Review Meeting with State Health
Secretaries
on
11th & 12th September, 2012.
Revised National TB Control Programme
(RNTCP)
RNTCP - Components of DOTS Strategy
(Directly Observed Treatment- Shortcourse)
• Political commitment
• Diagnosis by microscopy
• Adequate supply of Short Course
drugs
• Directly Observed Treatment
• Accountability
TB Register
RNTCP – Goal and Objectives
• Goal
– To decrease mortality and morbidity due to TB and cut
transmission of infection until TB ceases to be a major
public health problem in India.
• Objectives:
– To achieve and maintain a case detection of at least 70%
of new sputum positive TB patients
– To achieve and maintain a cure rate of at least 85% in
newly detected smear positive cases
Moving towards Universal Access i.e. detection of 90% of all estimated TB
cases (including Drug Resistant & HIV-TB) in the community and
successful treatment of at least 90% of the TB patients registered.
State-wise New Sputum Positive Case
Detection Rate & Treatment Success Rate
State-wise Performance (2011)
New Smear Positive Case Detection Rate
(NSP CDR)
Performance
States
Good
A &N , AP, Arunachal Pradesh, Chandigarh,
(NSP CDR >= 70%)
Delhi, Gujarat, HP, Jharkhand, Meghalaya,
(15 states/UTs)
Nagaland, Rajasthan, Sikkim, UP,
Puducherry
Moderate
Chhattisgarh, D & N Haveli, Goa, Haryana,
(NSP CDR 50 - 70%)
J&K, Karnataka, Kerala, MP, Maharashtra,
(18 states/UTs)
Manipur, Mizoram, Orissa, TN, Tripura,
Uttarakhand, Punjab, Assam, West Bengal
Poor
(NSP CDR < 50%)
(3 states/Uts)
Bihar, Daman and Diu, Lakshadweep
State-wise Performance (2010)
New Smear Positive Treatment Success Rate
(NSP TSR)
Performance
States
Good
(NSP TSR >= 85%)
(27 states/UTs)
AP, Arunachal Pradesh, Chandigarh, Delhi,
Gujarat, HP, Jharkhand, Nagaland,
Rajasthan, UP, Puducherry, Chhattisgarh,
Haryana, J&K, MP, Maharashtra, Manipur,
Mizoram, Orissa, TN, Tripura, Uttarakhand,
Punjab, West Bengal, Bihar, Daman and
Diu, Lakshadweep.
Poor
(NSP TSR < 85%)
(8 states/Uts)
Sikkim, D & N Haveli, Karnataka, A &N ,
Assam, Meghalaya, Goa, Kerala,
New TB Case Detection during 2011 v/s 2010
27 States/UTs have shown
a decline/no improvement
in New TB Case Detection
in
2011 v/s 2010
Relatively better
performing
States
States/UTs
A&N Islands
Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chandigarh
Chhattisgarh
D & N Haveli
Daman & Diu
Delhi
Goa
Gujarat
Haryana
Himachal Pradesh
Jammu & Kashmir
Jharkhand
Karnataka
Kerala
No. of
Districts
1
24
14
24
38
1
16
1
2
25
2
30
21
12
14
24
31
14
No. of Districts with NSP Case
Detection Rate (2011)
>=70%
50-70%
<50%
1
19
8
6
2
0
3
1
0
17
2
18
8
4
6
11
13
3
0
4
5
8
12
1
7
0
2
8
0
10
11
4
6
11
16
5
0
1
1
10
24
0
6
0
0
0
0
2
2
4
2
2
2
6
States/UTs
Lakshadweep
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Orissa
Puducherry
Punjab
Rajasthan
Sikkim
Tamil Nadu
Tripura
Uttar Pradesh
Uttarakhand
West Bengal
Grand Total
No. of
Districts
1
50
55
9
7
8
11
31
1
20
33
4
31
4
71
13
19
662
No. of Districts with NSP Case
Detection Rate (2011)
>=70%
50-70%
<50%
1
15
11
3
2
5
3
9
0
9
21
1
5
2
34
6
3
252
0
17
27
4
1
2
4
15
0
10
10
3
19
2
36
6
8
274
0
18
17
2
4
1
4
7
1
1
2
0
7
0
1
1
8
136
States/UTs
A&N Islands
Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chandigarh
Chhattisgarh
D & N Haveli
Daman & Diu
Delhi
Goa
Gujarat
Haryana
Himachal Pradesh
Jammu & Kashmir
Jharkhand
Karnataka
Kerala
No. of Districts with NSP Treatment
Success Rate (2010)
Total no. of
Districts
>=85%
75-85%
<75%
1
24
14
24
38
1
16
1
2
25
2
30
21
12
14
24
31
14
0
23
9
7
29
1
10
0
2
12
1
28
14
12
13
19
9
3
1
1
4
15
9
0
5
1
0
12
1
2
7
0
1
5
21
11
0
0
1
2
0
0
1
0
0
1
0
0
0
0
0
0
1
0
States/UTs
Lakshadweep
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Orissa
Puducherry
Punjab
Rajasthan
Sikkim
Tamil Nadu
Tripura
Uttar Pradesh
Uttarakhand
West Bengal
Grand Total
No. of
Districts
1
50
55
9
7
8
11
31
1
20
33
4
31
4
71
13
19
662
No. of Districts with NSP Treatment
Success Rate (2010)
>=85%
75-85%
<75%
1
46
30
8
4
5
11
23
1
18
33
2
20
3
68
11
10
485
0
4
23
1
2
3
0
7
0
2
0
1
11
1
3
2
9
166
0
0
2
0
1
0
0
1
0
0
0
1
0
0
0
0
0
11
Uttar Pradesh: District-wise Annual New
Smear Positive Case Detection Rate in 2011
Uttar Pradesh: District-wise Annual New Smear
Positive Treatment Success Rate in 2010
Madhya Pradesh: District-wise Annual New
Smear Positive Case Detection Rate in 2011
Madhya Pradesh: District-wise Annual New Smear
Positive Treatment Success Rate in 2010
Bihar: District-wise Annual New Smear
Positive Case Detection Rate in 2011
Bihar: District-wise Annual New Smear
Positive Treatment Success Rate in 2010
Maharashtra: District-wise Annual New
Smear Positive Case Detection Rate in 2011
Maharashtra: District-wise Annual New Smear
Positive Treatment Success Rate in 2010
Tamil Nadu: District-wise Annual New Smear
Positive Case Detection Rate in 2011
Tamil Nadu: District-wise Annual New Smear
Positive Treatment Success Rate in 2010
Orissa: District-wise Annual New Smear
Positive Case Detection Rate in 2011
Orissa: District-wise Annual New Smear
Positive Treatment Success Rate in 2010
Punjab: District-wise Annual New Smear
Positive Case Detection Rate in 2011
Punjab: District-wise Annual New Smear
Positive Treatment Success Rate in 2010
Status of PMDT Services
(Programmatic Management of Drug-Resistant TB)
 PMDT Services
introduced in Aug
2007
 All 35 State/UTs
have introduced
PMDT services of
which 18 have
achieved complete
geographical
coverage
 802 million (65%)
pop have access to
services across 435
districts
 67 DR-TB Centers
are functional
0-25%
26-50%
51-75%
76-99%
100%
Certified :
N=42
Culture & Drug Sensitivity
Testing (DST) Labs Network
JAMMU & KAS HMIR
29 RNTCP supported labs
HIMACHAL P RADE SH
13 Additional
PUNJAB
HARYANA
NDTC
AIIMS-2
LRS
CHD
UTTARAKHAND
ARUNACHAL PRADE SH
HARYANA
DELHI
Gurgaon
RAJASTHAN
SIKKIM
UTTAR PRADE SH
JALMA
BIH AR
ASS AM
NAGALAND
MEGHALAYA
MANIPUR
JHARKHAND
GUJARAT
TRIPURA
WEST BENGAL
MADHYA P RADE SH
MIZORAM
CHHATIS GARH
ORIS SA
MAHARASHTRA
ANDHRA PRADE SH
GOA
KARNATAKA
Technology
- Solid culture:34
- Line Probe Assay: 29
- Liquid Culture:10
TRC
NTI
PO NDIC HERR Y
TAMIL NADU
KERALA
IRL (Certified )
IRL (Under Certification)
IRL (Equipment's being procured)
Med Col / NGO / Private Labs (Certified)
Med Col / NGO / Private Labs
(Under Certification )
Med Col / NGO / Private Labs (Preparatory)
National Reference Labs
Critical Gaps in PMDT
1. State PMDT Committee meetings not held regularly
2. Slow scale up of PMDT services in few states
• UP (15%), ASSAM (16%), BIHAR (22%), KA (31%), MP (54%)
3. Laboratory capacity limited
• UP (2), WB (2), KA (2), RJ (2), MP (3), BI (0), PB (0), HP (0), JK (0)
4. Deficit of DR TB Centers against norm (1/10million
population) with service gaps
• UP (2/20), BI (1/11), MP (2), KA (1/6), TN (3/7), WB (3/9), AS (1/3),
HR (1/3), CG (1/2)
5. High % of confirmed MDR TB Cases not put on treatment
in 2012
• WB (48%), MH (40%), RJ (28%), HP (35%), HR (28%), GU (27%)
Action Points (1)
• Strengthening the quality of basic DOTS services
– Ensure sanctioned posts are filled and all staff trained.
– Ensure availability of quality diagnostic and treatment services.
– Ensure availability of free X-Ray services linked with all facilities.
– Ensure quality drug supply for first-line, 2nd line ATT drugs and
antibiotics.
– Bringing services closer to the community with the help of ANM,
MPW, ASHA.
• Strengthening supervision and monitoring
– Use COMPOSITE INDICATORS
– Implement Focused Action Plan in Under-performing Districts
– Use of online case-based reporting system for data entry.
• Identifying areas with low suspect examination and
prioritize case finding
Action Points (2)
• Promoting community screening of suspects and
referral.
• TB diagnosis and treatment facilities at all Nutritional
Rehabilitation Centers (NRCs).
• Referral linkages for diagnosis of EP-TB cases.
• Focused attention for Urban areas.
• Expanding efforts to engage all care providers.
– Innovative approaches to engage the private sector.
– Need based involvement with accountability.
– Timely payment of dues.
• Active case finding in high risk population TB-HIV,
TB-Diabetes.
Action Points for PMDT - (1)
1. State PMDT Committee meetings to be held every quarter
to review progress and address local challenges
2. Expedite 100% coverage to PMDT services in the states by
Dec ’12
• Complete – establishment of DR-TB centers, Labs and
Drug Stores upgrades, Staffing & Trainings, Central
Appraisals in remaining districts
3. Expedite lab capacity enhancement to enable move
towards universal DST
• Complete – Civil works, equipment installation & AMC,
power backup, HR, proficiency testing in various
technologies in all remaining labs in the states.
Action Points for PMDT – (2)
4. Expedite scale up of DR TB Centres (norm @ 1/10
million population)
• Upgrade for airborne infection control, provide
nurses and ward attendants
• Free beds, investigations, ancillary drugs, food etc.
5. Improve coordination b/w labs, districts, field staff and
DR TB centre for prompt treatment of confirmed MDR TB
cases in the states
RNTCP - Newer Initiatives
All
States/UTs
need
to
ensure
all
out
efforts
towards
implementation of –
1.
TB Notification Order dated 7th May 2012.
2.
Patient-wise data entry in “Nikshay” for all TB cases detected
with effect from 1st January 2012 (Case Based Web Based
Recording & Reporting System).
3.
The Gazette Notification dated 7th June 2012 on the banning
the import, manufacture, sale, distribution and use of “ All
Serological Tests for TB Diagnosis”.
4.
Enforcement of Schedule H – All ANTI-TB drugs are under
Schedule H (i.e. should be sold only on the prescription of
registered medical practitioner).
NIKSHAY
(Case Based Web Based Recording & Reporting System)
www.tbcindia.nic.in
Assam – District wise Annual New Smear Positive
Case Detection Rate, 2011 (in %age)
Assam – District wise Annual New Smear Positive
Treatment Success Rate, 2010 (in %age)
Jharkhand – District wise Annual New Smear
Positive Case Detection Rate, 2011 (in %age)
Jharkhand – District wise Annual New Smear
Positive Treatment Success Rate, 2010 (in %age)
West Bengal – District wise Annual New Smear
Positive Case Detection Rate, 2011 (in %age)
West Bengal – District wise Annual New Smear
Positive Treatment Success Rate, 2010 (in %age)
Chhattisgarh – District wise Annual New Smear
Positive Case Detection Rate, 2011 (in %age)
Chhattisgarh – District wise Annual New Smear
Positive Treatment Success Rate, 2010 (in %age)
Karnataka – District wise Annual New Smear
Positive Case Detection Rate, 2011 (in %age)
Karnataka – District wise Annual New Smear
Positive Treatment Success Rate, 2010 (in %age)
Action Points (3)
• Improving communication and outreach.
– focused strategies, targeting hard-to-reach groups.
– innovative communications strategies to generate
demand from patients, and
– improving cooperation from the private sector.
• State and District TB-HIV Coordination Committee
Meetings not being conducted regularly in many
States/Districts, the frequency of which should be
ensured.
Airborne Infection Control – (1)
• National Guidelines for Airborne Infection Control in
Health Care and Other settings developed and
disseminated (available on www.tbcindia.nic.in ) that
covers
 Managerial responsibilities at State, District and Facility
level
 Administrative, Environmental & Engineering, Personal
Protective Controls
 Infection control measures at congregate and
community level
• Prioritized implementation across DR TB Centres and
TB C-DST Laboratories.
Airborne Infection Control – (2)
• Pilot implementation to assess operational feasibility
underway at 35 health care facilities (Primary to
Tertiary care including 10 ART centres) in 3 states (GU,
AP, WB)
• Pilot results will guide refinement of the national
guidelines
• Future scale up of the guidelines implementation
proposed through integration with NRHM, NCDC &
NIHFW with technical support from CTD in
 Capacity building of state teams
 Integration as a chapter in the Infection Control
Plans and Strategies of Health care facilities.