Operational Handbooks

This support includes all information necessary to help patients and their caregivers understand TB, including the biological and social determinants of the disease, and agree on the steps for following the treatment plan and participating in local activities to engage communities in the response to TB. As an example, the Guide on the standardized package of community-based support services to improve TB outcomes describes many of the possible services for adherence support in detail (19).

TB causes suffering and even death. Despite highly effective treatment, there are many psychological, social, medical and economic factors that can prevent people from accessing diagnosis, following care plans and successfully completing a course of treatment. The following is an adapted summary of how these factors may have an impact on psychological health, health-seeking behaviour and adherence (8):

Ensuring adherence to TB therapy is one of the important challenges for achieving a successful treatment outcome, particularly for patients with drug-resistant TB (DR-TB). This is because of the large number of medications, the frequent and serious adverse drug reactions, and the social and financial costs to patients related to TB treatment.

In view of the high burden of disease, death and suffering associated with TB, Standard 9 of the International standards for tuberculosis care (1) states: “A patient-centred approach to treatment should be developed for all patients in order to promote adherence, improve quality of life, and relieve suffering.

Tuberculosis (TB), including its drug-resistant forms, can affect people in all parts of society. However, its effects are often most devastating among the poorer and more marginalized members of a society. A person’s quality of life, social status and financial situation can be made worse both by the disease and by its treatment, namely: adverse drug reactions produced by the treatment, the high costs he or she may have to pay while undergoing care and treatment, having to miss work due to illness, and the stigma and discrimination linked to the disease.

People-centred (or person-centred) care is defined as “providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions”.

Social support in this document is defined as support to TB patients that includes informational and educational support (health education and counselling), psychological or emotional support, material support and companion support.

This operational handbook was prepared and coordinated by Linh Nguyen and Fuad Mirzayev, with input from Ernesto Jaramillo and Matteo Zignol, and under the overall direction of Tereza Kasaeva, Director, WHO Global Tuberculosis Programme. The WHO Global Tuberculosis Programme gratefully acknowledges the contributions of all experts involved in the production of the latest updates of the WHO guidelines on tuberculosis care and support, on which this handbook is based, as well as other contributors listed below.