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Referral mechanisms for DR-TB services
Learning ObjectivesEnumerate the referral mechanisms - who, whom, how and where for DR-TB services. Narrate how the referral mechanism works and who can be a resource for smooth coordination. To include Referral mechanisms between the nodal and district DR-TB committees (for the public sector).
Presumptive Drug-resistant TB (DR-TB) is identified by the health facility doctor during passive screening or by health staff/ community volunteers during Active Case Finding (ACF).
Prompt referral and sample collection is an important step after identifying presumptive TB/ DR-TB.
After detection, referrals should be made promptly by the Community Health Officer (CHO) at Health and Wellness Centre (HWC)/ Senior Treatment Supervisor (STS)/ Tuberculosis Health Visitor (TBHV) to the health facility or Nodal/ District DR-TB Centre (N/DDR-TBC) for pre-treatment evaluation and treatment initiation. Every district has DDR-TBC for the treatment of DR-TB cases. However, for complicated DR-TB cases,that need either super-speciality or complex medical equipment and intensive care (like invasive ventilators), such patients are referred to Nodal DDR-TBCs.
Referral linkages for further domiciliary treatment are to be ensured by health facility doctor, N/DDR-TBC, senior DR-TB TB-HIV supervisor, STS, TBHV, CHO and general health staff.
Identification of suitable treatment supporters by CHO/ STS/ TBHV is essential, and the periodic follow-up of clinical/ bacteriological examination is to be managed.
The cascade of referral mechanism and function of various stakeholders is described below.
Figure: Cascade of referral mechanism and function of various stakeholders; Source: Guidelines for Programmatic Management of Drug-resistant Tuberculosis in India, NTEP, CTD, WHO, MoHFW, 2021, p48.
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Assessment
| Question 1 | Answer 1 | Answer 2 | Answer 3 | Answer 4 | Correct Answer | Correct Explanation | Page id | Part of Pre-Test | Part of Post-Test |
| The patients are referred to N/DDR-TBC for pre-treatment evaluation. | True | False | 1 | After detection of DR-TB, referrals should be made promptly by the CHO at HWC/ STS/ TBHV to the health facility or N/DDR-TBC. | Yes | Yes | |||
| Who ensures referral linkages for domiciliary treatment of patients? | Senior DR-TB coordinator | TB Health Visitor | Community health officers | All of the above | 4 | Referral linkages for domiciliary treatment are to be ensured by the health facility doctor, N/DDR-TBC, senior DR-TB coordinator, TB-HIV supervisor, STS, TBHV, CHO and general health staff. | Yes | Yes |
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