Durgical
EN
Open the app

Nursing in the tuberculosis programme: case finding, directly observed treatment, contacts and adherence

  • Safe practice

In the TB programme the nurse finds people with cough, opens their treatment record, agrees how each dose is supervised and follows them and their contacts.

Updated

What it is

Tuberculosis is preventable and curable, but treatment lasts months and stopping early can lead to drug resistance. Colombia's national TB programme (Resolución 227 de 2020) gives the nursing professional concrete tasks: enrol the person in the programme, check that the case was notified to SIVIGILA, hold a nursing consultation before treatment starts and then every month, agree the type of directly observed treatment (DOT) with the person, assess the risk of loss to follow-up and coordinate social and psychological support. DOT can be given at the IPS, in the community, at home or virtually. The nursing assistant supports the daily supervision and tells the nurse when the person misses doses. The territorial team searches for symptomatic people among the contacts.

What it requires

  • The programme records: individual treatment card, register of symptomatic respiratory patients and the contact book.
  • Verification of the medical prescription and of the medicines for each phase, per protocol.
  • The validated instrument for the risk of treatment abandonment (an annex of the national guideline).
  • Respiratory protection (N95 respirators) for high-risk procedures and for people with untreated infectious TB.

Components

  • Case finding: active search for people with cough in every service and in vulnerable groups.
  • Diagnosis: quality sputum samples and the diagnostic algorithms of the programme.
  • Supervised treatment and monthly nursing follow-up.
  • Contact study and education of the family.
  • Social support: nutrition, psychology and social work for people at risk of abandoning treatment.

How it is applied (and why)

  1. Ask about cough in every contact with the service and refer people who meet the definition — finding cases early cuts transmission.
  2. Teach the person how to produce a good sputum sample — the programme asks for samples that meet laboratory quality criteria.
  3. Enrol the person, open the treatment card and check the SIVIGILA notification — the programme follows each case by name.
  4. Hold the first nursing consultation: knowledge, beliefs, fears and daily life — the plan must fit the person to be followed.
  5. Agree the DOT modality with the person (IPS, community, home or virtual) — supervision should not become a barrier.
  6. Supervise each dose being swallowed and record it on the card the same day — the record shows adherence at a glance.
  7. Apply the abandonment-risk tool and refer medium or high risk to psychology and social work — support prevents loss to follow-up.
  8. Offer the HIV test and teach cough hygiene and home ventilation — TB and HIV are managed together, and the family is protected.
  9. Act on two missed days: call, visit and bring the person back — early action avoids treatment failure and resistance.
  10. Hold monthly consultations and report adverse reactions to the doctor — the plan is adjusted as the person progresses.

In nursing practice

  • Supervision does not mean the person must come to the IPS every day; choose the modality that lets them finish treatment.
  • Stigma keeps people away: speak privately, with respect, and explain that treatment stops transmission.
  • Watch for weight loss and food insecurity; refer to nutrition and social programmes.
  • Prisons, street dwellers, Indigenous communities and migrants need the specific approaches of the national guideline.

Common mistakes

  • Giving the medicines to take home without the supervision agreed in the plan.
  • Waiting until the next monthly visit to act on missed doses.
  • Forgetting to search for symptoms among contacts at the times set by the programme.
  • Wearing a respirator in a way that humiliates the person instead of explaining why it is used.

Test yourself

Think of the answer, then tap the question to see it.

What does DOT mean in the TB programme?

Directly observed treatment: every dose is swallowed under the supervision of a health worker or community agent and recorded on the individual treatment card.

How often does the nurse hold a consultation with the person on TB treatment in Colombia?

Before treatment starts and then every month, with a care plan to strengthen adherence.

What should happen when a person misses treatment for two consecutive days?

The team locates the person and brings them back to treatment; the nursing assistant reports the absence to the nurse.

When are contacts of drug-susceptible TB searched for symptoms?

In the first week after the index case is detected, at six months and at one year after treatment starts.

Add to my cards (4)

Elsewhere in DurgiPedia

Connections

← All of nursing

Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: Resolución 227 de 2020: lineamientos técnicos y operativos del Programa Nacional de Prevención y Control de la Tuberculosis (Ministerio de Salud y Protección Social, Colombia, 2020); Tuberculosis: fact sheet (World Health Organization, 2026); Guidelines for the Investigation of Contacts of Persons with Infectious Tuberculosis (MMWR Recommendations and Reports 54(RR-15)) (Centers for Disease Control and Prevention (CDC), 2005).

Spotted a mistake?We are always improving for the community. Tell us what is wrong and our team will review it.Report a mistake

Representative model, for educational purposes only.