Appendix B: De-isolation review and recommendations

• The preponderance of data suggests that appropriate treatment rapidly renders people with tuberculosis (TB) non-infectious, perhaps within a few days of treatment initiation, even for initially smear-positive cases. • These studies also suggest that sputum smear and culture status are less predictive of infectiousness once patients are established on effective therapy. • Nevertheless, there remains some uncertainty as to when, precisely, people with TB on treatment are rendered completely non-infectious. • The insistence on smear conversion before lifting airborne precautions may unnecessarily prolong isolation and cause patient harm with little public health benefit. • For people with TB that are medically well enough, ambulatory treatment and home isolation is to be preferred over prolonged hospital isolation. This will attenuate some but not all harms of prolonged isolation.