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Presentation 1 Introduction

Presentation 1 Introduction. Contents • Global Tuberculosis Scenario Burden of Tuberculosis in India •RNTCP- Evolution, objectives, structure, achievements. Global burden of TB. 2 billion infected, i.e. 1 in 3 of global population

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Presentation 1 Introduction

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  1. Presentation 1Introduction • Contents • • Global Tuberculosis Scenario • Burden of Tuberculosis in India • •RNTCP- Evolution, objectives, structure, achievements NTF Presentations for RNTCP Sensitization First edition 10th Nov 06

  2. Global burden of TB • 2 billion infected, i.e. 1 in 3 of global population • 9.4 million (139/lakh) new cases in 2008, 80% in 22 high-burden countries • 4 m new sm+ve PTB (61/lakh) casesin 2008 • Global incidence of TB has peaked in 2004 and is declining. • 1.77m deaths in 2007, 98% in low-income countries • MDR-TB -prevalence in new cases around 3.6% NTF Presentations for RNTCP Sensitization First edition 10th Nov 06 Ref: WHO Global Report, 2006

  3. Estimated TB incidence rate, 2007 :Source: WHO Geneva; WHO Report 2009: Global Tuberculosis Control; Surveillance, Planning and Financing

  4. Millennium Development Goals • Goal 6: “Combat HIV/AIDS, malaria and other diseases” • Target 8: “By 2015, to have halted and begun to reverse the incidence of malaria and other major diseases…” • Indicator 23: between 1990 and 2015 to halve prevalence of TB disease and deaths due to TB • Indicator 24: to detect 70% of new infectious cases and to successfully treat 85% of detected sputum positive patients NTF Presentations for RNTCP Sensitization First edition 10th Nov 06

  5. Stop TB Partnership Targets • By 2005: • At least 70% people with sputum smear positive TB will be diagnosed. • At least 85% cured. • By 2015: • Global burden of TB (prevalence and death rates) will be reduced by 50% relative to 1990 levels. • Reduce prevalence to <150 per lakh population • Reduce deaths to <15 per lakh population • Number of people dying from TB in 2015 should be less than 1 million, including those co-infected with HIV • By 2050: • Global incidence of TB disease will be less than or equal to 1 case per million population per year NTF Presentations for RNTCP Sensitization First edition 10th Nov 06

  6. Stop TB Strategy, 2006 • Vision: A world free of TB • Goal: To dramatically reduce the global burden of TB by 2015 in line with Millennium Development Goals and the Stop TB Partnership targets NTF Presentations for RNTCP Sensitization First edition 10th Nov 06

  7. Components of Stop TB Strategy, 2006 • Pursuing high-quality DOTS expansion and enhancement • Addressing TB/HIV, MDR-TB and other challenges • Contributing to health system strengthening • Engaging all health providers • Empowering people with TB, and communities • Enabling and promoting research NTF Presentations for RNTCP Sensitization First edition 10th Nov 06

  8. Directly Observed Treatment, Short-course strategy (DOTS), 1994 • Government commitment to TB control • Diagnosis by smear microscopy mostly on self-reporting symptomatic patients • Standardised short course chemotherapy (SCC) with direct observation of treatment (DOT) • Efficient system of drug supply • Efficient recording and reporting system with assessment of treatment results • Five components were expanded in 2002 NTF Presentations for RNTCP Sensitization First edition 10th Nov 06

  9. Global Situation • Since 1995,over 21 million patients have been diagnosed and treated in DOTS programmes • In 2007, 5.5 million new and relapse TB cases were initiated on treatment under DOTS strategy • Of 2.5 million new smear positive patients registered in 2006, 85% were successfully treated under DOTS NTF Presentations for RNTCP Sensitization First edition 10th Nov 06

  10. NTF Presentations for RNTCP Sensitization First edition 10th Nov 06

  11. International Standards for TB Care-2006-revised in 2009 • Developed by Tuberculosis Coalition for Technical Assistance • Members of TCTA • American Thoracic Society • WHO (World Health Organisation) • CDC (Center for Disease Control and Prevention) • KCNV(Dutch Tuberculosis Foundation), • IUATLD (The International Union Against Tuberculosis and Lung Disease) • Part of the new STOP TB Strategy and global plan to Stop TB NTF Presentations for RNTCP Sensitization First edition 10th Nov 06

  12. International Standards for TB Care • The ISTC is designed to address the care of patients of all ages with any manifestation of the disease, including multi-drug resistant and extra-pulmonary tuberculosis and tuberculosis combined with HIV infection. • The ISTC is also designed to guide providers everywhere, regardless of the circumstances of their practice. • Consists of 21 standards for Public Health Responsibility NTF Presentations for RNTCP Sensitization First edition 10th Nov 06

  13. INDIA NTF Presentations for RNTCP Sensitization First edition 10th Nov 06

  14. Problem of TB in India • Estimated incidence • 1.96 million new cases annually • 0.8 million new smear positive cases annually • 75 new smear positive PTB cases/1lakh population per year • Estimated prevalence of TB disease • 3.8 million bacillary cases in 2000 • 1.7 million new smear positive cases in 2000 • Estimated mortality • 330,000 deaths due to TB each year • Over 1000 deaths a day • 2 deaths every 3 minutes Gopi P et al (TRC), IJMR, Sep 2005 NTF Presentations for RNTCP Sensitization First edition 10th Nov 06

  15. Problem of TB in India (contd) • Prevalence of TB infection • 40% (~400m) infected with M. tuberculosis (with a 10% lifetime risk of TB disease in the absence of HIV) • Estimated Multi-drug resistant TB • < 3% in new cases • 12% in re-treatment cases • TB-HIV • ~2.31 million people living with HIV (PLWHA) • 10-15% annual risk (60% lifetime risk) of developing active TB disease in PLWHA • Estimated ~ 5% of TB patients are HIV infected NTF Presentations for RNTCP Sensitization First edition 10th Nov 06

  16. India is the highest TB burden country accounting for more than one-fifth of the global incidence Global annual incidence = 9.4 million India annual incidence = 1.96 million India is 17th among 22 High Burden Countries (in terms of TB incidence rate) NTF Presentations for RNTCP Sensitization First edition 10th Nov 06 Source: WHO Geneva; WHO Report 2009: Global Tuberculosis Control; Surveillance, Planning and Financing

  17. Estimated Incidence of TB in India*(No. of NSP Cases per 100,000 population, per year) * Estimated from recent ARTI survey North West East South ** For programme monitoring purpose estimated cases in East & South zones have been kept at the national level of 75 and this is within the upper limit of CI or ARTI in these zones NTF Presentations for RNTCP Sensitization First edition 10th Nov 06 Source: Module 9, Managing the RNTCP in your area

  18. Social and Economic Burden of TB in India Estimated burden per year • Indirect costs to society $3 billion • Direct costs to society $300 million • Productive work days lost due to TB illness 100 million • Productive work days lost due to TB deaths 1.3 billion • School drop-outs due to parental TB 300,000 • Women rejected by families due to TB 100,000 NTF Presentations for RNTCP Sensitization First edition 10th Nov 06 TRC, Socio-economic impact of TB on patients and family in India, Int J Tub Lung Dis 1999 3: 869-877

  19. RNTCP NTF Presentations for RNTCP Sensitization First edition 10th Nov 06

  20. Evolution of TB Control in India • 1950s-60s Important TB research at TRC and NTI • 1962 National TB Programme (NTP) • 1992 Programme Review • only 30% of patients diagnosed; • of these, only 30% treated successfully • 1993 RNTCP pilot began • 1998 RNTCP scale-up • 2001 450 million population covered • 2004 >80% of country covered • 2006 Entire country covered by RNTCP NTF Presentations for RNTCP Sensitization First edition 10th Nov 06

  21. Objectives of RNTCP • To achieve and maintain a cure rate of at least 85% among newly detected infectious (new sputum smear positive) cases • To achieve and maintain detection of at least 70% of such cases in the population NTF Presentations for RNTCP Sensitization First edition 10th Nov 06

  22. Organizational Chart Ministry of Health and Family WelfareDirectorate General of Health ServicesCentral TB Division RNTCP Organization structure: State level Health Minister Health Secretary MD NRHM Director Health Services Additional / Deputy / Joint Director (State TB Officer) State TB Cell Deputy STO, MO, Accountant, IEC Officer, SA, DEO, TB HIV Coordinator etc., State Training and Demonstration Center (TB) Director, IRL Microbiologist, MO, Epidemiologist/statistician, IRL LTs etc., NTF Presentations for RNTCP Sensitization First edition 10th Nov 06

  23. Structure of RNTCP at district levels District Magistrate/ District Collector District Administration Chief Medical Officer and other supporting staff District Health Services DTO, MO-DTC (15%), LT, DEO, Driver, Urban TB Coordinators, TBHVs, Communication Facilitators Nodal point for TB control District TB Centre One/ 500,000 (250,000 in hilly/ difficult/ tribal area) Medical officer-TB Control, Senior Treatment supervisor(STS), Senior TB Laboratory Supervisor(STLS) Tuberculosis Unit Medical Officer, paramedical staff And Laboratory Technician (20-50%) One/ 100,000 (50,000 in hilly/ difficult/ tribal area) Microscopy Centre TB Health Visitors (TBHV), DOT Provider (MPW, NGO, PP, ASHA, Community Volunteers) DOT Centre NTF Presentations for RNTCP Sensitization First edition 10th Nov 06

  24. Unique features of RNTCP • District TB Control Society • Modular training • Patient wise boxes • Sub-district level supervisory staff (STS, STLS) for treatment & microscopy • Robust reporting and recording system NTF Presentations for RNTCP Sensitization First edition 10th Nov 06

  25. Annualized New Smear-Positive Case Detection Rate and Treatment Success Rate in DOTS Areas, India, 2000-2009* • Population projected from 2001 census • Estimated no. of NSP cases - 75/100,000 population per year (based on recent ARTI report) NTF Presentations for RNTCP Sensitization First edition 10th Nov 06

  26. Impact of RNTCP • Cure rate more than doubled compared with earlier NTP, 85% global target consistently achieved 2003 onwards • Case detection rate is more than 70% • Case fatality reduced from 29% to 4% in NSP cases, and deaths due to TB from 500,000 to <330,000 a year • Over 11 million patients initiated on DOTS, and over 2 million additional lives saved NTF Presentations for RNTCP Sensitization First edition 10th Nov 06

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