National TB Elimination Programme

By,
Dr. Tanuja P. Pattankar
Assistant Professor
Department of Community Medicine
Top causes of Death Worldwide in 2017
• TB-KSHAYA ROG
• PTHISIS(WESTERN)

• ROBERT KOCHS Birthday ON MARCH 24TH

( WORLD TB DAY)
 Epidemiological
triad

25/05/18 Epidemiology of Pulmonary TB

 Agent Factors
Tuberculosis (TB) is an infectious disease caused by the bacterium Mycobacterium
tuberculosis (MTB) which generally affects the lungs, but can also affect other
parts of the body

One patient with infectious

pulmonary TB if untreated can
infect 10-15 persons in a year
 Host factors
• Age
• Sex
• Heredity
• Nutrition
• Immunity

25/05/18 Epidemiology of Pulmonary TB

 Risk Factors
oMalnutrition oSubstance abuse etc.
oDiabetes o Overcrowding
oHIV infection o Inadequate ventilation
oPoor immunity
o Enclosed living/
oSevere kidney disease
working conditions
oOther lung diseases
o Occupational risks
e.g. silicosis

25/05/18 Epidemiology of Pulmonary TB

 Who are vulnerable to TB
• Poor and vulnerable groups
• Living in overcrowded places
• Living in substandard places
• Poor nutrition
• Interaction with other diseases (such as
HIV/AIDS)
• Migration to high prevalence communities
• Diabetic
• one sputum positive case infects nearly 10-15
persons /yr

• Annual risk of infection(ARI)-most informative

index of magnitude of problem of tb.
• Present 1.2% 50/lakh/yr.
 History of TB control Programme
• 1962- National tuberculosis control program.

• 1993- WHO adopted DOTS strategy for control.

RNTCP started in india
• 1997- DOTS included officially in RNTCP.

• 1999- covered 130 million population in country

• 2006- fastest expansion of DOTS in the world

covered 1114 million population(whole country)

• 2006-11 SECOND PHASE OF RNTCP

• 2007- DOTS PLUS for MDR

• 2009-new +ve case detection rate -70%

treatmaent success rate of 86% achieved
>1200 labs across country
261 medical colleges,300 NGOS
• IMPACT OF PROGRAM=

<2000- Annual Risk of TB infection ARI - (1.7%)

2010 - ARI (1.2%)

• 2012-2017 ( TB free India) national strategic plan

• 2017-2025(DETECT-TREAT-PREVENT-BUILD)NATIONAL STRATEGIC PLAN
• 2016-2035 (END TB)
 TB Notification under NTEP

35

30 28.8 28.7
27.4 26.4
25 26.9 24.04 lakhs
23.2 21.5 lakhs
20 6.8 lakhs (28%)
18.3 lakhs 5.3 lakhs (25%)
3.8 lakhs (21%)
15 12% increase in
case finding
18% increase in
10 case finding
16.1 lakhs (75%) 17.2 lakhs (72%)
14.4 lakhs (79%)
5

0
2017 2018 2019

Public Private
NTEP Target Incidence Estimate (WHO Global Report)
12
 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
National Strategic Plan (2017-25)

Multi-
sectoral
response Active
Community
Engagement
Case
Finding

TB
Preventive
Measures Strategies Co-
morbidities

ICT Tools for Private

adherence sector
and engagement
monitoring Drug
Resistant
TB
15
Organizational structure

Supporting Facilities

 National Reference
Laboratories (6)
 Intermediate Reference
Laboratories (31)
 Culture and DST Laboratories
(81 including IRL/NRL)
 CBNAAT Laboratories (1268)
 DRTB Centres- 703
 Key Services

1. Free diagnosis and treatment for TB patient

2. Public health action- contact tracing, testing
for co-morbidities etc.
3. Treatment adherence support
4. Nutrition assistance to TB patients (DBT-
Nikshay Poshan Yojana)
5. Preventive measures
 Strengthening Case Finding in the Public Sector
ACTIVE APPROACH TO CASE FINDING
PASSIVE APPROACH TO CASE FINDING
Chest X Ray:
Clinically diagnosed TB
increased from 8.8 lakhs in
2017 to 12.7 lakhs in 2019
Revised Diagnostic
Algorithm for TB: Increase
in DR-TB cases from 38,000
in 2017 to 66,000 in 2019
Upfront Rapid Molecular
Testing: Increased from
5.23 lakhs upfront tests in
2017 (16% yield) to 11.34
lakhs in 2019 (17% yield)
Intensive Case Finding in Health
facilities- Screening for TB
among:
-DM patients increased from
11.5 L in 2018 to ~20 L in 2019
- ICTC/ART referrals increased
from 3.35 L in 2017 to 3.94 L in
2019
Active Case Finding in vulnerable
population: from 5.5 crore
population screened in 2017 to
28 crores screened in 2019. Yield
increasing from ~27,000 to
~63,000 TB patients.
Leveraging Outreach of other
Healthcare Programmes: 8.3
lakhs referrals from Health &
Wellness Centres .
Strengthening Case Finding in the Private Sector

Schedule H1 Implementation: The number of

chemists registered in Nikshay increased from
15221 in 2017 to over 43000 chemists notifying
20,609 TB cases in 2019.

77% Increase
Mandatory Notification of TB: Gazette in private
notification issued in March 2018; Provisions sector
of Sections 269 and 270 of the Indian Penal notification
Code (IPC) in 2019 from 3.8
lakhs in 2017
to 6.8 lakhs in
2019.
Patient Provider Support Agency through JEET
and Domestic Resources: From 48 PPSAs in 2017
to 220 PPSAs in 2019 and 266 PPSAs in 2020.
 Treat

• Daily Regimen
Treatment • Shorter Regimen
• Newer Drugs
• IT Enabled Adherence
Support
Patient Centric Care • Comorbidity
management
• Financial incentives
Reduce Out-of-pocket •
Direct Benefit Transfer
Expenditure
 Direct Benefit Transfer (DBT) 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/-)
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 reporting of Treatment Outcome
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
 Paradigm shift in management of
Drug Resistant TB
Shorter MDR TB regimen
MDR-TB Success Rate
70%
66,308
Shorter MDR TB
60% Regimen 0.6
BDQ Containing regimen
50%
47% 47% 48%
12589
40% 46%

30%
2016 2017 2018 2019 Dlm Containing regimen
Conventional MDR Regimen 445
Shorter MDR Regimen

All oral longer regimen

DR-TB Success Rate 4072
(MDR with additional
resistance & XDR) All Oral Longer Regimen Launch by AS&DG,
70% Bedaquilline Jharkhand (Jan 2020)
0.66
60% (CAP)
50%
40%
30% 36%
28% 31%
20% 27%
2016 2017 2018 2019
Conventional XDR Reg-
imen
 Multi-sectoral Engagement
TB care services in Socio-economic
health support &
infrastructure Empowerment
Infection
Prevention Information
Education
Address Communication
Determinants
Corporate
Prevention and
Care at Work Place Social
Responsibility

TB - A social problem & needs multi-sectoral approach

Inter-Ministerial Coordination
AYUSH (Ayurveda, Yoga & Naturopathy, Unani, Siddha and
Homoeopathy)
• 1st meeting of National Technical Expert Group on NTEP-AYUSH Collaboration &
e-consultation of experts held
• 2nd draft of Policy Document and Joint Letter drafted

Railways
• Joint Working Group to be formed to monitor implementation

Defence
• Action Plan developed.
• 95 Ex- Servicemen Contributory Health Scheme (ECHS) Polyclinics registered in
Nikshay, remaining underway

Labour and Employment

• MoU signed in September 2020
 Community Engagement
TB Forums at the National, State
Transformation of TB survivors to TB and District level to provide a
platform for all stakeholders,
champions including the community, to voice
Capacity building and mentoring their views
programme
Engagement of existing community
groups like PRI, SHG, VHSNC, MAS,
Youth Club
Grievance redressal mechanism
Involvement of community
representatives in different forums
 Call Centre- Nikshay Sampark

 1800-11-6666 Counselling
Nikshay Treatment
 Outbound & Inbound Poshan Adherence
Yojana
 Time – 7 to 11
 Languages – 14 Grievance
Information
 100 call centre agents Redressal

 Pan-India coverage Follow

TB
 Citizen – Patient - ProvidersNotification Up
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
 Bending the Curve
Accelerating towards a TB free India
Thank
ThankYou
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