcomes. | Patients treated for TB infection may be categorised either as new or previously treated. The treatment outcome possibilities are completed, lost to follow-up, stopped or died as described in Table 2 . Table 2. Patient categories and treatment outcomes | ACCEPT | train |
5464e5aa0e6f4ab8b34ea2e1683fdb71 | National-TB-Infection-Treatment-Guidelines_2023.pdf | Category definition | New: Never had TPT or took treatment for less than four weeks.
Previously treated: Past TPT or another regimen for four or more weeks, and either completed or stopped for any reason (e.g., due to adverse events, developed TB, lost to follow-up). | New Never had TPT or who took treatment for less than four weeks. Previously treated Past TPT or another regimen for four or more weeks and either completed or stopped for any reason (e.g. due to adverse events, developed TB, lost to followup) | ACCEPT | train |
ba1c8df66e944ad4a79d98e7363bcd52 | National-TB-Infection-Treatment-Guidelines_2023.pdf | TB Preventive Treatment (TPT) outcomes | **Treatment Completed**: An individual who has taken and completed preventive treatment within the prescribed period.
**Lost to Follow-Up**: An individual whose treatment was interrupted for four weeks or more (if on a four-month regimen), two consecutive months (if on a six-month regimen), or three consecutive months... | Treatment completed Individual who has taken treatment and completed preventive treatment within the prescribed period. Lost to follow-up An individual whose treatment was interrupted for four weeks or more (if on four or more months regimen) OR two consecutive months (if on a six-month regimen) OR three consecutive mo... | ACCEPT | train |
8ea59d6468c449b99b9cc27859996703 | National-TB-Infection-Treatment-Guidelines_2023.pdf | Follow-up visits | Individuals should be monitored monthly (every three or six months depending on the duration of treatment). For individuals with co-morbidities, appointments should be aligned with other scheduled chronic disease or ART visits to avoid multiple visits for care. At each visit, the following must be done:
- Screen indi... | Individuals should be monitored monthly (three or six months depending on the duration of treatment). For individuals with co-morbidities, try to align appointments with other scheduled chronic disease or ART visits to avoid multiple visits for care. At each visit the following must be done: • screen individuals for si... | ACCEPT | train |
dd86c89ddfbb4f2f81c64a8fd5cf75f2 | National-TB-Infection-Treatment-Guidelines_2023.pdf | Adverse events | While most adverse events are minor and occur rarely, specific attention should be paid to drug-induced hepatotoxicity, severe peripheral neuropathy, and hypersensitivity. Assess individuals for signs and symptoms suggestive of hepatitis, such as new-onset vomiting, right upper quadrant pain, and jaundice. If any of th... | While most of the adverse events are minor and occur rarely, specific attention should be paid to drug-induced hepato-toxicity, severe peripheral neuropathy as well as hypersensitivity. Assess individual for signs and symptoms suggestive of hepatitis such as new-onset vomiting, right upper quadrant pain and jaundice -i... | ACCEPT | train |
14b47e5c0545401ba01f3cea3d4e5dc6 | National-TB-Infection-Treatment-Guidelines_2023.pdf | Management of common adverse events | Increased blood pressure: Reassure the individual and inform them about avoiding tyramine and histamine-containing foods (e.g., tuna, cheese, red wine) while receiving Isoniazid. Consider a referral to a dietitian. Flushing is usually mild and resolves without treatment. If flushing is bothersome, an antihistamine may ... | Increased blood pressure Reassure individual and inform about avoiding tyramine and histaminecontaining foods (e.g. tuna, cheese, red wine) while receiving Isoniazid -consider a referral to a dietitian. Flushing is usually mild and resolves without treatment. If flushing is bothersome to the individual, an antihistamin... | ACCEPT | train |
0229c0d21aae4cc0a0ef11263a46fc4a | National-TB-Infection-Treatment-Guidelines_2023.pdf | Isoniazid(H) Rifapentine (P) | Mild rash and itching should be treated with antihistamines and topical steroid creams. Hypersensitivity is uncommon and usually occurs three to seven weeks after the initiation of treatment with Isoniazid (H). Symptoms may include hives (raised, itchy rash) and fever. Discontinue treatment until the reaction resolves. | Mild rash and itching Treat with antihistamine and topical steroid creams. Hypersensitivity uncommon usually occurs -three to seven weeks after initiation of treatment Isoniazid(H) Symptoms: Hives (raised, itchy rash), fever (may occur) Discontinue treatment until the reaction resolves. | ACCEPT | train |
4c82d62c9d774124bf743a9ad650bb04 | National-TB-Infection-Treatment-Guidelines_2023.pdf | Management of common adverse events | Signs/Symptoms:
A hypersensitivity reaction occurs after the first three to four doses and begins approximately four hours after ingestion of the medication Rifapentine (P).
Symptoms include: flu-like symptoms, fever, headache, dizziness, shortness of breath, wheezing, nausea, muscle and bone pain, rash, itching, r... | Signs/symptoms Management Hypersensitivity reaction occurs after the first three to four doses and begins approximately four hours after ingestion of medication Rifapentine (P) Symptoms: Flu-like symptoms, fever, headache, dizziness, shortness of breath, wheezing, nausea, muscle and bone pain, rash, itching, red eyes, ... | ACCEPT | train |
03cce579cfe94bdc926554791c9b7bd2 | National-TB-Infection-Treatment-Guidelines_2023.pdf | Drug-drug Interactions | Points to note:
- Daily Rifampicin plus Isoniazid for three months (3RH) should not be given to infants and children on protease inhibitors (PI) or nevirapine-based ART due to drug-drug interactions.
- Rifapentine and Isoniazid (3HP) should not be offered to ART-naïve individuals starting Dolutegravir-containing ART ... | Points to note: • Daily Rifampicin plus Isoniazid for three months (3RH) should not be given to infants and children on protease inhibitors (PI) or nevirapine-based ART due to drug-drug interactions. • Rifapentine and INH (3HP) should not be offered to ART-naïve individuals starting Dolutegravircontaining ART due to la... | ACCEPT | train |
ee8b475d2a2847549fdf05f11f39d37d | National-TB-Infection-Treatment-Guidelines_2023.pdf | Treatment adherence and completion of treatment | Adherence and completion of treatment are important for ensuring successful outcomes and preventing the development of TB disease. Ongoing education and counseling must be provided. | Adherence and completion of treatment are important for ensuring successful treatment and preventing the development of TB disease. Education and counselling must be provided on an ongoing basis. | ACCEPT | train |
27968b30b803481faed88b20d33413bb | National-TB-Infection-Treatment-Guidelines_2023.pdf | Treatment interruption and discontinuation | Categorization of Treatment Interruption
Individuals who are initiated on longer treatment regimens (six or more months) and interrupt treatment should be categorized as follows:
- Interrupted treatment for less than three consecutive months
- Interrupted treatment for more than three consecutive months
- Interrupted ... | Categorisation of treatment interruption • Individuals who are initiated on the longer treatment regimens (six or more months) who interrupt treatment should be categorised as follows: • interrupted treatment for less than three consecutive months • interrupted treatment for more than three consecutive months • interru... | ACCEPT | train |
41ff9c48322f49e5a00d5b35869d3a3f | National-TB-Infection-Treatment-Guidelines_2023.pdf | If an individual misses one dose | For daily doses: The individual should take the missed dose as soon as they remember within the same day. If this is on the following day, take the next scheduled dose and continue with the regular schedule. Do not take two doses on the same day.
For weekly doses: The individual should take the missed dose as soon as... | For daily doses: The individual should take the missed dose as soon as they remember within the same day. If this is on the following day, take the next scheduled dose and continue with the regular schedule. Do not take two doses on the same day. For weekly doses: The individual should take the missed dose as soon as t... | ACCEPT | train |
01b45fd10cd041a9ae64a82ac11875ce | National-TB-Infection-Treatment-Guidelines_2023.pdf | Monitoring And Evaluation | Monitoring is the periodic assessment of program activities to determine whether they are proceeding as planned. It provides managers with continuous feedback on implementation, enabling informed decisions regarding service delivery and ensuring effective and efficient use of resources for maximum impact. Evaluation, o... | Monitoring is the periodic assessment of programme activities to determine whether they are proceeding as planned. It provides managers with continuous feedback on implementation, to make informed decisions regarding service delivery and ensure effective and efficient use of resources for maximum impact. Evaluation, on... | ACCEPT | train |
02493b017f914963a937f09b97125dde | National-TB-Infection-Treatment-Guidelines_2023.pdf | Data flow processes and reporting | - Facilities, districts, and provinces are expected to report according to the District Health Management Information System (DHMIS) policy and processes illustrated in Figure 6.
- With facility-level digitization, data from patient folders is captured directly into the three interlinked electronic registers (TIER) sy... | • Facilities, districts and provinces are expected to report according to the District Health Management Information System (DHMIS) Policy and processes illustrated in Figure 6 . • With facility level digitisation, data from the patient folders is captured directly into the three interlinked electronic registers (TIER)... | ACCEPT | train |
b457f7a91e574e90ae2d8d12bdc29b08 | National-TB-Infection-Treatment-Guidelines_2023.pdf | Cascade analysis at facility level | • Facilities must conduct a care cascade analysis of aggregated data from screening to treatment outcomes. This will help identify gaps within the cascade and develop plans to address these gaps using quality improvement methodology. Examples of TB evaluation cascades for HIV-positive clients and contacts of TB index p... | • Facilities must conduct a care cascade analysis of aggregated data from screening to treatment outcomes. This will help to identify gaps/leakages within the cascade and develop plans to address the gaps using the quality improvement methodology. Examples of TB evaluation cascades for HIV-positive clients and contacts... | ACCEPT | train |
6b116b94c24f489a99cf5bbd2dfaca88 | National-TB-Infection-Treatment-Guidelines_2023.pdf | Completion of TPT prior to enrolment in differentiated service delivery (DSD) model | Where patients have started TPT at ART initiation and the TPT treatment course is shorter than six months (e.g., 3HP), TPT should be completed prior to the assessment for and enrollment in RPCs (facility pick-up points, adherence clubs, or external pick-up points). If patients have started TPT at ART initiation or afte... | Where patients have started TPT at ART start and the TPT treatment course is shorter than six months (e.g., 3HP), TPT should be completed prior to the assessment for and enrolment in RPCs (facility pick-up points, adherence clubs or external pick-up points). Where patients have started TPT at ART start or after ART sta... | ACCEPT | train |
d5b7ab9036454e068a6b4d6056006acf | National-TB-Infection-Treatment-Guidelines_2023.pdf | TPT initiation and completion within DSD model | Where adult patients are already enrolled in RPCs (facility pick-up point, adherence club, or external pick-up point) and have previously missed TPT, these patients should be supported to complete a course of 12H within their RPCs model. These patients should be assessed at their annual comprehensive clinical consultat... | Where adult patients are already enrolled in a RPCs (facility pick-up point, adherence club or external pick-up point) and have previously missed TPT, these patients should be supported to complete a course of 12H within their RPCs model. These patients should be assessed at their annual comprehensive clinical consulta... | ACCEPT | train |
cd9252d90705460bbc6dc54e3bb5bed0 | National-TB-Infection-Treatment-Guidelines_2023.pdf | Transition to TLD regimen | For patients using RPCs who are eligible and opting to switch to TLD, TPT eligibility should be assessed at the time of switch. For TPT-eligible patients, 3HP may be offered to be started with TLD, provided the patient agrees to additional facility clinical review dates. Alternatively, 12H can be prescribed and aligned... | For patients making use of RPCs who are eligible and opting to switch to TLD, TPT eligibility should be assessed at switch. For TPT eligible patients, 3HP could be offered to the patient to be started with TLD, provided the patient agrees to additional facility clinical review dates. Alternatively, 12H can be scripted ... | ACCEPT | train |
804e509240df411081e45166fed7341a | National-TB-Infection-Treatment-Guidelines_2023.pdf | Adherence Step 1 Education of patient | - How treatment for TB infection differs from treatment for TB disease.
- Type of treatment regimen suitable for the patient and the rationale behind it.
- Risk factors associated with treatment, such as: | • How treatment for TB infection differs from treatment for TB disease. • Type of treatment regimen suitable for the patient and why. • Risk factors associated with treatment, such as: | ACCEPT | train |
de69cbd0982f4442b9a6fa6cd496de99 | National-TB-Infection-Treatment-Guidelines_2023.pdf | Adherence Step 4 Getting to appointments | How will I get to my clinic appointments? The best time to collect my treatment will be: If I face difficulties keeping clinic appointments, my alternative plan will be: | How will I get to my clinic appointments: The best time to collect my treatment will be: If I face difficulties with keeping clinic appointments my alternative plan will be: | ACCEPT | train |
600da88d3ca648a09e1d223d7670efdd | National-TB-Infection-Treatment-Guidelines_2023.pdf | Adherence Step 5 -Treatment schedule | The best time for me to take my treatment is: I am taking the following treatment and will add this to my daily dose: I am not taking any other medication and will need a reminder to take my weekly/daily dose. | The best time for me to take my treatment is: I am taking the following treatment and I will add this treatment to my daily dose: I am not taking any other medication and will need a reminder to take my weekly/daily dose: | ACCEPT | train |
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