The second week of August 2016. While much of Indian mainstream media’s attention was on the performance of its athletes at the Rio Summer Olympics, the country quietly took its first significant step in framing evidence based health guidelines for a major public health issue, with the release of INDEX-TB guidelines for diagnosis and management of extra-pulmonary tuberculosis (EPTB) in India. This marked a key milestone, the guidelines being among the first in the country to have been developed through rigorous evidence-based methods, including quality assessment of the supporting evidence.
INDEX-TB guidelines were developed over one and a half years, with involvement of a large number of experts from different organ system sub-specialties. The project was convened by the department of medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, which is a WHO Collaborating Centre (WHO-CC) for Training and Research in Tuberculosis. Partners and key contributors included the WHO Country Office for India, and Central TB Division, Ministry of Health and Family Welfare, Government of India. The methodology support team comprised of members from the Cochrane Infectious Diseases Group and Cochrane South Asia.
With EPTB accounting for about one-fifth of all cases of tuberculosis, a major health burden in India, many aspects of diagnosis and management remain shrouded in uncertainty. With the release of this extensively peer-reviewed document, health providers at primary and secondary care institutions are likely to have better guidance for systematic management of EPTB. The guidelines address three key areas of management of EPTB specific for each organ system
- Use of Xpert MTB/RIF for diagnosis
- Use of corticosteroids
- Duration of treatment
Part-1 of the guidelines lists the methods used and key recommendations. Part-2, Clinical practice points, summarizes all other key aspects of diagnosis and treatment of EPTB, and is intended to serve as a reference for further refinement in the evidence-informed guidelines and for future research.
INDEX-TB Guidelines 2016 can be accessed from the website of the Indian Council of Medical Research, as well as from the website of Cochrane South Asia.