Referral mechanisms for DR-TB services
DR-TB referral mechanisms ensure timely evaluation and treatment. Suspected cases identified via screening are referred to designated centers for pre-treatment. Complex cases may be referred to specialized Nodal centers.
Referral mechanisms for DR-TB services
Presumptive Drug-resistant TB (DR-TB) is identified by the health facility doctor during passive screening or by health staff/community volunteers during Active Case Finding (ACF).
Prompt referral and sample collection is an important step after identifying presumptive TB/DR-TB.
After detection, referrals should be made promptly by the Community Health Officer (CHO) at Health and Wellness Centre (HWC)/Senior Treatment Supervisor (STS)/Tuberculosis Health Visitor (TBHV) to the health facility or Nodal/District DR-TB Centre (N/DDR-TBC) for pre-treatment evaluation and treatment initiation. Every district has a DDR-TBC for the treatment of DR-TB cases. However, for complicated DR-TB cases that need either super-specialty or complex medical equipment and intensive care (like invasive ventilators), such patients are referred to Nodal DDR-TBCs.
Referral linkages for further domiciliary treatment are to be ensured by the health facility doctor, N/DDR-TBC, senior DR-TB TB-HIV supervisor, STS, TBHV, CHO, and general health staff.
Identification of suitable treatment supporters by CHO/STS/TBHV is essential, and the periodic follow-up of clinical/bacteriological examination is to be managed.
The cascade of referral mechanisms and the function of various stakeholders is described below.
Figure: Cascade of referral mechanism and function of various stakeholders;
Source: Guidelines for Programmatic Management of Drug-resistant Tuberculosis in India, NTEP, CTD, WHO, MoHFW, 2021, p48.
Resources
- Guidelines for Programmatic Management of Drug-resistant Tuberculosis in India, NTEP, CTD, WHO, MoHFW, 2021.
Assessment
Question 1: The patients are referred to N/DDR-TBC for pre-treatment evaluation.
- True
- False
Correct Answer: True
Question 2: After detection of DR-TB, referrals should be made promptly by the CHO at HWC/STS/TBHV to the health facility or N/DDR-TBC.
- Yes
- Yes
Question 3: Who ensures referral linkages for domiciliary treatment of patients?
- Senior DR-TB coordinator
- TB Health Visitor
- Community health officers
- All of the above
Correct Answer: All of the above
Correct Explanation: Referral linkages for domiciliary treatment are to be ensured by the health facility doctor, N/DDR-TBC, senior DR-TB coordinator, TB-HIV supervisor, STS, TBHV, CHO and general health staff.