DR-TB Treatment Care Cascade

The Drug-resistant TB (DR-TB) treatment process for all DR-TB patients follows a care cascade.

• DR-TB patient tracing by health staff
  • Referral for treatment initiation to health facility/ district or nodal DR-TB site 
    • Pre-treatment evaluation 
    • Decision on patient’s treatment regimen by DR-TB committee
      • DR-TB treatment initiation*
        • Counselling of patient and his/her family 
          • Treatment supporter identification in consultation with the patient
            • Active Drug Safety Monitoring (aDSM) form filling 
              • Adverse Drug Reaction (ADR) Management (as and when needed)
                • Follow up visits to the nearest Health Facility (HF)

*(H Mono/ Poly DR-TB Patient - Any health facility; Multidrug/ Extensively DR-TB (M/ XDR-TB) Patient - Nodal/ District DR-TB Centre (N/DDR-TBC); Contact of MDR/ DD-TB with FQ-susceptibility - TB Preventive Therapy after ruling out active disease)

HFs are responsible for updating the information of DR-TB patients in Nikshay on a real-time basis.

This entire care cascade needs to be monitored by the Medical Officer of the TB Unit (MO-TU) and the senior DR-TB TB-HIV supervisor. The figure below elaborates on these processes that should be followed in the DR-TB treatment care cascade.

Figure: Processes for all DR-TB Patients in the Treatment Care Cascade; Source: PMDT Guidelines India, 2021, p43.

Abbr: PTE: Pre-treatment Evaluation; ADR: Adverse Drug Reaction; aDSM: Active Drug Safety Monitoring

Resources

• Guidelines for Programmatic Management of Drug-resistant Tuberculosis in India, March 2021.
• Companion Handbook to the WHO Guidelines for the Programmatic Management of Drug-resistant Tuberculosis, 2014.
• WHO Consolidated Guidelines on Tuberculosis, Module 4 - Treatment: Drug-resistant TB Treatment.

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