Fifth-largest burden in the world, 140 deaths a day — the regimen, the doses, the weight bands and the monitoring, plus the three WHO regimens Pakistan declines to use.
Pakistan declines three WHO regimens. For adults, the 4-month HPMZE course "is not recommended under programmatic conditions in Pakistan due to high fluoroquinolone resistance". For children, the NTP says the 4-month regimen is not for routine programme settings — though the Chest Society's own 2026 table reproduces it, and step 4 shows both. And for TB meningitis, the 6-month option was rejected for insufficient evidence in favour of 12 months. Elsewhere in this section national bodies adapt WHO guidance. Here they decline it.
Every recommendation here carries a divergence badge.Same as international guidelinePakistan-adaptedLocal data onlyNational guideline outdated
Primary clinical source is the Pakistan Chest Society's Clinical Practice Guidelines: Tuberculosis (2026) — regimens, doses, weight bands, monitoring and special-population adjustments come from it directly. Burden, Xpert coverage and the BPaLM rollout position come from the government's National Strategic Plan 2024–2026. The paediatric divergences come from the Pakistan Pediatric Journal summary of the National TB Programme's 2024 updates.
Decision-support only, and an unusual sourcing caveat. The National TB Programme's own revised clinical guidelines are still not publicly retrievable — the programme websites no longer host a document library. The PCS 2026 guideline cites those NTP guidelines among its references, which makes it the closest obtainable proxy, but it is a professional society document rather than the programme's own. Where the two differ, this page shows both and says which is which.
✓ Clinically reviewed by Dr Mehdi Raza, MBBS · 06 Aug 2026.
Step 1 · The scale, and the gap
WHO Global TB Report 2025 · National Strategic Plan 2024–26
Top five in the world, and 140 deaths a day Local data only
Estimated cases, 2024
670,000
Share of global TB burden
6.3% — fifth worldwide
Position in Eastern Mediterranean Region
Largest contributor
Deaths
≈ 140 per day
Estimated incidence
264 per 100,000
Notified incidence
145 per 100,000
Share of the global gap between estimated and diagnosed cases
7.2%
The missing half. Those last three lines are the story. For every two people Pakistan diagnoses, roughly one more has TB and is not counted — walking around, infectious, untreated. Pakistan alone accounts for 7.2% of the world's missing TB cases.
Treatment works — until the organism is resistant Local data only
Drug-sensitive TB treatment success has been above 90% since 2012, and the 2020 cohort reached 94%. That is a genuinely good programme result. For pre-XDR and XDR-TB in the same period, treatment success was 67%. The PCS guideline puts the expected success rate of the standard regimen at around 85%.
That 27-point drop is the argument for the referral rule in step 7 — and for not creating resistance in the first place, which is what the monitoring schedule in step 5 is for.
Step 2 · Finding it
National Strategic Plan 2024–26 · NTP 2024 paediatric updates
What the programme says, and what actually happens Pakistan-adapted
Policy. The NTP has adopted WHO's diagnostic recommendations, including rollout of Xpert MTB/RIF Ultra in key health centres, and endorses computer-aided diagnosis software for reading digital chest X-rays in TB screening for people aged 15 and over.
Practice, in the programme's own words.The diagnosis of TB is still mainly based on smear microscopy because of the limited coverage of Xpert testing, and partial use of specimen transport systems.
There are 475 operational Xpert machines across 424 sites nationally, of which 33 are XDR machines and 33 sit in the private sector. Most are in tertiary hospitals and district or tehsil headquarters hospitals. In spite of decentralising Xpert to tehsil level, many patients still have no access to it.
What that means for you. So: request Xpert where you can get it, and know that a negative smear in a symptomatic patient does not exclude TB. If your facility has no Xpert, the specimen transport system is the route — use it rather than treating smear-negative as TB-negative.
Why it is flagged: WHO recommends rapid molecular testing as the initial diagnostic. Pakistan has adopted that as policy while its own strategic plan records that practice is still mainly smear microscopy. The honest position is both.
Diagnosing children Same as international guideline
Xpert MTB/RIF Ultra as the initial diagnostic tool for TB in children.
Stool and gastric aspirate specimens can be tested by Xpert Ultra — useful where a child cannot expectorate.
Computer-aided diagnosis software for digital chest X-ray applies to adults and adolescents aged 15 and over, not younger children.
The PCS 2026 guideline is explicit that TST and IGRA are not to be used to screen for TB disease in children — those tests speak to infection, not disease.
And a line worth keeping in mind on the wards: TB treatment should never be used as a "trial of treatment".
Step 3 · Check the glucose
Pakistani bidirectional screening data
Screen every TB patient for diabetes Local data only
Among 6,312 people tested at TB treatment initiation in Pakistan, 1,516 — 24% — were newly diagnosed with diabetes. Not known diabetics: newly diagnosed.
Pakistan has both a top-five TB burden and one of the highest diabetes prevalences in the world, and the two feed each other. The PCS guideline puts the TB risk multiplier for diabetes at three to five times. Diabetes raises TB risk and worsens TB treatment outcomes; TB worsens glycaemic control. Bidirectional screening programmes exist here for exactly this reason.
In practice. A TB diagnosis is one of the highest-yield opportunities you will get to find undiagnosed diabetes. Check a fasting glucose at treatment initiation — and remember the national diabetes guideline does not diagnose on HbA1c. Rifampicin also interacts with oral antidiabetics, so a known diabetic's control will need rechecking once treatment starts.
The diabetes side of this is covered in our type 2 diabetes pathway, including why the national guideline does not diagnose on HbA1c.
Step 4 · Which patient, and what Pakistan does differently
WHO versus NTP, side by side
Select a category. Each shows what WHO recommends and what the Pakistani programme actually does.
Step 5 · The regimen
Pakistan Chest Society, Clinical Practice Guidelines: Tuberculosis 2026
The first-line regimen, and why it is four drugs Pakistan-adapted
Any large population of M. tuberculosis contains naturally resistant mutants at a rate of roughly one in a million to one in a hundred million for any single drug. Treat with one or two drugs and the susceptible bacilli die while the resistant mutants multiply. Give four effective drugs together and the probability that a single bacillus is resistant to all four is vanishingly small. That arithmetic is the whole reason for HRZE.
Intensive phase — 2HRZE: isoniazid, rifampicin, pyrazinamide and ethambutol daily for two months. Continuation phase — 4HR: isoniazid and rifampicin daily for four months. Around 85% of patients achieve a successful outcome on it.
Drug
Adult dose
What it does, and what to watch
Isoniazid (H)
5 mg/kg, max 300 mg daily
Highly bactericidal against rapidly dividing bacilli; resistance develops fast if used alone. Hepatitis and peripheral neuropathy — give pyridoxine.
Rifampicin (R)
10 mg/kg, max 600 mg daily
The key sterilising drug, active against extracellular and intracellular bacilli. Hepatotoxicity, CYP450 induction, orange body fluids.
Pyrazinamide (Z)
25 mg/kg, max 2 g daily
Works in the acidic environment inside macrophages, so it kills dormant bacilli. Hepatotoxicity, hyperuricaemia, arthralgia.
Ethambutol (E)
Max 1.6 g daily
Bacteriostatic; included to prevent resistance emerging while the bacterial load is high. Optic neuritis — warn about loss of red-green colour vision.
Fixed-dose combinations, by weight band
The guideline recommends FDCs with proven bioavailability: fewer pills, fewer prescribing errors, better adherence, less resistance, and simpler forecasting and supply. Single-drug formulations are reserved for the situations FDCs cannot handle — chiefly drug toxicity, where agents have to be reintroduced one at a time to identify the culprit.
Bacteriologically confirmed, rifampicin-sensitive new pulmonary TB
Bacteriologically confirmed new TB with unknown rifampicin status
Bacteriologically confirmed rifampicin- and isoniazid-sensitive pulmonary TB, whether or not previously treated
Clinically diagnosed pulmonary TB, whether or not previously treated
Extrapulmonary TB — except CNS, bone and joint TB, where longer therapy applies
Children — regimens by age and severity Same as international guideline
Same shape as adults: a two-month intensive phase then a four-month continuation phase. Infants aged 0–3 months with presumptive or confirmed pulmonary TB or tuberculous peripheral lymphadenitis should be treated promptly with 2HRZ(E)/4HR, with dose adjustment for age.
Age group and disease
Regimen
Infants under 3 months or under 3 kg — PTB of any severity
2HRZ or 2HRZE intensive
3 months to under 12 years — non-severe PTB
2HRZ(E) then 2HR — see the conflict flagged in step 4
3 months to under 12 years — severe PTB
2HRZE then 4HR
12 to under 16 years — severe PTB
2HRZE intensive
16 to under 20 years — PTB of any severity
2HRZE intensive
0–19 years — extrapulmonary TB
2HRZE then 4HR
0–19 years — TB meningitis
2HRZE then 10HR
0–19 years — osteoarticular TB
2HRZE then 10HR
3 months to under 16 years — peripheral lymph node TB
2HRZ or 2HRZE then 2HR
Dispersible FDC weight bands — tablets per dose
Formulation
Under 2 kg
2–2.9 kg
3–3.9 kg
4–7.9 kg
8–11.9 kg
12–15.9 kg
16–24.9 kg
Intensive — HRZ 50/75/150, 2 months
¼
½
¾
1
2
3
4
Intensive — E 100, 2 months
¼
½
¾
1
2
3
4
Continuation — HR 50/75 daily, 4 months
¼
½
¾
1
2
3
4
Monitoring on treatment Same as international guideline
Situation
What to do
Bacteriologically confirmed pulmonary TB
AFB smear microscopy at the end of months 2, 5 and 6
Clinically diagnosed pulmonary TB
AFB smear at the end of month 2. If negative, no further sputum monitoring — follow clinically, including body weight
Follow-up smear turns positive
Xpert MTB/RIF — if Ultra was not done at baseline, or the rifampicin result was indeterminate
Not improving clinically, or failure suspected
AFB culture and drug-susceptibility testing at the end of month 2 and at the end of treatment
If treatment is interrupted. Treatment interruptions are handled by length. Under four weeks: continue the same treatment and complete 60 doses of the intensive phase. Four to eight weeks or more: do a smear and Xpert — rifampicin-sensitive means restarting the six-month course (or the Hr-TB regimen if that is what they were on), and rifampicin-resistant means referral to a PMDT site.
Step 6 · Special situations
Pakistan Chest Society 2026 — chapter 7
Treatment principles do not change; the regimen does. These are the four situations you are most likely to meet.
Pregnancy and breastfeeding
Pregnancy is not a contraindication to the standard regimen, and treatment should not be delayed — maternal TB raises the risk of maternal death, low birth weight and congenital TB. Breastfeeding continues on first-line therapy.
Isoniazid, rifampicin and ethambutol are considered safe in pregnancy.
Pyrazinamide is endorsed by both WHO and the NTP; no teratogenicity reported.
Streptomycin and the other aminoglycosides are contraindicated — fetal ototoxicity.
Pyridoxine 25–50 mg daily alongside isoniazid.
Rifampicin induces hepatic enzymes and can defeat hormonal contraception — advise barrier or non-hormonal methods.
Liver disease — graded by Child–Pugh
Three of the four first-line drugs are hepatotoxic, so the regimen is chosen by the severity of the liver disease rather than by its presence.
Child–Pugh A: the standard six-month regimen, with baseline and monthly liver function tests.
Child–Pugh B: avoid carrying all three hepatotoxic drugs — isoniazid, rifampicin and ethambutol for 9–12 months without pyrazinamide, with or without a fluoroquinolone. Baseline LFTs then two-weekly for the first two months.
Child–Pugh C: avoid hepatotoxic drugs where possible — ethambutol, streptomycin and a fluoroquinolone, with or without other non-hepatotoxic agents, for 18–24 months. Monthly LFTs and mandatory specialist input.
Renal impairment and dialysis
Isoniazid and rifampicin are cleared hepatically and need no adjustment. Ethambutol and pyrazinamide are renally excreted and do.
eGFR below 30 or on dialysis: ethambutol 15 mg/kg three times weekly, pyrazinamide 20 mg/kg three times weekly.
Aminoglycosides: avoid if possible, contraindicated in severe impairment.
On dialysis days, give drugs after the session — not before, or they are dialysed off.
Monthly renal profile, and vision testing while on ethambutol.
HIV co-infection
Co-infection worsens both diseases, so antiretroviral therapy starts early and the two programmes have to coordinate.
Start ART within 2 weeks if the CD4 count is below 50/mm³, and within 8 weeks if it is above 50.
Preferred ART with rifampicin: tenofovir plus lamivudine or emtricitabine, plus efavirenz.
Rifampicin lowers levels of protease inhibitors and NNRTIs. Nevirapine should be avoided with rifampicin.
Dolutegravir can be used with rifampicin but needs the dose doubled to 50 mg twice daily.
Co-trimoxazole prophylaxis for all HIV/TB patients, plus pyridoxine 25–50 mg daily.
Step 7 · If it is resistant — recognise and refer
Pakistan Chest Society 2026 — chapter 13
Drug-resistant TB — recognise and refer, do not treat Local data only
The guideline's own word of caution.It is recommended to avoid treating patients suspected/proven cases of DR-TB because the treatment of such cases need comprehensive package to diagnose, treatment and follow up. Beside drugs required to treat are not available in the open market and half-hearted treatment will lead to development of more drug resistance and pool of patients with total drug resistance which will be a public health hazard.
The classification, in one table
Type
Definition
Mono-drug resistant
Resistance to one first-line drug only
Poly-drug resistant
Resistance to more than one first-line drug, but not to both isoniazid and rifampicin
MDR-TB
Resistance to at least both isoniazid and rifampicin
RR-TB
Rifampicin resistance by phenotypic or genotypic method, with or without other resistance
Pre-XDR TB
MDR or RR-TB plus resistance to any fluoroquinolone
XDR-TB
MDR or RR-TB plus fluoroquinolone resistance plus resistance to at least one Group A drug — bedaquiline or linezolid
Who is most at risk of drug-resistant TB
Previously treated patients
Symptomatic contacts of a known RR-TB patient
Immunocompromised patients, including HIV
Children under 15, and patients with extrapulmonary TB
Patients on treatment who fail to convert at the end of the intensive phase or at later follow-up
Patients reported smear-negative who are in fact smear-positive
What you are expected to do
Identify the presumptive MDR-TB patient
Counsel them about what happens next
Refer for Xpert testing and liaise with the PMDT site to confirm enrolment
Monitor and manage minor side effects
Support the patient through to completion
What happens after you refer. At the PMDT site, baseline investigations are free, a treatment supporter is identified for directly observed therapy, a psychologist provides psycho-social support, one month of medicines is dispensed at a time, a treatment coordinator makes a household visit, and monthly follow-up carries a cash incentive paid to the patient and the treatment supporter by mobile transfer.
After treatment. After treatment completes, review every six months for two years: sputum smear and culture where sputum is available, body weight, chest X-ray, and drug-susceptibility testing if the culture is positive. Patients who stop early should be traced and assessed on the same schedule.
Where to refer — PMDT sites, March 2025
Reproduced from the PCS 2026 guideline. Seventy-eight sites across the country; confirm the site is still operating before sending a patient a long distance.
Punjab — 26 sites
Attock — DHQ Hospital
Bahawalpur — BV Hospital
Bahawalnagar — DHQ Hospital
Chakwal — DHQ Hospital
Faisalabad — DHQ Hospital
Gujranwala — DHQ Hospital
Jhang — DHQ Hospital
Kasur — DHQ Hospital
Khanewal — DHQ Hospital
Lahore — Mayo Hospital
Lahore — Jinnah Hospital
Lahore — Gulab Devi Hospital
Layyah — DHQ Hospital
Lodhran — DHQ Hospital
Mandi Bahauddin — DHQ Hospital
Mianwali — DHQ Hospital
Multan — Nishtar Hospital
Murree — Samli Sanatorium
Okara — DHQ Hospital
Rahim Yar Khan — Sheikh Zayed Hospital
Rawalpindi — Leprosy Hospital
Rawalpindi — Military Hospital
Sargodha — DHQ Hospital
Sheikhupura — DHQ Hospital
Sialkot — AIM Hospital
Vehari — DHQ Hospital
Sindh — 16 sites
Badin — DHQ Hospital
Hyderabad — LUMHS
Jacobabad — DHQ Hospital
Jamshoro — ICD Kotri
Karachi Malir — NCC
Karachi East — OICD Hospital
Karachi Korangi — Indus Hospital
Karachi South — JPMC
Khairpur — TB Hospital
Larkana — CMC Hospital
Mirpurkhas — DHQ Hospital
Nawabshah — PMC Hospital
Qambar Shahdadkot — DHQ
Sanghar — DHQ / CH Sanghar
Sukkur — GMM Hospital
Tharparkar — DHQ Hospital, Mithi
Khyber Pakhtunkhwa — 19 sites
Abbottabad — ATH
Bannu — KGNTH
Buner — DHQ Hospital
Charsadda — DHQ Hospital
Chitral — DHQ Hospital
D.I. Khan — MMMTH
Dir Lower — DHQ Hospital
Hangu — DHQ Hospital
Haripur — DHQ Hospital
Kohat — DHQ Hospital
Lakki Marwat — DHQ Hospital
Malakand — DHQ Hospital
Mansehra — DHQ Hospital
Mardan — MMC
Nowshera — DHQ Hospital
Peshawar — Lady Reading Hospital
Shangla — DHQ Hospital
Swabi — DHQ Hospital
Swat — STH
Balochistan — 11 sites
Quetta — FJ Chest Hospital
Hub — Jam Ghulam Qadir Hospital
Jaffarabad — DHQ Dera Allah Yar
Jhal Magsi — RHC
Kech (Turbat) — DHQ Turbat
Khuzdar — Teaching Hospital
Loralai — DHQ Hospital
Nushki — DHQ Hospital
Qilla Abdullah — DHQ Abdul Rehman Zai
Qilla Saifullah — DHQ Killa Saifullah
Usta Mohammad — DHQ Hospital
Islamabad, AJK and Gilgit-Baltistan — 4 sites
Islamabad — PIMS
Muzaffarabad — Abbas Institute of Medical Sciences
Mirpur — DHQ Mirpur
Gilgit — Provincial Headquarters Hospital
Step 8 · Prevention, and where TB collides with the rest of your practice
WHO 2022 · NTP 2024 · PCS 2026 · cross-pathway
TB preventive treatment Same as international guideline
WHO and the NTP both endorse a range of options: 3 months of weekly rifapentine plus isoniazid (3HP), 3–4 months of daily isoniazid plus rifampicin or rifampicin alone, and 6–9 months of daily isoniazid — the last being less preferred because the long course completes poorly.
The PCS guideline notes that the shorter rifamycin-based regimens are the more attractive option for Pakistan, subject to drug availability, cost, interactions and monitoring capacity. Active TB must be excluded first — symptoms, chest X-ray and appropriate microbiology — before any preventive course starts.
Who to consider it for
Household contacts of active pulmonary TB
People living with HIV or on immunosuppression
Silicosis, chronic renal failure, diabetes, malnutrition, or heavy alcohol or tobacco use
Health care workers and people in congregate settings
Anyone recently infected, in a high-burden setting
Two things this pathway shares with the rest of the site
Rifampicin destroys hepatitis C treatment
Rifampicin is a potent P-gp inducer and is contraindicated with sofosbuvir-based direct-acting antivirals. Pakistan has both the world's largest hepatitis C burden and a top-five TB burden, so co-infection and co-treatment are routine rather than theoretical. Sequence the two; do not run them together.
A respiratory fluoroquinolone given empirically for pneumonia has antimycobacterial activity. In a patient whose "pneumonia" is actually TB, it blunts the clinical picture, delays the diagnosis, and selects for fluoroquinolone-resistant TB. That resistance is not an abstraction here — it is the stated reason Pakistan refuses WHO's four-month adult regimen, and it is what separates MDR from pre-XDR disease.
Two months of isoniazid, rifampicin, pyrazinamide and ethambutol, then four months of isoniazid and rifampicin — 2HRZE/4HR. With fixed-dose combinations that is 2 tablets daily at 30–39 kg, 3 at 40–54 kg and 4 at 55 kg and above, in both phases. Around 85% of patients achieve a successful outcome.
Can adults in Pakistan have the WHO 4-month TB regimen?
No. The Pakistan Chest Society's 2026 guideline states that WHO's 4-month HPMZE regimen — rifapentine and moxifloxacin based — is not recommended under programmatic conditions in Pakistan because of high fluoroquinolone resistance. Pakistan keeps the six-month regimen.
Can I use the WHO 4-month regimen for a child with non-severe TB?
The two Pakistani authorities differ, so know which governs your setting. The NTP's 2024 updates say the 4-month regimen (2HRZ(E)/2HR) should not be used in routine programme settings, restricting it to specialised paediatric care. The Pakistan Chest Society's 2026 guideline reproduces it in its own regimen table for non-severe pulmonary TB in children aged 3 months to under 12 years.
How long is TB meningitis treated in Pakistan?
Twelve months — 2HRZE followed by 10HR, and both Pakistani authorities agree on it. The NTP rejected WHO's 6-month 6HRZEto option for insufficient evidence, and the Chest Society's paediatric table gives the same 2HRZE/10HR for TB meningitis and for osteoarticular TB.
What if my patient is isoniazid-resistant but rifampicin-sensitive?
Six months of HRZE plus levofloxacin if fluoroquinolone status is sensitive or unknown; six months of HRZE alone if fluoroquinolone-resistant. A previously treated patient with unknown isoniazid status, excluding relapse, gets six months of RHZE. Previously treated patients must have rifampicin testing, and if rifampicin-sensitive, isoniazid and fluoroquinolone testing too.
When do I repeat the sputum smear?
For bacteriologically confirmed pulmonary TB, at the end of months 2, 5 and 6. For clinically diagnosed pulmonary TB, at the end of month 2 only — if negative, follow clinically including body weight. If a follow-up smear turns positive, do an Xpert; if the patient is not improving, send culture and drug-susceptibility testing.
Is TB treatment safe in pregnancy?
Yes, and it should not be delayed — untreated maternal TB raises the risk of maternal death, low birth weight and congenital TB. Isoniazid, rifampicin, ethambutol and pyrazinamide are all used; streptomycin and the other aminoglycosides are contraindicated. Add pyridoxine 25–50 mg daily, continue breastfeeding, and remember rifampicin can defeat hormonal contraception.
Is BPaLM available in Pakistan?
It has been adopted, but access lags policy. BPaL(M) started in September 2022 in four PMDT sites in Punjab, and the National Strategic Plan targets scaling it from 1,862 to 4,589 patients across 2024–2026. Which regimen a patient actually gets depends on which PMDT site they reach.
Should I rely on a negative smear to exclude TB?
No. Pakistan's own National Strategic Plan states that diagnosis is still mainly based on smear microscopy because Xpert coverage is limited. There are 475 Xpert machines across 424 sites, mostly in tertiary and district hospitals. A negative smear in a symptomatic patient does not exclude TB — use the specimen transport system to get an Xpert.
How big is Pakistan's TB burden?
An estimated 670,000 cases in 2024 — 6.3% of the global total, fifth worldwide, and the largest contributor in the Eastern Mediterranean Region. TB kills around 140 people a day in Pakistan.
Why is the notification gap important?
Estimated incidence is 264 per 100,000 against notified incidence of 145. Pakistan accounts for 7.2% of the global gap between estimated and diagnosed cases — meaning a very large number of infectious people are undiagnosed and untreated.
Should TB patients be screened for diabetes?
Yes. Among 6,312 people tested at TB treatment initiation in Pakistan, 24% were newly diagnosed with diabetes. Pakistan has both a top-five TB burden and one of the world's highest diabetes prevalences, and each worsens the other.
Can I treat TB and hepatitis C at the same time?
Not with rifampicin and a sofosbuvir-based regimen. Rifampicin is a potent P-gp inducer and is contraindicated with sofosbuvir-based direct-acting antivirals. Sequence the two rather than running them together.
Clinically reviewed by Dr Mehdi Raza, MBBS
MBBS — FCPS Postgraduate Trainee at Combined Military Hospital (CMH) Multan. Graduated from Federal Medical & Dental College, Islamabad. Full profile →
Sources
Pakistan Chest Society — Clinical Practice Guidelines: Tuberculosis, 2026. 91 pages. The primary clinical source for this page: first-line drugs and doses, fixed-dose combination weight bands, treatment indications, the isoniazid-resistant regimens, monitoring and interruption rules, paediatric regimens by age and severity, special-population adjustments, the drug-resistant TB classification and referral policy, and the PMDT site list. Its own reference list cites the National TB Control Programme's national guidelines for the management of tuberculosis (Ministry of NHSR&C, 2023) and the Pakistan Pediatric Association's 2023 paediatric TB guidelines.
National Strategic Plan for Tuberculosis Prevention, Care and Control in Pakistan, January 2024 – December 2026. Ministry of National Health Services, Regulations and Coordination. Source of the Xpert coverage figures, the smear-microscopy reality statement, the BPaL(M) rollout status and targets, and the treatment success rates.
Pediatric Tuberculosis: Key Updates from WHO Consolidated Guidelines 2022 and National TB Control Program, Pakistan Guidelines 2024. Pakistan Pediatric Journal. Source of the NTP's refusal of the 4-month paediatric regimen in routine programme settings and of the 6-month TB meningitis regimen.
WHO Global Tuberculosis Report 2025 — source of the 670,000 cases, 6.3% global share, top-five ranking, and the 7.2% share of the global diagnostic gap.
Pakistani bidirectional TB–diabetes screening data — 6,312 people tested at TB treatment initiation, 24% newly diagnosed with diabetes.
SOURCING NOTE: the National TB Programme's own revised clinical guidelines remain not publicly retrievable; the programme websites no longer host a document library. The PCS 2026 guideline cites them and is the closest obtainable proxy, but it is a professional society document. Where it and the NTP updates differ — non-severe paediatric TB — this page shows both.