Diagnostic Algorithm for TB Disease in NTEP

Persons with cough of more than 2 weeks, with or without other symptoms suggestive of TB, should be promptly identified as presumptive pulmonary TB patients.

Under NTEP, they are to be referred to the designated microscopy centre (DMC) for sputum examination using the Request form for examination of biological specimen.

Patients belonging to the key population EPTB, HIV and Paediatrics groups (after X-ray screening in case of children) can be directly referred for NAAT.

All presumptive TB patients in the public and private sector must be evaluated for TB based on the diagnostic algorithm for pulmonary and extra-pulmonary TB (EPTB) and the following points must be considered:

• All presumptive pulmonary TB patients must be subjected to sputum smear examination. In places where TB diagnostic laboratories are upgraded to NAAT testing, NAAT can be offered for all presumptive TB patients upfront
• If both the chest X-ray and sputum smear (NAAT in integrated places) results are negative, but the physician considers the patient as presumptive TB, the patient needs to be referred to a chest physician for further evaluation
• NAAT testing will be performed to rule out Rif. resistance before treatment initiation (In places where transition has not yet been happened to NAAT for diagnosis)
• NAAT results will decide if the patient is MTB detected with either Rif. Resistance or Rif. Sensitive
• Upfront NAAT is offered for key populations like PLHIV/children/EPTB
• M.TB detected on NAAT will be further subjected for FL–LPA, SL-LPA, LC DST and based on the results DR-TB regimen may be initiated

Resources

• Technical and Operational Guidelines for TB Control in India 2016
• Revised PMDT Guidelines in India 2021

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