Role of drug-resistant tuberculosis center in improving the treatment outcome in tuberculosis patients

Dear Sir,

Under Indian circumstances, a patient is diagnosed to be suffering from multidrug-resistant tuberculosis (MDR-TB), provided sputum culture is positive for Mycobacterium tuberculosis bacilli and is resistant to isoniazid and rifampicin with or without other anti-TB drugs, presuming that the drug sensitivity test (DST) has been done in a laboratory certified by Revised National TB Control Program (RNTCP). ^[1] Although, the global TB report – 2013 suggest that the incidence of MDR-TB is on the rise, the exact case load is not known owing to the absence of drug resistance surveillance universally. ^[2] To brought about a significant reduction in the number of drug resistant TB cases in the Indian circumstances, the program managers have advocated for implementation of a good quality Directly Observed Treatment program. ^[3]

Research findings have revealed that multiple potential determinants (viz. duration of therapy, individual susceptibility, adverse drug reactions, family support, etc.) eventually determine the final treatment outcome. ^[4],[5] On account of longer treatment duration, infrastructure constraints, and need of periodic follow-up throughout the course of treatment, the program advocates for decentralization of treatment. ^[1] However, decentralization has its own associated challenges as it requires continuous monitoring & supervision to meet with the needs of the patients. Thus, an expert resource center called as Drug-resistant TB (DR-TB) center has been established in Indian settings to cater a wide range of services to ten million population. ^[1] These centers have been instituted within the premises of a government medical college hospital. ^[1],[2]

The functioning of the DR-TB center is executed through a DR-TB center committee, which generally comprises of a Chairperson – Medical Superintendent / Director of the institute; Vice-chairperson – Head of respiratory medicine / general medicine department; Nodal officer; Medical officer of the DR-TB center; Clinicians – Heads of Psychiatry / Gynecology / ENT / Microbiology; one pulmonologist from NGO / private sector; and local program managers. ^[1]

The DR-TB center has a defining role in the management of drug resistant forms of TB, namely in conducting pre-treatment evaluation (viz. a thorough clinical / laboratory evaluation by a team of doctors to ensure suitability of different patients with the line of management); initiation of treatment; maintenance of hospital wards; implementation of airborne infection control measures; management of severe adverse drug reactions; free laboratory investigations; alterations in the line of management during the course of treatment; shifting patient from intensive phase to continuation phase; transfer-in and transfer-out of patients; management of records; and outcome declaration. ^[1],[3]

In conclusion, the DR-TB center plays a crucial role in not only ensuring the best possible outcome for drug resistant patients started on treatment, but even acts as a resource center for providing timely guidance to the program managers.

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1755-6783.145046