H Mono/Poly DR-TB Patient Flow from Diagnosis to Treatment Initiation

If Isoniazid (H) mono/ poly Drug-resistant TB (DR-TB) is detected by First-line Line Probe Assay (FL-LPA) then:

• Appropriate clinical evaluation is conducted by the treating doctor.
• All oral H mono/ poly DR-TB regimens can be initiated by the trained Health Facility (HF) doctor/ private healthcare provider at the respective HF itself.
• Wait for the results of the Second-line Line Probe Assay (SL-LPA) and Liquid Culture and Drug Susceptibility Testing (LC&DST).
• These patients need not be sent to the district DR-TB centre unless deemed necessary.
• As soon as the results of SL-LPA and LC&DST are available, the microbiologist/ staff at the Culture and Drug Susceptibility Testing (C&DST) lab must enter the results in Nikshay and inform the concerned HF and District TB Officer (DTO) on the same day.
• According to the SL-LPA and LC&DST results, the treating doctor may need to modify the regimen using the replacement sequence for the H mono/ poly DR-TB regimen.

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Figure: H mono/poly DR-TB patient diagnostic flow; Source: Guidelines for PMDT, India 2021, p102.

At any time during the treatment with DS-TB or H mono/poly DR-TB regimen with or without modifications, if there are signs of non-response, the patient must be subjected to Nucleic Acid Amplification Test (NAAT) again to rule out amplification of rifampicin-resistance.

Resources

• Guidelines for Programmatic Management of Drug-resistant Tuberculosis in India, March 2021.

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