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  • TB Treatment Adherence

    Content

    Tuberculosis(TB) is curable if patients are treated with effective, uninterrupted anti-tuberculous treatment. Treatment adherence is critical for curing individual patients, controlling the spread of infection in the community, and minimizing the development of drug resistance.

    Adherence to treatment means that a patient follows the recommended course of treatment by taking all the prescribed medications for the entire length of time, as necessary. In other words, “right dose for the right duration”.

    In Drug Sensitive Tuberculosis(DSTB), a TB patient completes 168 doses of TB treatment and adheres to TB treatment.


     

  • Importance of Treatment adherence

    Content

    Adherence to tuberculosis(TB) treatment is important for promoting individual and public health. Poor adherence to TB treatment results in:

    • More individual suffering and death,
    • Costly treatment as treatment regimens lengthen and
    • Increases the risk for Drug Resistant Tuberculosis

     

    Proper treatment of all forms of TB is critical to reducing individual morbidity and mortality and to interrupting transmission among family and community members.


     

  • Recording and Monitoring Adherence

    Content

    Recording of Treatment Adherence can be done as

    • Manually by DOT/Health Care Provider in TB Treatment Card of a patient.
    • Self-reported by Patient using digital tools for reporting adherence using 99 DOTS and MERM technologies.

     

    Monitoring Treatment Adherence:

    All TB patients should be monitored to assess their response to TB treatment. Nikshay Adherence calendar has a colour legend for various doses taken by a patient

     

    Figure: Sample Nikshay Adherence Calendar in web and Mobile App

     

    COLOUR LEGEND DOSE DESCRIPTION
      Treatment Start /End Denotes Treatment start and End Date
      Digitally Reported Dose Denotes that the patient has successfully called the Toll Free Number displayed on the envelope
      Manually Reported Dose Indicates that the staff has marked manually confirmed dose for the day
      Unreported Dose Indicates that there was no call event received on Nikshay for that day
      Manually Reported Missed Dose Indicates that the staff has marked a manually confirmed missed dose for the day
      Digitally Reported(From Shared Phone Number) Indicates that the patient has been calling from a shaed number(A mobile number that is common for more than one patient)
    DSTB Paper Treatment Card

    Figure: DSTB Treatment Card (Paper)
     

  • Digital Adherence Monitoring Technologies

    Content

    99DOTS is a low-cost digital adherence technology built-in Nikshay that uses inexpensive packaging(envelopes or stickers) with medication that enables people taking medication to engage with their treatment daily. This packaging, distributed to TB patients taking medications, has a hidden number behind perforated flaps on the external envelope; in some cases, the number may be fixed outside the medication blister or pill bottle. This number can be a toll-free number that can be called to register daily adherence or a code sent by SMS, USSD, or other communication channels. Calling or messaging the number is free!

    Figure: 99 DOTS Envelope

     

    MERM: The Medication Event Reminder Monitor(MERM) is a digital pillbox that provides daily pill-taking reminders and facilitates remote monitoring of medication adherence. This system provides visual and audible reminders for both daily dosing and refill,.transmits this data to a server so that healthcare providers can remotely visualize patients’ dosing histories to support enhanced adherence counselling. 

     

    Figure: MERM Box

     


     

  • Recording manual doses in Nikshay

    Content

    Manual recording of Adherence in Nikshay:

    in Nikshay, Adherence can only be recorded only if there is corresponding dispensation being issued to a Patient 

    Figure: Steps to record manual dose in Nikshay

     

    Recording in Patient Treatment Card:

     

    Figure: Filled Treatment card for TB Patient

     


     

  • Treatment Support

    Content

    A person affected by TB requires support throughout the course of treatment and beyond that. The support to a TB patient is essential to ensure that s/he completes the treatment without affecting her/his quality of life (QoL). Keeping the patient as the central figure in the continuum of care, and ensuring social and personal circumstances are supportive (not only meeting immediate requirements of medical treatment) is the key to treatment support.

     

    Figure: Key Components of Treatment Support

     

    Resources

    National Strategic Plan for Tuberculosis Elimination 2017–2025, RNTCP, 2017.

    A Patient-centred Approach to TB Care, WHO, 2018.

     

    Assessment

    Question​ 

    Answer 1​ 

    Answer 2​ 

    Answer 3​ 

    Answer 4​ 

    Correct answer​ 

    Correct explanation​ 

    DOT is the only treatment support provided to TB patients.

    True

    False

     

     

    2

    Ensuring social and personal circumstances are supportive for treatment adherence and not just medical requirement is the key to treatment support.

     

  • Treatment supporter to TB Patient

    Content

    A Treatment Supporter can be any person such as a Medical Officer, MPWs, community volunteers working with the program etc. Even a patient’s relative or family member can be a Treatment Supporter.

     

    As per NTEP guidelines, salaried NTEP/General Health System staff may also be assigned as treatment supporters for a patient.  However, they will not be eligible for any honorarium.

     

    A patient can only be linked to one treatment supporter at a time in Nikshay.