Under the overall guidance of Community Health Officer, the Accredited Social Health Activist (ASHA) at Ayushman Bharath-Health and Wellness Centre (AB-HWC) perform the following roles:
The key level for the management of public health services is the district level. The District Tuberculosis Centre (DTC) is the nodal point for tuberculosis (TB) control activities in the district.
Functions of the DTC
The primary role of the DTC is a managerial one. The DTC is the central program management unit of the district responsible for all activities related to National TB Elimination Programme (NTEP) implementation such as:
On the lines of the State Health Mission, every district has a District Health Mission headed by the Chairperson, Zila Parishad. It has the District Collector as the Co-Chair and Chief Medical Officer as the Mission Director.
To support the District Health Mission, every district has an integrated District Health Society (DHS) and all the existing societies as vertical support structures for different national and state health programmes are being merged in the DHS.
The End TB Strategy is based on 3 pillars underpinned by 4 principles (see figure below). The strategy follows a multi-pronged approach incorporating patient-centred care and prevention, bold policies and supportive systems, and intensified research and innovation.
Figure: Pillars and Principles of the End TB Strategy; Source: Proposed Post-2015 Global Tuberculosis Strategy and Targets, WHO, 2015
Universal access to quality TB care is defined as when all TB patients in the community access early, good-quality diagnostic and treatment services in a manner that is affordable and convenient to the patient in time, place and person.
All affected communities must have full access to TB prevention, care and treatment, including:
The quality assurance component of the National TB Elimination Programme (NTEP) drug supply system ensures that each drug used by a patient is safe, efficacious and has appropriate standards of quality.
For maintaining the quality of drugs, a system of pre-dispatch & post-dispatch testing of drugs is established.
The World Health Organisation (WHO) recommends Tuberculosis Preventive Treatment (TPT) among contacts exposed to Multidrug-resistant TB (MDR-TB) with Fluoroquinolone (FQ)-sensitive, or Isoniazid (H)-resistant with Rifampicin (R) sensitive DR-TB patients.
Points to be Considered Before TPT Initiation
The current TB treatment strategy is based on a patient-centred approach to treatment and alleviation of patients' suffering that has been restricted mostly to its physical aspects. However, difficulties faced by patients and families affected by life-threatening diseases span across physical, psychological, social and spiritual aspects. Therefore, a more holistic approach to patient treatment requires broadening to a patient-centric care approach with palliative care services.
Palliative care would be necessary for the care of:
The flow of patients from diagnosis to treatment initiation and follow-up till final treatment outcome submission for Multidrug-resistant (MDR)/ Rifampicin-resistant TB (RR-TB) patients on a shorter oral Bedaquiline (Bdq)-containing regimen is depicted in the figure below.
Figure: Flow of MDR/RR-TB Patients on Shorter Oral Bdq-containing Regimen; Source: Guidelines for PMDT, India, 2021, p107.
The flow of patients from diagnosis to treatment initiation and follow-up till the final treatment outcome submission for Isoniazid (H) mono/ poly Drug-resistant TB (DR-TB) is depicted in the figure below.
Figure: Flow of H Mono/ Poly DR-TB Patients; Source: Guidelines for PMDT, India, 2021, p107.