DR-TB linkages

This pilot project aims to scale up the access and coverage of the presumptive and MDR-TB patients to Universal Drug Susceptibility Test (UDST). Moreover, it aims to build stronger linkages from prioritized high load Designated Microscopic Centres (DMCs) to districts Nucleic Acid Amplification Tests (NAATs) and subsequently develop linkages to centrally placed Intermediately Reference Laboratory (IRL) to address dropoutrates and optimize treatment
Operational Area
The project is operational in six high burden & challenging areas in Telangana namely Hyderabad, Jayashankar,Bhupalapally, Mulugu, Asifabad, Gadwal and Wanaparthy.

Objectives

  • Support the efforts of National Tuberculosis Elimination Programme’s (NTEP)of ensuring optimum & timely coverage of presumptive/identified TB patients by streamlining the sub-optimal linkages between DMCs-NAAT Labs-IRL Lab for access of NAAT, line probe assay (LPA) and Liquid Cultures tests
  • Streamline & strengthen sputum collection & transportation between identified high burden DMCs, NAAT Labs & IRL.
  • Optimize turnaround time from the point of collection of sample to reporting the transmission
  • Minimize the recording and reporting discrepancies at selected DMCs, Cartridge Based Nucleic Acid Amplification Test (CBNAAT) and IRL levels
  • Mitigate the gap existing between the follow up samples and ensure that the follow up samples are retrieved & processed at the stipulated intervals as per the guidelines

Approach

The project adopts an approach of reducing the time gap between the collections of samples and reaching them to the CBNAAT sites of the corresponding districts by using the services of specimen collection & transportation agent (SCT Agent) and local courier agencies for Reports delivery, treatment initiation & Follow up.

Activities

  • Line listing of patients
  • NTEP Sample collection from patients and deposition at DMCs
Muhammad Abid
Delhi
Md. Abid (46 years), from a middle-class family in Delhi, had co-infection of HIV and TB and taken the TB treatment for six months. When the TB symptoms resurfaced after some years, he went to a private hospital for treatment and underwent a CBNAAT test. As he was found to be MDR positive, his report was sent to the DRTB team.
A DRTB coordinator linked him to a government hospital in Shahdara after convinced him about the benefits of undergoing the treatment. As there was no facility to test blood, Abid was sent to another hospital for the test but was denied the test due to his HIV status. The coordinator ensured that the testing was done in another facility and took him to the DOTS supervisor. The coordinator counseled and motivated him to overcome self-stigma, take his HIV drugs regularly and start his MDR TB treatment. Abid is on the path to recovery now.

Expected outcome

  • Increase in the number of presumptive cases reaching NAAT sites for initial molecular screening within 2 days of sample pick up
  • Increase in the number of MDR TB positive cases to have access to LPA tests at IRL within 12 days, from the time of sample pick up to delivery of reports
  • Increase in the number of follow up cases that are subjected to liquid cultures with a turnaround time of 60 days