Flow Chart of MDR/RR-TB Patients on Shorter Oral Bedaquiline-containing Regimen from Diagnosis to Treatment Outcome

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Flow Chart of MDR/RR-TB Patients on Shorter Oral Bedaquiline-containing Regimen from Diagnosis to Treatment Outcome

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Flow Chart of MDR/RR-TB Patients on Shorter Oral Bedaquiline-containing Regimen from Diagnosis to Treatment Outcome

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The flow of patients from diagnosis to treatment initiation and follow-up till final treatment outcome submission for Multidrug-resistant (MDR)/ Rifampicin-resistant TB (RR-TB) patients on a shorter oral Bedaquiline (Bdq)-containing regimen is depicted in the figure below.

Figure: Flow of MDR/RR-TB Patients on Shorter Oral Bdq-containing Regimen; Source: Guidelines for PMDT, India, 2021, p107.

Abbr: HF: Health Facility; DS-TB: Drug-sensitive TB; NAAT: Nucleic Acid Amplification Test; R: Rifampicin; F-LPA: First Line-Line Probe Assay; S-LPA: Second Line-Line Probe Assay; CHO: Community Health Officer; MO: Medical Officer; PP: Private Practitioner; N/DDR-TBC: Nodal/ District Drug-resistant TB Centre; DR-TBC: Drug-resistant TB Centre; FQ: Fluoroquinolone; SLD: Second-line Drugs.

MDR/RR TB patient flow can be explained as:

MDR/RR-TB patients, after confirmation of their diagnosis, are counselled by the medical officer of the Health Facility (HF)/ Community Health Officer (CHO)/ Private Practitioner (PP).
The patient is referred to the District/ Nodal DR-TB Centre (D/NDR-TBC) for DR-TB treatment initiation.
The patient's Pre-treatment Evaluation (PTE) is undertaken at the D/NDR-TBC.
The patient details are updated by DR-TBC staff in the National TB Elimination Programme (NTEP) referral form and related formats/ Nikshay.
Treatment is initiated at the DR-TBC and the patient is counselled for treatment adherence, cough etiquette, adequate nutrition and follow-up.
The DR-TBC counsellor/ assigned staff ensures linkage to the patient support system after counselling. Counselling is also offered to the family considering the long course of DR-TB treatment and the need for psychosocial support.
Based on the Line Probe Assay (LPA) reports, the treatment regimen will be continued, or the regimen will be stopped and the patient will be initiated on a longer oral regimen.
Patients are regularly followed up for follow-up tests, assessment of response to treatment, and monitoring as well as management of adverse drug reactions, if any.