4 .6 .6 If a patient’s DST results have changed from baseline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 4 .6 .7 Initiate counseling for possible treatment failure before terminating treatment

4 .6 .6 If a patient’s DST results have changed from baseline

Explain to the patient that the laboratory results mean that the drugs may not be effective in killing the TB bacilli. The patient will have to see a Treatment Center physician for a physical exam and for a possible change in the treatment regimen. The Treatment Center physician will present the case again to the Consilium for possible regimen change after: • Conducting a physical exam and assessing the progress of the patient. • Reviewing the treatment regimen in relation to medical history, previous treatment, contacts and all previous DST reports. Continue to give supervised treatment to the patient with the prescribed regimen until a decision has been made to change it. If the Consilium recommends a regimen change, request new drugs and discontinue other drugs; and retrieve drugs from the Treatment Site. (See module F: Manage Drugs and Supplies for MDR-TB) Depending on the progress of the patient and his physical state and needs, refer the patient to the psychosocial team at the Treatment Center.

4 .6 .7 Initiate counseling for possible treatment failure before terminating treatment

For patients who are considered to have failed outcome, Treatment Center staff should initiate counseling and provide moral support through a psychologist or psychosocial team before terminating treatment. This can be devastating to a patient and must be handled with utmost caution and good timing.

Now do Exercise D – Written Exercise and Individual Feedback

When you have reached this point in the module, read and follow the instructions for Exercise D. When you have finished the exercise, review your answers with a facilitator.