Patient monitoring — MSF Tuberculosis — Médecins Sans Frontières 2026

MSFClinical guideline (chapter)Current edition

From Tuberculosis › Chapter 9: Treatment of drug-susceptible tuberculosis · Médecins Sans Frontières, Current online edition, 2026

Monitoring protocol for patients on drug-susceptible tuberculosis treatment, covering clinical visits, bacteriological tests and investigations.

In one sentenceMonitor drug-susceptible TB patients every 2 weeks initially then monthly, with smear microscopy every 2 months (expecting negative at months 2, 4, 6), baseline diabetes screening, and targeted blood tests based on comorbidities.

Issuer: Médecins Sans Frontières
Edition: Current online edition, 2026
Audience: Clinicians, TB programme staff
Evidence: Expert consensus
Reviewed: 22 Oct 2026 · GMJ

Read the original on MSF Whole guideline (PDF)

Summary by GMJ Guidelines Desk•Reviewed by Prof. Giorgi Pkhakadze, MD, MPH, PhD•Record updated 22 Oct 2026•Next check Apr 2027

What this guideline says

GMJ summary

This section of MSF’s tuberculosis guideline establishes a structured monitoring protocol for all patients on drug-susceptible TB treatment, regardless of regimen. Monitoring encompasses clinical assessment, bacteriological testing and additional investigations to detect treatment response, adverse effects and adherence issues throughout the treatment course.

Clinical visits should occur every other week for the first month, then monthly if uncomplicated, with more frequent assessment for those with comorbidities, adverse effects or pregnancy. For pulmonary TB, bacteriological monitoring is essential: smear microscopy every 2 months until completion (expected negative at months 2, 4 and 6), with rapid molecular tests and culture reserved for positive microscopy at month 2 or later, or clinical deterioration.

Additional investigations are tailored to patient risk factors and regimen: chest radiography for non-bacteriologically confirmed cases and children, bone X-rays every 6 months for osteoarticular TB, and blood tests (liver function, renal function, full blood count, glucose/HbA1C) at baseline with targeted follow-up based on comorbidities and drug toxicity profiles. HIV testing is recommended at baseline and every 6 months in high-prevalence areas.

Key points

For clinicians — doses and thresholds as stated in the guideline

Clinical visits: every 2 weeks for the first month, then monthly if no problems; more frequent if comorbidities, severe adverse effects or pregnancy
Smear microscopy for pulmonary TB: perform every 2 months until treatment completion; expected negative at months 2, 4 and 6
If microscopy positive at month 2 or later: perform rapid molecular tests to detect emergence of rifampicin or isoniazid resistance
If microscopy positive at month 4: perform culture and phenotypic drug susceptibility testing
Chest radiography: baseline for children with presumed PTB and non-bacteriologically confirmed PTB; bone X-ray every 6 months for osteoarticular and spinal TB
Blood tests at baseline for all: HbA1C and/or glucose to detect diabetes; HIV, hepatitis B and C if status undocumented
Liver function tests (AST, ALT): monthly monitoring for patients with pre-existing hepatic disease
HIV testing: repeat every 6 months in high HIV prevalence areas; CD4 count and viral load every 6 months for HIV-infected patients

Blood tests at baseline and during treatment

Table extracted from the guideline

Tests	Indications
Full blood count (haemoglobin, red and white blood cells, platelets)	HIV-infected patients on rifabutin or zidovudine (AZT), at baseline, then once a month for the first 2 months, then if indicated
Liver function tests (AST and ALT; bilirubin if elevated liver enzymes)	Patients with pre-existing hepatic disease, at baseline, then once a month
Serum creatinine	Patients with renal insufficiency at baseline, then if indicated
HbA1C and/or blood glucose level	All patients, at baseline, to detect diabetes. If diabetes is detected, monitor according to standard protocols
HIV, hepatitis B and C	For patients with undocumented status; HIV test every 6 months in high HIV prevalence areas. Tests can be repeated in case of recent exposure
CD4 count and viral load	HIV-infected patients: at baseline, then every 6 months

Source: Médecins Sans Frontières, Patient monitoring — MSF Tuberculosis. Reproduced in summary form.

From the guideline

Verbatim

“If treatment is effective, microscopy at Month 2, 4 and 6 should be negative.”

— Médecins Sans Frontières, Patient monitoring — MSF Tuberculosis, Section 9.6.2 (2026)

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 someone who has worked extensively on TB control in the South Caucasus, I find MSF's systematic approach to patient monitoring particularly valuable for Georgia's TB programme, which faces the dual challenge of maintaining treatment adherence in remote mountain villages whilst detecting the emergence of drug resistance early. The recommendation I would emphasise to Georgian clinicians is the universal baseline screening for diabetes with HbA1C or glucose, given our rising diabetes prevalence and the bidirectional relationship between TB and diabetes that complicates both treatment outcomes and drug tolerability. The implementation caveat for Georgia is ensuring that smear microscopy capacity exists at the rayon level to enable testing every 2 months without requiring patients to travel long distances, and that rapid molecular testing is accessible when microscopy remains positive at month 2, which currently may necessitate specimen transport to reference laboratories in Tbilisi. The guidance's integration of clinical, bacteriological and biochemical monitoring aligns well with Georgia's existing vertical TB programme structure, but will require strengthening laboratory networks in Adjara, Kakheti and Samtskhe-Javakheti regions.

ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 22 Oct 2026

Applicability

Georgia and the South Caucasus

Georgia has a moderate TB burden with pockets of high multidrug-resistant TB prevalence, making robust monitoring protocols essential. This MSF guidance is particularly relevant for the National Center for Tuberculosis and Lung Diseases and regional TB programmes, as it provides practical monitoring schedules adaptable to resource constraints. National programmes should ensure smear microscopy capacity at every 2-month interval as specified, and access to rapid molecular testing for patients with persistent positive microscopy to promptly detect acquired drug resistance. The recommendation for universal baseline diabetes screening (HbA1C/glucose) aligns with Georgia’s rising diabetes prevalence and the known TB-diabetes syndemic. Implementation would require ensuring consistent access to basic blood tests and radiology in rural and mountain regions where TB prevalence may be higher and healthcare access more limited.

Questions this guideline answers

Quick answers

How often should patients with uncomplicated drug-susceptible TB be seen?

Every 2 weeks for the first month, then once a month if there are no particular problems. Additional visits may be required for comorbidities, severe or multiple adverse effects, or pregnancy.

When should bacteriological tests be repeated during treatment?

Smear microscopy every 2 months until treatment completion. If microscopy is positive at month 2 or later, perform rapid molecular tests. If microscopy is positive at month 4, perform culture and phenotypic drug susceptibility testing.

Can rapid molecular tests be used to monitor treatment progress?

No, rapid molecular tests cannot be used to monitor treatment progress. They should only be performed if microscopy or culture is positive at month 2 or later, to detect the emergence of new drug resistance.

Which patients need baseline blood glucose or HbA1C testing?

All patients starting TB treatment should have baseline HbA1C and/or blood glucose level testing to detect diabetes. If diabetes is detected, monitor according to standard protocols.

Related on GMJ

Interconnected resources

Dictionary of Public Health

Drugs A–Z

Rifampicin

Conditions A–Z

GMJ News coverage

Quality & accreditation

Same guideline

Adjunctive Therapy in Drug-Susceptible Tuberculosis — MSF TuberculosisChapter 9: Treatment of drug-susceptible tuberculosis
Special situations in drug-susceptible tuberculosis treatment — MSF TuberculosisChapter 9: Treatment of drug-susceptible tuberculosis
Alternative treatment regimens for drug-susceptible tuberculosis — MSF TuberculosisChapter 9: Treatment of drug-susceptible tuberculosis
Conventional treatment regimens for drug-susceptible tuberculosis — MSF TuberculosisChapter 9: Treatment of drug-susceptible tuberculosis
Drugs for drug-resistant tuberculosis — MSF TuberculosisChapter 8: Tuberculosis drugs and treatment regimens
Tuberculosis drug formulations — MSF TuberculosisChapter 8: Tuberculosis drugs and treatment regimens

Patient monitoring — MSF Tuberculosis

What this guideline says

Key points

Blood tests at baseline and during treatment

From the guideline