DR-TB Coordinator

Each of the stakeholder plays important role in DR-TB service delivery and has specific responsibility which is being monitored. 

The flow diagram below depicts the processes involved in the delivery of drug-resistant tuberculosis (DR-TB) services and specific functions of various stakeholders.

Figure 1: Cascade of DR-TB services and functions of various stakeholders
Source: Guidelines for PMDT in India, 2021, p.8

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Figure 1: History of PMDT in India (2007 to 2020).; Source: Guidelines for PMDT in India, 2021 p.02 ​

The Terms of Reference (ToR) for the District DR-TB Centre (DDR-TBC) committee are:

Under the National TB Elimination Program (NTEP), Drug-resistant TB (DR-TB) patients receive standardized DR-TB treatment boxes (called Patient-wise Boxes - PWB) for each month. These boxes are either with the health facility nearest to DR-TB patients (DOT centre) or with the treatment supporter who is involved in the care of DR-TB patients. 

Steps involved in the preparation of second-line drug boxes for DR-TB patients:

The treatment algorithm for Multidrug-resistant/ Rifampicin-resistant TB (MDR/ RR-TB) patients is a part of an integrated diagnostic and treatment algorithm under Programmatic Management of Drug-resistant Tuberculosis (PMDT).

The Drug-resistant TB (DR-TB) treatment process for all DR-TB patients follows a care cascade.

The two methods available for laboratory diagnosis of drug resistance/ susceptibility are as follows: 

Figure: Laboratory Diagnosis Methods: Drug Resistance Testing (DRT) and Drug Susceptibility Test (DST)

Resources

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

The National TB Elimination Programme (NTEP) follows an integrated algorithm for screening and ruling out active Tuberculosis (TB) among Household Contacts (HHCs) of Drug-resistant Tuberculosis (DR-TB) patients.

Figure: Integrated Algorithm for Screening and Ruling out Active TB among HHCs of DR-TB Patients; Source: Guidelines for PMDT in India, 2021, p118.

The concept of Patient Turnaround Time (P-TAT) is to find out how much time was taken from the identification of the patient for a test to getting the result of that test and initiation of patient's treatment based on the test result.

The National TB Elimination Programme (NTEP) have set benchmarks to monitor the P-TAT as provided in the table below. 

Under the National TB Elimination Programme (NTEP), the treatment outcome definitions of Drug-susceptible TB (DS-TB) and Drug-resistant TB (DR-TB) have been aligned in recent times. However, the treatment outcome is declared at different time points for certain outcomes (e.g., cured/ treatment completed) since the duration of DR-TB treatment is longer when compared to DS-TB treatment.