Training on NTP Manual of

Procedures, 6th Edition:

OVERVIEW
Module 1—Training on NTP Manual of Procedures, 6th Edition: OVERVIEW 1

Objectives

At the end of this module, you are expected to:

1. Explain the process of revision

2. Summarize the different revisions done

Introduction and Overview

• Why Revise the MOP?

• Who are the intended users?
• Organization and content
• Process of revision
• Key changes in the revised MOP, 6th. Ed.
• Training Program
Why Revise the MOP?
 Module 1—Training on NTP Manual of Procedures, 6th Edition: OVERVIEW 3

Why Revise the MOP?

• AO 2015-0024: Implementing Guidelines on ITIS

• AO 2015-0029: Revised Policies and Guidelines on Hospital TB DOTS under the NTP
• AO 2015-0032: Technical Guidelines for Implementing DOTS Strategies in Jails and Prisons
• DM 2015-0294: Revised Clinical and Laboratory Baseline and Follow-up for DRTB
• AO 2015-0039: Guidelines for Managing Tuberculosis Control Program During Emergencies and
Disasters
• DM 2016-0034: Classification of TB Disease Based on Bacteriological Status of Drug Resistant Cases
• DM 2016-0285: Implementation of Xpert MTB/Rif as Primary diagnostic tool for presumpotive DRTB
abd Presumptive DSTB among selected vulnerable population
• DM 2016-0334: Use of ITIS for submission of all NTP Quarterly reports
• AO 2016-0040: Revised policies and guidelines on the implementation of the PMDT
• DM 2016-0383: Use of Bedaquiline in Treatment of DRTB under Program Conditions
• DM 2017-0152: Cancellation of Drug Holiday during Treatment of Drug-resistant TB
• DM 2017-0250: Provision of patient-centered supervised Treatment for Drug-resistant Tuberculosis
• DM 2017-0343: Guidelines on the use of Category II Treatment regimen
• DM2017-0281: PMDT Implementing Guidelines
• DM 2018-0065: Guidelines on Integrating Paragonimiasis in the NTP Microscopy Services
Module 1—Training on NTP Manual of Procedures, 6th Edition: OVERVIEW 4

To include new international recommendations on TB

care

2013 2014

2015

2014

2019

2017

2018
2016
Module 1—Training on NTP Manual of Procedures, 6th Edition: OVERVIEW 5

For whom is the MOP?

Primary users – frontline HCWs directly involved in

patient care for both private and public health facilities
with TB services
§ Physicians
§ Nurses
§ Allied health workers

Secondary users – those who are involved in planning,

implementation and monitoring of the program
§ Program managers at all administrative levels
§ Development partners
§ Other government agencies and stakeholders
Module 1—Training on NTP Manual of Procedures, 6th Edition: OVERVIEW 6

Organization and Content

Features of the Revised Edition:

Focused on the technical approach to patient care

§ Screening
§ Diagnosis
§ Treatment
§ Preventive treatment
§ Recording and Reporting

§ Emphasis on patient-centered care

§ Guidelines for DSTB/DRTB

Cascade of Care
 Module 1—Training on NTP Manual of Procedures, 6th Edition: OVERVIEW 7

MOP, 5TH ED. REVISED MOP, 6TH ED.

1. Introduction 1. Patient-centered care
2. Case Finding 2. Screening and Diagnosis
3. Case Holding ▪Screening
4. TB Preventive Treatment ▪Diagnosis
5. Recording and Reporting 3. Treatment
6. Drug Supply Management ▪DSTB Treatment
7. Referral System ▪DRTB Treatment
8. Advocacy, Communication, 4. Latent TB Infection
Social Mobilization 5. Recording and Reporting
9. Certification and
accreditation
10.Monitoring, Supervision,
Evaluation
Module 1—Training on NTP Manual of Procedures, 6th Edition: OVERVIEW 8

Process and Revision

Module 1—Training on NTP Manual of Procedures, 6th Edition: OVERVIEW 9

Key Changes in MOP, 6th. Ed.

SCREENING

§ Revised definition of symptom criteria for presumptive

TB
§ Chest X-ray as screening tool
§ Describes screening for four settings/groups:
1. Intensified case finding in heath facilities
2. Active case finding in targeted communities or
settings
3. Screening among Health Care Workers
4. Contact Tracing

DIAGNOSIS

§ Introduction of Rapid Diagnostic Test (e.g., Xpert) as

primary diagnostic test
§ Additional guidance on clinical diagnosis
§ Removal of scoring system for clinical diagnosis in
children (3/5 criteria)
§ Guidance on further testing based on Xpert Test
result
Module 1—Training on NTP Manual of Procedures, 6th Edition: OVERVIEW 10

TREATMENT

§ Decision on treatment regimen based on DST (Xpert

Test)
§ New treatment regimens – all oral regimens
§ Patient-centered approach to treatment adherence:
community/home treatment, may have family member
as treatment supporter
§ Post-treatment follow-up (even for DSTB patients)

PREVENTION

§ Expanded eligibility for TB Preventive Treatment (TPT)

• Contacts above 5 years old, selected
clinical high-risk group.

§ Revised recommendation on who should get TST

§ Shorter TPT regimens
 Training Program
NTP Manual of Procedures, 6th. Ed.
Module 1—Training on NTP Manual of Procedures, 6th Edition: OVERVIEW 12

Objectives of the Training

At the end of this training, the participants will be able to:

1. Implement the revised guidelines on TB screening,

diagnosis, treatment and TB preventive treatment.

2. Utilize and implement the new recording and reporting

system.
Module 1—Training on NTP Manual of Procedures, 6th Edition: OVERVIEW 14

Reminders

§ The MOP guidelines are expected to cover majority of

cases/scenarios encountered by health workers.

§ For scenarios or cases not covered by current policy and

procedures, physician’s decision based on patients
welfare (i.e., patient-centered) shall be applied.

§ Referral to specialists and advisory committee (TB MAC

to be discussed in diagnosis) may also be done for
difficult cases but this should not result to unnecessary
delay in provision of services.

§ In the end, the primary accountable to the patient is the

attending health workers (any decisions should therefore
have the patients welfare as primary consideration).

§ Should you have any questions, please look into the FAQ
document.