Flow Chart of H Mono/Poly DR-TB Patients from Diagnosis to Treatment Outcome​

The flow of patients from diagnosis to treatment initiation and follow-up till the final treatment outcome submission for Isoniazid (H) mono/ poly Drug-resistant TB (DR-TB) is depicted in the figure below.

Figure: Flow of H Mono/ Poly DR-TB Patients; Source: Guidelines for PMDT, India, 2021, p107.

Abbr: HF: Health Facility; DSTB: Drug-sensitive TB; R: Rifampicin; NAAT: Nucleic Acid Amplification Test; H: Isoniazid; S-LPA: Second Line-Line Probe Assay; F-LPA: First Line-Line Probe Assay; Lfx: Levofloxacin; Mfx(h): High-dose Moxifloxacin; CHO: Community Health Officer; MO: Medical Officer; PP: Private Practitioner; DR-TB: Drug-resistant TB; NDR-TBC: Nodal Drug-resistant TB Centre; DR-TBC: Drug-resistant TB Centre; Z: Pyrazinamide; Lzd: Linezolid; E: Ethambutol; Cs: Cycloserine;Cfz: Clofazimine. 

H mono/ poly DR-TB patient flow can be explained as:

• H-resistant DR-TB patients after diagnosis confirmation are counselled by the medical officer of the Health Facility (HF)/ Community Health Officer (CHO)/ Private Practitioner (PP).
• Patients will be evaluated by the health facility doctor after the necessary pre-treatment evaluation and initiated on H mono/ poly DR-TB regimen. 
• Patient details are then updated by local health staff in related formats/ Nikshay.
• After treatment initiation, the patient is counselled for treatment adherence, cough etiquette, adequate nutrition and follow-up.
• Based on the Second Line-Line Probe Assay (SL-LPA) report, the patient’s regimen will be continued or modified as per the Drug Susceptibility Test (DST) result.
• Contact tracing and TB preventive treatment initiation will be done after ruling out active TB.
• 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.

Resources

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

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