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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.

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Central TB Division Ministry of Health & Family Welfare New Delhi

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  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

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