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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.

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MDR TB Management in Community LRS Experience

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  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

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