LT-Microscopy & NAAT

The continuum of counselling and care is essential to constantly motivate TB patients to take their full drug regimen and complete it in due course.  

Counselling is regularly given by counsellors, treatment supporters and all those involved with patient care and treatment.  

Counselling should start at the initial point of contact as soon as the diagnosis is established and continued during all visits: 

The DMC lab register can be generated from Nikshay as a spreadsheet and stored electronically or printed for paper records.

Steps for generating DMC Register from Nikshay:  

1. Login to Nikshay Reports using your login ID and password.
2. Under Reports, click on ‘Patient wise List’ and select the option for ‘DMC Register’ (see screenshot below) 

The eligibility for TB Preventive Treatment (TPT) relies on ruling out active TB among individuals and groups who are known to have a high risk of acquiring TB. 

Prioritization of the target population for TPT is based on elevated risk of progression from infection to TB disease or increased likelihood of exposure to TB disease: At-risk populations include:  

Presumptive pulmonary TB patients are subjected to sputum smear microscopy (Ziehl Neelsen (ZN)/ Florescence Microscopy (FM)). Two consecutive sputum specimens will identify the vast majority (95–98%) of smear-positive TB patients

Two specimens are collected:

• One Spot and one early morning sample OR
• Two supervised spot specimens collected at least one hour apart, and smears made from both the samples.

If one or both smears are positive, the patient is diagnosed as a microbiologically confirmed pulmonary TB case.

Cartridge Based Nucleic Acid Amplification Test (CBNAAT) is a rapid molecular diagnostic test. It is used for diagnosis of Tuberculosis (TB) and Rif-resistant Tuberculosis (RR-TB) in NTEP. Results are obtained from unprocessed sputum samples in about 2hours which helps in early detection and treatment of TB patients. 

India has vast number of CBNAAT laboratories which are utilized for TB/RR-TB detection and Universal Drug Susceptibility Testing (UDST) under the National TB Elimination Program (NTEP).  

The National TB Elimination Program (NTEP), promotes the following principles to diagnose TB:

1. Try to establish the microbiological confirmation for all cases
2. Use rapid molecular diagnostics upfront wherever possible for diagnosis of TB and early identification of resistance to treating drugs.
3. Focus more on quality sample collection and timely transportation for a better microbiological confirmation 

Microbiological Confirmation for All Cases

At a DMC, the STS primarily ensures that 

1. All patient services from enrolment to outcomes for a TB patient are completed optimally. This is done by monitoring information submitted by the DMC such as referral for testing, no of people tested, no of people diagnosed with TB, initiated on treatment. 

2. All the patients started on treatment are tested promptly using the appropriate follow-up testing schedule( i.e. at the end of IP and CP). 

3. Maintain profile of the DMC in the Nikshay such as tagging the PHI as DMC, name of contact person and other particulars

Patient Identifiers are key for identifying a patient in the Nikshay. Ideally, there should be only one identifier for each patient which identifies patient as well as processes for lifetime. However, during the continuum of care, one identifier may not be appropriate to represent the episodes and other processes. Hence there are various ids which are tagged to one patient in Nikshay. Knowing each ID and its purpose is therefore important. The various IDs that are present in Nikshay and their purpose are described below:

Nikshay being the final updated repository of information of TB patient services, different roles perform various actions on the patient and TB service information in Nikshay and keep it updated. These roles range from health volunteers and treatment supporters on the field to health providers and doctors at health facilities. Each role acts on or inputs information based on the services he/she provides. The information is required to updated when it is generated by the person generating it (eg by the CBNAAT LT once the results of a CBNAAT test is available). 

Bidirectional screening is a method to identify cases in diseases which have predisposition to each other or has a significant influence on each other. For example TB and HIV, where having HIV increases risk of developing TB and cases with TB would have poor outcomes if co-infected with HIV.

Screening for TB is done through four-symptoms complex based screening or through Chest X-ray. Screening for the linked disease is carried out as per the policies of the corresponding health program.