The Patients’ Charter for Tuberculosis Care (the Charter) outlines the rights and responsibilities of people with TB. It empowers people affected by TB and their communities through this knowledge. Initiated and developed by persons affected by TB from around the world, the Charter makes the relationship with healthcare providers a mutually beneficial one.
In pregnant women diagnosed with multi-drug resistant (MDR)/rifampicin-resistant TB (RR-TB), if the duration of pregnancy is <20 weeks*, the patient should be advised to opt for medical termination of pregnancy (MTP) in view of the potential severe risk to both the mother and the fetus. Figure 1 shows the management algorithm for pregnant patients based on their gestational age.
The Stock Register is a paper-based recording register kept in drug stores of the National Tuberculosis Elimination Programme (NTEP). It is useful to ensure uninterrupted supply of anti-TB drugs to the patient. The stock register is maintained at the state, district, and tuberculosis unit (TU) drug stores, by the storekeeper.
Uses of the Stock Register
The private sector for tuberculosis (TB) care is everything outside the ambit of government-run public health initiatives. It consists of a wide range of providers from individual medical practitioners of many different systems of medicine, including:
Ayushman Bharat (AB) is an attempt to move from a selective approach to health care to deliver comprehensive range of services spanning from preventive, promotive, curative, rehabilitative and palliative care. AB-HWCs are envisaged to deliver expanded range services that go beyond maternal and child health care services to include care for non-communicable diseases, palliative and rehabilitative care, oral, eye and ear nose and throat care, mental health and first level care for emergencies and trauma, including free essential drugs and diagnostic services.
Tuberculosis (TB) unit (TU) is the sub-district level supervisory unit of National TB Elimination Program with the following organogram:
Figure: Organogram of a TB Unit
(PHI: Peripheral Health Institution)
TUs are based mainly on National Health Mission (NHM) health blocks with the aim of aligning with the NHM Block Programme Management Unit (BPMU) for optimum resource utilization and appropriate monitoring.
The Medication Event Reminder Monitor (MERM) is a digital pillbox that has been designed to monitor Multidrug-resistant TB (MDR-TB) treatment in resource-constrained settings, using relatively affordable technology and drugs provided by the National TB Elimination Programme (NTEP).
Figure: MERM Container for Shorter/ Longer Oral MDR-TB Regimen; Source: Guidelines for PMDT in India, 2021, p143.
Providing health education and counselling to each Drug-resistant TB (DR-TB) patient is an essential step in the management of DR-TB patients.
It is important to consider the long duration of treatment and the multitude of factors that may influence the overall treatment continuation and success.
The treatment duration of any DR-TB regimen is long enough for the patient who needs multiple sessions of counselling, preferably more frequently in the initial phase of treatment.
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)
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.