Sr. DR-TB TB-HIV Supervisor

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

The table below provides the details about the clinical evaluation and laboratory tests that need to be done during Pre-treatment Evaluation (PTE) to initiate patients on shorter injectable-containing Multidrug-resistant (MDR)/ Rifampicin-resistant Tuberculosis (RR-TB) regimens.

During the treatment of Drug-resistant TB (DR-TB) patients, there are some important points that patients and caregivers must be counselled on. 

The table below shows all the aspects of DR-TB counselling that must be covered by health workers.

The State Drug Store (SDS) shall constitute drug boxes for:

1. Shorter oral Bedaquiline (Bdq)-containing Multi-drug resistant (MDR)/ Rifampicin-resistant Tuberculosis (RR-TB) regimen (Type A and B)
2. Longer oral Multi (M)/ Extensively Drug-resistant Tuberculosis (XDR-TB) regimen
3. Isoniazid (H) mono/ poly DR-TB regimen

Boxes will be prepared manually only and not through Nikshay Aushadhi software.

From Nikshay Aushadhi drugs will be supplied in loose to districts.

Loose drugs will be supplied to the Nodal (N)/ District DR-TB Centre (DDR-TBC) from the State Drug Stores (SDS)/ District Drug Stores (DDS) as per the consumption pattern of the previous month and requested via Nikshay Aushadhi.

Standard Patient-wise Boxes (PWBs) are constituted for TB patients initiated on Isoniazid (H) Mono/ Poly Drug-resistant TB (DR-TB) regimen. 

This regimen has no segregation in terms of Intensive Phase (IP) or Continuation Phase (CP), hence drugs are provided in a single type of PWB. 

Table: Constituents of standard PWB (6 months) of H mono/ poly DR-TB regimen; Source: Guidelines for PMDT, India 2021, p134

Adverse Drug Reactions (ADRs), such as renal toxicity, may occur from the Drug-resistant TB (DR-TB) treatment regimen.

Suspected agent(s): Amikacin (Am)

Adverse Drug Reactions (ADRs), such as psychotic symptoms, may occur from the Drug-resistant TB (DR-TB) treatment regimen.

Suspected agent(s): Cycloserine (Cs), Isoniazid (H), Fluoroquinolone (FQ)

Suggested Management Strategies

Adverse Drug Reactions (ADRs), such as arthralgia, may occur from the Drug-resistant TB (DR-TB) treatment regimen.

Suspected agent(s): Pyrazinamide (Z), Fluoroquinolone (FQ), Bedaquiline (Bdq)

Suggested Management Strategies​