1 / 30

Central TB Division Ministry of Health & Family Welfare New Delhi

Revised National Tuberculosis Control Programme Status, Challenges & Achievements and impact on TB epidemiology. Central TB Division Ministry of Health & Family Welfare New Delhi. Global Burden. Of the 22 High burden countries are 12 are in Asian continent 8 in Africa.

heid
Download Presentation

Central TB Division Ministry of Health & Family Welfare New Delhi

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Revised National Tuberculosis Control ProgrammeStatus, Challenges & Achievements and impact on TB epidemiology Central TB DivisionMinistry of Health & Family WelfareNew Delhi

  2. Global Burden • Of the 22 High burden countries are • 12 are in Asian continent • 8 in Africa

  3. Global annual incidence = 8.9 million India is the highest TB burden country globally accounting for one fifth of the global incidence Source: WHO Geneva; WHO Report 2004: Global Tuberculosis Control; Surveillance, Planning and Financing

  4. Problem of TB in India • Incidence of TB disease: 1.8 million new TB cases annually (0.8 million new infectious cases) • Prevalence of TB disease: 3.8 million bacteriologically positive (2000) • Deaths: about 370,000 deaths due to TB each year • TB/HIV: ~2.5 million people with HIV; • About 5% of TB patients estimated to be HIV positive • MDR-TB in new TB cases <3% • Substantial socio- economic impact

  5. RNTCP – Goal and Objectives • Goal • The goal of TB control Programme is 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 a case detection of at least 70% of new sputum positive TB patients • To achieve a cure rate of at least 85% in such patients

  6. Achievements of RNTCP 1993-2007

  7. Population in India covered under DOTS and Total Tuberculosis Patients put on treatment each quarter 346566

  8. Annualized New Smear-Positive Case Detection Rate and Treatment Success Rate in DOTS Areas, India, 1999-2007* • Population projected from 2001 census • Estimated no. of NSP cases - 75/100,000 population per year (based on recent ARTI report)

  9. Treatment Outcome of Smear Positive Cases registered under RNTCP DOTS, 1993-2006 Sp + Retreatment = 1,119,369 NSP = 2,997,753

  10. Extra-pulmonary TB – By Site Source of pie-diagram: RNTCP Data from 13 Districts, Q3 2004

  11. Treatment outcome of New Extra-Pulmonary Patients registered under RNTCP DOTS (2005-2006) (all forms of EP TB) Total cases (n =354,025)

  12. Other Sector involvement • >2900 NGOs involved under RNTCP • ~18,000 PPs involved • 150 Corporate Houses participating • 261 Medical Colleges involved • Involvement of professional bodies • IAP involved in development of Pediatric guidelines 2005 • IMA actively collaborating in 167 districts/ 6 states under Rd 6 GFATM Project • Coalition of professional bodies established (2007) • Assoc. of Physicians of India (API)/ Indian Academy of Pediatricians (IAP)/ National College of Chest Physicians (NCCP)/ Indian Chest Society (ICS) / Federation of Family Physicians of India (FFPI)

  13. Contribution of Various Sectors: 14 intensified urban PPM sites summary of contributionby different health sectors (1st Qtr 06 – 4th Qtr 06) N=788381 N=52111 N=26649 N=77884

  14. TB suspects referred from ICTC for evaluation, 2005-2007 > 5 fold increase in referrals (Jan-Nov) (Jan-Nov) (Jan-Nov)

  15. TB patients Newly HIV Tested, 2005-2007 > 3 fold increase in last 3 years Jan-Nov Jan-Nov Jan-Nov

  16. MDG Goals: Progress • Indicator 23: between 1990 and 2015 to halve prevalence of TB disease and deaths due to TB • Studies by NTI, TRC suggest annual decline in prevalence by 9%-11%. • Mortality rates have declined from 42 per 100,000 population in 1990 to 29 per 100,000 population in 2005 • Trends in Incidence to be measured by repeat national ARTI survey in 2007-09 • Indicator 24: to detect 70% of new infectious cases and to successfully treat 85% of detected sputum positive patients • The global NSP case detection rate is 60% and treatment success rate is 84% • RNTCP consistently achieving global bench mark of 85% treatment success rate; and case detection rate close to 70% (2007 – 70%)

  17. Challenges: Road ahead

  18. Implement all components of the newStop TB Strategy

  19. Component 1: Pursue high quality DOTS expansion and enhancement

  20. New Smear Positive Case Detection Rate, India Third Quarter, 2007 >70% 50% - 69.9% 30% – 49.9% <30%

  21. Cure Rate by district, India Third Quarter, 2006 >85% 80% – 84.9% <80%

  22. Component 2: Address TBHIV, MDR TB (1) • Strengthening of collaborative activities across the country • National Framework for Joint TB HIV Collaborative activities • Establish collaborative mechanisms • Service delivery coordination – Intensified TB case finding at ICTCs & ART centers • Documentation and reporting • ACSM & involevment of NGOs • Operational issues: • ART-DOTS linkages – improving access • CPT prophylaxis to co-infected patients - operationalisation • Provider initiated routine referrals of TB patients for VCT • INH prophylaxis to at ART centers – efficacy/ feasibility • Assess impact of HIV burden on TB epidemiology • Periodic surveillance of HIV prevalence among TB patients

  23. Component 2: Address TBHIV, MDR TB (2) • National DOTS Plus Guidelines framed and disseminated • Gujarat and Maharashtra initiated DOTS Plus services in 2007. • Plan to expand to 7 additional states in 2008 • Challenges • Non standardized regimen being practiced for 1st line anti TB treatment • Irrational use of 2nd line drugs • Looming threat of XDR TB

  24. Component 3: Contribute to Health Systems Strengthening • NRHM - window of opportunity for strengthening existing health systems • Indian Public Health Standards – for all health care facilities • Improved Human Resource management • Strengthening of community outreach through ASHA workers • Innovative collaborations with NGO and Private sector

  25. Component 4: Engage all care providers • Need for strengthening involvement of PPs • IMA involved in 167 districts in 6 states under Rd 6 GFATM project – starting July 2007 • Coalition of Professional Organisations - IMPACT • Expand scope of involvement of NGOs, especially in hard to reach areas/ areas with weak government health system • Consortium of NGOs • Systematic involvement of other sectors- Railways/ Coal/ ESI/ Faith based organizations • Varying administrative control and geographical spread • Definite role of Medical Colleges • In seeking involvement of all health care providers, promoting rational use of anti TB drugs • Role envisaged by NTF and echoed by JMM 2006 • Addressing competing interests of private providers/ market forces • Regulation/ Legislation

  26. Component 5: Empower people with TB and Communities • Mass media important to generate awareness • Local/ Focal ACSM strategy to increase awareness and thus address community needs and generate demand • Generate demand for quality services • sharing information through different media (mass media, schools, organized groups) • Increase utilization of services • informing patients and communities, • promoting neighbourhood DOT provision, • motivating patients with the support of cured persons, • involving other care providers in the community • Enhancing patient satisfaction • patient provider counselling, • using traditional healer/ cured persons for DOT provision,

  27. Component 6: Enable and promote research • RNTCP to pro-actively participate in national and international trials on • New diagnostic tools • Rapid diagnostic methods like MGIT, Hain’s test etc. • New drugs/ vaccines • Promote operational research on RNTCP • 6 large scale OR projects undertaken by Medical Colleges were approved by the National OR Committee in 2006-07. • Over 20 more OR proposals from Medical Colleges are in process for approvals. • Post Graduate Thesis by Medical College residents, being undertaken on RNTCP topics

  28. Assessment of Impact • Nation wide ARTI Survey – 2007-09 • Co-ordinated by NTI, Bangalore in association with • New Delhi TB Centre (North Zone) • MGIMS, Wardha (West Zone) • LRS Institute, New Delhi (East Zone) • CMC, Vellore (South Zone) • Disease prevalence Surveys – 2007-09 • TRC Chennai – MDP project • NTI, Bangalore • MGIMS, Wardha • PGI, Chandigarh • AIIMS, New Delhi • JALMA, Agra • RMRCT, Jabalpur Symptomatic screening + CXR + Sputum Smear + Culture Symptomatic screening + Sputum Smear + Culture

  29. Conclusions • Significant progress since 1993 • 30 million suspects examined • Over 8 million patients registered on treatment; thus saving >1.4 million lives • Global benchmarks almost achieved • Challenges • Expand reach of standardized treatment/ ISTC across all care providers • Establish systems for diagnosis and management of MDR TB • Promote rational use of 2nd line drugs • Prevent emergence of XDR TB • Achieve TB related MDGs by 2015 • Limit impact of HIV and MDR on TB epidemiology

  30. Thanks www.tbcindia.org

More Related