15.3  Referral of people suspected of being infected with TB and TB cases

You know from Study Sessions 13 and 14 that a very important role for you is referring people suspected of having TB — specifically those with a cough for two or more weeks — to a health institution for TB diagnosis. Referrals can come about in other ways. Sometimes a doctor may diagnose TB and then refer the patient with the drugs to your health facility to continue their treatment under your supervision. Those patients need registration at your level and continued follow-up needs to be put into place.

If a patient is very sick or has major treatment side-effects (recall Study Session 14), it may be necessary to refer the patient to a doctor or to a hospital for care of the acute problem. However, sometimes such a patient then believes that, because of the treatment received at the hospital, there is no need to come to you for regular TB treatment and he or she may then discontinue treatment. When a referral of this type comes about, discuss the situation with the patient and their family and emphasise the need to return to your health facility to continue treatment after discharge from the doctor or hospital.

15.2.1  Monitoring of patients with sputum smear-positive pulmonary TB

15.3.1  Coordinating transfers when a patient is moving