Revised National Tuberculosis Control

Programme
Overview - Key Priorities

Dr K S Sachdeva
Deputy Director General, Central TB Division
Revised National Tuberculosis Control Programme
Ministry of Health and Family Welfare
 What is Tuberculosis?
Tuberculosis (TB) is an infectious Tuberculosis generally affects the
disease caused by the bacterium lungs, but can also affect other
Mycobacterium tuberculosis parts of the body
(MTB)

One patient with infectious

pulmonary TB if untreated can
infect 10-15 persons in a year
 Risk factors
Medical
o Malnutrition
o Diabetes
o HIV infection
o Low body weight
o Severe kidney disease
o Other lung diseases (silicosis)
o Substance abuse etc.

Environmental
o Overcrowding
o Inadequate ventilation
o Enclosed living/working
conditions
o Occupational risks
 The TB threat is REAL in India

28 Lakh 4.2 Lakh 1.4 Lakh

people fell ill from people died from people had drug-
TB TB resistant TB

Missing 1 patient Less than

million TB dies every 50% treated
patients minute successfully

WHO Global TB Report 2017

In India…….

40 crore infected

35 lakh estimated
TB patients annually

4.2 lakh deaths

Due to TB annually

5
 India: MDG6 TB target
TB EPIDEMIC REVERSED 50% DROP IN TB MORTALITY
Rate per 100,000 population 50% DROP IN TB Prevalence

35 lakh
HIV
additional
lives saved New cases All cases reduced Deaths reduced
declining
ed by half by half

v
465  195 per lakh pop

e
216  167 per lakh pop 38  17 per lakh pop

hi
(58% reduction)
(23% reduction) (55% reduction)

A c
WHO Global TB Report 2016
 Sustainable Development Goals (SDG)
Vision: A world free of TB
Zero TB deaths, Zero TB disease, and Zero TB suffering
Goal: End the Global TB Epidemic (<10 cases per 100,000 population)
 

 
TARGETS
INDICATORS
SDG 2030
Reduction in number of TB deaths
compared with 2015 (%)
90%
Reduction in TB incidence (new case) rate
compared with 2015 (%)
80%
TB-affected families facing catastrophic
expenditures due to TB (%)
Zero
TB Free India
• India has committed to End
TB by 2025, 5 years ahead of
the global SDG target

• Prime Minister of India

launched TB Free India
campaign at ‘Delhi End TB
Summit’ on 13th March, 2018

• The campaign calls for a

social movement focused on
patient-centric and holistic
care driven by integrated
actions for TB Free India
 National Private sector
Strategic Plan engagement

(2017-25) Community
Engagement
Active Case
Finding

Preventive Strategi TB
Measures
es Co-morbidities

ICT Tools for

adherence and Multi-sectoral
monitoring response
Drug Resistant
TB

9
 Ministry of Health & Family Welfare

Organizational Central TB Division

structure
State TB Cell
36 States / UTs

District TB Centre
Supporting Facilities 733 Districts

 National Institutes (6) TB Unit

 National Reference Laboratories (6) One per 1.5 – 2.5 lakh population

 Intermediate Reference Laboratories (29)

Designated
 State TB Training and Demonstration Centres (26) Microscopy Centre
One per 1 lakh population
 Culture and DST Laboratories (49)
 DR-TB Centres (148) Peripheral
 CBNAAT Laboratories (1180) Health Institute
 Key Services

1. Free diagnosis and treatment for TB patient

2. Provision of rapid diagnostics
3. Testing of all TB patients for drug resistance
and HIV
4. Management of associated diseases
5. Treatment adherence support
6. Nutrition assistance to TB patients
7. Preventive measures
Strategy to find

Reaching High
patients
Active TB Sensitive
seeking care
Case Finding in Private Diagnostic
Sector tool
 i
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Direct Benefit Transfer (DBT) schemes
Existing schemes:
1. Honorarium to Treatment Supporters – For provision of
treatment support to TB patients (Adherence, ADR
monitoring, counselling @Rs.1000/- to Rs.5000/-)
2. Patient Support to Tribal TB Patients (Financial Patient
Support @Rs750/-)
New Schemes:
3. Nutritional Support to All TB patients (Financial Support to
Patients @Rs.500/-month)
4. Incentives to Private Providers (Rs.500/- for Notification &
Rs.500/- for Follow-up with Treatment Outcome @Rs. 500)
5. Incentives to Informant (Rs. 500/- is given on diagnosis of TB
among referrals from community to public sector health
facility)
Prevent
• Air borne infection control measures
• Strengthen Contact Investigation
• Preventive treatment in high risk groups
• Manage Latent TB Infection
• Address determinants of disease
Increased Access to Diagnostic
Services
 Expansion of microscopy centres to improve
access
 Phase 1 - PHCs where a Laboratory Technician (LT) is
available
 Phase 2 – Other PHCs
Current Status – 16.1 lakh TB patients notified in
public sector (12% in 2018)
1675
Microscopy Centres in 2018
8
14,5 1 microscopy centre at ~75,000
Microscopy Centres in 2017
76 population Policy Update in RNTCP, 2018
Universal Drug Susceptibility
Testing
 All TB patients to be tested for Rifampicin Resistance
Current Status – 60% of target
 DR-TB patients diagnosed
(54% from 2017)

Testing for Rifampicin to All

59544
Testing for INH
Rif
38,60 Resis Mono Testing for Second line
5 tanc /Poly
e DR-TB FQ/SLI Resistance
Policy Update in RNTCP, 2018
2018 2017
Paradigm shift in management of Drug Resistant TB
Shorter BDQ
Regimen

• All • MDR/RR-
MDR/RR- TB
TB patients
patients with
without resistance
resistant to addl.
to addl. SLD &
SLD eligible

> 20,000 patients on Shorter regimen

Policy Update in RNTCP, 2018
> 4,600 patients on BDQ containing regimen
62 patients on DLM containing regimen
 Injection Free Regimen
Treatment for Previously Treated TB Patients
Injection
2HRZES Free 2HRZE
1HRZE regimen for
3HRE 4,20,000 4HRE
patients

Treatment for INH Resistant TB Patients

Injection Free
(3-6) Km Lfx R E Z regimen for Lfx R E Z
~1,00,000
patients Policy Update in RNTCP, 2018
 Gazette on TB Notification
48 Cities in JEET & others
90 Cities approved in PIP
Mandatory Notification of TB
patients
Provider
Influence Provider

pitals Laboratories Pharmacies

Notification
 Public Health Actions
RNTCP Linkage
Provisions of Sections 269 and 270 of the
Indian Penal Code (IPC)
Treatment Support
Notices
Patient
Policy Update in RNTCP, 2018
1 519
 Multi-sectoral Engagement
TB care services in Socio-economic
health support &
infrastructure Empowerment
Infection
Prevention Information
Education
Address Communication
Determinants

Prevention and Corporate Social

Care at Work Place Responsibility

Policy Update in RNTCP, 2018

TB - A social problem & needs multi-sectoral approach

P
a
t

e
n
Community Engagement
t
s 2
Transformation of TB survivors to
| 3 2 TB champions
5
C 1 S Capacity building and mentoring
o t programme
m
m D a Engagement of existing
u
n i t community groups like PRI, SHG,
s e VHSNC, MAS, Youth Club
t t s Grievance redressal mechanism
y
4 r Involvement of community
i representatives in different
a
c forums
k t
h s
Call Centre
 1800-11-6666 Nikshay Counsel
Poshan
 Outbound & Inbound Yojana ling

 Time – 7 to 11 Treatm
Informa ent
 Languages – 14 tion Adhere
nce
 100 call centre agents
TB
 Pan-India coverage Notifica Grievance
Redressal
tion
 Citizen – Patient - Providers Follow
Up
Policy Update in RNTCP, 2018
Subnational Certification for
TB Free District / State

 Accelerate efforts
TB
 Contextual strategies Free

 Generate healthy competition

 Recognition for achieving “Disease Free” status through
monetary and non-monetary awards

Policy Update in RNTCP, 2018

District
Award Categories Criteria Monetary Award for Non-Monetary
Decline in incidence rate District (in Rs.) Recognition
compared to 2015
Bronze 20% 2 lakhs Certification and
Felicitation at the
Silver 40% 3 lakhs National Level
Gold 60% 5 lakhs
TB Free Status 80% 10 lakhs

State
Award State/Uts with State/Uts with State/Uts with Non-Monetary
Categories population <50 lakh population 50 lakh – population >5 Cr Recognition
5 Cr
Bronze 10 lakhs 15 lakhs 25 lakhs Certification and
Felicitation at
Silver 20 lakhs 35 lakhs 50 lakhs the National
Gold 40 lakhs 60 lakhs 75 lakhs Level
TB Free Status 60 lakhs 75 lakhs 1 Crore
State TB Index

Policy Update in RNTCP, 2018

Key Challenges

1. Under reporting and uncertain care of TB patients in

private sector

2. Reaching the unreached – Slums, Tribal, vulnerable

3. Drug Resistant TB

4. Co-morbidities – HIV, Diabetes

5. Undernutrition, overcrowding

6. Lack of awareness and poor health seeking behaviour lead

to delay in diagnosis
 Key Take Away
• Improve TB notification rate Ensure mandatory TB
notification from private sector
• Active TB Case Finding to reach the unreached
• Optimum utilization of CBNAAT machines
• Expand Universal Drug Susceptibility Testing coverage
• Expansion of newer treatment regimens (daily regimen,
bedaquiline, delamanid, shorter MDR TB regimen)
• NIKSHAY Poshan Yojana to every TB patients
• 100% reporting through NIKSHAY
• Collaboration with Line Ministries to tackle social
determinants of TB
• Community participation for TB Elimination
 Bending the Curve
Accelerating towards a TB free India
Thank You
Thank You