20. Recording and Reporting

This card is issued and completed for every patient after being diagnosed with TB. The medical officer or relevant staff e.g., PO, TLCA fill-up the Tuberculosis Treatment Card as soon as a patient is diagnosed with TB. It contains information about the TB patient’s details (name, age, sex, address, and contact details), the patient’s diagnostic classifications, results of initial and follow-up sputum-smear examinations, treatment regimen, medicine doses, initial and follow-up body weight, HIV status, and medicine collection data. There is a special box for paediatric TB cases and the drug doses of child TB should be filled up in the box accordingly. If during the course of treatment, the dosages (number of FDC tablets) change due to changes in the weight band (due to weight gain or loss), the revised number of tablets should be documented underneath the boxes preceded by the date of change.

The original card should be kept at the health facility where the patient is registered and duplicate is sent to the treatment centre from where the patient received DOTS. This card needs to be updated on a daily basis and in real time to correctly reflect the medicine intake of the patient. The DOT provider should mark each and every dose in the designated spaces in the Tuberculosis Treatment Card. Once every fortnight, the original treatment card needs to be updated with the information recorded on the duplicate card. This card updating takes place during supervisory visits and while the provider visits the registering health facility for collection of medicines.

The medical officer or relevant staff e.g., PO, TLCA, prepare this card for each and every TB patient at diagnosis. This card has to be safely retained by the patient. The most important information recorded on this card are the date of treatment initiation and the categorization of the patient. The patient should be instructed to carry this card each time s/he attends the health facility to avail any TB related services (follow up visits, visits to address possible ADRs etc.). The patient should be advised to safely retain this card after completing treatment for future reference.

This register is kept at the TB treatment facility. The Tuberculosis Register contains all the important general information of the patient, classification of the disease, and type of patient, date of start of treatment, X-ray results, smear microscopy results, Xpert MTB/RIF results, histopathology results and the treatment outcome. This register should be updated regularly according to the Tuberculosis Treatment Card of the patient.

The date of registration is the date the patient is registered in the Tuberculosis Register. This date may be different from the date the patient was diagnosed in the laboratory or started treatment. Space should be kept blank at the end of each quarter to highlight the end of the quarterly cohort. This will facilitate preparation of the quarterly reports and cohort analysis of treatment outcome. At the end of the quarter, a tally can be made by age, sex (males and female patients), disease classification, type of patient or treatment outcome. Each quarter should be started on a new page. From this register the quarterly reports on case notification, case detection and treatment outcome will be compiled. The information in the TB Register also entered in the electronic TB register. At every opportunity the electronic register should be updated and regular reports generated from it for programmatic use. On the regular basis, the paper-based registers and the electronic register should be compared to ensure concordance. It is the responsibility of the staff that maintains the register to keep it up-to-date.

The purpose of the register is to record all relevant details of each and every test performed in a TB Laboratory. This helps in ensuring that all presumptive TB cases have the correct diagnostic test requested and performed, and the test results recorded. The Tuberculosis Laboratory register is kept at all laboratories performing sputum examination for AFB and Xpert MTB/RIF. The microscopist or medical technologist lab who examines the smears, enters all information into the register.

The register gives information on the number of presumptive TB cases examined, the number of bacteriologically confirmed TB cases detected and the number and results of follow up smear examinations. It also gives information on the number of Xpert MTB/RIF positive cases detected (if available).

A Laboratory Serial number is assigned to each patient who has been referred for sputum examination and it starts with 1 at the beginning of each calendar year. Some blank space should be left at the end of each quarter in the register. At the end of each quarter, the following information should be recorded (1) number of presumptive TB cases (2) number of total smears examined (3) number of smear-positive patients diagnosed (4) number of follow up smears examined and (5) number of positives among the follow up smears examined. Source of referral (referred by) also needs to be documented. Each quarter will start on a new page but the serial number will continue throughout the year.

The medical officer or relevant staff e.g., PO, TLCA, paramedic who requests the smear/Xpert MTB/RIF examinations should fill up this form. If the smears are examined at the facility where the patient attends, the form should be brought to the laboratory with the first "on-the-spot" specimen. The patient should be given a sputum cup for the early morning specimen. If smears are examined at another facility, the two smears/samples with the filled-in request form should be brought to the examining laboratory.

It is essential to indicate whether the sputum is sent for diagnosis or follow-up. A detailed address (including mobile phone number) of the patient should be recorded if sputum is sent for diagnosis. This is important to trace the patient if sputum is found positive and the patient does not return to the health facility.

Early morning sample is preferable for testing on Xpert MTB/RIF (if available). If facility to perform Xpert MTB/RIF is not available, sputum sample should be transported to the nearest facility with Xpert MTB/RIF. This form will be used for sample other than sputum too, and hence, the nature of sample collected / referred for testing needs to be clearly mentioned.

This form should be kept at all DOTS Centres. This form will be used for requesting Lab tests for presumptive DR TB cases (for diagnosis) and DR TB cases on treatment (for follow up). It is mandatory to completely fill all the four parts (A-D) of the form and send it to the designated NTRL / RTRLs or Xpert MTB/ RIF sites along with the samples or the patient f(or diagnosis or follow up) from the DOTS centres. It should be ensured that the reason for requesting culture & DST and Xpert MTB/RIF test is clearly mentioned, indicating the risk group.

After examining samples for diagnosis (in case of presumptive DR TB cases) or follow up (in DR TB cases on treatment) the lower part (E) of the form should be filled up completely by NTRL/RTRLs or Xpert MTB/RIF sites and sent back to requesting sites (DOTS Centers) immediately.

This form is used for referring or transferring patients from one health facility to another. It should be filled in triplicate: one copy goes to the receiving centre, one is given to the patient and one remains in the file. The receiving facility should fill the bottom part of the form and return it to the referring institution as soon as the patient reports.

This form should be prepared quarterly with a copy to the concerned District authority. The requirement for each item is calculated by multiplying the number of cases in the last quarter (by category), the number of treatment doses and average units per dose to arrive at the working stock or running requirement. This figure is then multiplied by 2 to estimate the required and buffer stock for one quarter. The stock in hand stock, at the time of the indent, is then subtracted from the estimated requirement (calculated above) to arrive at the requirement for each drug item for one quarter. At a minimum, adequate stock for at least one patient from each category should be ensured at all times - even when there were no patients during the previous quarter/s (especially for Previously Treated and Paediatric TB cases). Over stocking should be avoided by redistribution of excess medicines to the nearest low stock facilities before preparing the indent for the next quarter. In the unlikely event of a drug stock out, the actual duration, in days, should be mentioned in the remarks column.

This form should be used for retrieval of patients who do not turn up for their scheduled drug intake.

Prepare this report as follows:

• Identify all patients registered in the Tuberculosis Register during the quarter under reporting
• Looking at the columns "Category" and "Pre-treatment smear examination", count the number of new male smear-positive cases, using tally marks with a pencil or every patient counted
• Continue in the same way with the new female smear-positive cases
• All new smear-positive cases have now been identified and they should be entered in the Block 1 (Column 1)
• In the same way Xpert MTB/RIF positive cases should be identified and entered in Block 1
• Divide the new smear-positive male and female patients according to the age groups and record the numbers in Block 2. Verify that the total number of males and females for all age groups matches with the number reported in Block 1. In the same way, numbers of Xpert MTB/RIF positive cases should be counted, recorded and verified according to sex and age category in Block 3.
• Count (and mark) (1) the smear-positive previously treated patients, divided into relapses, treatment after failure and treatment after LTFU, (2) the Xpert MTB/RIF new & previously treated, (3) the smear-negative cases, (4) the extra-pulmonary cases and (5) the other previously treated, divided into males and females, and enter these numbers in the respective columns of Block 1
• Add the totals of column 1-8/9 and enter these in column 6
• Verify that all patients registered during the quarter concerned have been accounted for and included in the report
• Do the same for smear-negative and extra-pulmonary patients and enter the numbers in Blocks 4 and 5.
• The information for Block 6 will be collected from TPT/IPT register. This register will be maintained according to the TPT guidelines. The age group below 15 years will get 3HR, the 15 years and above age group will get 3HP and PLHIV will get IPT and have to be reported accordingly (0 to less than 10 years and 10 to less than 15 years).
• In Block 8 and 8B, data of presumptive TB cases among PLWHA should be reported.

The report should be filled in triplicate. One copy should be sent to the District Medical   to the NTP HQ in Dhaka and one should be kept in the records. The report should be prepared and submitted promptly at the end of the quarter (latest by the 15th of the next month).

This report is for cohort analysis of the treatment results. The different types of patients are evaluated separately. The evaluation is done quarterly for the cohort that started the treatment 12 - 15 months earlier. The information should be collected from the updated Tuberculosis Register. Description of the treatment outcomes is presented in section 5.11. The report should be prepared in the same way as the case finding report.

This report provides information about the smear result at the end of the first two months (new bacteriologically confirmed TB patients) or three months (retreatment patients) of treatment. Unusually low conversion rates indicate wrong categorization or poor treatment adherence while excessively high conversion rates may indicate poor quality microscopy (scanty or low grade positive smears are missed). The report should be prepared in the same way as the case finding report.

This report replaces the TB 13 report:" Quarterly Report on Laboratory Findings of Tuberculosis". This report is prepared quarterly and provides information on diagnostic and follow-up smears examined, for positive, scanty and negative results and the type of Microscopy used (ZN or FM microscopy). The results of Xpert MTB/RIF too can be interpreted. This report is part of the smear rechecking system and included in the EQA SOP.

This form should be used for referral of patients with a cough of 2 weeks or more, with or without other signs and symptoms of TB, to the nearest DOTS centre for further examination. This may also be used for referring presumptive TB among household contacts (defined earlier), patients with unexplained cough, fever, weight loss or night sweats for one week or more.

The table below is provided as a handy reference on reporting timelines. The reports should be sent within two weeks after the quarter is finished. A cohort is a group of patients diagnosed and registered for treatment during a quarter.

A year is divided into four quarters and each quarter contains three months. 1st quarter (January, February, March), 2nd quarter (April, May, June), 3rd quarter (July, August, September), 4th quarter (October, November, December).

Reporting quarter for case finding, smear conversion and treatment result.