This Updated Clinical Reference Guide is a revision of the Management of RR-TB: A Clinical Reference Guide, published in November 2019. The main changes in the document include introducing the 6-month regimens known as BPaL and BPaL-L regimens, discussion of the new inclusion and exclusion criteria, treatment modalities, treatment follow up and post-treatment follow-up.

It is expected that patients initiated on the existing 9-month and 18-month regimens will continue their treatment regimens until completion. This means that during the years 2023 and 2024, we will have RR-TB patients receiving the 6-month, the 9-month and the 18-month regimens. Therefore, to ensure clinical guidance for all patients on treatment, the existing Clinical Reference Guide of November 2019 will be used concurrently with this updated one for the next 2 years. The shorter 6-month regimen is essential in reducing the loss to follow-up among patients treated with this regimen. Efforts need to be made to identify and initiate eligible patients on this regimen.

The Updated Clinical Reference Guide is based on the latest available evidence and the most recent recommendations from the World Health Organization. It will support the introduction and implementation of BPaL and BPaL-L regimens in South Africa. I urge all provinces to use these guidelines to enhance the clinical management of rifampicin-resistant tuberculosis.