1 / 22

MDR TB Management in Community LRS Experience

MDR TB Management in Community LRS Experience. LRS INSTITUTE OF TB & RESPIRATORY DISEASES SRI AUROBINDO MARG : NEW DELHI. DOTS-Plus LRS Process. Strengthening Lab Preparing operational guidelines Revising records & Reports Training Ensuring logistics Implementation.

vidor
Download Presentation

MDR TB Management in Community LRS Experience

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. MDR TB Management in CommunityLRS Experience LRS INSTITUTE OF TB & RESPIRATORY DISEASES SRI AUROBINDO MARG : NEW DELHI

  2. DOTS-Plus LRS Process • Strengthening Lab • Preparing operational guidelines • Revising records & Reports • Training • Ensuring logistics • Implementation

  3. DOTS-Plus LRSCase Enrollment • Suspect MDR - Cat II failure • Patient work up • Sputum C/S • 2 consecutive days • If one +ve, correlate with X-ray & Clinical • MDR Case - in vitro RH resistance

  4. DOTS-Plus LRSFlow of Patient Suspect (Cat-II failure) Referred to RNTCP Department Sputum C/S Lab. Informs RNTCP Department of the sensitivity result Non-MDR MDR Cat II DOTS-Plus Repeat C/S at end of I.P. and review

  5. DOTS-Plus LRSManagement Protocol • Informed consent • MDR case registration • Hospitalization • Pretreatment investigations • Treatment initiation under Specialist

  6. DOTS-Plus LRSTreatment Regimen • IP : - Kana, Cyclo, Ethio, PZ, Oflox - 6-9 mths - 3 consecutive monthly spt culture negative • CP : - Cyclo, Ethio, Oflox - Minimum 18 mth after spt. Conv. • Daily DOTS : Evening dose family DOT provider, empty blister Pac next morning

  7. DOTS-Plus LRSTreatment Regimen • Resistance / Toxicity to any drug - replace it with PAS • Capreo replaces Kana • Premature termination - Committee

  8. DOTS-Plus LRSHospitalization • Minimum one month • Linkage with TBHV in field • Health education & social support • Ascertain tolerability to drugs

  9. DOTS-Plus LRSFollow up • Spt. Smear & culture • IP - monthly • CP - every 2 month • 2 samples each time • If 6 months +ve • Continue IP • Repeat Sensitivity • Ensure DOTS • X-ray every 6 months

  10. DOTS-Plus LRSClinical Follow up • Specialist to see • During hospitalization • Switch from IP to CP • To define treatment outcome • Serious adverse reactions • Socio Psychological support at every visit • Clinical Psychologist • MSW • Health Education team

  11. DOTS-Plus LRSDefaulter Action Protocol • TBHV • Same afternoon • Revisit next day • STS visit 3rd day • MOTC visit 4th day • More than one such default - Intensive Health Education at LRS

  12. DOTS-Plus LRSLRS AREA • RNTCP DOTS Plus guidelines • 3 year data analysis (2002-04) • 16 lakh population in South Delhi • 14 peripheral centres • Total patients 58

  13. DOTS-PLUS LRSAge Distribution Age Group

  14. DOTS-Plus LRSResistance Pattern

  15. DOTS-Plus LRSResistance Pattern of S,Z,Em MDR Patients

  16. DOTS-Plus LRSSputum Conversion Cohort 2002-03 (2 year) n = 38

  17. DOTS-Plus LRSTime to Conversion Cohort 2002-03 (2 year) n = 26 %

  18. DOTS-Plus LRSTreatment Outcome 2002 Cohortn = 13

  19. DOTS-Plus LRSIssue Before Treatment • Pre-treatment home address verification • Hospitalization - not patients friendly • Socio economic problem • Need for training • Need for effective linkage between RNTCP and hospital

  20. DOTS-Plus LRSIssue during Treatment • Management of adverse reaction • Medicine storage difficulties • Effective blisters pack counting • Lack of patients complaince

  21. DOTS-Plus LRSOther Issues • Mechanism of supervision and monitoring • Flow of medicine • Monthly quarterly and annual reporting

  22. THANK YOU

More Related