A cold chain is a system of transporting and storing TB specimens at optimum temperature while being transported from the peripheral health institutions to the diagnostic labs to reduce the growth of contaminating endogenous respiratory organisms.
Cold chain requirements for transportation of TB diagnostic specimens are (Figure 1):
The following are a few of the steps for comprehensive infection control measures:
The Medication Event Reminder Monitor (MERM) is a digital pillbox that has been designed to monitor Multidrug-resistant TB (MDR-TB) treatment in resource-constrained settings, using relatively affordable technology and drugs provided by the National TB Elimination Programme (NTEP).
Figure: MERM Container for Shorter/ Longer Oral MDR-TB Regimen; Source: Guidelines for PMDT in India, 2021, p143.
Providing health education and counselling to each Drug-resistant TB (DR-TB) patient is an essential step in the management of DR-TB patients.
It is important to consider the long duration of treatment and the multitude of factors that may influence the overall treatment continuation and success.
The treatment duration of any DR-TB regimen is long enough for the patient who needs multiple sessions of counselling, preferably more frequently in the initial phase of treatment.
Discuss in general about MERM box and its utility in NTEP
The following figure depicts the flow of Drug Resistant-TB (DR-TB) patients from diagnosis of DR-TB to treatment initiation and follow-up till final treatment outcome submission for patients on a longer oral regimen.
Figure: Flow of M/XDR-TB Patients on a Longer Oral Regimen; Source: Guidelines for PMDT, India, 2021, p108.
It is important to give proper doses of medicines to patients in second-line Multidrug-resistant TB (MDR-TB) regimens according to their weight band.
The tables below provide information on the dosing of medicines used in MDR-TB regimens by weight band for patients under 15 years.
Table 1: Dosing of Group A medicines used in MDR-TB regimens by weight band for patients under 15 years;
Source: Annexure 15, PMDT Guidelines, India, 2021.