Drug Resistant (DR) TB : TRAINING MANUAL for medical doctor is developed to facilitate the capacity building of medical doctors and other health care workers on DR TB management at the service delivery sites.
The National TB program is focused on enhancing the detection, care and treatment outcomes of TB patients through the provision of high-quality TB services and by strengthening the healthcare system to ensure universal access to quality TB care.
To ensure that medical professionals have the necessary knowledge and skills to effectively manage TB patients, it is essential that quality training is provided.
The training manual divided into 10 modules with case studies, self-assessment questionnaire, and relevant exercises. It is intended to be used as a reference material for providing quality DR TB services at service delivery sites.
Objectives
At the end of the training, the participants will be able to
- Describe the global and Nepal-specific situation of DR TB epidemic, END TB strategy and National Strategic plan (NSP), 2021/22 – 2025/26. n Define DR TB, identify types and explain the causes of drug resistance and role of different levels in PMDT.
- Explain diagnostic tests for DR TB, sputum specimen collection and transportation and diagnostic algorithms for DR TB
- List different types of DR TB treatment regimen, drugs and explain the principles for treating
MDR/RR-TB cases n Initiate the most appropriate regimen promptly, perform clinical and laboratory assessments per national guidelines, and optimize case management.
- Monitor the follow up and treatment of DR TB patients and learn about aDSM.
- Manage the DR-TB patients with comorbidities and in special situation.
- Apply good IPC practices in his/her workplace, promote treatment adherence of patients by education and counseling sessions as well as provision of (available) social economic support. n Record and Report PMDT data per national guidelines.
Target Audience: This is a 3-day training program with site visits (DR TB treatment centers and Reference laboratories) designed for medical doctors and other healthcare professionals who are involved in the treatment, care, and management of DR TB patients.
Type of Drug Resistant TB (DR TB) based on drug resistance
Based on drug susceptibility testing (DST) of clinical isolates confirmed to be M. tuberculosis, DR TB patients are classified into below category:
- Monoresistance: resistance to one first-line anti-TB drug only
- Polydrug resistance: resistance to more than one first-line anti-TB drug (other than both isoniazid and rifampicin)
- Isoniazid Resistant TB (Hr-TB): TB disease caused by a strain of M. tuberculosis complex that is resistant to isoniazid but susceptible to Rifampicin
- Rifampicin resistant (RR TB): TB caused by M. tuberculosis strains that is resistant to
Rifampicin. Refers to either multidrug-resistant TB (MDR TB) or Rifampicin Resistant TB (RR-TB) n Multidrug resistant (MDR TB): resistance to at least both isoniazid and rifampicin n Pre-Extensively Drug-Resistant TB (Pre-XDR TB): TB disease caused by a strain of M. tuberculosis complex that is resistant to rifampicin (and may also be resistant to isoniazid), and that is also resistant to at least one fluoroquinolone (either levofloxacin or moxifloxacin)
- Extensively Drug-Resistant TB (XDR TB): TB disease caused by a strain of M. tuberculosis complex that is resistant to rifampicin (and may also be resistant to isoniazid), and that is also resistant to at least one fluoroquinolone (levofloxacin or moxifloxacin) and to at least one other “Group A” drug (Bedaquiline or Linezolid)
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