Base Technical Content in text and simple images.
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.
There are two main interim treatment outcomes that can occur during Drug-resistant TB (DR-TB) treatment. These are:
Bacteriological Conversion: This occurs after bacteriological confirmation of TB in at least two consecutive cultures (applicable for DR-TB and Drug-sensitive (DS-TB)) or smears (applicable for DS-TB only), taken on different occasions, at least 7 days apart, are found to be negative.
Adverse Drug Reactions (ADRs) have been graded based on their severity. The figure below provides criteria for the assessment of the severity grade of ADRs.
Figure: Criteria for Severity Grade Assessment of ADRs
The World Health Organisation-Uppsala Monitoring Centre (WHO-UMC) system has been developed as a practical tool for the assessment of case reports.
The table below lists the various causality categories and their assessment criteria that have been developed under this system.