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The patient-centred care approach is the practice of caring for patients (and their families) in ways that are meaningful and valuable to the individual patient.
The severity of TB disease is crucial for management strategies and treatment outcomes.
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 suggested treatment regimen covering maximum non-Mycobacterium Tuberculosis (NTM) mainly Mycobacterium Avium Complex (MAC) is as follows:
Intensive Phase (IP) is for 3 months and can be extended to a maximum of 6 months with all four drugs.
It is very important that medical care continues and the patient is not abandoned once the therapy has been suspended. Several supportive measures can be used for this.
Dyspnoea, and to a much lesser extent pain, are among the most distressing symptoms in the last stages of the disease. Thus, access to opioids and other controlled medicines is fundamental for delivering high standards of palliative and end-of-life care to patients with Multidrug-resistant Tuberculosis (MDR-TB).
The details on palliative care supportive measures are as below:
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.
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TREATMENT OUTCOMES |
DEFINITION |
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The World Health Organization (WHO) defines palliative care as an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illnesses, through prevention and relief of suffering by means of early identification, impeccable assessment, and treatment of pain and other physical, psychosocial and spiritual problems.
The goal of such treatment is to improve the quality of life for both the patient and their family.
Shift from Shorter to Longer Drug-resistant TB (DR-TB) Regimen
Reasons for regimen shift: Resistance, tolerability, availability and emergence of exclusion criteria.
The inventory of Cartridge Based Nucleic Acid Amplification Test (CBNAAT) cartridges and Truenat chips supplied by the centre or procured by the states/ districts should be managed through Nikshay Aushadhi (see the figure below).
Figure: Inventory Management of NAAT Cartridges/ Chips in Nikshay Aushadhi Portal; Source: Guidelines for PMDT, India, 2021, p142.