Impact of various policy options with regard to mid-CP follow-up on the number of cases of tuberculosis treatment failures detected early¹ and laboratory workload.

1<p>Detected as a case of treatment failure around two-three months earlier than if detected at the end of the treatment.</p>2<p>Percentage calculated by taking follow-up required under present policy as denominator.</p>3<p>Gain/Loss in absolute numbers indicated respectively by a positive or a negative sign; CP-Continuation Phase of TB treatment.</p

Flow of cases of sputum smear-positive Tuberculosis as per successive sputum smear microscopy results.

<p>Mid-CP follow-up refers to the sputum smear microscopy which is scheduled between the 4^th and 6^th month of anti-TB treatment, i.e. in the middle of the ‘continuation phase’ (CP) of typical anti-TB treatment. Cases that are found to be smear-positive at 5^th month or later are considered as not responding to treatment (‘treatment failure’). Numerals shown in rectangular boxes refer to number of cases with treatment failure who were detected two-three months earlier than at the end of treatment as they were smear-positive in mid-CP follow-up at or beyond 5^th month of anti-TB treatment. Numerals shown in clear ovals refer to number of cases with treatment failure that were detected only at the end of treatment because they were either smear-negative in mid CP follow-up, or had a smear-positive mid-CP result before 5^th month of anti-TB treatment. Numerals shown in shaded ovals refer to number of cases with treatment failure who missed their mid-CP follow-up scheduled at or beyond 5^th month of treatment. These cases could have been detected two-three months earlier had they undergone mid-CP follow-up and were found to be smear-positive.</p

Timing of follow-up sputum smear examinations.

<p>Treatment duration and timing of follow-up sputum smear examinations for new and previously-treated cases of tuberculosis, highlighting the timing of the follow-up mid-continuation phase sputum smear examination. The initial two-three month intensive phase (light blue bars) is followed by a follow-up sputum smear examination (pink bars). If the follow-up sputum smear examination is positive, an additional 1-month extended-intensive phase treatment is given (dark blue bar), with additional follow-up sputum smear examination. After the intensive phase (or extended intensive phase), the continuation phase of treatment (grey bars) is immediately begin. After two months of continuation phase (i.e. between months 4 and 6), the mid-continuation phase (mid-CP) follow-up sputum smear examination is done (red bars, circled with dotted line). At the end of the continuation phase, a final follow-up sputum smear examination is done.</p