3.2 Safety monitoring and management, provision of patient support and management of comorbidities

All treatment offered to people with MDR/RR-TB should align with WHO-recommended standards, including patient-centred care and support, informed consent where necessary, principles of good clinical practice, active TB drug safety monitoring and management (aDSM), and regular patient monitoring to assess regimen effectiveness. Health care providers must offer careful clinical and bacteriological follow-up to assess the TB treatment response, with general laboratory support to monitor and manage adverse events and comorbidities. The provision of social support is essential to enable adherence to treatment (17). Certain programmatic components (e.g. aDSM) (17, 18) are recommended for all patients on any MDR/RR-TB regimen (Web Annex 3). An appropriate schedule of laboratory tests and clinical examinations should be included in the patient’s treatment chart to identify adverse events (17). In settings where aDSM has not yet been fully rolled out and national guidelines have not been updated, patients should not be left to wait until all programme components are fully in place before they can receive potentially life-saving interventions. The WHO consolidated guidelines also reinforce the message that patient support is critical for good adherence and improved outcomes (19).

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