G: Monthly follow-up visit to the Treatment Center physician

Annex G

Monthly follow-up visit to the Treatment Center physician (Summary for clinicians)

The Treatment Center physician conducts monthly clinical evaluation of MDR-TB patients to monitor progress. This visit of the MDR-TB patient to the clinician is routinely done monthly but should also be done even out of schedule on occasions when there are uncontrolled adverse drug reactions, reconversion to positive smear for patients who have been decentralized, and if there are co-morbid illnesses that need attention. Depending on the condition, either the patient is treated at the Treatment Center or referred to a specialist or hospital. This visit should include the steps below.

Assess the patient’s general condition. If the patient has difficulty breathing or is acutely ill, first assess and

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y classify the illness. Refer if necessary for serious conditions. Treat the acute illness, if mild.

Weigh the patient.

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y

y

y

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y Review the drugs that the patient is taking. Examine the patient’s Category IV Treatment Card and ask the patient about the drugs actually taken. Ask about symptoms and side effects. If the patient is experiencing side effects, manage them appropriately. This may include reassuring a patient who has minor side effects. Reinforce important information on MDR-TB and its treatment. Encourage the patient to ask questions. Answer any questions the patient may have about the disease or treatment and discuss any fears or concerns.

Review the results of any recent sputum examinations or other tests. Explain it to the patient in simple terms. If any change in treatment is needed either due to an uncontrolled adverse reaction or a change in the DST pattern, change the regimen at once and schedule the case to be presented in the next consilium. If however, there is uncertainty about what regimen to give, and the change is not urgently needed, present it first in the consilium prior to making any modification. Explain the change to the patient.

Assess whether the patient is improving. If the patient has weight loss, other signs of disease, or poor clinical progress, consider other causes (such as HIV) and give appropriate treatment or refer if needed.

Be familiar with the most frequently associated diseases and other problems of patients with TB and MDR-TB in the area and how to manage them. In an area of high HIV prevalence, the initial medical history should obtain information to assess HIV risk factors. If a patient is known to be HIV-positive, give the necessary support including referral to an HIV clinic and other additional support. Follow-up to identify and treat opportunistic infections. The possible impact of HIV on MDR-TB treatment includes delayed sputum smear and culture conversion, increased mortality, and drug side-effects.

Motivate the patient to take the treatment regularly. Praise the patient for successfully taking the treatment so far, and give the patient support for continuing the treatment. Do not blame the patient when there are problems with adherence. This can discourage patients and cause default. One of the biggest problems in MDRTB control is the negative attitude of health workers toward patients. If there are any problems with continuing the treatment, work with the patient to overcome the problems.