TB CONTROL PROGRAMS

END TB STRATEGY 2050

AND
Nepal’s National Control Programs for TB
 TB Burden in Nepal
• Tuberculosis (TB) is a major cause (one of the top 10
causes) of death worldwide and in Nepal.
• The leading cause of death from a single infectious
agent (ranking above HIV/AIDS) worldwide = TB
• TB can affect anyone anywhere, but the disease
occur mostly in adults (90%) and nearly twice in
men than women as these are more active
population and so more exposure.
• TB is curable with medicine (nearly 90% cure rates)
and preventable.
• TB is a disease of poverty
 Data of 2019 [2076/77]
• In 2019 ,Globally TB- infected = 10 million And TB-
deaths = 1.4 million [56% of men aged ≥15 yr + 12% of
children aged <15 yr + 8.2% of PLHIV].
• In NEPAL in FY 2076/77, NTP registered total 27,745 (63%
male and 37% female), of which new cases = 27,232 [BUT
Total estimated cases= 68000]
• Out of 27,232 new TB cases:- 54% PBC cases (Pulmonary
Bacteriologically Confirmed)+ 14% PCD
cases(=Pulmonary Clinically Diagnosed) + 32% EPTB cases
• 58.7% cases from Terai region . And 24% cases from
Bagmati province , 21% from province2 and 20% from
Lumbini province.
 Drug Resistant (DR) TB
• In Nepal nearly 2,200 people were estimated to developed
DR TB, but only 517 were detected (i.e. 76.% were missed)
and out of diagnosed 384 on DR TB treatment (i.e. 25.8%
were lost to follow up).
• 3% ↓ in annual incidence rates of TB in Nepal but the TB
burden in Nepal is still higher than estimated.
• 4955 DOTS centers; 765 microscopic centers; 22 DR TB
treatment centers; 81 DR TB treatment sub-centers; 6 DR TB
hostels; 1 DR TB home; Diagnosis services provided via 72
Genexpert sites; 2 Culture labs with DST and LPA services.
• TB preventive therapy scaled up to 39 districts.
• About a quarter of the world’s population is infected with M.
tuberculosis .
Cont…
• NEPAL Adopts the DOTS strategy in 1996; Stop TB
Strategy in 2006 and the End TB Strategy in 2015.
• SDG Target 3.3 - By 2030, end the epidemics of AIDS, TB,
malaria and neglected tropical diseases, and water-
borne diseases and other communicable diseases
WHO End TB Strategy : 3 objectives
1.↓ annual incidence rate of TB compared to 2015(%)
a. Milestones b. Targets
• 80% : 2030 milestone SDG 2030 End TB 2035
• 50% : 2025 milestone
• 20%: 2020 milestone 80% 90%
2.↓ annual TB deaths compared to 2015 (%)
a. Milestones b. Targets
• 90% : 2030 milestone SDG 2030 End TB 2035
• 75% : 2025 milestone
• 35% : 2020 milestone 90% 95%
3. No (zero) households affected by TB face catastrophic
cost by 2020 .
Vision: world free of TB – zero death, disease and
suffering d/t TB
Goal: End the global TB epidemic
Principles:
1. Government stewardship and accountability with
monitoring and evaluation
2. Strong coalition with civil society organizations and
community
3. Protection and promotion of human rights , ethics
and equity
4. Adaptation of the strategy and targets at country
level with global collaboration
Pillars and components
Pillar 1: Integrated, patient-centred care and
prevention
Components:
a. Early Dx of TB including universal DST and
systematic screening of risk groups
b. Tx of all TB cases including DR TB and patient support

c. Collaborative TB/HIV activities and management of

comorbidities.
d. Preventive Tx of people at high risk and vaccination
against TB
Pillar 2: bold policies and supportive systems
Components :
a. Political commitment with adequate resources for
TB care and prevention
b. Engagement of communities , civil society
organizations and public and private care providers
c. Universal health coverage policy , regulatory
frameworks for case notification , vital registration ,
quality and rational use of medicines and infection
control
d. Social protection , poverty alleviation and actions
on other determinants of TB
Pillar 3: Intensified research and innovation
Components:
a. Discovery, development and rapid uptake of new
tools, interventions and strategies
b. Research to optimize implementation and impact
and promote innovation
NTCC(focal point of NTP) National Strategic
Plan (NSP)2016-21 with VISION of TB Free Nepal
(i.e. Ending TB) by 2050
(NTP= National TB Program)
(NTCC=National TB Control Centre)
• VISION
 TB Free Nepal by 2050 (based on the National Health Policy
2014 and the End TB Strategy) : - The ending of TB has
been defined as less than 1 TB patient per 1,000,000
population.
• GOAL
 To decrease the TB Incidence Rate by 20%, from 2015 to
2021 i.e. to identify additional 20,000 new TB cases by next
5 years.
OBJECTIVES and STRATEGY (NSP 2016-21)
Objective1 : To ↑ case notification through improved
health facility-based diagnosis
• Strategy- strengthen and expansion of tb diagnostic
services
Objective2 : To maintain the treatment success rate of
90% for all forms of TB (except drug resistant TB) by
2021
• Strategy - Ensure and strengthen supply and storage
of quality TB drugs for all TB patients + promote
psychosocial support system for TB patients
CONT…
Objective 3: To provide DR TB diagnostic services to
50% of the presumptive MDR TB patients by 2018 and
100% by 2021 and to successfully treat at least 75% of
those diagnosed.
• Strategy- expansion of DR TB treatment
services+capacity building of service providers.
Objective 4: To expand case finding by engaging
service providers for TB care from the public sector
• Strategy- engagement of medical colleges and their
teaching hospitals
Cont…
Objective 5: To gradually scale up Community System
Strengthening Program (CSSP) at 60% of the local
administrative units by 2018 and to 100% of the
administrative units by 2021
• Strategy- advocacy and community based activities
Objective 6: To strengthen health system through
Human Resource (HR) management, capacity
development, financial management, and
infrastructure development
• Strategy- Human Resource Management + Capacity
building of all levels + Infrastructure development
Cont…
Objective 6: To strengthen health system through Human
Resource (HR) management, capacity development,
financial management, and infrastructure development.
• Strategy- Human Resource Management + Capacity
building of all levels + Infrastructure development.

• The burden of TB - measured in terms of incidence

(new+relapse cases), prevalence(new +old cases) and
mortality.
• higher incidence (1.6 times), higher prevalence (1.8
times), and higher mortality rates (3.1 times) in 2018 as
compared to previous.
• Case Notification Rate (CNR) in Nepal: -
all forms of TB :- 93/100000
incident TB cases: 91/100000
Globally 9 million people become ill each year
TB is curable (90%) and preventable
Impact of COVID-19 on TB progress : pushed back to
8 years