6 .2 Assign a Pre-enrollment number to the patient if confirmed to have MDR-TB

When you have finished this exercise, please discuss your answers with a facilitator.

For Treatment Center Staff

Read through until the Summary of important points in the module and tell your facilitator when you have reached that point.

6 .2 Assign a Pre-enrollment No . to the patient if confirmed to have MDR-TB

A patient confirmed to be MDR-TB either by DST or by consilium decision should be put on treatment as soon as possible. However, this does not always happen for various reasons, e.g., the patient may have a) gone back to the province and cannot be located (“early default”), b) died, or c) refused treatment.

It is important to track the waiting time of patients from consultation or screening to diagnosis to the time they are treated as MDR-TB. If this is too long, the Treatment Center will have to review its process of diagnosis and enrolment.

The last column, Column 19, of the TB Symptomatics Masterlist is entitled “Pre-enrollment No.”. Not all patients will be assigned this number. As discussed in section 6.1 above, the Pre-enrollment No. is given only to two groups of patients entered in the TB Symptomatics Masterlist, namely a) those who have been confirmed to be MDR-TB by DST and b) those with consilium decision to treat even if not confirmed to be MDR-TB by DST but highly suspected to be MDR-TB from the clinical standpoint. The latter includes critically ill patients who have either pending culture or DST results and cannot wait for these results to be released and immediate treatment needs to be started. This also includes patients who have negative cultures due to intake of drugs with anti-TB action prior to sputum collection, and those with non-viable or contaminated culture in the laboratory.

If the patient with the Pre-enrollment No. is enrolled, write the treatment start date under the Pre-enrollment No. If the patient is not enrolled, indicate the reason why under the Pre-enrollment No. These reasons can be that the patient is lost or has gone back to the province, the patient has died while waiting for treatment, or has decided not to start the treatment at all for whatever reason, etc.

The Pre-enrollment No. is coded as YY (current year)-NNNN (accrual number which starts with 0001 at the start of every year). For example, a patient bearing the Pre-enrollment No. 08-0329 means that the patient qualified for start of treatment in year 2008 and was the 329th patient to be given a Pre-enrollment number in 2008.

Once a patient with a Pre-enrollment No. is started on treatment, he is entered into the Category IV Register. All patients put on treatment will be entered into the Category IV Register and each one is assigned a unique Category IV Registration No. See Module C: Treat MDR-TB Patients and the Reference Booklet for instructions on how to fill out the Category IV Register.