Answers to self-assessment questions

1. The following groups are considered high risk for MDR-TB and should be referred for testing at a Treatment Center

Retreatment cases 1. Failure - Category I failure - Category II failure (chronic TB case)

2. Relapse of category I or II

3. Return after default

4.

5. “Other” type of patients: a) Non-DOTS patients b) “Other –positive” c) “Other-negative”

Non-converters of category II

New or retreatment cases

6.

7. Symptomatic contacts of a drug-resistant case

HIV-positive patients who have pulmonary or extra-pulmonary TB symptoms or have chest x-ray findings suggestive of TB

2. Two samples are needed. They are collected as follows: • First sample (spot sputum specimen): on Day 1 at the Treatment Center. • Second sample (early morning sputum specimen): on Day 2 at the MDR-TB suspect’s home, first thing after waking.

3. The MDR-TB Screening Form is an individual form for each MDR-TB suspect that holds a large amount of background information about the patient. The TB Symptomatics Masterlist is a record of all TB suspects, including TB and MDR-TB suspects seen at the MDR-TB Treatment Center.

4. Screening Code, date of screening, complete name and address, age, date of birth, and sex, no. of previous

TB treatment, source of referral (site or doctor), site where last treated for TB, registration group, risk factors, symptoms, chest x-ray results (if available)

5. Smear, Culture and DST –

Clinically deteriorating patients may need to be started on treatment urgently before the DST results are available or they will be at risk of dying. These patients should be identified by the physician, and their cases presented to the

Consilium immediately.

6. If an MDR-TB suspect’s DST results show resistance to H, R and E, the Consiliumex should be completed to present the case to the Consilium in order to make a decision about treatment.

7. Inform the patient clearly and in a sensitive way. It is important to inform the MDR-TB suspect as soon as possible about drug resistance and the next steps that will be taken to start treatment.

8. The physician must present the case to the Consilium immediately. Either the culture needs to be repeated or empiric treatment needs to be started.

9. All efforts should be made to contact or locate the person. Call the patient or his contacts within the week. You may ask the referring DOTS facility to help locate the patient. This may require you to visit the patient’s address recorded in the TB Symptomatics Masterlist.

Patients with MDR-TB who are left untreated can infect many others with MDR-TB and delays in treatment can lead to worse treatment outcomes.

10. If possible, all household contacts of a confirmed MDR-TB patient should be interviewed at the Treatment center for symptoms of TB. All those with symptoms regardless of age, and all children less than five years even without symptoms should be evaluated by a physician by history and physical examination. For all ages with cough of more than two weeks, sputum smear and culture will be done.

End of Module B

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