Summary of important points

Health workers should keep in mind that all previously treated patients, as well as non-converters of Category II, symptomatic contacts of MDR-TB, and HIV-positive patients with symptoms of TB, are considered MDR-TB suspects.

Any person in these high-risk groups for MDR-TB should be immediately referred to the appropriate Treatment Center using the MDR-TB Suspects Referral Form for screening and diagnosis.

At the Treatment Center, screen every MDR-TB suspect and fill out an MDR-TB Screening Form. This includes a physical examination by a physician and his preliminary diagnosis and plans for further diagnosis and/or treatment. Be sure to write down the complete name and complete address of every MDR-TB suspect in the TB Symptomatics Masterlist, so that the TB suspect can be located once the results of the various tests show that the patient has TB and in case the TB suspect does not return. Inform the MDR-TB suspect about the process and discuss the Paunawa or Terms of Understanding with him to

continue the diagnosis.

Collect two sputum samples from every MDR-TB suspect for diagnosis. Use the Mycobacteriology Request Form and the Laboratory Receiving Form for Specimens to request for sputum examinations and to send the samples to the corresponding Culture Center. When the results of the smear, culture and DST are received from the laboratory, record the results in the TB Symptomatics Masterlist.

All specimens will be cultured at the Culture Center automatically regardless of the smear result. If culture results are positive, the culture isolate will be sent for DST to a DST Center If the culture results are negative, the treatment center Physician may refer the patient to the Consilium for clinical assessment on whether or not sputum should be recollected or empiric treatment should be given. If the DST shows that the DR-TB suspect has confirmed MDR, the patient will be assigned a Pre-enrollment No. by the Treatment Center. Likewise, a patient not confirmed to be MDR-TB by DST but highly suspected to be MDR and decided by the Consilium to start treatment will be assigned a Pre-enrollment No. by the Treatment Center.

A patient who has confirmed drug resistance or MDR-TB or those decided by the Consilium to be started on treatment must be informed immediately. If he does not call or visit the Center, locate this patient as soon as possible. Assign a Pre-enrollment No.

Present MDR-TB cases confirmed by DST to the Consilium to be able to start treatment immediately to prevent the spread of the disease to others in the household and community and to improve the condition of the patient. Assign a Pre-enrollment No.

Present also to the Consilium cases highly suspected to be MDR-TB even without DST confirmation as not all patients can wait for DST results and there are some culture-negative patients who deserve Category IV treatment.

A patient who is started on treatment is entered into the Category IV Register and is assigned a Category IV

Registration No.

Ask patients with confirmed drug resistance to bring to the DOTS facility all his contacts for interview of symptoms.

The following household contacts will be checked for TB and MDR-TB –

Children less than five years regardless of symptoms

Those five years and above who have cough for more than 2 weeks