PMDT structure and roles

PMDT structure and roles

The National TB Elimination Programme (NTEP) in India has established well-organised Drug-resistant TB (DR-TB) management structures at the national, state and district level.

Figure: Diagrammatic representation of the organisational structure of Programmatic Management of DR-TB (PMDT)

Abbr:

NDR-TB: Nodal Drug-resistant TB; NAAT: Nucleic Acid Amplification Test; LPA: Line Probe Assay; CDST: Culture and Drug Sensitivity Test; DDR-TB: District DR-TB

The organisational structure and functions at different levels are described in the table below.

Level

Organisational Structure

Type of Organisation

Function

National-level

Central TB Division (CTD), Ministry of Health and Family Welfare (MoHFW), Government of India (GoI)

Administrative

Providing resources/ devising policies/ issuing guidelines/ monitoring and evaluation/overall administration of the programme

National Technical Expert Group

Advisory

Reviewing evidence Recommendation in guidelines

National Reference Laboratory (NRL)

Operational

Providing laboratory-related expertise, External Quality Assurance (EQA) guidelines, Accreditations, a centre of excellence in diagnostics

State-level

State TB Cell, Health Department

Administrative

Providing resources, implementing guidelines, monitoring and evaluation/ overall administration of the programme

State PMDT Committee

Advisory

Overseeing implementation as per guideline, taking strategic decisions, reviewing the progress in implementation and feedback/ suggestion to NTEP

Nodal DR-TB Committee

Advisory

Guiding treatment of difficult to treat DR-TB cases, reviewing the progress of treatment and Adverse Drug Reaction (ADR) management, providing technical expertise for decisions at the State PMDT Committee, etc.

Intermediate Reference Laboratory (IRL)

Operational

Providing laboratory-related services and expertise at the State level, EQA, and capacity building for diagnostic services

Nodal DR-TB Centres

Operational

Providing treatment services to difficult-to-treat DR-TB cases, a centre of excellence in DR-TB treatment

District-level

District TB Cell

Administrative

Providing resources, implementing guidelines, monitoring and evaluation/ overall administration of the programme

District TB Forum

Advisory

Overseeing implementation as per guideline, reviewing the progress in implementation, facilitating and monitoring the involvement of communities

District Comorbidity Committee

Advisory

Review and rectify TB-comorbidity components with regard to HIV, diabetes, addiction and other review coordination with other health programmes like Rashtriya Bal Swasthya Karyakram (RBSK), Rashtriya Kishorethe Swasthya Karyakram (RKSK), Reproductive Maternal Newborn Child plus Adolescent Health (RMNCH+A) etc.

District DR-TB Committee

Advisory

Guiding treatment of DR-TB cases, reviewing progress of treatment and ADR management, etc.

NAAT/ LPA/ CDST Laboratories

Operational

Providing diagnostic services to detect DR-TB in the district (at more than one district)

District DR-TB Centre

Operational

Providing treatment services to DR TB cases, ADR management etc.

DR-TB services integration into the general health system

Block-level/ Ward-level

Block Medical Officer/ Medical officer in office

Operational

Implementation of guidelines/ monitoring and evaluation of feedback

Health facility-level

Health facility doctor, Master in Public Health Skills (MPHS), Multipurpose Health Worker (MPHW), Accredited Social Health Activist (ASHA)

Operational

Implementation and review

Health & Wellness Centre, Sub-Centre

Community Health Officer (CHO)

Operational

TB screening and community intervention, coordination amongst various health programmes for TB-related activities

Community

ASHA, Panchayati Raj Institutions (PRI), Anganwadi Workers (AWW), other volunteers and community leaders

Operational

Implementation , community engagement through PRI, Village Health and Nutrition Day (VHND) , Community meetings, peer educators/TB champions/adolescent groups and Anganwadi sessions

The organisational structure based on functional roles can be classified into diagnosis, treatment and drugs.

Diagnosis:

Name of Facility

Functions

Health Facility

To identify presumptive cases/collect and transport specimen

To communicate results to patients

Collect and refer follow-up specimen

NAAT Site

Diagnose TB and Rifampicin-resistant (RR) patients at district/ sub-district level

Maintain records for Ni-kshay

Transport the second sample to C&DST lab for First-line Line Probe Assay (FL-LPA) and Second-line Line probe Assay (SL-LPA)

C&DST Lab

Receive diagnosis and follow-up samples

Performs FL-LPA, SL-LPA, Liquid Culture (LC) and LC-DST

Maintain records for Ni-kshay (LIMS)

Provide rapid results to district , field and DR-TB centre

Treatment:

Name of Facility

Functions

Health Facility

Identify treatment supporter

To support and supervise DR-TB patients during treatment

Manage Minor side effects

Refer patients for treatment initiation

District DR-TB Centre

Initiate DR-TB regimen

Manage and record ADR

Consult for complications

Maintain records and Ni-kshay

Coordinated with Nodal DR-TB centre/Field

Monitor DR-TB treatment

Nodal DR-TB Centre

Maintain ward and Airborne Infection Control (AIC)

Undertake pretreatment evaluation and initiate treatment

Manage major ADR

Mentor and supervise concerned DDR-TBC

Drugs:

Name of Facility

Functions

District Drug Store

Coordinate test results.

Refer patients to N/DDR-TBC

Coordinate the drug flow from the district drug store to the field level

Maintain records, Ni-kshay, monitor and supervision

State Drug Store

Prepare and ship drug boxes to the district level

Manage supply chain for diagnostics and drugs

Maintain records in Ni-kshay Aushadhi

Resources

• Guidelines for Programmatic Management of Drug-resistant Tuberculosis in India, NTEP, WHO, MoHFW, GoI, 2021.

Assessment

Question

Answer 1

Answer 2

Answer 3

Answer 4

Correct Answer

Correct Explanation

Page id

Part of Pre-Test

Part of Post-Test

Which of the following is part of the PMDT structure under NTEP?

NACP

NACO

District Comorbidity Committee

None of the above

3

The district comorbidity committee is part of the PMDT district-level structure. The committee reviews and rectifies TB-comorbidity components with regard to HIV, diabetes, addiction and other review coordination with other health programmes like RBSK.

Yes

Yes

The PMDT organisational structure is based on functional roles that can be classified into diagnosis, treatment and drugs.

True

False

1

The PMDT organisational structure is based on functional roles that can be classified into diagnosis, treatment and drugs.

Yes

Yes

LMS Page Link

https://cms.swasth-egurukul.in/en/page-preview/62542

---