In this module we will learn about
Key Messages for TB Patients
When a TB patient has been diagnosed, the doctor should provide the patient with key messages about the diagnosis and treatment of TB.
The DOTS Facilitator will supplement this information by providing more information about TB, its spread, treatment and follow up.
Following are the key messages:
- Tuberculosis is curable
- TB medicines are provided free of cost
- Patient should take medicines regularly for 8 months
- Free of cost TB drugs will be provided at treatment center near to your residence.
- Show him the tablets and explain the number of each tablet to take daily.
- Do not get worried if your urine is orange coloured.
- Must report to treatment center, if any complaint with intake of drugs.
- TB bacilli spread through droplet infection when the patient is coughing or sneezing, therefore the patient should cover the mouth at the time of coughing or sneezing.
- Encourage the patient to safely dispose of the coughed out sputum
- TB does not spread through utensils, clothes or sexual relations
- Visit this center at completion of 2/3 months of treatment. Bring sputum for
examination. Your progress will be assessed & further treatment will be advised accordingly.
- Nursing mother can feed their baby.
- Do not spit where others are sitting
- TB Patients should go for HIV screening.
- Take guidance for nutrition.
Explaining “DOT” to the Patient
Directly observed treatment (DOT) is important to ensure daily intake of medicine. It is very important to explain the importance of “direct observation” to the patient and help the patient to identify an acceptable and accessible means of supervising his/her treatment.
Direct observation is required for all patients taking Rifampicin.
- Directly Observed treatment is important because TB patients may fail to comply with the treatment due to prolonged duration or forget to take medicine especially when they start feeling well. Treatment supporters are helpful in encouraging patients to take the recommended drug, dose and duration and therefore increase the chance of curing the patient.
- It is important to make sure the patient appreciates the need to identify a person who can support him/her to complete treatment without interruptions.
- Observed treatment is required for intensive phase of Cat 1 and entire duration of treatment in Cat 2 to avoid the risk of drug resistance.
Managing Household Contacts
All household contacts (children below 5 years age and symptomatic adults) should be screened and managed according to the NTP case management guidelines.
After interviewing the patient, the DOTS facilitator should take a decision based on the following two points:
- All children less than 5 years of age should be brought to the diagnostic center for further assessment and management. They can be tested with PPD if available.
No TB symptoms
If not given
H/O cough, fever and or weight loss
Reff: to child specialist
Child with beast fed by smear positive mother
- treat mother
- continue breast feed
- give BCG
- Adults and children (older than 5 years of age) with symptoms suggestive of
tuberculosis i.e. cough > three weeks, weight loss, fever etc. should be asked to visit the diagnostic center at their earliest convenient date.
(cough >2 weeks or other TB symptoms
Arrange for sputum microscopy
Tuberculosis & Tobacco
A strong association
Smoking substantially increases the risk of tuberculosis (TB) and death from TB.
- More than 20% of global TB incidence may be attributable to smoking.
- Controlling the tobacco epidemic will help control the TB epidemic.
- Smoking is a risk factor for TB, independent of alcohol use and other socioeconomic risk factors.
- Smoking increases the risk of TB disease by more than two-and-a-half times.
What can we do as doctors involved in diagnosing and treating TB patients?
- First of all TB DOCTOR SHOULD NOT USE TOBACCO in any form AND ACT AS A ROLE MODEL FOR HIS PATIENTS.
- Doctor should take a Tobacco use history and document it on TB card.
- Doctor should give a strong advice to all tobacco users to quit.
- Remember 5As and 5Rs
Patient oriented actions
The 5 ‘A’s
- ASK TB patients about their tobacco use
- Advise them to quit
- Assess their willingness to attempt to quit
- Assist in their attempt to quit
- Arrange follow up with them
Relevance: ensure TB patients know their treatment will be more effective if they quit smoking.
- Risks: point out all the risks of continuing to smoke including the risk of TB relapses.
- Rewards: educate the TB patient about the many other benefits of quitting smoking.
- Roadblocks: ask the TB patient to identify obstacles to quitting smoking.
- Repetition: continue to encourage the TB patient to quit smoking.