Processes to support retention on TPT
People on TPT should be seen by health care workers at scheduled intervals appropriate to the country context (fortnightly, monthly, quarterly). These encounters may happen in clinics, in the community or in the household and serve to dispense medicines, assess progress and update records. Each such contact is an opportunity:
- to ask the individual about adherence as well as strategies being used to assist with adherence; show that you are also interested in helping them to adhere to treatment; discuss how many daily/ weekly doses were missed and how this can be avoided in the future.
- for adherence counselling as appropriate by
- discussing any identified barriers and proposing joint solutions, as well as
- using motivational interviewing techniques to improve adherence (134) (How do you feel when you have missed a dose? How do you want to change that?).
- for checking used blister packs and examining all remaining pills to assess if the pill count corresponds with the expected consumption in the interval.
- to ask specifically about adverse events and TB symptoms.
- to check contact information against clinic records, including one verified cellphone number and the number of a close contact person.
- to update the monitoring system and flag any person who misses a visit for a follow-up call within one week of missing the scheduled clinic visit to enquire:
- about adverse events, TB symptoms, pregnancy
- whether the person still has medicines available
- and fix the next clinic appointment as soon as possible.
Management of missed doses
¹¹ See also Table 5.3 for the thresholds of regimen prolongations due to consecutive or erratic interruptions