CHO-M5: Public Health Action

Public Health Action is conducted under the NTEP programme to support and prevent further health complications among TB patients after diagnosis.

 

Figure: Various activities under Public Health Action

 

 

Nutrition constitutes an important part of TB Treatment. Undernutrition increases the risk of Tuberculosis (TB), and in turn, TB can lead to malnutrition. It has been demonstrated that undernutrition is a risk factor for progression from TB infection to active TB disease, and undernutrition at the time of diagnosis of active TB is a predictor of increased risk of death and TB relapse. There is, as yet, little evidence showing that additional nutrition support improves TB-specific outcomes, but low body mass index, as well as lack of adequate weight gain during TB treatment, are associated with an increased risk of TB relapse and death.

The following table illustrates the effect of undernutrition on outcomes in TB.

Effects on disease	Increased severity of disease Increased risk of death
Effects on treatment	Delayed sputum conversion Risk factor for drug-induced hepatotoxicity Malabsorption of rifampicin Reversion of positive cultures in Multidrug-resistant (MDR) -TB
Effects on long-term outcomes	Increased rate of relapse
Effects on contacts	Increased incidence in undernourished contacts

 

The basic recommendations to address the nutritional needs of TB patients are discussed below.

1. Conducting an initial nutrition assessment of TB patients with further monitoring
2. Providing ongoing counselling for patients on their nutritional status; Diet for TB patients starting treatment should include: cereals (maize, rice, sorghum, millets, etc.), pulses (peas, beans, lentils, etc.), oil, sugar, salt, animal products (canned fish, beef and cheese, dried fish), and dried skimmed milk
3. Managing severe acute malnutrition according to national guidelines and WHO recommendations
4. Managing moderate undernutrition for TB patients who fail to regain normal Body Mass Index (BMI) after two months of TB treatment or appear to lose weight during TB treatment and evaluating for proper treatment adherence and other comorbidities. If indicated, these patients should be provided with locally available nutrient-rich or fortified supplementary foods.
5. Special categories of TB patients, such as:

• Children who are less than 5 years of age should be managed as any other children with moderate undernutrition.
• Pregnant women with active TB and patients with MDR-TB should be provided with locally available nutrient-rich or fortified supplementary foods.

     6. Micronutrient supplementation for all pregnant women as well as lactating women with active TB. These women should be provided with iron and folic acid and other vitamin and minerals to complement their maternal micronutrient needs. In situations when calcium intake is low, calcium supplementation is recommended as part of antenatal care.

To achieve the above objectives, the guidelines for nutrition for TB patients are available and a mobile application (N-TB) is available for decision-making on nutritional support for TB patients.            

Improving nutritional status at a population level is important for TB prevention which should be part of broader actions on social determinants. All efforts should be made to link TB patients for nutritional support which can be done through the existing public distribution system, local self-government or Non-governmental Organisations (NGOs)or donor agencies or through the corporate sector under Corporate Social Responsibility (CSR).

 

Resources

• Guideline: Nutritional Care and Support for Patients with Tuberculosis, WHO, 2013.
• Guidance Document: Nutritional Care and Support for Patients with Tuberculosis in India, MoHFW, WHO, CTD, 2017.
• Training Modules (1-4) For Programme Managers & Medical Officer NTEP, CTD, WHO, MoHFW, 2020.
• Guidelines for Programmatic Management of Drug-resistant Tuberculosis in India, MoHFW, WHO, 2021.

 

Assessment

Question 1	Answer 1	Answer 2	Answer 3	Answer 4	Correct Answer	Correct Explanation	Page id	Part of Pre-Test	Part of Post-Test
Undernutrition doesn’t affect the outcomes of TB.	True	False			2	Undernutrition affects the outcomes of TB in terms of treatment.

Who can provide Psychosocial support?

Family Members, Peer groups, treatment support groups, TB Champions, Community Health Volunteers(CHVs) and NGOs can provide psychosocial support to TB patients and their families by:

 

• Building a strong sense of community
• Helping the patients to contact a health worker or visit a health facility
• Providing treatment support to take their drugs and finish their treatment. Family members, community-based volunteers and workers can be trained as treatment supporters by NGOs
• Facilitating patients to access DBT for nutritional support under NPY
• Helping TB patients with comorbidities to visit the referral facility for treatment
• Treatment adherence support through peer support and education and individual follow up
• Home-based palliative care for TB
• Awareness generation, providing right information, behaviour change communication and community mobilisation for reducing stigma and discrimination
• Facilitating patients to join yoga/meditation/exercise groups once the active phase is over
• Facilitating and arranging rehabilitative services for problems/disabilities in TB patients
• Social and livelihood support
• Food supplementation
• Income-generation activities(NGO can start or facilitate patients to join activities like candle making, making festival-related goods)
• Sensitising PRIs to engage TB patients(who can work) through the Mahatma Gandhi National Rural Employment Guarantee Scheme(MGNREGS)

Substance use has been one of the major reasons for non-adherence to TB treatment and therefore, the National TB Elimination Programme (NTEP) has implemented several initiatives for control and de-addiction of substance use in association with various other health programmes like the National Tobacco Control Programme (NTCP), Drug De-Addiction Programme (DDAP), etc.

NTEP has also included referral services to de-addiction facilities for TB patients as a part of the ‘Standards for TB Care in India (STCI)'.

 

Deaddiction Services and Linkages

1. Brief substance use counselling during the pre-treatment, treatment initiation and regular follow-up counselling sessions by the trained NTEP staff.
2. Referral to National Tobacco Quitline provides telephonic counselling via the toll-free number in English and Hindi languages 8 a.m. to 8 p.m. between Tuesday to Sunday.
3. Referral to mCessation Programme provides evidence-based behavioural change Short Text Messages (SMSs) in English and Hindi languages on mobile phones, which include health information on tobacco use hazards, tips on quitting, and encouragement for those attempting to do so.
4. Referral to nearest Tobacco cessation clinics/ centres in the government facilities.
5. Referral under the Drug De-Addiction Programme (DDAP) wherein affordable, easily accessible and evidence-based treatment for all substance use disorders are provided through the government health care facilities of the Ministry of Health and Family Welfare, viz., All India Institute of Medical Sciences (AIIMS), New Delhi; Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh; National Institute of Mental Health and Neuro-Sciences (NIMHANS), Bengaluru; Dr Ram Manohar Lohia (RML) Hospital, New Delhi; AIIMS, Bhubaneswar; and Central Institute of Psychiatry (CIP), Ranchi.

 

Resources

• National Strategic Plan 2017-2025 for TB Elimination in India, MoHFW, India, 2017.
• National Framework for Joint TB-tobacco Collaborative Activities, MoHFW, India, 2017.

Assessment

Question​	Answer 1​	Answer 2​	Answer 3​	Answer 4​	Correct answer​	Correct explanation​	Page id​	Part of Pre-test​	Part of Post-test​
What service does the National Tobacco Quitline provide?	Telephonic counselling	Face-to-face counselling	None of the above	Both 1 & 2	1	National Tobacco Quitline: Telephonic counselling via the toll-free number in English and Hindi languages.	​	Yes	Yes

Eliminating the catastrophic expenditure on TB patients and their families has been an important goal of the World Health Organisation's (WHO’s) END TB strategy.

The National TB Elimination Programme (NTEP) has also attempted the same through various partnerships and one of the action plans under this strategy was to provide transport allowance to cover the TB treatment-related travel costs of the TB patients as well as their attendants.

Travel cost for Drug-resistant TB (DR-TB) patients

• Travel costs are reimbursed for DR-TB patients travelling to District or Nodal DR-TB Centre for initiation/ follow-ups/ adverse reaction management during the treatment, along with one accompanying person/ attendant.
• The reimbursement is as per actual cost per visit through public transport with a limit of up to Rs. 400 per visit within the district and up to Rs. 1000 per visit for outside district travel.

Travel cost for TB Patients in tribal/ hilly/ difficult areas

• TB Patients from tribal /hilly/difficult areas are provided with an aggregate amount of Rs. 750 as transport allowance to cover patients and the attendants' travel costs.
• Rs. 750 as a one-time payment at the time of noti­fication.

Travel cost for Presumptive TB patients to visit District TB Centres (DTC)/ collection centres for testing

• Presumptive TB patients travelling to DTC/ collection centre are reimbursed as per actual cost with public transport.

Resources

• Guidelines on Programmatic Management of Drug-resistant TB (PMDT) in India, 2021, CTD, MoHFW, India.
• Direct Benefi­t Transfer Manual for National Tuberculosis Elimination Programme. Central TB Division, Ministry of Health & Family Welfare, India, 2021.

Assessment

Question​	Answer 1​	Answer 2​	Answer 3​	Answer 4​	Correct answer​	Correct explanation​	Page id​	Part of Pre-test​	Part of Post-test​
How much amount is provided as transport allowance to tribal/ hilly area patients and their attendants during their TB treatment	Rs.250	Rs.500	Rs.750	Rs.1000	3	Rs. 750 is provided as transport allowance to Tribal/ hilly area patients and their attendants during their TB treatment.	​	Yes	Yes

Nikshay Poshan Yojana (NPY) is one of the four initiative-based support schemes which provides financial support to TB patients for their nutrition. A financial incentive of Rs. 500 per month will be provided to patients on anti-TB treatment till the completion of treatment.

• All TB patients who are registered/ notified (from both public/ private sectors) on the Nikshay Portal on or after 1^st April 2018 are beneficiaries of the scheme.
• The incentive is paid in cash and will be deposited to the Aadhaar enabled bank account of the patient. In the case of paediatric TB patients, money will be deposited in parents'/ guardians’ accounts.
• The first instalment of Rs. 1000 total for the first 2 months is expected to be disbursed immediately after starting treatment. To ensure treatment adherence, after the first instalment, the conditionality of follow-up examination is applicable.
• Each month of treatment extension, Rs. 500 will be transferred to the patient's DBT account, till the treatment is continued.
• In some states, where the incentive is transferred in-kind, they should provide food baskets with a total value not less than the corresponding eligible benefit.

Figure: Aims of Nikshay Poshan Yojana

The health volunteer/ Treatment supporter, Multi-purpose Health worker in-charge, or the Senior Treatment Supervisor (STS), are responsible to collect the bank details of the patient from the field level and enter it on the Ni-kshay.

 

Resources

Nutritional Support DBT Scheme Details, CTD.

Direct Benefi­t Transfer Manual for National Tuberculosis Elimination Programme, CTD, 2020.

Guidelines for Programmatic Management of Drug-resistant TB in India, 2021.

 

Assessment

Question​	Answer 1​	Answer 2​	Answer 3​	Answer 4​	Correct answer​	Correct explanation​
Only patients seeking treatment in public hospitals are eligible for Nikshay Poshan Yojana.	True	False			2	All patients who are receiving treatment from both public and private sectors and are notified on the Nikshay platform are eligible to receive the benefit.

 

The government of India introduced Direct Benefit Transfer (DBT) to ensure that the benefits and subsidies are reaching the beneficiaries directly and to fasten the process. Through the process, money is directly transferred to the beneficiaries' bank account keeping the intermediary agencies and stakeholders only to manage the process of payment.

 

National TB Elimination Programme (NTEP) transfers all benefits to patients using the two systems:

• Nikshay
• Public Finance Management System (PFMS)

 

DBT Schemes available in the NTEP

 

Nikshay Poshan Yojana (NPY)

Objective: To provide nutritional support to TB patients at the time of noti­fication and subsequently during the course of treatment.

Beneficiary: All unique TB patients noti­fied on or after 1st April 2018 (including all existing TB patients under treatment for at least one month from this date).

Benefit Amount: Rs. 500 for a treatment month paid in instalments of up to Rs. 1000 as an advance.

 

Transport Support for TB patients in Notified Tribal Areas

Objective: To provide ­financial support as transport allowance for TB patients belonging to notifi­ed tribal areas (in addition to the nutritional support provided under NPY).

Beneficiary: All noti­fied TB patients from notifi­ed tribal areas.

Benefit Amount: Rs. 750 as a one-time payment at the time of notifi­cation.

 

 

Incentives for Private Sector Providers and Informants

Objective: To provide ­financial incentives for noti­fication and subsequent follow-up until completion of treatment of TB patients who are diagnosed/ treated by a private provider.

Beneficiary: Private providers (private practitioner, hospital, laboratory and chemist) who notify TB patients to NTEP on Nikshay.

Incentive Amount: Rs. 500 as a one-time payment on noti­fication and Rs. 500 to a private practitioner or hospital for updating the patient’s treatment outcome.

 

Treatment Supporters’ Honorarium

Objective: To provide an honorarium to the treatment supporters for supporting TB patients.

Beneficiary: Community Treatment Supporters who support patients during treatment, leading to a successful outcome (cured or treatment completed).

Incentive Amount: Rs. 1,000 as a one-time payment on the update of outcome for drug-sensitive TB patients and Rs. 2,000 on completion of Intensive Phase (IP) and Rs. 3,000 on completion of Continuation Phase (CP) of treatment for drug-resistant TB patients.

 

Criteria/ Pre-requisites for Availing the Benefits in NTEP

 

• All benefits are processed for the respective beneficiary base on the rules and eligibility criteria defined above except for the treatment supporter, which needs to be manually uploaded by the TB Unit (TU) level staff.
• Beneficiary ID in Nikshay will be assigned to all patients which are unique. The benefits processed will be tracked under this ID. All beneficiaries need to register their bank details in Nikshay to enable DBT.

 

Treatment Supporter

 

A trained treatment supporter, who can be a health worker or community volunteer, will assist the patient to adhere to the drugs, provide counselling support, nutritional support, screen for adverse reactions, psycho-social support, comorbidity management and follow-up laboratory investigations.

 

The Treatment Support Honorarium is available as per the following eligibility:

• The treatment Supporter must be registered in Nikshay and designated as the primary Treatment Supporter.
• The linked patient must complete treatment or has to be cured.
• The treatment Supporter should not be a salaried government employee.

 

 

Resources

Direct Benefi­t Transfer Manual for National Tuberculosis Elimination Programme, CTD, 2020.

 

Assessment

Question	Answer 1	Answer 2	Answer 3	Answer 4	Correct Answer	Correct Explanation
Only patients and treatment supporters seeking treatment in the public sector are eligible for DBT benefits.	True	False			2	Private providers are eligible for financial incentives for noti­fication and subsequent follow-up until completion of treatment of TB patients who are diagnosed/ treated by them.

 

Figure: Components of Ayushman Bharat Yojana

Pradhan Mantri Jan Arogya Yojana (PM-JAY) is one of the two key components of the Ayushman Bharat Yojana launched by the Government of India as part of the National Health Policy 2017. It is one significant step toward achieving Universal Health Coverage (UHC) and Sustainable Development Goal - 3 (SDG3): Good health and well-being.

Aim

To provide health protection cover to poor and vulnerable families against financial risk arising from catastrophic health episodes.

Provisions

• Financial protection (Swasthya Suraksha) to 10.74 crore poor, deprived rural families and identified occupational categories of urban workers’ families as per the latest Socio-Economic Caste Census (SECC) data (approx. 50 crore beneficiaries). It will offer a benefit cover of Rs. 5,00,000 per family per year (on a family floater basis).
• Cover medical and hospitalisation expenses for almost all secondary care and most of the tertiary care procedures. PM-JAY has defined 1,350 medical packages covering surgery, medical and daycare treatments, including medicines, diagnostics and transport.
• To ensure that nobody is left out (especially girl child, women, children and the elderly), there will be no cap on family size and age.
• Cashless & paperless at public hospitals and empanelled private hospitals.
• Beneficiaries are not required to pay any charges for hospitalisation expenses.
• Benefit also includes pre and post-hospitalisation expenses.
• The scheme is entitlement based; the beneficiary is decided based on the family being figured in the SECC database.

Benefits for the Health Care System of the Country

• Helps to achieve UHC and SDG.
• Ensures improved access and affordability of quality secondary and tertiary care services through a combination of public hospitals and well-measured strategic purchasing of services in health care deficit areas from private care providers, especially the not-for-profit providers.
• Significantly reduces out-of-pocket expenditure for hospitalisation. Mitigates financial risk arising out of catastrophic health episodes and consequent impoverishment for poor and vulnerable families.
• Acts as a steward, align the growth of the private sector with public health goals.
• Promotes the use of evidence-based health care and cost control for improved health outcomes.
• Strengthens public health care systems through the infusion of insurance revenues.
• Enables the creation of new health infrastructure in rural, remote and under-served areas.
• Increases health expenditure by the government as a percentage of Gross Domestic Product (GDP).

Resource

• National Health Portal

 

Assessment

Question	Answer 1	Answer 2	Answer 3	Answer 4	Correct answer	Correct explanation	Page id	Part of Pre-test	Part of Post-test
PM-JAY benefits can be redeemed only from government hospitals.	True	False			2	PM-JAY provides cashless & paperless benefits at public hospitals and empanelled private hospitals. It ensures improved access and affordability of quality secondary and tertiary care services through a combination of public hospitals and well-measured strategic purchasing of services in health care deficit areas from private care providers, especially not-for-profit providers.		Yes	Yes

TB Aarogya Sathi empowers Citizens(including TB Patients under NTEP) and to serve as a Direct interface with the healthcare system. The App is aimed at augmenting the initiatives of the Central TB Division, Government of India in proactively increasing awareness among the citizens and ensuring availability of free and quality assured drugs and diagnostics to all citizens in the country.

Citizens using the TB Aarogya Sathi App will have access to common FAQs regarding TB, Information on the symptoms of TB and Side effects of Anti TB drugs. Using the app, any user will be able to find the closest health facilities that can assist in diagnosis of TB.

Patients registered with Nikshay will have access to the Adherence, Treatment Progress and DBT Details.

Citizen:

• Informative Content available for all Citizens using the App(no login required to access this content)
  • Information on TB 
  • Symptoms of TB
  • Side Effects of TB
  • Health Facility Search
  • BMI Assessment
  • Nikshay Sampark Helpline
  • Motivational Videos
  • Nutritional Advice

Patient:

• Patients registered in Nikshay get access to additional information(after login)
  • Adherence Details
  • Treatment Progress Details
  • DBT Details

 

TB Aarogya Sathi App is available in Google play store and can be download using this QR Code

Figure: TB Aarogya Sathi Application snapshot

 

Video: Download the Tb Arogya Sathi App and Steps to Login

Video: Health Facilities

Video: Summary and Treatment Progress View

Video: Adherence Details and DBT Details View

Video: DBT Details View

Video: Adding bank details in the Arogya Sath App

Video: Symptom Checker-Overview

Video: Screening for Self and Others

Video: Post enrolment follow-up cycle in Nikshay

Contact tracing is a process to identify people who are  at a high risk of developing TB due to their contact with a known TB case.

The aim of contact tracing is to find other people with TB disease and those infected with TB

All close contacts, especially household contacts of a Pulmonary TB patient, should be screened for TB. 

In paediatric TB patients, reverse contact tracing for the search of any active TB case in the child's household must be undertaken.

Particular attention should be paid to contacts with the highest susceptibility to TB infection.

Figure: Contacts to be Prioritized for contact TB screening

 

Index TB patient: Initially identified person of any age with new or recurrent TB in a specific household or other comparable settings in which others may have been exposed. The Index TB patient is the person on whom a contact investigation is centred, but is not necessarily the source/ primary case.

Contact: Any individual who was exposed to a person with active TB disease

Household Contact (HHC): Person who shared the same enclosed living space as the index TB patient for one or more nights or for frequent or extended daytime periods during the three months before the start of current TB treatment.

Close contact: Person who is not in the household but shared an enclosed space, such as at a social gathering, workplace or facility, for extended periods during the day with the index TB patient during the three months before the commencement of the current TB treatment episode. 

Contact tracing: Contact tracing is the process of listing out all the contacts (household contacts and close contacts) of the index TB patient. Contact tracing has to be done for all Index TB cases, whether pulmonary (sputum positive or negative) or Extra-pulmonary (EPTB). As per the current policy, it is compulsory to trace household contacts but it is desirable to trace other close contacts (workplace, social gathering etc) also. 

Why Contact Tracing  is done: Contact tracing is followed by contact investigation to identify active TB cases and Tuberculosis Preventive Treatment (TPT) beneficiaries.

Contact investigation: This is a systematic process for identifying previously undiagnosed people with TB disease and TB infection, among the contacts of an index TB patient.

Conducting Contact Tracing and Contact Investigation

Once a new/ recurrent TB case is diagnosed (ideally within 1 week), a healthcare worker (usually the Multipurpose Worker (MPW) from the nearby public health facility visits/ tele calls the patient’s household, interviews the patient about his/her contacts in the household and other settings such as workplace or social gatherings. The contacts’ details are recorded in a standardised format and entered in Ni-kshay contact tracing module. Each contact's details enter the workflow as a presumptive TB case or TPT beneficiary.

The traced contacts are screened for TB using a symptom checklist and if found to have any symptoms suggestive of TB, they are tested using X-ray/ sputum microscopy/ Cartridge-based Nucleic Acid Amplification Test (CBNAAT) as required. 

 

Outcome of Contact Tracing and Contact Investigation

• Those contacts diagnosed with active TB are initiated TB treatment.
• As per the current policy, those HHC of sputum-positive Pulmonary TB (PTB), in whom active TB disease is ruled out, are considered for TB Preventive Therapy (TPT)

 

References

• Guidelines for Programmatic Management of TB Preventive Treatment in India, 2021.
• Technical and Operational Guidelines for Tuberculosis Control in India, 2016.

 

Assessment

 

Question​	Answer 1​	Answer 2​	Answer 3​	Answer 4​	Correct answer​	Correct explanation​	Page id​	Part of Pre-test​	Part of Post-test​
Which of the following statements are true?	Contact tracing should always be followed by contact investigation.	Household contacts of Extrapulmonary TB are offered TPT.	The index case is always the primary source of infection in the household.	Contact tracing and investigation need to be done only during ACF campaigns.	1	2- Only HHC of Sputum positive PTB cases are offered TPT. 3 – The index case need not be the primary source of infection in the household. 4 – Contact tracing and investigation are to be done routinely for all TB cases. ACF campaigns are only an added measure.	​	Yes	Yes

Contact Tracing plays an important role in the detection of all those who are secondarily infected for proper diagnosis and prompt treatment. This process can be recorded and reported in Ni-kshay under the ‘contact tracing’ option. The process of recording contact tracing in Ni-kshay is given below.

 

Process Overview

Detailed Step-wise Procedure

 

Step 1: Login to the Ni-kshay ecosystem and enter the patient ID for which the contact tracing details are being recorded.

Step 2: Click on the ‘Contact tracing’ tab to reach the contact tracing window.

 

Step 3: Click on the 'Edit' tab and fill in the relevant information in the fields provided.

 

 

Step 4: Once the details are entered, click on the ‘update’ tab present at the upper right corner of the window to finish the process. A message will be displayed by the system once the details are updated successfully.

 

 

Step 5: Once the details are updated successfully, an option to add the contact will appear at the upper right corner of the contact tracing window. This option can be used to add contacts as Beneficiaries (Presumptive TB/ TB Preventive Treatment (TPT) beneficiaries) in the system.

 

 

Step 6: Selecting the 'Add contact' tab will take the user to the enrollment window. The process of entering information in this window is similar to adding a New presumptive TB case in Ni-kshay, except that the option of “Contact of Known TB Patient” is automatically selected for the field “Key Population”.

Once the contact is added as a beneficiary (Presumptive TB/ TPT beneficiary) in the system, the contact details can be seen in the contact tracing tab.

Video: Recording Contact tracing in Ni-kshay (Web)

 

 

Video: Recording Contact tracing in Ni-kshay (Mobile App)

 

Resources

• Contact Tracing, Ni-kshay Knowledhge Base, Ni-kshay Zendesk.

 

Assessment

Question​	Answer 1​	Answer 2​	Answer 3​	Answer 4​	Correct answer​	Correct explanation​	Page id​	Part of Pre-test​	Part of Pre-test​
Contact tracing plays an important role in the detection of all those who are secondarily infected.	False	True			2	Contact tracing plays an important role in the detection of all those who are secondarily infected for proper diagnosis and prompt treatment.		Yes	Yes

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

 

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

• 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 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:

• Guidance Document: Nutritional care and support for patients with Tuberculosis in India

 

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