MODULE C
All MDR-TB patients should have: • • • • •
DSSM: monthly until treatment is completed. Culture: monthly during the intensive phase and every two months during the continuation phase or when needed. DST: every 4 months while culture-positive when amplification is suspected. Chest x-ray: every 6 months. Blood chemistries: every 6 months for patients younger than 50 years; every 3 months for patients 50 years and older.
Since there is no pre-established duration for MDR-TB regimens because the time for conversion is not predictable the schedules for DST, chest x-rays and blood chemistries must be monitored throughout treatment.
4.6 Implement treatment decisions Meet with the patient to explain the results of the follow-up examinations and the next step of treatment.
4.6.1 Decentralize patient to a Treatment Site •
Explain to the patient who has culture converted followed by at least 2 negative smears that the treatment is progressing well, inform the patient that he is eligible to receive treatment at his/her local DOTS facility as soon as other criteria for decentralization are met. A detailed explanation of the steps to decentralize a patient can be found in Module E: Ensure Continuation of MDR-TB Treatment.
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Congratulate the patient, however, explain that there are still a number of months to continue and emphasize the importance of continuing the treatment.
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Explain to the patient about the process of decentralization, and that the care will remain the same, the patient will be able to go to a Treatment Site in his community, and that every month it will still be necessary for him to come to the Treatment Center for treatment and follow-up. The possibility for Treatment Site staff or a barangay health worker to supervise treatment on Saturdays will be discussed during initial endorsement.
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Reiterate to the patient the importance of the PMDT Patient’s Booklet. This will serve as a link between the Treatment Center and the Treatment Site. This must be available and carried by the patient at all times while he is receiving treatment.
4.6.2 Shift the patient to continuation phase of treatment •
Explain to the patient who has had a negative culture result for 4 consecutive months from the beginning of treatment and has received an injectable agent for at least 6 months that the treatment has worked well. He is no longer infectious and is ready to begin the next phase of treatment. Congratulate the patient, but explain that there are still a number of months to continue and the importance of continuing the treatment.
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Be sure that the patient finishes all doses of the intensive phase drugs, and then start the patient on continuation phase. The continuation phase will not include the injectable agent, unless there are no other treatment options.
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Explain to the patient about the continuation phase of treatment, including that the injection will no longer be given, the schedule, and how long this treatment phase will last.
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Begin giving the patient the continuation phase of treatment, marking the Category IV Treatment Card each time that you administer the drugs as you did during the intensive phase.
4.6.3 If the patient is at risk of treatment failure Patients who do not show signs of improvement after four months of treatment are at risk for treatment failure. All patients who do not culture convert, clinically improve, or have reappearance of disease after month 4 of treatment, should be considered high-risk for treatment failure. •
A review of the Category IV Treatment Card should be done to confirm that the patient has adhered to treatment and that the treatment has been adequately supervised.
104 Treat MDR-TB Patients
