DSHS TB Medication Availability Notification

Please adhere to the current medication usage criteria outlined in the below documents until otherwise instructed by the DSHS Tuberculosis and Hansen’s Disease Unit.

• No current TB medication shortages as of April 9, 2025.

Short Course Treatment for Tuberculosis – January 10, 2025

This information is intended for DSHS-supported regional and local health department TB programs.  

Dear Colleagues: 

On Friday, January 3, 2025, tuberculosis (TB) treatment guidelines were published in the American Journal of Respiratory and Critical Care Medicine, “Updates on the Treatment of Drug Susceptible and Drug Resistant Tuberculosis: An Official ATS/CDC/ESR/IDSA Clinical Practice Guidelines.” These guidelines introduce shorter treatment regimens for patients diagnosed with TB disease.  

Here are Texas guidelines when considering using any of the following short course regimens to treat patients with TB disease:

1. Four-month regimen for drug-susceptible TB using moxifloxacin and rifapentine:
   • DSHS remains in a moxifloxacin shortage.
   • The TB Unit will be looking at how to implement this regimen; please continue to prioritize moxifloxacin for patients who cannot use an alternative regimen.
2. Short-course regimen for children with non-severe TB: 
   • Standing Delegation Orders (SDOs) released September 1, 2024 includes this regimen (see DSHS SDOs, Attachment 7).
   • Educational materials are also available from Heartland National TB Center: heartlandntbc.org/training-archives/ (scroll to 2023 Trainings – August 31st).   
3. Bedaquiline/Pretomanid/Levofloxacin (BPaL) with or without moxifloxacin regimen(s) for patients with rifampin resistant TB:
   • These regimen(s) have been implemented in Texas since 2021.
   • Medical consultation is required when considering using the regimen. 
   • Standing Delegation Orders (SDOs) released September 1, 2024 include updates on drugs used in this regimen (DSHS SDOs, Patients with Drug Resistant Tuberculosis [DR-TB], Attachment 8).
   • Please continue to prioritize moxifloxacin as per TB Unit guidance.
      

TB Standing Delegation Orders and Standing Medical Orders

Standing Delegation Orders and Standing Medical Orders for Tuberculosis Prevention and Care for FY 2024 are now available.

The Standing Delegation Orders (SDOs) and Standing Medical Orders (SMOs) are written instructions, orders, and procedures prepared by the Department of State Health Services Tuberculosis and Hansen’s Disease Unit to promote consistent evaluation and treatment practices for persons with suspected or confirmed TB disease and latent TB infection.

The purpose of this document is to provide authority for specific acts of tuberculosis (TB) clinical services under the authority of Rule Title 22, Texas Administrative Code §193.2, Standing Delegation Orders.

The intended audience for the SDOs and SMOs includes physicians, registered nurses, licensed vocational nurses, and non-licensed staff working in local health departments with TB programs and DSHS Public Health Regions.

The revised Standing Delegation Orders and Standing Medical Orders for Tuberculosis Prevention and Care are effective September 1, 2023.

Enroll in Medicaid as a TB Medicaid Provider

The DSHS Tuberculosis and Hansen’s Disease Unit encourages local health department TB programs to enroll in Medicaid as a TB Medicaid Provider.

Information on the enrollment process for first-time enrollees can be found on the Texas Medicaid and Healthcare Partnership (TMHP) website.

Clinics requesting reimbursement for TB services must also enroll as a TB Medicaid Provider. To enroll, the clinic must apply for a DSHS letter verifying their TB services and may attach the letter to their Medicaid application. To apply for the letter, clinics may fill out the Medicaid Provider Application.