## Referral Protocol at Sub-Centre Level **Key Point:** The Sub-Centre is the most peripheral unit of the Indian public health system and is NOT equipped to initiate or dispense anti-TB drugs. Its role is case identification and referral, not treatment. ### Role of Sub-Centre in TB Control - Identification and screening of suspected TB cases - Rapid diagnostic testing (RDT) using approved kits - Referral to PHC or designated TB unit with proper documentation - Follow-up of referred cases and support to treatment adherence - Does NOT stock or dispense anti-TB drugs ### Correct Management Pathway ```mermaid flowchart TD A[Suspected TB at SC]:::outcome --> B[Rapid Diagnostic Test]:::action B --> C{Test Result}:::decision C -->|Positive| D[Generate referral slip]:::action D --> E[Refer to PHC]:::action E --> F[PHC confirms diagnosis & initiates DOTS]:::action C -->|Negative| G[Counsel & follow-up]:::action ``` **High-Yield:** The PHC is the first point where anti-TB drugs are stocked and DOTS (Directly Observed Therapy Short-course) is supervised. The SC acts as a case-finder and feeder unit. **Clinical Pearl:** Even with a positive RDT at SC, formal confirmation and treatment initiation must occur at PHC or higher facility. This ensures: - Proper drug accountability - Supervision of therapy - Management of comorbidities and adverse effects - Linkage to NTEP (National TB Elimination Programme) registry ### Why 8 km distance is NOT a barrier - PHC is the designated first-referral unit for SC - Patient transport is the responsibility of the health system - Delay in referral is NOT justified by distance [cite:Park 26e Ch 8]
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