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National Tuberculosis Programme Nepal

National Tuberculosis Programme Nepal. Dr. Rajendra Pant Director. Situation of Tuberculosis. 1 TB patient transmits TB bacilli to 10-15 persons annually!!!!!!. A glimpse of NTP. Free diagnosis of TB through: - 554 diagnosis centers Free anti-TB drug distribution

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National Tuberculosis Programme Nepal

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  1. National Tuberculosis Programme Nepal Dr. Rajendra Pant Director

  2. Situation of Tuberculosis 1 TB patient transmits TB bacilli to 10-15 persons annually!!!!!!

  3. A glimpse of NTP • Free diagnosis of TB through: - 554 diagnosis centers • Free anti-TB drug distribution - 1,184 treatment centers • 3,074 treatment sub-centers • 84 DR center/sub-center • 8 MDR hostel • Directly Observe Treatment (DOT) • Integrated health program

  4. Vision TB Free Nepal Goal To reduce the mortality, morbidity and transmission of tuberculosis until it is no longer a public health problem

  5. MDG Target Vs. Achievements (NPC-2013)

  6. Post MDG and NSP 2015-20 Mile stone for 2025 • 75 % reduction in Tuberculosis deaths (compared with 2015) • 50% reduction in TB incidence ( compared with 2015) • Less than 55/100000 • Targets for 2035 • 95% reduction in TB deaths compared with 2015 • 90% reduction in TB incidence compared with 2015 • Less than 10/100000 • NSP 2015-20 • 85 % Case Finding Rate • Maintaining minimum 90% treatment success rate • Covering Hard to reach population

  7. NTP Policy Updates • Active Case Finding • All Treatment centers as DOTS Center • Two sputum sample for sputum microscopy • Full implementation of HMIS for NTP recording and reporting • Use of Master TB Register in district • HIV test of all TB patients • Redefined registration category and treatment outcome

  8. Annual Case Finding Trend

  9. National Sputum Conversion Trend

  10. National Treatment Success Trend

  11. DRTB Management Treatment Centers : 13 Treatment Sub-Centers : 71 Total Registered Cases : 1542 Fiscal Year-068/069 : 262 XDR TB : 52 Fiscal Year 068/069 : 11 Legend Mountain Hill Terai

  12. Cohort Report of Enrolled MDR TB

  13. Progress on major indicators of NTP inline with Global Targets

  14. Major Challenges for NTP Economic challenge Managerial challenge Technical challenge

  15. Managerial Challege Un-diagnosed cases Miss-diagnosed cases Un-notified Notified cases

  16. Without faster progress, we face a tidal wave of preventable disease and death

  17. KAPs 1 people at increased risk of TB due to biological risks compromised immunity and exposure to pathogens • PLHIV Diabetics • Smokers • People with other health conditions that decrease immunity (e.g. people on long term therapeutic steroids, people on immune suppressant treatment, malnourished) • Silicosis and other dust related lung disorders • Alcohol abusers (>40 gm or 50 mL/day)

  18. KAPs 2 people who have increased exposure due to where they live or work – overcrowding, poor ventilation Contacts of TB patients (in households, workplaces, educational facilities) Slum dwellers in urban settings People living in hostels Health care workers Incarcerated people (prisoners) and staff working in correctional facilities Miners, peri-mining or mining-affected population

  19. KAPs 3 people who have limited access to health services due to gender, geography, limited mobility, legal status, stigma Women and children in settings of poverty • Geography • Remote populations • Deep sea fishermen • Limited mobility • Homeless • Elderly • People living with physical and mental disabilities Migrants, refugees and internally displaced people Indigenous peoples and ethnic minorities • Stigmatised • Sex workers and victims of sex trafficking • People who use drugs* (fit in biological as well?) • Men who have sex with men

  20. Summary Screen Fast track transport systems Diagnose Use Xpert more, it’s cheaper Collaborate Providers for high risk groups Community Empower Social protect Transport, cash transfers Legislation Ban drugs, serological tests New ways Active, enhanced case finding

  21. Managerial Challege • ACSM • Active case finding- Lab Un-diagnosed cases • PAL • TB HIV • Lab Miss-diagnosed cases Un-notified • PPM • ISTC • Pt. Charter Notified cases

  22. Because of use of ARI (Annual Risk of Infection): • observed prevalence of infection, approximating the incidence of infection • Developed and adopted in 1992 • Has been discarded by many nations as estimate Technical Issue: Improper Estimation Need revision of estimation find the true prevalence for true estimation. Prevalence Survey

  23. What is Prevalence Survey? • cross-sectional and population-based survey of a representative sample of the population in which the number of people with TB disease is measured.

  24. Objective of Prevalence survey • To measure prevalence of bacteriologically-positive (smear and/or culture positive) pulmonary TB • To understand health seeking behavior of TB symptomatic and TB cases

  25. Thank you

  26. Implementation Modality • Internal: • NTC • Outsourcing of Research Management Agency • External • RIT/JATA will provide technical support through out the survey period • WHO

  27. Duration and Budget • Duration • Approximately 3 years- To produce full survey report (2013 to 2016) • Required Budget • 2,011,295 US$ • Funding available • GFATM- 1,292,795 USD • Funding required from Nepal govt & other agengies- 716,500 USD

  28. Way forward……….. • Assurance of budget from MoHP to address budget gaps • Protocol Approval • Outsourcing Research Management Agency • Tendering of equipments (Lab, x-ray) • Training • Piloting • Field operation

  29. Major Recommendations of In-depth Review-2013 • Introduce “sputum courier system”, . • Expand PAL to urban HPs and sub-HPs • Nominate TB-Infection Control focal person and revise guidelines. • Enhance the quality of existing DR-TB programme through e.g., dcentralizing DOT in DR-TB management. • Expand Open MRS system. • Integrate TB guideline within guidelines of IMCI and PPM • Introduce stricter controls/ban and adequate measures for restricting distribution of anti-TB drugs in the open market. • Further integrate the TB reporting into the HMIS. • Conduct TB prevalence survey to measure burden of disease immediately.

  30. Major plan- (2013-2015) • NSA phase 2 Application (GFATM -23 million)- Signed with GF • Active Case Finding • Microscopic camps -75 districts( prisons, slum, hard to reach area) • FCHV door to door mobilization – Contact tracing • Transportation of sputum slides- DOTS center/Sub canters to MC in mountainous districts • Piloting of community DOTS- 5 Districts (Kaski) • Prevalence survey • Data integration- complete data via HMIS.

  31. Major planning ……. • Expansion of Gene Xpert machines -14 places (NTC-17,HERD-5) • Establish of culture facilities in 3 regions • Construction of TB Hospital • Establish of DR Home in Bandipur • Establish MDR Hostels in 5 places with in Hospitals premise • DOT Provider at Districts- 15 HA/Staff Nurse(4 in WDR) • Annual workshop with districts finance, Statistics and store staff at regional level. • National TB Conference • Recording reporting format revised. implemention from IInd Trimester.

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