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RNTCP - Components of DOTS Strategy (Directly Observed Treatment- Shortcourse)

Review Meeting with State Health Secretaries on 11 th & 12 th September, 2012. Revised National TB Control Programme (RNTCP). RNTCP - Components of DOTS Strategy (Directly Observed Treatment- Shortcourse). TB Register. Political commitment Diagnosis by microscopy

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RNTCP - Components of DOTS Strategy (Directly Observed Treatment- Shortcourse)

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  1. Review Meeting with State Health Secretaries on 11th & 12th September, 2012.Revised National TB Control Programme (RNTCP)

  2. RNTCP - Components of DOTS Strategy(Directly Observed Treatment- Shortcourse) TB Register Political commitment Diagnosis by microscopy Adequate supply of Short Course drugs Directly Observed Treatment Accountability

  3. RNTCP – Goal and Objectives 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. • 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

  4. State-wise New Sputum Positive Case Detection Rate & Treatment Success Rate

  5. State-wise Performance (2011) New Smear Positive Case Detection Rate (NSP CDR)

  6. State-wise Performance (2010) New Smear Positive Treatment Success Rate (NSP TSR)

  7. 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

  8. Uttar Pradesh: District-wise Annual New Smear Positive Case Detection Rate in 2011

  9. Uttar Pradesh: District-wise Annual New Smear Positive Treatment Success Rate in 2010

  10. Madhya Pradesh: District-wise Annual New Smear Positive Case Detection Rate in 2011

  11. Madhya Pradesh: District-wise Annual New Smear Positive Treatment Success Rate in 2010

  12. Bihar: District-wise Annual New Smear Positive Case Detection Rate in 2011

  13. Bihar: District-wise Annual New Smear Positive Treatment Success Rate in 2010

  14. Maharashtra: District-wise Annual New Smear Positive Case Detection Rate in 2011

  15. Maharashtra: District-wise Annual New Smear Positive Treatment Success Rate in 2010

  16. Tamil Nadu: District-wise Annual New Smear Positive Case Detection Rate in 2011

  17. Tamil Nadu: District-wise Annual New Smear Positive Treatment Success Rate in 2010

  18. Orissa: District-wise Annual New Smear Positive Case Detection Rate in 2011

  19. Orissa: District-wise Annual New Smear Positive Treatment Success Rate in 2010

  20. Punjab: District-wise Annual New Smear Positive Case Detection Rate in 2011

  21. Punjab: District-wise Annual New Smear Positive Treatment Success Rate in 2010

  22. 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%

  23. Certified : N=42 29 RNTCP supported labs 13 Additional Culture & Drug Sensitivity Testing (DST) Labs Network NDTC AIIMS-2 LRS Gurgaon JALMA IRL (Certified ) IRL (Under Certification) • Technology • Solid culture:34 • - Line Probe Assay: 29 • - Liquid Culture:10 TRC IRL (Equipment's being procured) NTI Med Col / NGO / Private Labs (Certified) Med Col / NGO / Private Labs (Under Certification ) Med Col / NGO / Private Labs (Preparatory) National Reference Labs

  24. Critical Gaps in PMDT • State PMDT Committee meetings not held regularly • Slow scale up of PMDT services in few states • UP (15%), ASSAM (16%), BIHAR (22%), KA (31%), MP (54%) • Laboratory capacity limited • UP (2), WB (2), KA (2), RJ (2), MP (3), BI (0), PB (0), HP (0), JK (0) • 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) • High % of confirmed MDR TB Cases not put on treatment in 2012 • WB (48%), MH (40%), RJ (28%), HP (35%), HR (28%), GU (27%)

  25. 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

  26. 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.

  27. Action Points for PMDT - (1) • State PMDT Committee meetings to be held every quarter to review progress and address local challenges • 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 • 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.

  28. 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

  29. RNTCP - Newer Initiatives All States/UTs need to ensure all out efforts towards implementation of – TB Notification Order dated 7th May 2012. Patient-wise data entry in “Nikshay” for all TB cases detected with effect from 1st January 2012 (Case Based Web Based Recording & Reporting System). The Gazette Notification dated 7th June 2012 on the banning the import, manufacture, sale, distribution and use of “ All Serological Tests for TB Diagnosis”. 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).

  30. NIKSHAY(Case Based Web Based Recording & Reporting System)

  31. Thank You www.tbcindia.nic.in

  32. Assam – District wise Annual New Smear Positive Case Detection Rate, 2011 (in %age)

  33. Assam – District wise Annual New Smear Positive Treatment Success Rate, 2010 (in %age)

  34. Jharkhand – District wise Annual New Smear Positive Case Detection Rate, 2011 (in %age)

  35. Jharkhand – District wise Annual New Smear Positive Treatment Success Rate, 2010 (in %age)

  36. West Bengal– District wise Annual New Smear Positive Case Detection Rate, 2011 (in %age)

  37. West Bengal – District wise Annual New Smear Positive Treatment Success Rate, 2010 (in %age)

  38. Chhattisgarh – District wise Annual New Smear Positive Case Detection Rate, 2011 (in %age)

  39. Chhattisgarh – District wise Annual New Smear Positive Treatment Success Rate, 2010 (in %age)

  40. Karnataka – District wise Annual New Smear Positive Case Detection Rate, 2011 (in %age)

  41. Karnataka – District wise Annual New Smear Positive Treatment Success Rate, 2010 (in %age)

  42. 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.

  43. 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.

  44. 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.

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