Treatment Support Plan

In order to achieve TB treatment success, a good treatment support plan for the patients is essential.  The National TB Elimination Programme (NTEP) recommends developing a treatment support plan for each patient at the time of treatment initiation. A holistic Treatment Support Plan (TSP) must include the following:
 

1) Treatment Supporter (TS) for each patient

• A Treatment Supporter (TS) who is acceptable and accessible to the patient and accountable to the health system (healthcare worker/ community volunteer/ private practitioner/ family member) identified in mutual consultation with the patient and provider during pre-treatment evaluation. 
• The assigned TS should be able to receive training on drug administration, adherence monitoring, Adverse Drug Reaction (ADR) referrals etc., and perform these functions.
   

2) Periodic review of patient’s treatment

• Treatment Initiation counselling and monthly or need-based (in high TB prevalence areas) follow-up counselling to all TB patients and their family members must be included through staff who have expertise in the same, to address both bio-medical and psycho-social issues that could impact treatment.
• The TSP must also include a protocol for the field monitoring staff to capture each instance of treatment interruption and Adverse Drug Reactions, so that they can be effectively addressed before the patient turns lost to follow-up.

3) Psychosocial Support to TB patients and their families

• Counselling to the patients experiencing stigma, discrimination, marital/family discords, substance users etc. by the trained staff, and appropriate referrals for psychiatric ,de-addiction support etc. should be offered whenever required.
• The focus should be on observing, identifying and capturing above mentioned factors during treatment initiation as well as in each follow up visit.
• Home visit follow ups with consent from the patients must also be included in the TSP which may allow for better understanding and management of psycho-social issues.
• As an extension of TSP, community engagement activities which includes key persons such as politicians, religious leaders, self-help groups, TB champions etc by the TB staff is recommended to raise awareness and sensitise the communities about TB and also articulate a whole-of-society approach to ending TB.
   

4) Referral linkages for needy TB patients - to central and state government’s various social welfare and protection schemes and additional nutrition support services

• With the aim to eliminate catastrophic expenditure due to TB, the Government of India (GoI) has insisted on linking TB patients and households to the applicable government social welfare and protection schemes.
• The treatment supporters and the health systems staff who are in regular contact with the patients (Senior Treatment Supervisors, TB Health Visitors, District Programme Supervisors) should be trained in referral linkages so as to enable further support to the patients and their family members to avail the benefits under schemes.
• The GoI has rolled out a Direct Beneficiary Transfer (DBT) mechanism to support TB patients' nutrition (Ni-kshay Poshan Yojana) and travel during treatment whereas several state governments have also initiated certain state-specific schemes for TB patients across the country.
• Further as a part of patients treatment support, the GoI has initiated the ‘Nikshay Mitra’ campaign under the ‘Pradhan Mantri TB Mukth Bharat Abhiyan’ where in persons/companies/societies can adopt an entire block/ward to provide nutrition support to TB patients for a specific treatment period.
   

5) Treatment Completion Counselling

The TSP must include an end of treatment counselling for all patients, on the importance of post treatment follow ups and holistic self-care approach for leading an overall healthy life and also the ability to focus on life after TB treatment completion.

Resource

• Training Modules (1-4) for Programme Managers & Medical Officers, NTEP, 2020.
• National Strategic Plan for Tuberculosis Elimination 2017-2025, RNTCP, 2017.
• Pradhan Mantri TB Mukt Bharat Abhiyaan - Guidance Document,  CTD, India, 2022.

Assessment