Management of DR-TB Patients: Lost to Follow-up

Patients who are “lost to follow-up” (interrupt treatment continuously for 2 months or more) and return back for Drug-resistant TB (DR-TB) treatment under National TB Elimination Programme (NTEP):

• Will be given an outcome of “Lost to Follow-up”(LTFU)
• Would be subjected to repeat Nucleic Acid Amplification Test (NAAT) and First Line/ Second Line - Line Probe Assay (FL/ SL-LPA), Liquid Culture and Drug Susceptibility Testing (LC&DST) as per the diagnostic algorithm to restart appropriate treatment.

If there are signs of impending treatment failure for any Multi-drug Resistant (MDR)/ Rifampicin-resistant Tuberculosis (RR-TB) regimen patient with or without additional resistance to second-line drugs, the patient should be switched to longer oral Multi (M)/ Extensively Drug-resistant TB (XDR-TB) regimen and evaluated further to modify appropriately based on DST results, if required.

If a patient has received the shorter oral bedaquiline-containing MDR/ RR-TB regimen for more than one month and returns for treatment after continuous interruption of 2 months or more, the patient is not restarted on a shorter oral bedaquiline-containing MDR/ RR-TB regimen.

Resources

• Guidelines for Programmatic Management of Drug-resistant Tuberculosis in India, March 2021.
• Central TB Division, MoHFW Govt of India, Training Modules (1-4) for Programme Managers & Medical Officers (NTEP), 2020.

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