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 Ni-kshay Online Portal under National Tuberculosis (TB) Elimination Program (NTEP) has a provision for generating TB treatment outcome reports which should be downloaded periodically to understand the TB treatment adherence and response to TB treatment provided to the patients.
Following are the steps to download and review the treatment outcome report from Ni-kshay.
Step 1: Open the Nikshay Reports page.
Step 2: Under Notification Reports, click Outcome Reports.
The World Health Organisation (WHO) recommends Tuberculosis Preventive Treatment (TPT) among contacts exposed to Multidrug-resistant TB (MDR-TB) with Fluoroquinolone (FQ)-sensitive, or Isoniazid (H)-resistant with Rifampicin (R) sensitive DR-TB patients.
Points to be Considered Before TPT Initiation
The current TB treatment strategy is based on a patient-centred approach to treatment and alleviation of patients' suffering that has been restricted mostly to its physical aspects. However, difficulties faced by patients and families affected by life-threatening diseases span across physical, psychological, social and spiritual aspects. Therefore, a more holistic approach to patient treatment requires broadening to a patient-centric care approach with palliative care services.
Palliative care would be necessary for the care of:
There are two main interim treatment outcomes that can occur during Drug-resistant TB (DR-TB) treatment. These are:
Bacteriological Conversion: This occurs after bacteriological confirmation of TB in at least two consecutive cultures (applicable for DR-TB and Drug-sensitive (DS-TB)) or smears (applicable for DS-TB only), taken on different occasions, at least 7 days apart, are found to be negative.
Adverse Drug Reactions (ADRs) have been graded based on their severity. The figure below provides criteria for the assessment of the severity grade of ADRs.
Figure: Criteria for Severity Grade Assessment of ADRs
The World Health Organisation-Uppsala Monitoring Centre (WHO-UMC) system has been developed as a practical tool for the assessment of case reports.
The table below lists the various causality categories and their assessment criteria that have been developed under this system.
Attribution definitions for causality assessment are divided into five categories and are as follows:
Adverse Event (AE) that is not related to the use of the drug.
AE for which an alternative explanation is more likely, e.g., concomitant drug(s), concomitant disease(s) or the relationship in time suggests that a causal relationship is unlikely.
There are three methods for reporting pharmacovigilance activities (see figure below).
Figure: Three Methods for Reporting Pharmacovigilance Activities