Operational Handbooks

1. International Standards for Tuberculosis Care. The Hague: Tuberculosis Coalition for Technical Assistance; 2014.
2. Health systems strengthening glossary [website]. Geneva: World Health Organization; 2016.
3. A people-centred model of TB care. A blueprint for eastern European and central Asian countries, first edition.

Palliative care is the preventing and relieving of the suffering of people affected by TB during and after treatment and at the end-of-life.

5.1 Models of care for all TB patients

Although traditionally patients with DR-TB were hospitalized for portions of, and sometimes all of, their treatment, recommendations on this have changed. With the increasing use of all-oral DR-TB treatment, patients with DR-TB should be treated whenever possible in an outpatient-based treatment programme similar to patients with DS-TB (60–62).

This section focuses on a key recommendation on patient care and support by providing health education and counselling on the disease and treatment adherence to TB treatment (15, 16).

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. This approach should be based on the patient’s needs and mutual respect between the patient and the provider”.

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.

1. WHO consolidated guidelines on tuberculosis. Module 4: Treatment and care. Geneva: World Health Organization; 2025.
2. Guidelines for treatment of drug-susceptible tuberculosis and patient care (2017 update). Geneva: World Health Organization; 2017 (https://apps.who.int/iris/bitstream/handle/10665/255052/9789241550000-eng.pdf).
3. WHO consolidated guideline on tuberculosis. Module 1: Prevention – tuberculosis preventive treatment.

Introducing the longer and shorter MDR-TB regimens entails a series of steps that are the same as those necessary when an NTP introduces a new MDR-TB treatment component. This section summarizes some key considerations for those steps.