1. Unit 5 Isoniazid Prevention Therapy: B Family Case Botswana National Tuberculosis Programme Manual Training for Medical Officers

2. Slide 2 Unit 5: Case Study B Family Case Mrs. B is 28 years old and is concerned about a cough her husband has had for 2-3 weeks She also suspects that he may be engaging in behaviours that would put him at risk for HIV Mrs. B decides to go to the clinic to get tested for HIV

3. Slide 3 Unit 5: Case Study B Family Case: Question 1 What TB screening questions do you ask Mrs. B?

4. Slide 4 Unit 5: Case Study B Family Case: Answer 1 Cough for 2-3 weeks Weight loss Night sweats Fever Malaise Shortness of breath Chest pain Haemoptysis You ask the patient if she has experienced the following symptoms:

5. Slide 5 Unit 5: Case Study B Family Case: Question 2 Mrs. B denies any TB symptoms and her exam does not show any signs that would be suspicious of TB She reports that she lives with her: 3 children (all under 7 years old) 32 year-old husband 22 year-old sister 56 year-old mother She reports that her husband has had a cough for 2-3 weeks and she is concerned that he might have TB She is also concerned that he may be engaging in behaviours that would put him at risk for HIV Based on what she reports, what do you do next for Mrs. B?

6. Slide 6 Unit 5: Case Study B Family Case: Answer 2 Test Mrs. B for HIV

7. Slide 7 Unit 5: Case Study B Family Case: Question 3 Mrs. B tests positive for HIV and her husband is diagnosed with smear-positive pulmonary TB What is your management plan for Mrs. B?

8. Slide 8 Unit 5: Case Study B Family Case: Answer 3 Counselling Do fine needle aspiration from lymph node Draw blood for CD4 Initiate contact tracing Send a health worker to her home to screen her 3 children, mother and sister for symptoms of TB

9. Slide 9 Unit 5: Case Study B Family Case: Question 4 FNA showed only reactive changes in the lymph node (no sign of TB), so you can assume that she has PGL What do you do now?

10. Slide 10 Unit 5: Case Study B Family Case: Answer 4 Start her on IPT (Isoniazid Preventive Therapy) 300mg daily (+ pyridoxine, 25mg daily) x 6 months Patient education regarding the benefits of IPT Start her on ARVs, depending on her CD4 count

11. Slide 11 Unit 5: Case Study B Family Case: Question 5 How do you do contact tracing? Who is responsible? What do you evaluate the contacts for? Where do you record the information?

12. Slide 12 Unit 5: Case Study B Family Case: Answer 5 (1) A health worker goes to the patient’s home to interview all family members for signs and symptoms of TB (contact tracing) A clinic-based nurse is responsible for contact tracing Contact examination form should be used

13. Slide 13 Unit 5: Case Study B Family Case: Answer 5 (2) Evaluate the contacts for: Cough for 2-3 weeks Weight loss Night sweats Fever Malaise Shortness of breath Chest pain Haemoptysis If any family member is symptomatic, ask that family member to come to the clinic

14. Slide 14 Unit 5: Case Study B Family Case: Answer 5 (3) Record the information in a TB contact examination form The form, with case notes for the patient, is maintained at the clinic A nurse or doctor uses this information to initiate INH prophylaxis in children or IPT in adults Annex 11, form 7 in the BNTP manual

15. Slide 15 Unit 5: Case Study Unit 5 Cases: Diagnosing TB