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Microbiologically confirmed pulmonary Tuberculosis (TB), is the most common and infectious form of tuberculosis and forms the major source of infection in the community.

Every sputum smear-positive patient has the potential to spread the infection to 10 – 15 persons annually, if untreated.

An infectious TB patient becomes a source of infection for all close contacts (household members, workplace coworkers, students studying in the same class or people coming in close contact with such a case).

The district drug-resistant tuberculosis centre (DDR-TBC) committee is a clinical committee where the dean/principal/ director of the institute is the chairperson.

The patient on shorter oral Bedaquiline-containing multi-drug resistant (MDR)/rifampicin resistant TB (RR-TB) regimen shall be put on Type A and Type B box when initiated on treatment on a monthly patient wise box (PWB). Bedaquiline (Bdq) needs to be issued separately and stopped after 6 months. The patient should be provided with only Type A boxes when started on continuation phase (CP).​

Each of the stakeholder plays important role in DR-TB service delivery and has specific responsibility which is being monitored. 

The flow diagram below depicts the processes involved in the delivery of drug-resistant tuberculosis (DR-TB) services and specific functions of various stakeholders.

Figure 1: Cascade of DR-TB services and functions of various stakeholders
Source: Guidelines for PMDT in India, 2021, p.8

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Figure 1: History of PMDT in India (2007 to 2020).; Source: Guidelines for PMDT in India, 2021 p.02 ​

The Terms of Reference (ToR) for the District DR-TB Centre (DDR-TBC) committee are:

The management of hepatotoxicity during treatment with a shorter/ longer oral MDR-TB regimen is elaborated in the figure below. Careful monitoring of Alanine aminotransferase (ALT) and Aspartate aminotransferase (AST) levels is important to delineate the line of management.

Figure: Management of Hepatotoxicity During Treatment with Shorter/ Longer Oral MDR-TB Regimen; Source: Guidelines for PMDT, India, 2021, p89.

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Additional monitoring is recommended for pregnant women managed with a shorter/ longer oral Multidrug-resistant TB (MDR-TB) regimen including foetal and neonatal monitoring.

If Isoniazid (H) mono/ poly Drug-resistant TB (DR-TB) is detected by First-line Line Probe Assay (FL-LPA) then:

The National TB Elimination Programme (NTEP) follows a standard procedure to distribute drugs to the Tuberculosis Units (TUs) in which the key role is played by District Drug Store (DDS) pharmacist. 

For distribution of the drugs to the TUs, National Health Mission (NHM)/ NTEP allows for the hiring of the vehicle or utilizing the available vehicle.