Dr. Julie Li-Yu presented updated recommendations on how to screen and treat tuberculosis in patients with rheumatic diseases. Dr. Li-Yu and Dr Juan Javier Lichauco were representatives of the Philippine Rheumatology Association to the Task Force developing guidelines for TB management in the country. The slides posted were presented during the Joint Rheumatoid Arthritis - Osteoarthritis Special Interest Symposium held at the F1 Hotel in Taguig City last 28 November 2014.
Dr. Julie Li-Yu presented updated recommendations on how to screen and treat tuberculosis in patients with rheumatic diseases. Dr. Li-Yu and Dr Juan Javier Lichauco were representatives of the Philippine Rheumatology Association to the Task Force developing guidelines for TB management in the country. The slides posted were presented during the Joint Rheumatoid Arthritis - Osteoarthritis Special Interest Symposium held at the F1 Hotel in Taguig City last 28 November 2014.
RNTCP in India has gone a lot of updates in the resent times. The recent updates in RNTCP in India have been summarised in this presentation. Management of Drug sensitive and Drug Resistant TB have been included in the presentation.
Hello Guys,
This presentation consists of the updated guidelines under National tuberculosis elimination programme of India (MOHFW). The presentation includes case definitions and diagnostic algorithms for Pulmonary, Extrapulmonary and Drug resistant TB(MDR/ XDR TB) and the tratment protocols in pediatric cases.
Hope you find it useful.
RNTCP in India has gone a lot of updates in the resent times. The recent updates in RNTCP in India have been summarised in this presentation. Management of Drug sensitive and Drug Resistant TB have been included in the presentation.
Hello Guys,
This presentation consists of the updated guidelines under National tuberculosis elimination programme of India (MOHFW). The presentation includes case definitions and diagnostic algorithms for Pulmonary, Extrapulmonary and Drug resistant TB(MDR/ XDR TB) and the tratment protocols in pediatric cases.
Hope you find it useful.
Tuberculosis is a raging problem round the globe. Eradicating TB is a herculean task but is possible is efforts from all corners from the world. The diagnostics have taken a big leap and with effective medications, our dream of TB free world may come true. But unlimited efforts are need to reach our goal.
clinical standards for ds tb treatment 2022 (1).pptxPathKind Labs
To diagnose and treat drug susceptible pulmonary tuberculosis is of paramount importance in our efforts to eliminate tuberculosis. This describes seven clincal standards which should be practiced to obtain optimum results
National Tb pragramme, Has been in operation since 1962
Inadequacies that led to RNTCP :
Treatment success rates were unacceptably low.
There is no unique diagnostic method.
No Treatment Protocol.
Only 30% is diagnosed, so death and default rates remained high.
In 1993 to overcome the drawbacks mentioned, the NTP was revitalized and RNTCP was formulated.
Implemented in a phased manner, by 2000 it covered the whole country.
Objectives:
Achievement of at least 85 percent cure rates of infectious cases of TB.
Augmentation of case finding activities through quality sputum microscopy to detect atleast 70 percent of estimated cases.
1. Intensified active case finding
2. Diagnostic Criteria Changes :
Changes in few definitions like Defaulters → Loss to follow up , Relapse Tb → Recurrent TB.
In Adults – CBNAAT/ True NAAT is done in all cases of TB ( earlier CBNAAT was performed only for high risk cases )
In Paediatric age group – Chest X-ray and TST to be done first.
3. Treatment Criteria Changes :
Regimens with injectable agents are no longer recommended. Currently, for any case of TB only All Oral regimens are initiated
For Drug Sensitive TB 2months of HRZE and 4 months of HRE
For INH resistant TB – RZE + Levofloxacin for 6 months
In All oral MDR Rx regimen : only continuous phase for 18 months
✓ BEDAQUILINE or DELAMANID × 6 months
✓ LEVOFLOXACIN , LINEZOLID , CLOFAZAMINE , CYCLOSERINE × 18 months
Isoniazid Preventive therapy is given for all contact.
Decentralized Tuberculosis unit and DMC (Designated microscopy
centre) and Peripheral Health Institute at the door steps of the patients.
SMEAR MICROSCOPY FOR ACID FAST BACILLI
RAPID DIAGNOSTIC MOLECULAR TESTING
RADIOGRAPHY where available
TUBERCULIN SKIN TEST
CULTURE
S.No CBNAAT TruNAAT
1 PCR based PCR based
2 Cartridge based Chip based
3 AC environment needed No need
4 Cartridge to be stored in cold atmosphere No need
5 Continuous power supply needed Battery operated
6 Less manual work Semi automatic (Technician oriented )
7 Detects MTB as well as Rif resistance simultaneously Need separate chips for MTB and Rif resistance detection
8 Cross contamination unlikely Cross contamination possible
9 TAT : 112 min TAT : 60 min for MTB
60 min for Rif resistance
10 Intermediate level labaratories Point of care level
MTB not Detected
MTB detected, High/medium/low/very low, rifampicin resistance detected
MTB detected, High/medium/low/very low , rifampicin resistance not detected
MTB detected, High/medium/low/very low , rifampicin resistance indeterminate, Repeat the test in new sample.
Invalid result (Retest in fresh specimen)
Error (Repeat the test in same sample)
Clinical evaluation Laboratory based evaluation
History and physical examination Random blood sugar (RBS)
Height HIV testing following counselling
Weight Complete blood count (Hb, TLC, DLC, platelet count)
Psychiatric evaluation if required Liver function tests(including serum proteins)
TSH levels
Urine examination –
Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic o
Recent guidelines in the treatment of tuberculosisSHOEBULHAQUE1
The treatment of tuberculosis (TB) typically involves a combination of antimicrobial medications to effectively combat the bacteria causing the infection, primarily Mycobacterium tuberculosis. The standard treatment regimen for drug-susceptible TB usually consists of a combination of four first-line drugs: isoniazid, rifampicin, ethambutol, and pyrazinamide.
Nowadays, we are using some other regimens in multiple drug resistant tuberculosis.
Pulmonary tuberculosis
The bacterium Mycobacterium tuberculosis causes tuberculosis (TB), a contagious, airborne infection that destroys body tissue. Pulmonary TB occurs when M. tuberculosis primarily attacks the lungs. However, it can spread from there to other organs.
New treatment regimen is mentioned here.
Presentation on GPDP_Dr Bharat Rout, MoPR (1).pptxAbhijit Dey
Article 243G of the Constitution of India acknowledges Panchayats as institutions of local self-government and mandates them to prepare plans for economic development and social justice.
Gram Panchayat Development Plans (GPDP) to be prepared for effective implementation of flagship schemes/ programmes
Panchayat Development Plans (PDP) must be comprehensive and based on participatory process, which inter alia involves the full convergence of the schemes of Central and State Governments related to 29 subjects
Intermediate/Block and District Panchayats are responsible for preparing Block Panchayat Development Plan (BPDP) and District Panchayat Development Plan (DPDP) at the respective levels.
As a result, Panchayats envisage for an efficient and robust planning process as part of GP’s core functioning
Overview of TB Mukt Panchayat initiative 30082023-Dr Mrigen.pptxAbhijit Dey
‘Healthy Villages’ has been articulated in achieving Sustainable Development Goals in Panchayat Raj Institutions.
Health functionaries at the village and Sub-Centre/HWC levels along with the support of Gram Panchayats, are making substantial progress towards elimination of TB.
The efforts made need to be measured and validated through a certification process so that panchayats can be declared TB Free.
The certification process will motivate and empower the Panchayats to prioritize and undertake the implementation of program activities.
Small PPT on How to measure QT & How to calculate corrected QT.
To get value of cube root of RR(in second) please use google online calculator (search bar) or a scientific calculator
Jennifer Schaus and Associates hosts a complimentary webinar series on The FAR in 2024. Join the webinars on Wednesdays and Fridays at noon, eastern.
Recordings are on YouTube and the company website.
https://www.youtube.com/@jenniferschaus/videos
Presentation by Jared Jageler, David Adler, Noelia Duchovny, and Evan Herrnstadt, analysts in CBO’s Microeconomic Studies and Health Analysis Divisions, at the Association of Environmental and Resource Economists Summer Conference.
A process server is a authorized person for delivering legal documents, such as summons, complaints, subpoenas, and other court papers, to peoples involved in legal proceedings.
Russian anarchist and anti-war movement in the third year of full-scale warAntti Rautiainen
Anarchist group ANA Regensburg hosted my online-presentation on 16th of May 2024, in which I discussed tactics of anti-war activism in Russia, and reasons why the anti-war movement has not been able to make an impact to change the course of events yet. Cases of anarchists repressed for anti-war activities are presented, as well as strategies of support for political prisoners, and modest successes in supporting their struggles.
Thumbnail picture is by MediaZona, you may read their report on anti-war arson attacks in Russia here: https://en.zona.media/article/2022/10/13/burn-map
Links:
Autonomous Action
http://Avtonom.org
Anarchist Black Cross Moscow
http://Avtonom.org/abc
Solidarity Zone
https://t.me/solidarity_zone
Memorial
https://memopzk.org/, https://t.me/pzk_memorial
OVD-Info
https://en.ovdinfo.org/antiwar-ovd-info-guide
RosUznik
https://rosuznik.org/
Uznik Online
http://uznikonline.tilda.ws/
Russian Reader
https://therussianreader.com/
ABC Irkutsk
https://abc38.noblogs.org/
Send mail to prisoners from abroad:
http://Prisonmail.online
YouTube: https://youtu.be/c5nSOdU48O8
Spotify: https://podcasters.spotify.com/pod/show/libertarianlifecoach/episodes/Russian-anarchist-and-anti-war-movement-in-the-third-year-of-full-scale-war-e2k8ai4
Understanding the Challenges of Street ChildrenSERUDS INDIA
By raising awareness, providing support, advocating for change, and offering assistance to children in need, individuals can play a crucial role in improving the lives of street children and helping them realize their full potential
Donate Us
https://serudsindia.org/how-individuals-can-support-street-children-in-india/
#donatefororphan, #donateforhomelesschildren, #childeducation, #ngochildeducation, #donateforeducation, #donationforchildeducation, #sponsorforpoorchild, #sponsororphanage #sponsororphanchild, #donation, #education, #charity, #educationforchild, #seruds, #kurnool, #joyhome
ZGB - The Role of Generative AI in Government transformation.pdfSaeed Al Dhaheri
This keynote was presented during the the 7th edition of the UAE Hackathon 2024. It highlights the role of AI and Generative AI in addressing government transformation to achieve zero government bureaucracy
Jennifer Schaus and Associates hosts a complimentary webinar series on The FAR in 2024. Join the webinars on Wednesdays and Fridays at noon, eastern.
Recordings are on YouTube and the company website.
https://www.youtube.com/@jenniferschaus/videos
This session provides a comprehensive overview of the latest updates to the Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (commonly known as the Uniform Guidance) outlined in the 2 CFR 200.
With a focus on the 2024 revisions issued by the Office of Management and Budget (OMB), participants will gain insight into the key changes affecting federal grant recipients. The session will delve into critical regulatory updates, providing attendees with the knowledge and tools necessary to navigate and comply with the evolving landscape of federal grant management.
Learning Objectives:
- Understand the rationale behind the 2024 updates to the Uniform Guidance outlined in 2 CFR 200, and their implications for federal grant recipients.
- Identify the key changes and revisions introduced by the Office of Management and Budget (OMB) in the 2024 edition of 2 CFR 200.
- Gain proficiency in applying the updated regulations to ensure compliance with federal grant requirements and avoid potential audit findings.
- Develop strategies for effectively implementing the new guidelines within the grant management processes of their respective organizations, fostering efficiency and accountability in federal grant administration.
Donate to charity during this holiday seasonSERUDS INDIA
For people who have money and are philanthropic, there are infinite opportunities to gift a needy person or child a Merry Christmas. Even if you are living on a shoestring budget, you will be surprised at how much you can do.
Donate Us
https://serudsindia.org/how-to-donate-to-charity-during-this-holiday-season/
#charityforchildren, #donateforchildren, #donateclothesforchildren, #donatebooksforchildren, #donatetoysforchildren, #sponsorforchildren, #sponsorclothesforchildren, #sponsorbooksforchildren, #sponsortoysforchildren, #seruds, #kurnool
4. Standards for TB Care in India
•Standard 1: Testing and Screening for Pulmonary TB
•1.1 Testing:
• Any person with cough >2 weeks, fever >2 weeks, significant
weight loss, haemoptysis etc. and any abnormality in chest
radiograph.
• Children with persistent fever and/or cough >2 weeks, loss of
weight or no weight gain, history of contact with infectious
TB cases
5. •Standard 2: Diagnostic Technology
•2.1 Microbiological Confirmation on Sputum:
•All patients with presumptive pulmonary TB should undergo
RNTCP approved sputum test for rapid diagnosis of TB under
quality assurance (with at least two samples, including one
early morning sample,) for microbiological confirmation.
•2.2 Chest X-Ray as Screening Tool:
•Where available, initial chest X-Ray can be used as a
screening tool to increase the sensitivity in sputum smear
negative patients
Standards for TB Care in India
6. GOI & WHO approved Diagnostic Tools
1. Smear Microscopy (for AFB)
2. Culture (Liquid & Solid)
3. Rapid diagnostic molecular test
(CBNAAT)
+
4. CXR
Microbiolo
gicaltest
7. WHO approved diagnostic tests: PTB
Microbiological confirmation
Sputum smear microscopy for AFB (ZN Staining)
Fluorescence Microscopy (AO Staining)
GeneXpert (CBNAAT)
LPA(Line probe assay)
Liquid Culture/Solid Culture
+
Chest X-ray
Additional tests for Pediatric:
TST(Mantoux)
Procedures in case sputum is not expectorated:
Induced sputum by steam/nebulization
Broncheo-alveolar lavage
Gastric lavage
Serological test (IgG, IgM,
ELISA etc) are Banned !!!
Mountoux Test / IGRA / TB
Gold etc also not
recommended as routine
diagnostic.
[cant differentiate between
Active TB, LTBI or already
cured]
Empirical ATD use is not
recommended
8. Standards for TB Care in India
•Standard 3: Testing for Extra-Pulmonary TB
• Appropriate testing with appropriate specimens for
microscopy, culture and drug sensitivity testing (DST),
molecular test and histo-pathological examination.
• Endometrial biopsy (not menstrual blood)
• Plural fluid ADA (not culture)
• Standard 4: Diagnosis of HIV co-infection
• 4.1 All diagnosed TB patients should be offered HIV
counselling and testing.
9. Standards for TB Care in India
•4.2 Diagnosis of Multi-Drug Resistant TB (MDR-TB):
• Prompt and appropriate evaluation for MDR-TB should be
undertaken for the patients suspected of MDR-TB or Rifampicin
(R) resistance.
• MDR Presumptive case- Those who are tested positive in any of
follow-up test or Primary contact of MDR TB converted to a case
• 4.3 Diagnosis of Extensively Drug Resistant TB (XDR-TB):
• On detection of R resistance, patient may be offered second line
DST on an appropriate specimen using RNTCP approved
phenotypic or genotypic method, wherever available.
10. Standards for TB Care in India
•Standard 5: Probable TB
• Those without microbiological confirmation but with
strong clinical and other investigative evidence may be
diagnosed as “Probable TB”. (Clinical TB)
• In case of Negative Report on Rapid Molecular Test do
microbiologic culture & rule out other diagnosis before
ATT (Empirical ATT is not recommended)
•Standard 6: Paediatric TB
• Microbiological confirmation in clinical specimen with
smear microscopy / Preferably by rapid molecular test-
CBNAAT or culture.
11.
12. CBNAAT (Cartridge Based Nucleic Acid Amplification Test)
CBNAAT is an automated Cartridge Based
Nucleic Acid Amplification Test that has
demonstrated its potential to detect
tuberculosis and Rifampicin resistance with
high accuracy.
It is also called Gene Xpert MTB/RIF (Cepheid
Inc, USA) test, a highly sensitive and specific
tool with a quick turn-around time (TAT),
offers early diagnosis of TB and DR-TB) in the
programmatic settings amongst adult and
children as well.
Wide range of specimen e.g. Sputum, Gastric
Lavage, Pus, CSF, FNAC , Tissue biopsy ( except
blood, urine & stool) can be tested
Result within two hours.
Best result – if sample sent before or within
7days of treatment initiation
13. Candidate for CBNAAT
• All HIV patients
• All under 14 years
• All EPTB
• All DR TB Contacts
• If sputum –ve but X-ray suggestive
• If sputum & x-ray are negative but clinical suspicion is high
• Sputum +ve in any of the follow-up testing
• All previously treated patient (Cat-II)
14. DR TB Management Centre (THALI districts)
SL.NO. Name of the Hospital Address of the Hospital Catchment Districts
1
Mother Teresa Memorial
TB Hospital
Boral Main Rd, Prantik Pally, Garia, Kolkata 700084
Phone:033 2435 1240
Kolkata
2 Dr K S Roy TB Hospital
Dr Kumud Shankar Ray TB Hospital, K P C Medical College and
Hospital Campus, Jadavpur, Kolkata 700032
Phone:033 2412 2202
South 24 Parganas & Purba
Medinipur
3
R G Kar Medical College &
Hospital
1, Kshudiram Bose Sarani, Kolkata, 700004
Phone:033 2555 7656
North 24 Parganas
4 TL Jaiswal Hospital
Tulsiram Lakshmi Devi Jaiswal Hospital
Surendranagar, Liluah, Howrah, 711204
Phone: 099525 84191,03326559215, 03326555453
Howrah & Hoogly
CBNAAT Location within THALI Districts
District Existing CBNNAT Location RNTCP accredited Pvt LAB with CBNNAT (IPAQT Network)
KOL
STDC office, Dr BC Roy Polio Clinic Hospital (2 machine) AMRI Hospitals (Saltlake)
Tangra Chest Clinic (2 Machine) Probe Diagnostics
R G Kar Medical College Scientific Clinical Research Laboratory (Dr Subir Dutta's Lab)
N R S Medical College DRS. Tribedi & Roy Diagnostic Laboratory
School of Tropical Medicine Ramkrishna Mission Seva Pratisthan (Sishu Mangal)
NPG
Barasat DH Dr Lal Path Labs & Collection centers
Barrackpur SDH TATA Memorial Center (New Town)
Basirhat SDH SRL Diagnostics & Collection center
Bangaon SDH
HRA
Howrah District Hospital
Uluberia SDH
SPG
Canning SDH
Kakdwip SDH
Amtala RH
HGL Chinsura District Hospital
TML Tamluk DH
15.
16. Standards for TB Care in India
•Standard 7: Treatment with first-line regimen
•7.1 Treatment of New TB patients
• The initial phase - H, R, Z, E for two months
• The continuation phase - H, R and E for at least four months
• 7.2 Extension of Continuation Phase:
• Extend CP by 3 to 6 months in special situations like Bone &
Joint TB, Spinal TB with neurological involvement and neuro-
tuberculosis.
•7.3 Drug Dosages: As per body weight in weight bands
17. • Standard 7: Treatment with first-line regimen
New TB patient
IP CP
2
H
4
H
R R
Z E
E
Standards for TB Care in India
18. Previously treated* TB patient ( No MDR )
IP CP
2
H
+ 1
H
5
H
R R R
Z Z E
E E
S
Standards for TB Care in India
19. Daily dosage of ATT
First-line ATT Dosage per Kg body weight Maximum dosage per
day
Isoniazid
10 mg/kg 300 mg
Rifampicin
10-12 mg/kg 600 mg
Streptomycin
15 mg/kg 1 gram
Ethambutol
20-25 mg/kg 1500 mg
Pyrazinamide
30-35 mg/kg 2 grams
H , R ,S ,E, Z 10, 12 , 15, 25 , 35
20. Daily Dose – FDC Schedule for
Adults
(as per weight bands)
Weight
band
Number of tablets Inj.
Streptomy
cin
Intensive
phase
Continuatio
n phase
HRZE HRE
75/150/400/275
mg
75/150/275
mg
gm
25-39 kg 2 2 0.5 gm
40-54 kg 3 3 0.75 gm
55-69 kg 4 4 1 gm
≥70 5 5 1 gm
21. Drug Dosage for Paediatric TB
Weight
category
Number of tablets
(dispersible FDCs)
Inj.
Streptom
ycin
Intensive phase Continuation phase
HRZ E HR E
50/75/150 100 50/75/100 100 mg
4-7 kg 1 1 1 1 100
8-11 kg 2 2 2 2 150
12-15 kg 3 3 3 3 200
16-24 kg 4 4 4 4 300
25-29 kg 3 + 1A* 3 3 + 1A* 3 400
30-39 kg 2 + 2A* 2 2 + 2A* 2 500
*A=Adult FDC (HRZE = 75/150/400/275; HRE = 75/150/275)
22. 4FDC - Adult
Isoniazid, Rifampicin, Pyrazinamide and
Ethambutol
Note: Larger tablets compared to 3FDC
25. Standards for TB Care in India
•Standard 8: Monitoring Treatment Response
• 8.1 Follow up sputum microscopy: End IP & End Treatment (
at least one sample)
• 8.2 Extension of Intensive Phase: Extension of IP Not
Recommended
• 8.3 Offer DST in follow up sputum positive cases: For positive
sputum in follow-up any time during treatment.
• 8.4 Response to treatment in Extra-pulmonary TB: Assessed
clinically with radiological & relevant investigations.
• 8.5 Response to treatment in Children: Clinically assessed if
no sputum & radiological & relevant investigations.
• 8.6 Long term follow up: Follow up clinically and/or sputum
examination at the end of 6 ,12 , 18 & 24 months.
26. Standards for TB Care in India
•Standard 9: Drug Resistant TB Management
• 9.1 Treatment of M/XDR-TB (or R resistant TB): Confirmed by
Accredited laboratory should be treated with specialized
regimen.
•
• 9.2 Model of Care for Drug Resistant TB cases: Ambulatory
treatment.
•9.3 Regimen for MDR-TB (or Rifampicin Resistant TB) patients
• At least Pyrazinamide, Ethambutol,Levofloxacin,
Kanamycin/ Amikacin, Ethionamide/Prothionamide, and
Cycloserine or PAS .
30. Standards for TB Care in India
•Standard 10: Addressing TB with HIV Infection and other Co-
morbid Conditions
• 10.1 Treatment of HIV associated TB patients:
• Treatment with Daily regimen.
• 10.2 Anti-retroviral (ART) & Co-trimoxazole prophylactic
therapy (CPT) in TB HIV patients
•10.3 Isoniazid preventive therapy (6-9 month) in HIV patients
without active TB
31. TB and co-morbidities
•Considering closed association of TB and comorbidities it is
recommended that:
• All presumptive TB cases should be screened for HIV(substantiated by
research and recommended by WHO)
• All TB patients should be tested for Diabetes (random blood sugar)
• All HIV infected TB patients should be started on ART irrespective of CD
4 count.
• TB Patients with HIV, first starts with ATT, and then, after 2 weeks start
ART
• All HIV infected TB patients should be given (Co-trimoxazole Prophylactic
Treatment) CPT in order to prevent other opportunistic infection.
32. Standards for TB Care in India
•Standard 11: Treatment Adherence
•11.1 Patient centred approach for adherence
•11.2 Measures for treatment adherence
•11.3 Trained treatment supporter for treatment adherence
• 11.4 Information Communication Technology to promote
treatment literacy & adherence
33. Standards for TB Care in India
•Standard 12: Public Health Responsibility :
•Prescribe an appropriate regimen, ensure adherence
•Standard 13. Notification of TB cases:
•Report all TB cases and their treatment outcomes to public
health authorities. Any patient who is under ATT must be
notified to Govt
•Standard 14: Maintain Records for all TB patients
•.
34. Standards for TB Care in India
•Standard 15: Contact Investigation
• Standard 16: Isoniazid prophylactic therapy: Children <6
years of age who are close contacts of a TB patient, after
excluding active TB, should be treated with isoniazid for a
minimum period of 6 months and should be closely monitored
for TB symptoms
35. Standards for TB Care in India
• Standard 17: Airborne Infection Control:
• Airborne infection control should be an integral part of all
health care facility infection control strategy.
•Standard 18: Quality Assurance Systems
• 18a QA for diagnostic tests
• 18b QA for anti-TB drugs
•Standard 19: Panchayat Raj Institutions
•Standard 20: Health Education
36. Standards for TB Care in India
•Standard 21: Deaths audit among TB patients
•Standard 22: Information on TB Prevention and Care Seeking
•Standard 23: Free and Quality services
•Standard 24: Respect, Confidentiality and Sensitivity
•Standard 25: Care and support through social welfare
programmes
•Standard 26: Addressing counselling and other needs