The management principles of Extrapulmonary Tuberculosis (EPTB) are shown in the figure below.
Figure: Ten principles about what every EPTB patient in India needs as a basic standard of care
Abbr: CBNAAT:Cartridge-based Nucleic Acid AMplification Test; PTB: Pulmonary TB; NTEP: National TB Elimination Programme
Diagnosis of EP-TB
Follow-up Sputum Examination is useful for the clinical follow-up which helps in assessing the response to treatment, and to establish cure or failure at the end of treatment.
Pharmacovigilance is defined by the World Health Organisation (WHO) as the science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other drug-related problem.
Importance of Pharmacovigilance
Directly observed treatment (DOT) is one of the key elements of the DOTS strategy. In DOT, an observer (health worker or trained community volunteer, or trained family member for selected patients) watches and supports the patient intaking their drugs. Direct observation ensures treatment adherence with the right drugs, in right doses for the right duration.
TB patients may not stay in one place throughout the treatment duration. When they move from one place to other, there should be a mechanism to hand over the responsibility of continuing the patient's treatment in a facility near the new place of the patient. This is the concept of patient transfer and can be easily managed in Nikshay portal.
In the National TB Elimination Programme (NTEP), the ‘NTEP TB identity card’ is provided for their identification and record of clinical follow-ups.
The identity card is completed for each patient who has a Tuberculosis (TB) Treatment Card, and it is kept with the patient. Information from the TB Treatment Card is used to complete the identity card.
There are 3 parts in the NTEP TB identity card and details in each part is delineated in Table 1.
The Tuberculosis Treatment Card is a paper-based recording form that is kept in the institution treating the TB patient under the National TB Elimination Programme (NTEP). It is a pre-requisite documentation related to treatment services offered to TB patients under NTEP.
Uses of the TB Treatment Card
The TB treatment card is primarily used for:
It is extremely important for any type of TB patient to be initiated on the right treatment at the earliest in order to have better treatment outcomes. Therefore as soon as the patient is diagnosed, s/he should immediately be traced with the help of the Community Health Officer (CHO) of the Health and Wellness Centres (HWC), TB Health Visitors (TBHV) / Senior Treatment Supervisor(STS) and the health facility doctors and initiated on the appropriate treatment regimen.
Steps in TB Treatment Initiation
Definition, importance, process, format