Role of Medical Officer at and around a DMC in TB Diagnosis

The Medical Officer Designated Microscopy Centre (MO-DMC) at a Primary Health Facility is appointed from the General Health System. The MO-DMC is responsible for activities at DMC under the National TB Elimination Programme (NTEP).

Key Responsibilities of MO-DMC include

1. Screening and diagnosis

·        Clinical examination of all TB cases should be done by the MO. 

·        The MO should screen/refer:

o   All identified presumptive pulmonary TB cases for sputum smear microscopy, chest X-ray and presumptive Extra-pulmonary Tuberculosis (EPTB) cases for appropriate investigations

o   Presumptive TB cases with a negative sputum result to be referred for chest X-ray, followed by Cartridge-based Nucleic Acid Amplification Test (CBNAAT) as per diagnostic algorithm to ensure no TB case is missed

o   All diagnosed TB patients for Nucleic Acid Amplification Test (NAAT) for early diagnosis of resistance to Rifampicin (Rif)

o   All Rif-sensitive TB patients for first-line LPA testing

o   All presumptive TB patients for HIV testing

o   All diagnosed TB patients for HIV testing

o   HIV positive patients for TB by four symptom complex screening

o   All HIV positive TB patients to Antiretroviral Therapy (ART) centre for initiation of ART and Co-trimoxazole Prophylaxis Therapy (CPT).

2. Treatment initiation, follow up and treatment outcome

·        The MO should fill the original treatment card with details of treatment regimen according to weight-band and Drug Susceptibility Testing (DST) pattern.

·        It is the responsibility of the MO to ensure that all the diagnosed smear-positive patients start treatment or are referred for treatment.

o   All patients who are sensitive to Isoniazid (H) & Rifampicin (R) and all patients whose H & R status is not known should be initiated on first line anti-TB treatment.

·        The MO is responsible for clinically following-up the patient once in a month to:

o   Identify any ADR early

o   Assess clinical improvement

o   Support follow-up by laboratory investigations, whenever necessary

o   Control comorbid conditions like HIV and diabetes by appropriate treatment

o   Screen all patients for presence of symptoms of TB at the end of 6th, 12th, 18th and 24th month after completion of treatment and do a sputum culture in the presence of symptoms to diagnose recurrent TB.

3. Recording, reporting and TB notification

·        The NTEP Request Form for examination of biological specimens should be filled up completely by the MO.

·        The MO should coordinate with the STLS to ensure that tuberculosis-related laboratory services are properly performed and recorded by the laboratory technician.

·        Results recorded in the laboratory register, treatment cards and the TB Notification Register should be verified and ensured that they are consistent.

·        The MO should maintain TB Notification Register for patients diagnosed and transferred-in.

·        The MO should ensure that the treatment details are entered in Nikshay immediately.

·        Detailed description of symptoms and signs of ADRs to anti-TB drug should be recorded in TB Treatment Card by the MO.

·        The treatment outcome has to be recorded on the Treatment Card, Nikshay and the TB Notification register within one month of the event. Declaration of the treatment outcome has to be decided upon and signed with date by the MO.

·        The MO should ensure updating of Notification Register and Nikshay entry by the designated staff:

o   If any smear-positive patients are not entered in the TB Notification Register and are on treatment

o   For patients who have not been put on treatment after tracing them and putting them on treatment immediately

o   After collecting the bank account details of the patient for Direct Benefit Transfer of Nikshay Poshan Yojana.

4. Monitoring and supervision

·        Every week, the MO of the DMC should review the TB Laboratory Register to ensure that correct number of sputum smear examinations (two per presumptive TB case) are being performed for diagnosis.

·        The MO of the DMC should cross-check the results of the sputum examination in the TB Register with that of TB Laboratory Register and the TB Treatment Card.

·        The MO of the DMC should check the Tuberculosis Laboratory Register to make sure that all the columns have been completed.

o   The MO of DMC is responsible for determining the amount of reagents and consumables the DMC needs every month.

o   The MO should ensure uninterrupted supply of drugs; monitor monthly replenishment of stock to treatment supporter if drugs are not already
given and update in drug stock register and in Nikshay Aushadhi through designated staff.

·        The District TB Officer (DTO) conducts Random Blinded Rechecking (RBRC) of sputum smear microscopy and gives feedback and corrective actions to Lab technicians through MO-DMC.

Resources

Training Modules for Programme Managers and Medical Officers.

Assessment

Question

Answer 1

Answer 2

Answer 3

Answer 4

Correct answer

Correct explanation

Page id

Part of Pre-test

Part of Post-test

What are the key duties of a Medical Officer at DMC?

Screening and diagnosis

Advocacy and support to private practitioners

Treatment initiation, follow-up, treatment outcome

All the above

4

The Medical Officer (MO) at the DMC is responsible for screening, diagnosis, treatment initiation, follow-up, treatment outcome, monitoring and supervision, recording, reporting, TB notification, advocacy and support to private practitioners.

Yes

Yes