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  • TB Awareness Generation in Community

    Content

    Awareness should be generated in the community for promoting various health programmes, health seeking behaviours, screening of TB cases etc. by involving and sensitizing community influencers including PRI members and treatment support groups.

    Figure: Activities for awareness generation in community

     

  • Counselling of TB Patients

    Content

    Confidential dialogue between a health care provider and a patient that helps a patient to define his/her feelings, cope with stress, and to make informed decisions regarding treatment.

    The patient should be counselled at all the three phases i.e.,

    Pre-treatment counselling`

    • About TB disease and treatment
    • Air borne infection control
    • Need for adherence
    • Public Health Actions
    • Identification of adverse events
    • Tobacco /Alcohol cessations
    • Identification of comorbidities

    During Treatment Counselling

    • Importance of Adherence
    • Identification of adverse events
    • Importance of timely follow ups
    • Public Health Actions
    • Tobacco /Alcohol cessations
    • Management of comorbidities

    Post treatment Counselling

    • Testing at the end of treatment.
    • Long term follow up
    • Tobacco /Alcohol cessations

    Objectives of TB Counselling:

    • Prevention of TB transmission.
    • Provision of emotional support to TB patients.
    • Motivation of TB clients to complete treatment.
    • Helping patients make their own informed decisions about their behaviour and supporting them in carrying out their decisions.

    Figure: Characteristics of effective counselling

     

  • Do's & Don'ts for Patient Communication

    Content

    Do’s

    • Active listening, emphatic gestures and expressions
    • Ensure the confidentiality of the conversation done with the patient
    • Ensure Minimum interruption during the conversation with patient
    • Ensuring availability of IEC materials such as posters, videos, pamphlets etc. to dispel myths and misconceptions.

    Don'ts

    • Do not use any negative stereotypes
    • Do not have any physical wall or glass between patient and yourself
    • Do not breach the trust and confidentiality of the TB patient
    • Do not make threats or use coercive language
    • Do not exaggerate dangers or risk of TB
    • Do not blame or shame TB patients

     

  • Nutritional Counselling

    Content

    Nutritional Counselling begins with the nutritional assessment of TB patients by

    • Nutritional Status: Assessing the height, weight and BMI of the TB patient

    • Diet and Preference food for TB patients

    • Current appetite and food intake of TB patients

     

    Based on the nutritional assessment, following information can be conveyed to TB Patients

    • Patients with TB should be encouraged to have frequent food intake in the form of three meals and three snacks.

    • Attempts should be made to increase the energy and protein content in the meals and snacks without increasing its volume.

    • The addition of oil, butter or ghee to the chapati or rice can increase the energy content of the diet.

    • Pulses in other forms, e.g. sprouts, roasted Chana, groundnuts, can be taken as snacks in either fried or in roasted form. Milk and eggs to be included in the diet.

    • The use of easily available nutritious foods based on vegetarian/non-vegetarian preferences of the patients must be emphasized.

    • Information about NFSA (National Food Security Act) and Poshan abhiyan should be given.

    Figure: Healthy diet for TB Patients

     

    Resources:

     

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  • Key Points of Health Education and Counselling in DR-TB Care

    Content

    Providing health education and counselling to each Drug-resistant TB (DR-TB) patient is an essential step in the management of DR-TB patients. 

     

    It is important to consider the long duration of treatment and the multitude of factors that may influence the overall treatment continuation and success. 

     

    The treatment duration of any DR-TB regimen is long enough for the patient who needs multiple sessions of counselling, preferably more frequently in the initial phase of treatment. 

     

    Counselling during treatment offers an opportunity to explore and address past and present difficulties faced by patients. The National TB Elimination Programme (NTEP) provides a counsellor at every Nodal DR-TB Centre (NDR-TBC). 

     

    All counsellors and healthcare workers in the health system should know the key points of counselling for DR-TB patients, which include: 

    • Confidentiality and informed decision-making process
    • Information on the nature and duration of treatment 
    • Possible changes in the regimen based on the additional investigations carried out
    • Importance of adherence to treatment and the need for complete and regular treatment 
    • Consequences of irregular or premature cessation of treatment
    • Possible side effects of the drugs
    • Mechanism of infection transmission
    • Cough etiquette

    ​ 

    The counsellors are expected to maintain the counsellor register for recording the information related to counselling services provided under NTEP.

     

    Resources

     

     

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  • Components of Drug Resistant TB Counselling Tool

    Content

    During the treatment of Drug-resistant TB (DR-TB) patients, there are some important points that patients and caregivers must be counselled on. 

     

    The table below shows all the aspects of DR-TB counselling that must be covered by health workers.

     

    Table: DR-TB Counselling Tool; Source: PMDT Guidelines, March 2021, p232.
    DR-TB COUNSELLING TOOL COMPONENTS  DETAILS

    1. Greeting and Introduction: Build rapport in order to establish an effective relationship
    • Greet the patient and introduce yourself; establish boundaries by describing your role clearly
    • Collect basic demographic details 
    • Ensure that all the information shared or discussed will be kept confidential
    • Inform patients of free diagnosis and free treatment under National TB Elimination Programme (NTEP) 

    2. Education: Assess and provide correct and updated information
    • Provide basic information on TB and discuss about the symptoms of TB
    • Differentiate between drug-sensitive-TB and drug- resistant TB
    • Explain about the diagnosis of DR-TB
    • Explain about the DR-TB treatment regimen, duration, side effects and importance of adherence to the regimens
    • Assess and arrange available support systems for adherence
    • Addressing stigma and discrimination
    3. Importance of Cough Hygiene and Airborne Infection Control (AIC) at Home
    • Discuss about the contagious nature of TB
    • Inform about the correct cough hygiene and safe disposal of sputum
    • Provide information on the use of mask/ handkerchief
    • Explain that wet mopping is advisable
    4. Importance of Nutritious and High-protein Diet
    • Assess food habits
    • Advise the patient based on socio-cultural and economic background
    • Consider underlying comorbidities while advising on diet (e.g., diabetes, hypertension)

    5. Nikshay Poshan Yojana: Inform about social welfare schemes
    • Link the patient with Nikshay Poshan Yojana and other social welfare schemes
    6. Other Important Aspects of Counselling
    • De-addiction counselling
    • Sexual and reproductive health
    • Addressing mental health
    • Family/ caregiver counselling

     

    Resources

     

     

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  • DR-TB Counselling Register

    Content

    The Drug-resistant TB (DR-TB) counselling register is a format developed for documenting information about the patient's treatment-related and psycho-social status as observed by the counsellor during the course of the treatment and counselling services provided from the time of diagnosis till the post-treatment follow-up period.

    This register is maintained in all the District DR-TB Centres (DDR-TBCs) where the DR-TB counsellors are placed and are recognised as Annexure 13 under the Programmatic Management of Drug-resistant Tuberculosis (PMDT).

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    Figure: DR-TB Counselling Register; Source: Guidelines on Programmatic Management of Drug-resistant TB (PMDT) in India, 2021, CTD, MoHFW, India.

    The DR-TB counsellor is expected to update and maintain the counselling register on a regular basis.

    The DR-TB counselling register requires the counsellors to fill in the following information about the patients. 

    • District, Block, and Health facility from where the patient is receiving DR-TB treatment
    • Patient’s DR-TB diagnosis date, type of DR-TB, Ni-kshay id - Episode id
    • Name and mobile number of the patient’s treatment supporter
    • Observations during the counselling session as applicable related to the psycho-social aspects, and treatment adherence (i.e., for pre-treatment counselling, initial home visit counselling, follow-up counselling)
    • Reason for treatment interruption/ lost to follow-up along with details on the retrieval status of the patient

     

    Importance

    • Documenting the counselling sessions in an appropriate manner helps the counsellors to record the observations and take corrective actions wherever required.
    • This register can further be used to tailor future counselling sessions in a way that contributes to treatment adherence by the patients.
    • The counselling register also acts as a guide for the counsellor to refer the patients for psychiatric treatment whenever required.

     

    Resources

     

    Assessment

    Question     Answer 1     Answer 2     Answer 3     Answer 4     Correct answer     Correct explanation     Page id     Part of pre-test     Part of post-test    
    Who is responsible for writing the counselling register? Patient Nurse District TB Officer DR-TB Counsellor 4 The DR-TB counselling register is maintained in all the District DR TB Centres where the DR-TB counsellors are placed and are recognised as Annexure 13 under the Programmatic Management of Drug-resistant Tuberculosis (PMDT).         Yes  Yes