15.1 Selecting a treatment supporter
The treatment supporter should be someone who:
– Is preferably selected from existing community health workers or other persons with health background;
– Is acceptable to the patient and his/her family;
– Can observe confidentiality of the patient;
– Has a stable living situation;
– Has basic literacy skills (is able to read and write, has basic numeracy skills);
– Is motivated to care for MDR-TB patients;
– Lives near the patient and is able to make twice-daily DOT visits if indicated and to come to the house immediately in case of emergencies;
– Is committed to support the patient for the full length of treatment;
– Should not be immune-suppressed1 and is in good physical condition;
– Has received basic TB training and DR-TB specific training.
It is not recommended to have family members as treatment supporters. The family relationship may interfere with the ability to monitor MDR-TB treatment.
For children, preferably female DR-TB supporters are recommended; the parents or family members are not especially not appropriate to supervise doses.
15.2 Roles and responsibilities
– Supervises all doses of drugs and keep records on MDR-TB treatment card.
– Detects adverse effects and promptly refers the patient to health facility when necessary.
– Accompanies the patient to all medical consultation.
– Collects and transports monitoring sputum specimens for smear and culture.
– Provides information on the risk of transmission and the infection control measures at home.
– Performs contact tracing.
– Attends refresher trainings.
The most common cause of immunosuppression is HIV/AIDS, but chronic illnesses such as diabetes also alter the immune system and are a risk factor for TB infection and disease.