Induced sputum is considered in a situation where a person is unable to provide sputum sample in sufficient quantity for Tuberculosis (TB) diagnostic test. This situation is more evident in children.

Palliative care is provided by a team of physicians, nurses and other health professionals who work together with the primary care physician and referred specialists (or for patients who don't have those, hospital or hospice staff) to provide an extra layer of support. Hence, palliative care is to be initiated by the Nodal Drug-resistant TB Centres (NDR-TBCs) in the states.

There are 2 main modalities of palliative care under the National TB Elimination Program (NTEP):

Longer oral Multi (M)/ Extensive Drug-resistant (XDR) -TB treatment is specified with a definite regime and duration.

Regimen: (18-20) Levofloxacin (Lfx), Bedaquiline (Bdq) (6 months or longer), Linezolid^# (Lzd), Clofazimine (Cfz), Cycloserine (Cs)​​ (^# dose of Lzd will be tapered to 300 mg after the initial 6–8 months of treatment)​

Once a presumptive TB patient is identified, the patient is enrolled online by a healthcare worker or doctor in Nikshay online portal. For diagnosis of Tuberculosis, the treating physician can request a test utilizing the request test option of Nikshay online portal. The step-by-step approach for test request is as follows:

Step 0: Go to the Patients Page.

Step 1: Select the “Tests” tab.

Step 2: Click the “Add Test” button.

Requesting a Test on Nikshay

Drug Susceptibility Testing (DST) refers to in-vitro testing using either of the phenotypic methods to determine susceptibility. Drug Resistance Testing (DRT) refers to in-vitro testing using genotypic methods (molecular techniques) to determine resistance.    

Diagnostic services are provided free of cost at all public health laboratories, for patient referrals from the private sector. Laboratory services are also purchased from certified private sector laboratories through partnership schemes.

The Drug-resistant Tuberculosis (DR-TB) care cascade is to be ensured for every patient notified/ referred.  

The figure below showcases the flow of care cascade for a patient seeking care in the private sector.

Figure: Flow of Care Cascade for a Patient Seeking Care in the Private Sector

​Resources

The various provisions under the National Tuberculosis Elimination Programme (NTEP) for Nodal Drug-resistant Tuberculosis Centre (NDR-TBC) ​are:​

Human Resource​

NTEP provides remuneration to Senior Medical Officers (SMO), Statistical Assistants (SA) and counsellors, which may be made available for the NDR-TBC once it is approved in the Program Implementation Plans (PIP).

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Capacity Building​