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DTOs Quarterly Review Meeting, Ahmedabad 25 th Oct 2013

Explore the status of RNTCP in Gujarat presented by Dr. PV Dave, State TB Officer, discussing the goals, vision, and objectives of the program in combating Tuberculosis effectively.

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DTOs Quarterly Review Meeting, Ahmedabad 25 th Oct 2013

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  1. DTOs Quarterly Review Meeting, Ahmedabad 25th Oct 2013 Status of RNTCP in Gujarat Dr. PV Dave State TB Officer Gujarat 3rd Quarter 2013

  2. What is Tuberculosis ? Tuberculosis (TB) is a highly infectious bacterial disease caused by Mycobacterium tuberculosis. TB can affect any part of the body. When it affects the lungs it is called pulmonary TB. The commonest form of TB is pulmonary TB. TB in any other part of the body (i.e. other than lungs) is called extra pulmonary TB.

  3. India is the highest TB burden country accounting for an estimated one quarter of all TB cases worldwide Global annual incidence = 8.8 million India annual incidence = 2.3 million India is 16th among 22 High Burden Countries (in terms of TB incidence rate) Source: WHO Geneva; WHO Report 2011 Global Tuberculosis Control

  4. RNTCP Vision and Goal Vision The vision of the Government of India is a “TB-free India - through achieving Universal Access by provision of quality diagnosis and treatment for all TB patients in the community” Goal The goal of TB Control Programme is to decrease the morbidity and mortality by early diagnosis and early treatment to all TB cases thereby cutting the chain of transmission

  5. RNTCP Objectives as per 12th FYP Early detection and treatment of at least 90% of estimated all type of TB cases in the community, including Drug resistant and HIV associated TB. Successful treatment of at least 90% of new TB patients, and at least 85% of previously-treated TB patients Reduction in default rate of new TB cases to less than 5% and re-treatment TB cases to less than 10% Initial screening of all re-treatment smear-positive till 2015 and all Smear positive TB patients by year 2017 for drug-resistant TB and provision of treatment services for MDR-TB patients; Offer of HIV Counselling and testing for all TB patients and linking HIV-infected TB patients to HIV care and support; Extend RNTCP services to patients diagnosed and treated in the private sector.

  6. HEALTH IN THE MILLENNIUM DEVELOPMENT GOALS Goal 6: Combat HIV/AIDS, malaria and other diseases Target 6c: Halt and begin to reverse the incidence of malaria and other major diseases including TB. Indicator 6.9: Incidence, prevalence and death rates associated with TB Indicator 6.10: Proportion of TB cases detected and cured under DOTS Stop TB Partnership targets By 2005: At least 70% of people with sputum smear-positive TB will be diagnosed (i.e. under the DOTS strategy), and at least 85% successfully treated. The targets of a case detection rate of at least 70% and a treatment success rate of at least 85% were first set by the World Health Assembly of WHO in 1991. By 2015: The global burden of TB (per capita prevalence and death rates) will be reduced by 50% relative to 1990 levels. By 2050: The global incidence of active TB will be less than 1 case per million population per year.

  7. 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 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 such patients

  8. Directly Observed Treatment, Short-course (DOTS) – a five point strategy TB Register • Political and Administrative commitment • Good Quality Diagnosis by Sputum smear microscopy • Uninterrupted supply of good quality drugs • Directly observed treatment (DOT) • Systematic monitoring and accountability Note: Directly Observed Treatment (DOT) is only one of the five components of DOTS strategy

  9. Annual Risk of TB Infection (ARTI) - 1 One of the key epidemiological indicators of the tuberculosis situation in a community It represents the proportion of population that gets newly infected (or re-infected) with tubercle bacilli over the course of one year. Currently the average ARTI in the country as a whole is estimated to be 1.5%.

  10. Annual Risk of TB Infection (ARTI) - 2 It has been estimated that for every one percent annual risk of tuberculosis infection, there are about 50 new pulmonary sputum smear positive (NSP) cases 50 new pulmonary sputum smear negative (NSN) cases 25 re-treatment pulmonary cases 10 extra-pulmonary cases Totaling to 135 cases …………..per 100,000 population per year. This means that, with an ARTI of 1.6% for West Zone (including Gujarat), there will be 80 new smear positive cases, 80 new smear-negative cases, 40 re-treatment cases, and 16 extra-pulmonary cases, totaling to 216 cases ……………per 100,000 population per year.

  11. Estimated* Incidence of TB in India(No. of NSP Cases per 100,000 population, per year) * Estimated from ARTI survey North East West South ** For programme monitoring purpose estimated cases in East & South zones have been kept at the national level of 75

  12. Structure of RNTCP Central TB Division, DGHS, New Delhi DDG-TB, CMO-TB STO, Deputy STO, MO, Accountant, IEC Officer, TB-HIV Coordinator, SA, DEO Designated IRL and DOTS-Plus site State TB Cell DTO, MO-DTC, LT, DEO, Driver District TB Centre Nodal point for TB control Urban TB Coordinators, Communication Facilitator Tuberculosis Unit One/ 5 lakh (2.5 lakh in hilly/ difficult/ tribal area) MO-TC STS, STLS One/ lakh (0.5 lakh in hilly/ difficult/ tribal area) Designated Microscopy Centre MO, LT DOT Provider – MPW, NGO, PP, Community Volunteer TBHV DOT Centre

  13. RNTCP Infrastructure in Gujarat

  14. Human Resource – State level, 3rd Quarter 2013 * STC+STDC

  15. Other Human Resource in the state under TB cadre * Level: STC/ STDC/DTC/ADTC/periphery

  16. Human Resource – District Level,3rd Quarter 2013

  17. Gujarat state has been in the target zone, consecutively since last more than Seven Years 28 / 30 (93%) reporting units are in the target zone 119/144 (83%) TUs in target zone TB Suspects Examined – 3Q13 : 1,23,055 New Smear Positive Case Detection Rate – 3Q13 : 74% New Smear Positive Cure Rate – 3Q12 : 87% Total TB patients put on treatment : 18,444 New Smear Positive Cases put on treatment : 9283 Since the inception of RNTCP up to 30-9-13 Total TB suspect Examined : 46,79,151 Total TB Patients put on DOTS treatment, :9,97,884 New Smear Positive patients put on treatment :4,25,278 Additional lives saved : 1,79,619 Identification of MDR TB Suspects : 45,538 Diagnosis of MDR TB Cases : 5,802 MDR TB Cases Put on CAT – IV : 4,592 XDR TB Cases Put on CAT – V : 72 Achievements at a Glance 3rd Quarter 2013

  18. Annualized New Smear Positive Case Detection Rate and Treatment Success Rate in DOTS areas of Gujarat, 2000-3Q13

  19. Success Rate Vs Case Detection Rate (3Q12/3Q13)

  20. TB Suspects Examined per lac per quarter 3rd Quarter 2013 3rd Quarter 2011 Expected : 150 / Lac / Qtr Gujarat: 190 3rd Quarter 2012 Gujarat: 175 Gujarat: 197

  21. TB Suspects Examined per lakh per Quarter Expected : 150 / Lac / Qtr TB Units – Gujarat 3rd Quarter 2013 Gujarat: 197

  22. 3Q 2011 NSP Case Detection Rate 3Q 2013 Expected : 70% Gujarat State: 76% 3Q 2012 Gujarat: 74% Gujarat State: 72%

  23. NSP Case Detection Rate TB Units – Gujarat 3rd Quarter 2013 Expected : 70% Gujarat: 74%

  24. NSP Conversion Rate 4Q 2012 2Q 2013 Expected : 90% Gujarat State: 92% 1Q 2013 Gujarat: 92% Gujarat: 91%

  25. NSP Conversion Rate TB Units – Gujarat 2nd Quarter 2013 Expected : 90% Gujarat: 92%

  26. NSP Success Rate 1Q 2012 3Q 2012 Expected : 85% Gujarat State: 87% 2Q 2012 Gujarat: 87% Gujarat State: 86%

  27. NSP Success Rate TB Units – Gujarat 3rd Quarter 2012 Expected : 85% Gujarat: 87%

  28. Rate of change in suspects examined per lakh population (compared to same quarter in previous year) 3Q13 Vs 3Q12 Gujarat State : 12.6%

  29. Rate of change in suspects examined per s+ case diagnosed (compared to same quarter in previous year)3Q13 Vs 3Q12 Gujarat State : 6.7%

  30. RNTCP case finding at State level: Gujarat

  31. Total Case Notification Rate V/S NSP Case Notification Rate: Gujarat

  32. NSP Case Notification Rate V/S NSN Case Notification Rate

  33. Positive Notification Rate from PMR V/S Positive Notification Rate from CFR

  34. NSP Notification Rate V/S RT Positive Case Notification Rate

  35. Re-Treatment typewise Notification rate trend Gujarat

  36. Sputum conversion of NSP patients registered in 2nd quarter 2013

  37. Sputum conversion of RT Sm +ve patients registered in 2nd quarter 2013

  38. % of PHIs referring 2-3% of new adult OPDGujarat 3rd Quarter 2013

  39. Trend of treatment outcomes in Re-treatment +ve Cases Gujarat

  40. Major indicators – Internal Evaluations-3Q13

  41. Other Health Sector - 3Q13

  42. Chest Symptomatic ReferralsCivil / Gen. Hospitals (last 4 quarters) Ahmedabad Zone Norms 2-3% of new adult OPD for sputum microscopy

  43. Chest Symptomatic ReferralsCivil / Gen. Hospitals (last 4 quarters) Gandhinagar Zone Norms 2-3% of new adult OPD for sputum microscopy

  44. Chest Symptomatic ReferralsCivil / Gen. Hospitals (last 4 quarters) Surat Zone Norms 2-3% of new adult OPD for sputum microscopy

  45. Chest Symptomatic ReferralsCivil / Gen. Hospitals (last 4 quarters) Vadodara Zone Norms 2-3% of new adult OPD for sputum microscopy

  46. Chest Symptomatic ReferralsCivil / Gen. Hospitals (last 4 quarters) Bhavnagar Zone Norms 2-3% of new adult OPD for sputum microscopy

  47. Chest Symptomatic ReferralsCivil / Gen. Hospitals (last 4 quarters) Rajkot Zone Norms 2-3% of new adult OPD for sputum microscopy

  48. Chest Symptomatic Referral Rate of Medical Colleges (1)

  49. Chest Symptomatic Referral Rate of Medical Colleges (2)

  50. PP Involvement – Gujarat - since 2006

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