Establishment and responsibilities of DR-TB centers
1. Establishment and responsibilities of DR-TB centers
in medical college
Dr Sandeep Chauhan
National Consultant DR-TB
WHO NTEP Technical Support Network
Central TB Division, MoHFW
chauhans@rntcp.org, 94284 20424
2. Gazette notification
• “Every Teaching Hospital should have Anti-Retroviral
Treatment (ART) Centre and facility for management of
MDR-TB by the time of 3rd renewal (admission of 4th Batch
of MBBS students)” – October 2020
Medical colleges : Valuable resources for India
• Clinical expertise and capacity to manage difficult-to-
treat DR-TB cases
• Educating future generation of doctors
• Advocacy media and role models for private sector
• Advocacy with professional associations like IMA, IAP,
IAPSM and FOGSI etc.
https://www.nmc.org.in/e-gazette/gazette-minimum-requirements-for-annual-m-b-b-s-admissions-regulations-2020
3. D.O. letters from Ministry of HFW, GoI
A D.O. letter from the Medical Education Division, Ministry
of Health & Family Welfare, GoI to the Secretary, National
Medical commission to ensure establishment of DR-TB
centres in all the medical colleges.
A D.O. letter from the Joint Secretary (NTEP), Ministry of
Health & Family Welfare, GoI to the Principal Secretary
Health (All states/UTs) and Principal Secretary Medical
Education (All states/UTs) to ensure the establishment of
DR-TB centres in all the medical colleges.
4. D.O. letter from Joint Secretary, GoI dated 14th Jan 2021 (Annexure)…1
Infrastructure
• Normative amount as per “Norms and basis of costing” for NTEP for
infrastructure upgradation
Human
resource
• Provision of one each
• MO-medical college, TBHV, LT for TB detection centre (TDC)
Linkage for
diagnosis
• Linkages for specimen collection and transportation
Capacity
building
• Training on NTEP/PMDT guidelines and Ni-Kshay
NHM provisions for DR-TB facilities in medical colleges
5. D.O. letter from Joint Secretary, GoI dated 14th Jan 2021 (Annexure)…2
Drugs and
logistics
• Supply of diagnostic logistics (sputum cups, conical tubes, packaging materials, cartridges/chips if NAAT available etc.)
• Stock of FL and SL drugs including drugs for TPT, Support for ancillary drugs by linkages with General Health System
Patient
support
• Identification of treatment supporters
• NPY benefits to the patients
Recording and
reporting
• Provision of recording and reporting formats and registers and access to Ni-Kshay
Financial
support
• Payments as per the partnership options
NHM provisions for DR-TB facilities in medical colleges
6. Establishment of N/DDR-TBC
Nodal DR-TB Centre (NDR-TBC)
• Manage all forms of DR-TB,
including the complex forms
• Generally, in tertiary care
setting where expertise and
facilities for management of
complex DR-TB patients are
available
• Initiate all DR-TB regimens
District DR-TB Centre (DDR-TBC)
• May be established in institutes like medical
colleges, district hospitals, TB hospitals and
private or corporate institutes
• More than one DDR-TBC can be established to
improve access
• Initiate H mono/poly DR-TB, shorter oral
Bedaquiline-containing MDR/RR-TB regimen or
longer oral M/XDR-TB regimen provided the
centre does have expertise
• Checklist for establishing DDR-TBC can be found
Annexure 1, guidelines for PMDT in India 2021
7. Checklist for DR-TB centre
• Annexure 1 in Guidelines for
PMDT in India – 2021
• Medical colleges may assess their
respective facilities
8. Requirement from the institution for establishment of N/DDR-TBC
Preferably a tertiary/ secondary care institute
Free of cost PTE & other services (may be procured under partnership options)
AIC-compliant wards for male and female patients
An AIC-compliant outpatient clinic and a separated well-ventilated waiting area
N/DDR-TBC committee with relevant in-house specialists/ honorary members
Availability of oxygen and ventilators for critical care support
All experts are to be trained in the latest PMDT guidelines
Ancillary drugs to be provided for the management of ADRs at no cost to patients
Nursing and support staff should be available from the institute
Records and reports to be maintained for PMDT
Ni-Kshay entries to be done on real-time basis
Financial requirements to be availed through institute/ state budgets or NHM
9. Provision under NTEP for establishment of N/DDR-TBC
Existing MO-DTC or MO-medical college will provide support to the physician serving as
nodal officer of the DDR-TBC
Remuneration of Senior Medical Officer (SMO), Statistical Assistant (SA) and counsellor as
approved in the PIP for Nodal DR-TBC.
Senior DR-TB TB-HIV supervisor to maintain records and reports including Ni-Kshay entry
for DDR-TBC, while SA of NDR-TBC to maintain the same for NDR-TBC
Training concerned staff
Computer/ internet facility and Ni-Kshay login ID
Logistics, including 12 lead automated ECG machines and drugs
9
10. Functions of N/DDR-TBC
• Pre-treatment evaluation (PTE)
• Providing counselling to patients and family members
• Treatment initiation
• Follow-up monitoring
• Management and monitoring of adverse drug events
• Recording and reporting
• Airborne infection control
• Nutritional assessment
• Mental health support
• TB intensive respiratory care support (TB-IRCU)
• Palliative care
11. DR-TB centre committee
• A DR-TB centre committee is different from the medical college core committee
• A committee of clinicians under the chairpersonship of head of the institute
• Vice chair-person should be head of the department of respiratory medicine or general
medicine as applicable
• Members should include head of the departments of the institutes especially microbiology,
pediatrics, pharmacology, cardiology (or physician), any other as required
• Head of the departments of psychiatry, Ob & Gy, ENT, dermatology may be invited as
required
• Primary role of the committee is to arrange for examination of DR-TB patients referred for
their treatment eligibility and start DR-TB regimen for all eligible patients as per national
PMDT guidelines
• Further detail can be referred from annexure 2 of the guidelines for PMDT in India 2021
12. Engagement of paediatricians in DR-TB centre committee
• A D.O. letter from DDG-TB to the STOs
(all states/ UTs) – Nov 2020
• States/ UTs to direct all the DR-TB
centres that whenever any child with
any of DR-TB need to be admitted for
pre-treatment evaluation and
management, the child should be
managed in the existing DR-TB wards
• All DR-TB centres must pro-actively
engage the available pediatricians (in-
house/ honorary) in the DR-TB centre
committee for the management of
pediatric DR-TB patients
13. To summarize…
• All the medical colleges must have functional facility for the management of DR-TB including
paediatric DR-TB
• Good coordination between the medical college and concerned district TB officer
• Establishment of DR-TB centre committee
• Junior residents of the concerned departments (Respiratory Medicine, General Medicine,
Paediatrics, etc.) can be posted in the DR-TB centre of the medical college
• A dedicated posting of UGs during their compulsory rotating internship in the DR-TB centre
can be encouraged by the institution
• Posting of nursing students in the DR-TB centre can be encouraged