Module 3 Treatment Initiation Update - V1

Module 3:
Treatment Initiation
and Patient
Management
 Start Treatment
 Add Prescription
 Add Co morbidity
 Contact Tracing
 Adherence Tracking
 Closing case
Contents  Reinitiating case

 Delete a case
 Update/view health facilities
 Transferring a patient
 Patient notes
 CBNAAT Test to Nikshay
 ACF
 Tasklist
 Followup module
 Start Treatment
 Contact Tracing
 Closing case
Contents  Reinitiating case

 Delete a case
 Patient notes
 ACF
 Tasklist
 Followup module
► Initiation of Treatment is the third step in the Patient Management
Lifecycle in Nikshay (After Enrolment and Enter Test Details).
► In Treatment Details section, “Date of Diagnosis” and “Basis of
Diagnosis” gets populated based on the Diagnosis test details.
Start ► Once Treatment details are updated, the Adherence Calendar is
Treatment made available for view and update.
► The Start Treatment Screen is common for DS TB and DR TB Patients
► The Patient’s Regimen details should be updated from “Prescription”
Section.
Enter Treatment details
Step 1
Click on
Treatment
Details
White color box indicates

“Initiate Treatment” is pending
As Test is added but treatment details

not added, status is “Diagnosed But
Pending Treatment (Notified)
Click here to Start

treatment
Step 1 Step 2
Click on
Enter Type of
Treatment
Patient
Details
Can initiate case on

DSTB & DRTB
Step 1 Step 2 Step 3 Step 4
Click on
Enter Type of Enter Diagnosis Enter Adherence
Treatment
Patient details details
Details
Autopopulated based
on test result and is
non editable
Click here to Start

Message displayed as Treatment
Treatment Started
Step 1 Step 2 Step 3 Step 4 Step 4
Click on Treatment Enter Type of Enter Diagnosis Enter Adherence View Treatment
Details Patient details details details
Green color box

Indicates Test updated
Status of case
gets updated
Enter treatment details of DSTB patient- Mobile Version
Click on Treatment Enter Type of Enter Diagnosis Enter Adherence View Treatment
Details Patient details details details
Enter treatment details of DRTB patient
Step 1 Step 2
Click on Treatment Enter Type of
Details case
Click on PMDT to
initiate DRTB case
Enter treatment details of DRTB patient
Step 1 Step 2 Step 2
Click on Treatment Enter Type of Enter Regimen
Details case Details
Select
regimen
 Start Treatment
 Contact Tracing
 Closing case
 Reinitiating case
Contents  Delete a case
 Patient notes
 ACF
 Tasklist
 Followup module
► A Prescription should be added every time medicines are issued to the patient
► In this section, details of medicines issued (Product Name, No. of days for which medicines
are issued etc.) are captured
► More than one medicine details can be added in one prescription (For Eg. in DR TB multiple
drugs are issued to the patient)
► All the prescriptions added for a given patient are visible to the User
Add
Prescription
Add Prescription
Step 1 Step 2
Click on Add
Prescription Prescription
Click here to add

prescription
Add Prescription
Click on Add Enter a Product
Prescription Prescription (Medicine)
Select RNTCP
Enter no. of days

Select Product Name
for which medicine
and Weight Band
is being issued
To add more
drugs click here
Is applicable for issuance of

RNTCP FDC to private
sector patients via
chemists
Click here to add

prescription
View Prescription
Click on Enter a Product View or Edit
Add Prescription
Prescription (Medicine) Prescription
Details of all prescriptions added are shown here
Is applicable for issuance of

RNTCP FDC to private sector
patients via chemists
 Start Treatment
 Contact Tracing
 Closing case
 Patient notes
 ACF
 Tasklist
 Followup module
► Comorbidity refers to the
presence of one or more
additional diseases or
disorders co-occurring with a
primary disease or disorder.
Add ► In this section, HIV

Information, Diabetes
Comorbidity Information and Additional
Information like Tobacco user
or not, Alcohol intake etc can
be added for a patient.
► All the comorbidity details
added for a given patient are
visible to the User
Add Comorbidity
Step 1
Click on
Comorbidity
Add Comorbidity
Step 1 Step 2
Click on Click Edit
Comorbidity Details
Click here to add

Comorbidity
Details
Please Note that all fields are not Mandatory in Comorbidity section. The Staffs can fill the fields whichever they know
Add Comorbidity
Step 2 Step 3
Step 1
Add
Click on Click Edit
Comorbidity
Comorbidity Details
Details
Select HIV Status

Click here to Update
Comorbidity Details
Fill HIV Related details for

that Patient
Select the Date of Select whether the Patient is

Initiation at ART Initiated in ART centre or not
Centre Enter the Latest CD4 Count
Add Comorbidity
Step 2 Step 3
Step 1
Add
Click on Click Edit
Comorbidity
Comorbidity Details
Details
Select the Diabetes Status

for the Patient
Fill Diabetes Related details

for the Patient
Select the date of Initiation of

Select whether the Patient is initiated
Anti-Diabetic Treatment
for Anti-Diabetic Treatment
Enter any other

Co-Morbidity
Add Comorbidity
Step 2 Step 3
Step 1
Add
Click on Click Edit
Comorbidity
Comorbidity Details
Details
Select whether the Patient is a

Tobacco user or not
Select whether the Patient is linked to

discontinuing Tobacco intake
Select whether the Patient is a

Alcoholic or not
Add Comorbidity
Step 2 Step 3
Step 1
Add
Click on Click Edit
Comorbidity
Comorbidity Details
Details
One can Edit the

Comorbidity Details at
any time by clicking this
button
Message Displayed After Successfully

updating Comorbidity Details
Add Comorbidity- Mobile version
Step 2 Step 3
Step 1
Add
Click on Click Edit
Comorbidity
Comorbidity Details
Details
 Start Treatment
 Contact Tracing
 Closing case
 Patient notes
 ACF
 Tasklist
 Followup module
Contact Tracing
► Contact Tracing is a process of screening all household members in

contact with the TB patients including Children less than the age of six.
► Contact tracing is very necessary to establish the primary source
of the TB disease and to detect all those who are secondary
infected for proper diagnosis and prompt treatment
Contact Tracing ► Under Contact Tracing tab, the details of other household
members of the patient could be added.
► All the Contact Tracing details added for a given patient are visible
to the User
Contact Tracing
Step 1
Click on Contact
Tracing
Contact Tracing
Step 1 Step 2
Click on Contact Click Edit
Tracing Details
Click here to add

Contact Tracing
Details
Please Note that all fields are not Mandatory in Contact Tracing section. The Staffs can fill the fields whichever they know
Contact Tracing
Step 2 Step 3
Step 1
Click on Contact Click Edit Add Contact
Tracing Details Tracing Details Click here to update
Contact Tracing Details
Fill the Contact Tracing

Details of members aged
above 6 years old
Fill the Contact Tracing

Click here to add information of Details of members aged
vaccination given to child less below 6 years old
than 6 to prevent TB
Please Note that all fields are not Mandatory in Contact Tracing section. The Staffs can fill the fields whichever they know
Contact Tracing
Step 2 Step 3
Step 1
Tracing Details Tracing Details
One can Edit the Contact

Tracing Details at any
time by clicking this
button
Message Displayed After Successfully

updating Contact Tracing Details
Contact Tracing- mobile version
Step 2 Step 3
Step 1
Tracing Details Tracing Details
 Start Treatment
 Contact Tracing
 Adherence Tracking and management
 Closing case
 Patient notes
 ACF
 Tasklist
 Followup module
► As soon as the Patient’s treatment details are
entered and, Patient’s status changes to “On
treatment”, the ”Adherence” section is
displayed
► Nikshay 2.0 is integrated with ICT Based
adherence technologies of 99DOTS and
Adherence MERM.
If a 99 DOTS patient makes a call or if a
Tracking
►
MERM Patient opens his Medicine box to

indicate dose taken, Adherence calendar gets
updated.
► The Adherence Calendar can also be manually
updated for Missed dose or Dose taken
► Adherence details for a date range can be
updated by selecting multiple dates
► Tags (Remarks) can also be added for later
reference
Manual Adherence update
Step 1 Step 2
Click on Record Manual
Adherence Dose
Section is visible as Click here to Not

Treatment details mark doses available in
are entered manually mobile
version
Step 1 Step 2
Adherence Dose
After selecting dates, Click here

click here to confirm to cancel
Select dates
Step 1 Step 2
Adherence Dose
In confirmation window,
dates for which adherence is
being updated is displayed
Enter remarks here (if required)
Click here
to submit
View Calendar
Adherence Dose
Calendar updated with light green

colour as manually updated as dose
taken)
View Calendar
Adherence Dose
Calendar updated with maroon colour

as manually updated as missed dose)
Click on Record Manual Add Tags
View Calendar
Adherence Dose
Select dates to
be tagged
View Calendar Add Tags
Adherence Dose
Can select
multiple tags
Click on Record Manual Add Tags
View Calendar View Tags
Adherence Dose (optional)
On hovering mouse
tags are displayed
► In Nikshay Version 2.0, one can monitor adherence in the
following ways:
 Using On Treatment List (Notified) in Web Dashboard (NOT
AVAILABLE IN MOBILE)
Adherence  Using Patient Page in Web Dashboard
Monitoring in  Using Notification Report in Web Dashboard
Nikshay
Version 2.0
Adherence Monitoring - Using On Treatment Calendar in Web Dashboard
Step 1 – From Patient Management meu select On Treatment List (Notified) option
Step 2 – Select from Calendar/ List

Step 1 – From Patient Management meu select On Treatment List (Notified) option
Step 2 – Select from Calendar/ List

Step 3 – From the calendar

view, click on the Tech
column to sort the list as per
adherence technology. Once
you click sort the list will
group patients on 99D,
MERM and No technology
options
Step 4 – Here you can view

adherence calendar of all
patients in that hierarchy. You
can right-click on the patient
name to open the individual
patient calendar in a new
window.
Adherence Monitoring - Using Patient Page in Web Dashboard
From the patient page in web dashboard, you can view the adherence calendar and also see overall
adherence, technology only adherence, the type of adherence technology the patient is using, and you can
also mark manual and missed doses.
 Start Treatment
 Contact Tracing
 Closing case
 Patient notes
 ACF
 Tasklist
 Followup module
Closing Cases/ Assigning Outcomes
 A case record submitted to Nikshay is tracked till a logical end

point.
 The type of logical end will depend on whether the case is
Diagnosed/Notified and whether treatment was initiated or not
Closing Cases / 1. For Cases that are Test Pending  convert to TB Not Confirmed
2. For Cases Treatment has not been started  Assign Notification
Assigning Outcome or the reason for not initiating on treatment
Outcomes 3. For cases that have stopped/ completed treatment Assign

Treatment outcome.
 Moving a case to its logical end is called Closing a case.
 A patient’s record may be closed by going to the Close Case tab in
the patient management interface.
Closing Test Pending cases
Step 1
Click on Diagnosis
Pending
Step 1 Step 2
Click on Test
Select Patient
Pending
Click on Test Click on
Select Patients outcomes tab in
Pending
Patient’s Page
Click on
Outcomes
Click on close
case
Click on the Select the reason
Click on Test Patient Name to for closing case
Select patient
Pending assign outcome and click Submit
Confirm by selecting case

not diagnosed as TB
Click Submit
Verify that the status is changed to Presumptive(Closed)
Confirm Status change to

Presumptive (Closed)
Closing Notified (Treatment Not started) Cases
Step 1
Click
Click on
on
Treatment
TreatmentNot not
Started
started
Step 1 Step 2
Click on
Treatment not Select Patient
started
Click to get list of patients

Click on Test Click on
Select Patient outcomes tab in
Pending
Patient’s Page
Click on
Outcomes
Click on close
case
Click on Test Click on Select reason for
Select Patient outcomes tab in
Pending closing
Patient’s Page
Reason for
closing
Patients current
end date
Assign Treatment Outcome
Open the Click on the Close Click Close Case
Patient’s Page Case Tab Button
White color box indicates

that case is Open
Status of patient
is “On Treatment”
Click here to
Close Case
Select the reason
Open the Click on the Close Click Close Case for closing case
Patient’s Page Case Tab Button and click Submit
Click on
Submit
Select outcome
Enter Outcome
date
Verify that the status is changed to Outcome Assigned(Notified)
Green color box Indicates

Outcome has been updated
Status of patient is
“Outcome Assigned”
Edit Treatment Outcome date
Edit End Date

 Start Treatment
 Contact Tracing
 Closing case
 Patient notes
 ACF
 Tasklist
 Followup module
Reopening case
Open the Click on the Click Reopen
Patient’s Page Reopen Case Tab Case Button
Shows Treatment
outcome updated earlier
Click here to edit
treatment outcome details
Reopening case
Select the End Date
Open the Click on the Click Reopen
for that Patient and
Patient’s Page Reopen Case Tab Case Button
click Submit
Click on
Submit
Edit date and

click on Submit
Re-Initiating a Case on New Episodes
Re-initiating a  This feature allows to add multiple episodes for a patient. User can re-initiate an
outcome assigned case.
case on new  Using this option, we can retain the enrolment details for the same patient.
episode  Using this option we can view previous episodes for the same patient in the
Patient Management Page.
Re-initiating a Case on New Episode
Step 2 Step 3
Step 1
Click “CLICK HERE TO
Open the Click on the
REINITIATE CASE ON
Patient’s Page Reopen Case Tab
NEW EPISODE”
Click here
Step 1
Click “CLICK HERE TO Fill the Enrolment Click “+ADD CASE
Open the Click on the
REINITIATE CASE ON form with required AND PROCEED TO
Patient’s Page Reopen Case Tab
NEW EPISODE” fields ADD TEST”
Fill the Enrolment form

with required fields.
A New Patient/Episode ID is
generated once enrolment
form is filled and case is added
Click here
Step 1 Step 2
Click “IS THIS
Click “+New
CASE ALREADY
Enrollment”
ENROLLED?”
Enter the
Episode or
Patient ID for
the existing
patient
• One can also add a new episode to the patient by using the “+New Enrollment” tab in the home page, once you click that tab in the right corner
click “IS THIS CASE ALREADY ENROLLED?”
• After Entering the Patient or Episode ID, the enrolment form will open and the user can enter required fields and can click Add Case to generate a
new Patient or Episode ID
Once a new episode is created then, the status for

that episode is changed to Presumptive Open
One can select the other episodes for

that patient in the Patient
Management Page.
In a Patient Management Page an user can toggle between the various episodes added for that patient.
 Start Treatment
 Contact Tracing
 Adherence Tracking and
management
 Closing case
 Patient notes
 ACF
 Tasklist
 Followup module
► Before deleting a case, users should be careful because, “deletion”
can not be undone.
► While deleting, the user needs to select the reason for deletion
► The Audit Trail of deleted cases will be available with Nikshay Technical Team
and can be extracted and shared with CTD if required.
Delete a Case ► The deleted case will not be visible to users ( in the Application or in the
Reports/Registers)
Delete Case
Step 1
Click on “Others”
Section
Select “Delete
Case”
Delete Case details
Step 1 Step 2
Click on “Others” Select Reason for
Section Deletion
Select Reason
for deletion
Click here to Delete

Patient record
Deletion of Records is enabled based on the type of logins (Not for PHI or TU level users).
 Start Treatment
 Contact Tracing
management
 Closing case
 Patient notes
 ACF
 Tasklist
 Followup module
► The following Health Facilitates associated with the patient are
visible in this section:
► Enrolment Facility- The facility that enrols a Patient.
Update / View Diagnosing Facility- The facility that adds a positive test result.
►
► Current Facility (can be edited)- The current facility where the patient
patient Health takes treatment.
Facility details ► Residence Facility (Coming soon)
► ART Facility (if any)
► DR TB Facility (if any)
Update / View patient Health Facility details
Step 1
Click on Health
Facilities
Update / View patient Health Facility details
Step 1
Click on Health
Facilities
The Health Facilitates

associated with the patient
are displayed here
 Start Treatment
 Contact Tracing
management
 Closing case
 Patient notes
 ACF
 Tasklist
 Followup module
Transferring a Patient
► Patients can be transferred from one PHI to another by clicking on

“Health Facilities” in “Others” tab in patient management module.
► When a Patient is transferred to a new PHI then the DBT details for
that patient will also move to the new PHI.
Transferring a ► A patient can be transferred to any State, District, TU and PHI across
Patient the country.
Step 1
Click on Health
Facilities
Step 1 Step 2
Click Edit in the
Click on Health
Current Facility
Facilities
Row
Click here to change the

current facility for the patient
Step 2 Step 3
Step 1
Click Edit in the Select the appropriate
Click on Health PHI, TU, District and
Current Facility
Facilities State
Row
Select the
appropriate
PHI,TU,
District and
State
Click here
 Start Treatment
 Contact Tracing
management
 Closing case
 Patient notes
 ACF
 Tasklist
 Followup module
► Nikshay enables adding Notes to a Patient’s record so that users can
refer to it in future.
► Since multiple people (such as LT, TB HV, STS, SDPS etc.) interact
with a patient and access a patient’s records, this is a useful feature to
Add or view record Notes (Remarks) so that everyone can view
Patient Notes
Add/View Patient Notes
Step 1
Click on Notes
Click here to add Notes on any matter. E.g.

- Patient’s Phone issues
- Health issues like Adverse Drug Reaction
Step 1 Step 2
Enter Note
Click on Notes
Details
Few Frequently used

tags are predefined and
User can enter available
any note here
Enter Note View Note
Click on Notes
Details Details
Multiple Notes/ Tags

can be added
Notes/ Tags added are

displayed here
 Start Treatment
 Contact Tracing
management
 Closing case
 Patient notes
 ACF
 Tasklist
 Followup module
Uploading CBNAAT Test Results to Nikshay
 Central TB division has now provided the function in Nikshay to

directly upload CBNAAT results to Nikshay.
 PHIs with CBNAAT facilities will be provided with the ability to
Uploading upload CBNAAT test details to Nikshay.
CBNAAT Test  The results need to be exported in bulk from the CBNAAT machine
and uploaded to Nikshay on a daily basis by the Lab Technician.
Results to  The test details and the performance of the site are visible
Nikshay through a calendar based report with the details on number of
tests performed, MTB detected/not detected and Rif
sensitive/resistant patients
For more information on Uploading CBNAAT Test Results to Nikshay, please refer to the document in this link:
https://nikshayeverwell.blob.core.windows.net/training-materials-nikshay/Nikshay%20Documents/Uploading%20
CBNAAT%20Test%20Results%20in%20Nikshay.pdf
Uploading Genxpert Report to Nikshay
Select the PHI and click Choose file

and upload the CSV file exported
from Genexpert.
Note:
1. All tests done after 1st of December 2018 are to be uploaded.
2. Tests are to be uploaded daily to Nikshay. Preferably after the last test has been done for the day.
Report Module as Non Functional
1.Select the PHI and the

instrument and the
module serial number.
2. Select the from and to
date for the status
3. Select the status of
the module.
4. Click on Submit
If no tests are done, because modules are not functional, then this detail need to be updated in Nikshay.
This facility is only available for TU and PHIs.
Viewing Reports based on the Data Uploaded
All the tests uploaded can be viewed on a calendar based on the date of test. Each day a summary based on the type
of result is provided
 Start Treatment
 Contact Tracing
management
 Closing case
 Patient notes
 ACF
 Tasklist
 Followup module
Active Case Finding (ACF)
 The Active Case Finding (ACF) of Tuberculosis programme, a

national campaign, has been launched to prevent new infections
Active Case and new cases and thus reduce TB transmission in the community.
Finding (ACF)  The feature of ACF mapping details addition in Nikshay is active
now
Step 1 Step 2
Click Mapping Select the TU &

Details/Activity PHI
Select the TU & PHI

Click Mapping Select the TU & Fill the Form and

Details/Activity PHI click SAVE DATA
Select the type of Area
Fill the Details
Click SAVE DATA

Select the
Click Mapping Select the TU & Fill the Form and appropriate facility
Details/Activity PHI click SAVE DATA and click Add Activity
Report
Select the TU & PHI to see the ACF details below
Click Add Activity Report to

enter ACF results
Select the
Click Mapping Select the TU & appropriate facility Fill the Activity
Fill the Form and
Details/Activity PHI and click Add Activity Report Details
click SAVE DATA
Report and click Submit
Fill the Details
Click Submit
 Start Treatment
 Contact Tracing
management
 Closing case
 Patient notes
 ACF
 Tasklist
 Followup module
Task List (Web)
 Now, we have Task list in Nikshay which helps staffs to view

patients based on main parameters to take action like Adherence,
Task List Outcome date passed patients and Bank details patients.
(Web)  Task List is available at District, TU and PHI level users.
Task List (Web)
We have a separate tab called Task List in Nikshay.

Task List (Web)
Select the parameter to view

patients accordingly
This list contains details of patients who have missed doses on various instances (Missed doses between 3-5 days,
6-11 days and more than 12 days)
Task List (Web)
This list contains details of patients whose outcome date has passed .
Task List (Web)
This List contains details of patients whose bank details are missing.

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Module 3:

Contents  Reinitiating case

Contents  Reinitiating case

White color box indicates

As Test is added but treatment details

Click here to Start

Can initiate case on

Click here to Start

Green color box

Click here to add

Enter no. of days

Is applicable for issuance of

Click here to add

Details of all prescriptions added are shown here

Is applicable for issuance of

Add ► In this section, HIV

Click here to add

Select HIV Status

Fill HIV Related details for

Select the Date of Select whether the Patient is

Select the Diabetes Status

Fill Diabetes Related details

Select the date of Initiation of

Enter any other

Select whether the Patient is a

Select whether the Patient is linked to

Select whether the Patient is a

One can Edit the

Message Displayed After Successfully

► Contact Tracing is a process of screening all household members in

Click here to add

Fill the Contact Tracing

Fill the Contact Tracing

One can Edit the Contact

Message Displayed After Successfully

MERM Patient opens his Medicine box to

Section is visible as Click here to Not

After selecting dates, Click here

Enter remarks here (if required)

Calendar updated with light green

Calendar updated with maroon colour

Step 2 – Select from Calendar/ List

Step 2 – Select from Calendar/ List

Step 3 – From the calendar

Step 4 – Here you can view

 A case record submitted to Nikshay is tracked till a logical end

Outcomes 3. For cases that have stopped/ completed treatment Assign

Confirm by selecting case

Verify that the status is changed to Presumptive(Closed)

Confirm Status change to

Click to get list of patients

White color box indicates

Verify that the status is changed to Outcome Assigned(Notified)

Green color box Indicates

Edit End Date

Edit date and

Fill the Enrolment form

Once a new episode is created then, the status for

One can select the other episodes for

Click here to Delete

The Health Facilitates

► Patients can be transferred from one PHI to another by clicking on

Click here to change the