Flow Chart of M/XDR-TB Patients on Longer Oral Regimen from Diagnosis to Treatment Outcome

The following figure depicts the flow of Drug Resistant-TB (DR-TB) patients from diagnosis of DR-TB to treatment initiation and follow-up till final treatment outcome submission for patients on a longer oral regimen. 

Figure: Flow of M/XDR-TB Patients on a Longer Oral Regimen; Source: Guidelines for PMDT, India, 2021, p108.

Abbr: HF: Health Facility; MO-HF: Medical Officer Health Facility; CHO: Community Health Officer; PP: Private Practitioner; N/DDR-TBC: Nodal/ District Drug-resistant TB Centre

M/XDR-TB patient flow can be explained as below:

• DR-TB patients after DR-TB diagnosis confirmation are counselled by the medical officer of the Health Facility (HF)/ Community Health Officer (CHO)/ Private Practitioner (PP).
• Patient Referral to District/Nodal DRTB centre for DR-TB treatment initiation. 
• Patient's Pre-treatment Evaluation (PTE) undertaken at D/NDR-TB centre.
• Patient details updated by DR-TB Center staff in NTEP referral form and related formats/ Nikshay.
• Treatment is initiated at the DR-TB centre and the patient is counselled for treatment adherence, cough etiquettes, adequate nutrition and follow-up.
• DR-TB centre counsellor/ assigned staff ensures linkage of patient support system after counselling. 
• Counselling is also offered to families considering a long course of DR-TB treatment and the need for psychosocial support. 
• 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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