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To achieve high treatment completion rates and the desired epidemiological impact of the TB Preventive Treatment (TPT), monitoring TPT treatment adherence, including management of missed doses and Adverse Drug Reactions (ADRs), is of paramount importance under the National TB Elimination Programme (NTEP).

 

Significance of Monitoring Adherence to TPT

Adherence to the TPT course and treatment completion are important determinants of clinical benefit, both at the individual and population levels as:

  • Irregular or inadequate treatment reduces the protective efficacy of the TPT regimen.
  • Poor adherence or early cessation of TPT can potentially increase the risk of the individual developing TB, including drug-resistant TB.
  • Efficacy of TPT is greatest if at least 80% of the doses are taken within the duration of the regimen. The total number of doses taken is also a key determinant of the extent of TB prevention.

 

                                                            Figure: Strategies to Promote Adherence

 

Prevent TB India App and Integration with Nikshay as a Monitoring Tool

  • Currently, under the NTEP, the person’s lifecycle approach and TB treatment episode level are recorded in Nikshay.
  • TPT information management is integrated with this existing Nikshay approach. This includes information on screening, testing, eligibility assessment, TPT initiation, adherence monitoring and follow-up till treatment completion.
  • The NTEP has adapted the World Health Organisation (WHO) Prevent TB India app and hosted it on Nikshay as an interim solution till the Nikshay TPT module is developed and fully functional.
  • Health workers or treatment supporters will make entries directly into the app.
  • The TPT monitoring dashboard can be accessed by various levels of supervisors using their respective Nikshay login ids using a link provided in the Nikshay Reports section on TPT Reports.
  • A web-based comprehensive dashboard for Prevent TB initiative is also available at https://ltbi.nikshay.in/ltbi-generic-new/#/ 

 

Table: Roles of Stakeholders in Monitoring Adherence to TPT
Role Stakeholder
Treatment support and adherence monitoring including entry of daily doses taken in the Prevent TB India app/ Nikshay TPT module. Community volunteers (TB survivors/ champions, Accredited Social Health Activists (ASHAs) and Anganwadi Workers)
  • Regularly undertake home visits or tele/ video calls to monitor TPT adherence.
  • Identify treatment interruptions at the earliest (Dashboards of Prevent TB India app/ Nikshay TPT module may be checked every week along with pill counting).
  1. HWCs/ sub-centre/ urban health posts (Community Health Officers (CHOs), Auxillary Nurse Midwives (ANMs), multipurpose workers and other field staff)
  2. Primary Health Centres (PHCs)/ Urban PHCs/ Private clinic (Medical Officers (MO), staff nurse)
  • Adherence support and clinical monitoring through the concerned PHC/ sub-centre.
  • Supportive supervision and handholding support to field level facilities and frontline workers, ASHAs and community volunteers on digital recording, using Prevent TB India app and monitoring TPT and follow-up examinations.
 TB Unit (MO, Laboratory Technicians (LTs), staff nurse, pharmacist, counsellor (if available), Senior Treatment Supervisors (STS), Senior TB Laboroary Supervisors (STLS), TB Health Visitors (TBHV))
Ensuring adherence support for People Living with HIV (PLHIV) on TPT through mechanisms such as outreach workers, PLHIV networks, peer support groups, etc. Anti Retroviral Therapy (ART) centre/ Link ART centre (MO, pharmacist, (institutional) staff nurse, counsellor, care coordinator)
Monitor and support adherence to TPT. Tertiary care/ Medical colleges/ Corporate hospitals/ District hospitals/ Dialysis/ Cancer facilities (doctors, staff nurses)
Review data updating in Prevent TB India app/ Nikshay TPT module wherever available, check the quality of data regularly and provide feedback to TPT treatment supporters and for retrieval of TPT interrupters. Supervisory staff at all health facilities including the State/ District TB cell (State TB Officers (STO), District TB Officers (DTO), State/ District Programme Coordinators)

 

Resources:

 

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 tools are used to monitor TPT adherence under the NTEP? Video calls Counting empty blisters Directly asking the patient Options 1 and 2 4 TPT adherence monitoring tools include direct observation of drug intake, 99DOTS/ MERM, counting empty blisters, tele/ video calls and refill monitoring. ​    
Which of the following apps are currently used by NTEP to monitor TPT adherence? TB Aarogya Sathi Prevent TB India App TPT app for NTEP None of the above 2 NTEP has adapted the WHO Prevent TB India app and hosted it on Nikshay to monitor the entire TPT care cascade, including TPT adherence.      

 

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