From Tuberculosis › Chapter 3: Diagnosis and follow-up investigations · Médecins Sans Frontières, Current online edition, 2026
Baseline and follow-up investigations for TB patients to identify comorbidities, contraindications and drug adverse effects.
- Issuer
- Médecins Sans Frontières
- Edition
- Current online edition, 2026
- Audience
- Clinicians managing tuberculosis patients
- Evidence
- Expert consensus
- Reviewed
- 21 Oct 2026 · GMJ
What this guideline says
GMJ summary
This section of the MSF tuberculosis guideline specifies the laboratory and clinical investigations required in addition to TB diagnostic tests. The investigations are performed at baseline and during treatment to identify common comorbidities, contraindications to therapy and adverse effects of TB medications.
The guideline provides a comprehensive table matching specific tests to patient groups and treatment regimens. All TB patients should undergo testing for diabetes (HbA1c or glucose), and HIV/hepatitis B and C screening if status is unknown. Patients receiving MDR/RR-TB treatment require more extensive monitoring including liver function tests, whilst those on specific drugs require targeted investigations: ECG for QT-prolonging agents, audiometry for aminoglycosides, visual function tests for ethambutol, linezolid or thionamides, and full blood count for linezolid.
Key points
For clinicians — doses and thresholds as stated in the guideline
- All TB patients should undergo glycated haemoglobin (HbA1c) or blood glucose testing (fasting or random)
- HIV, hepatitis B and C testing indicated for patients with undocumented status
- Electrocardiogram (ECG) required for patients on QT-prolonging drug(s)
- Brief peripheral neuropathy screen (BPNS) indicated for patients on linezolid
- Visual function tests required for patients on MDR/RR-TB treatment including ethambutol, linezolid or a thionamide
- Audiometry necessary for patients on aminoglycoside (children under 5 years require specialised equipment and consultation)
- Liver function tests (AST and ALT) indicated for patients with pre-existing hepatic disease and those on MDR/RR-TB treatment
- Creatinine testing (serum creatinine and creatinine clearance) required for patients with pre-existing renal disease and those on aminoglycoside
Other investigations in TB treatment
Table extracted from the guideline
| Tests | Indications |
|---|---|
| Electrocardiogram (ECG) | Patients on QT-prolonging drug(s) |
| Brief peripheral neuropathy screen (BPNS) | Patients on linezolid |
| Visual function tests | Patients on MDR/RR-TB treatment including ethambutol, linezolid or a thionamide |
| Audiometry | Patients on aminoglycoside |
| Full blood count | Patients on linezolid (or rifabutin) |
| Liver function tests (AST, ALT) | Patients with pre-existing hepatic disease; Patients on MDR/RR-TB treatment |
| Creatinine (serum creatinine, creatinine clearance) | Patients with pre-existing renal disease; Patients on aminoglycoside |
| Serum electrolytes (potassium) | Patients on aminoglycoside |
| HbA1c or blood glucose (fasting or random) | All patients |
| HIV, hepatitis B and C testing | Patients with undocumented HIV, hepatitis B and C status |
| CD4 count and viral load | Patients with TB/HIV coinfection |
| Thyroid stimulating hormone (TSH) | Patients on thionamide or PAS |
| Pregnancy test | Patients of childbearing age with MDR/RR-TB |
Source: Médecins Sans Frontières, Other investigations — MSF Tuberculosis. Reproduced in summary form.
From the guideline
Verbatim
“The purpose is to identify common comorbidities, contra-indications, as well as adverse effects of TB drugs.”
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
As Editor-in-Chief of the Georgian Medical Journal and Chair of the Public Health Institute, I recognise that Georgia's high MDR-TB burden makes comprehensive monitoring essential to treatment success and patient safety. The recommendation I would stress to Georgian clinicians is universal diabetes screening for all TB patients, given the bidirectional relationship between TB and diabetes and the rising prevalence of diabetes in our region. The implementation caveat is that specialised tests such as audiometry and visual function assessment require equipment and trained personnel that may not be uniformly available across all regional TB centres, necessitating clear referral pathways and potentially centralised monitoring for patients on second-line regimens.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 21 Oct 2026
Applicability
Georgia and the South Caucasus
Georgia’s national TB programme manages one of the highest MDR-TB burdens in the WHO European Region, making these monitoring recommendations particularly relevant. The guideline’s emphasis on screening for comorbidities aligns with Georgia’s integrated approach to TB/HIV and the national hepatitis C elimination programme. Implementation will require ensuring laboratory capacity for specialised tests such as audiometry and visual function assessment across regional TB treatment centres, and integrating these investigations into the standardised monitoring protocols already established under the national TB programme with Global Fund and WHO support.
Questions this guideline answers
Quick answers
Which investigations are required for all TB patients regardless of treatment regimen?
All TB patients should undergo glycated haemoglobin (HbA1c) or blood glucose testing (fasting or random), and HIV, hepatitis B and C testing if their status is undocumented.
What monitoring is needed for patients on aminoglycosides?
Patients on aminoglycosides require audiometry (with specialised equipment for children under 5 years), creatinine testing (serum creatinine and creatinine clearance), and serum electrolytes (potassium) monitoring.
Which patients need liver function tests during TB treatment?
Liver function tests (AST and ALT) are indicated for patients with pre-existing hepatic disease and all patients on MDR/RR-TB treatment.
What is the Brief Peripheral Neuropathy Screen (BPNS)?
BPNS is a clinical examination for detecting peripheral neuropathy and grading the severity of symptoms, indicated for patients on linezolid.
Related on GMJ
Interconnected resources
Dictionary of Public Health
Drugs A–Z
Conditions A–Z
GMJ News coverage
Quality & accreditation
Same guideline
- Latent tuberculosis infection — MSF TuberculosisChapter 3: Diagnosis and follow-up investigations
- Active tuberculosis — MSF TuberculosisChapter 3: Diagnosis and follow-up investigations
- Summary of clinical presentations of tuberculosis — MSF TuberculosisChapter 2: Clinical presentation
- Clinical presentation of tuberculosis in HIV-infected persons — MSF TuberculosisChapter 2: Clinical presentation
- Disseminated or miliary tuberculosis — MSF TuberculosisChapter 2: Clinical presentation
- Extrapulmonary tuberculosis — MSF TuberculosisChapter 2: Clinical presentation
Other guidelines on this topic
- Issuer
- Médecins Sans Frontières
- Guideline
- Tuberculosis
- Chapter
- Chapter 3: Diagnosis and follow-up investigations
- Type
- Clinical guideline (chapter)
- Edition
- Current online edition, 2026
- Status
- Current
- Published
- 2026-10-14
- Scope
- Section 3.3 of MSF Tuberculosis guideline covering ancillary investigations
- Audience
- Clinicians managing tuberculosis patients
- Evidence
- Expert consensus
- Record history
- Created 21 Oct 2026 · updated 21 Oct 2026 · next check Apr 2027
Médecins Sans Frontières. 3.3 Other investigations. In: Tuberculosis [guideline]. Paris: MSF; 2026. Available from: [URL]GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
Was this article helpful?
