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  • PMDT structure and roles

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    PMDT structure and roles

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The National TB Elimination Programme (NTEP) in India has established well-organised Drug-resistant TB (DR-TB) management structures at the national, state and district level. 

Organizational structure of PMDT

Figure: Diagrammatic representation  of the organisational structure of Programmatic Management of DR-TB (PMDT)

Abbr: NDR-TB: Nodal Drug-resistant TB; NAAT: Nucleic Acid Amplification Test; LPA: Line Probe Assay; CDST: Culture and Drug Sensitivity Test; DDR-TB: District DR-TB

 

The organisational structure and functions at different levels are described in the table below.

Level Organisational Structure Type of Organisation Function
National-level Central TB Division (CTD), Ministry of Health and Family Welfare (MoHFW), Government of India (GoI) Administrative Providing resources/ devising policies/ issuing guidelines/ monitoring and evaluation/overall administration of the programme
National Technical Expert Group Advisory Reviewing evidence Recommendation in guidelines
National Reference Laboratory (NRL) Operational Providing laboratory-related expertise, External Quality Assurance (EQA) guidelines, Accreditations, a centre of excellence in diagnostics
State-level State TB Cell, Health Department Administrative Providing resources, implementing guidelines, monitoring and evaluation/ overall administration of the programme
State PMDT Committee Advisory Overseeing implementation as per guideline, taking strategic decisions, reviewing the progress in implementation and feedback/ suggestion to NTEP
Nodal DR-TB Committee Advisory Guiding treatment of difficult to treat DR-TB cases, reviewing the progress of treatment and Adverse Drug Reaction (ADR) management, providing technical expertise for decisions at the State PMDT Committee, etc.
Intermediate Reference Laboratory (IRL) Operational Providing laboratory-related services and expertise at the State level, EQA, and capacity building for diagnostic services
Nodal DR-TB Centres Operational Providing treatment services to difficult-to-treat DR-TB cases, a centre of excellence in DR-TB treatment
District-level District TB Cell Administrative Providing resources, implementing guidelines, monitoring and evaluation/ overall administration of the programme
District TB Forum Advisory Overseeing implementation as per guideline, reviewing the progress in implementation, facilitating and monitoring the involvement of communities
District Comorbidity Committee Advisory Review and rectify TB-comorbidity components with regard to HIV, diabetes, addiction and other review coordination with other health programmes like Rashtriya Bal Swasthya Karyakram (RBSK), Rashtriya Kishorethe  Swasthya Karyakram (RKSK), Reproductive Maternal Newborn Child plus Adolescent Health (RMNCH+A) etc.
District DR-TB Committee Advisory Guiding treatment of DR-TB cases, reviewing progress of treatment and ADR management, etc.
NAAT/ LPA/ CDST Laboratories Operational Providing diagnostic services to detect DR-TB in the district (at more than one district)
District DR-TB Centre Operational Providing treatment services to DR TB cases, ADR management etc.

 

DR-TB services integration into the general health system
Block-level/ Ward-level Block Medical Officer/ Medical officer in office Operational Implementation of guidelines/ monitoring and evaluation of feedback
Health facility-level Health facility doctor, Master in Public Health Skills (MPHS), Multipurpose Health Worker (MPHW), Accredited Social Health Activist (ASHA) Operational Implementation and review
Health & Wellness Centre, Sub-Centre Community Health Officer (CHO) Operational TB screening and community intervention, coordination amongst various health programmes for TB-related activities
Community ASHA, Panchayati Raj Institutions (PRI), Anganwadi Workers (AWW), other volunteers and community leaders Operational Implementation , community engagement through PRI,  Village Health and Nutrition Day (VHND) , Community meetings, peer educators/TB champions/adolescent groups and Anganwadi sessions

The organisational structure based on functional roles can be classified into diagnosis, treatment and drugs.

Diagnosis: 

Name of Facility

Functions

Health Facility
  1.      To identify presumptive cases/collect and transport specimen 
  2.      To communicate results to patients
  3.      Collect and refer follow-up specimen

NAAT Site
  1.      Diagnose TB and Rifampicin-resistant (RR) patients at district/ sub-district level
  2.       Maintain records for Ni-kshay
  3.       Transport the second sample to C&DST lab for First-line Line Probe Assay (FL-LPA) and Second-line Line probe Assay (SL-LPA)

C&DST Lab 
  1.       Receive diagnosis and follow-up samples
  2.       Performs FL-LPA, SL-LPA, Liquid Culture (LC) and LC-DST
  3.       Maintain records for Ni-kshay (LIMS)
  4.        Provide rapid results to district , field and DR-TB centre

 

Treatment:

 

Name of Facility

Functions

Health Facility 
  1.      Identify treatment supporter
  2.       To support and supervise DR-TB patients during treatment
  3.       Manage Minor side effects
  4.       Refer patients for treatment initiation

District DR-TB Centre
  1.      Initiate DR-TB regimen
  2.       Manage and record ADR
  3.       Consult for complications
  4.       Maintain records and Ni-kshay
  5.       Coordinated with Nodal DR-TB centre/Field
  6.        Monitor DR-TB  treatment

Nodal DR-TB Centre
  1.      Maintain ward and Airborne Infection Control (AIC)
  2.       Undertake pretreatment evaluation and initiate treatment
  3.       Manage major ADR
  4.       Mentor and supervise concerned DDR-TBC

 

Drugs:

 

Name of Facility

Functions

District Drug

Store
  1.       Coordinate test results.
  2.       Refer patients to N/DDR-TBC
  3.      Coordinate the drug flow from the district drug store to the field level
  4.       Maintain records, Ni-kshay, monitor and supervision

State Drug Store 
  1.      Prepare and ship drug boxes to the district level
  2.      Manage supply chain for diagnostics and drugs
  3.      Maintain records in Ni-kshay Aushadhi

 

Resources

 

Assessment

Question Answer 1 Answer 2 Answer 3 Answer 4 Correct Answer Correct Explanation Page id Part of Pre-Test Part of Post-Test
Which of the following is part of the PMDT structure under NTEP? NACP NACO District Comorbidity Committee None of the above 3 The district comorbidity committee is part of the PMDT district-level structure. The committee reviews and rectifies TB-comorbidity components with regard to HIV, diabetes, addiction and other review coordination with other health programmes like RBSK.   Yes Yes
The PMDT organisational structure is based on functional roles that can be classified into diagnosis, treatment and drugs. True  False     1 The PMDT organisational structure is based on functional roles that can be classified into diagnosis, treatment and drugs.   Yes Yes

 

LMS Page Link
https://cms.swasth-egurukul.in/en/page-preview/62542

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