DR-TB Coordinator

Pre-treatment counselling must serve as an informed decision-making process that enables patients to make a duly informed decision regarding the use of all anti-TB drugs and regimen, including newer drugs. 

Written consent is not needed for any treatment regimen under National TB Elimination Programme (NTEP).

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Figure: Key points to be covered during pre-treatment counselling; Source: PMDT Guidelines India, 2021, p45.

Drug resistance is caused by a genetic mutation that makes the drug ineffective against the mutant bacilli.

The causes of drug-resistant TB can be enumerated as follows: 

1. Providers/ Programme Related Causes:

• Inadequate or poorly administered TB treatment regimen
• Unavailability or poor quality of anti-TB drugs
• Poor monitoring of TB treatment
• Delay in detection and management of DR-TB

2. TB Patient/ Host Related Causes:

There are two main evaluations that must be conducted during pre-treatment evaluation to initiate patients on a shorter oral bedaquiline-containing MDR/RR-TB regimen. These evaluations are:

Clinical Evaluation

• History and physical examination
• Height check
• Weight check
• Psychiatric evaluation, if required

Laboratory-based Evaluation

The dosage for Drug-resistant TB (DR-TB) drugs used in the regimen by weight bands for adults are enumerated in the table below.

It is a well-known fact that although free, quality diagnostic, treatment and patient support services are available in the public health sector, a significant number of patients seek health services from the large, unorganized private health sector. 

Reaching out to these patients is important to:

In view of the availability of expertise in medical colleges, there is a felt need to leverage their strength to improve clinical, Adverse Drug Reactions (ADRs) and comorbidity management of patients with Drug-resistant Tuberculosis (DR-TB) across India. 

The following functions and package of services should be offered at each District Drug-resistant Tuberculosis Centre (DDR-TBC):

Figure: Functions of DDR-TBCs

Abbr: NDR-TBC: National Drug-resistant TB Centre; AIC: Airborne Infection Control

Resources

• Guidelines for Programmatic Management of Drug-resistant TB in India, 2021.

The following are requirements from institutions for establishing the district Drug-resistant Tuberculosis Centre (DDR-TBC):

Structural requirements:

Paradoxical Reaction

Occasionally, patients with HIV-related TB may experience a temporary exacerbation of symptoms, signs, or radiographic manifestation of TB after beginning TB treatment due to simultaneous administration of Anti-retroviral Treatment (ART) and TB medication. It was thought to be a result of immune reconstitution and is referred to as the Immune Reconstitution Inflammatory Syndrome (IRIS).

Symptoms and Signs