Revised National TB Control Programme

1. Revised National TB Control Programme DD/ DHO / CS meeting Date: 23-24 May 2014 Dr ManoharPawar (Jt. Director, Tuberculosis and Leprosy)

2. Content • Objectives of RNTCP • Maharashtra Performance: Case Finding and Case Holding • Nikshay • TB Notification • Finance

3. Objectives of RNTCP 2012-17 ● Early detection 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 • 85% of previously-treated TB Patients ● Reduction in default rate : • < 5 % in new cases and • < 10% in re- treatment TB cases ● Initial screening for MDR-TB patients • all re-treatment smear-positive till 2015 and • all Smear positive TB patients by year 2017 ● Offer of HIV Counselling and testing • for all TB patients and linking HIV- infected TB patients to HIV care and support; ● Support Private sector- • Extend RNTCP services to patients diagnosed and treated in the private sector.

4. Priority Issues decided at State level Review Meeting by Hon. Principal Secretary Health on 11 April 14 • Better awareness with effective ACSM • Enhance Screening of TB Symptomatics at OPDs/IPDs • Contact Screening: Adult & Pediatric • Drug availability -No Drug shortage in the field • DOTs to be followed to save life • ART 100% for TB-HIV co-infected • Nikshay: 100% Data Entry • NGO Workshop for their effective involvement • Improve TB Notification from Private Sector • 100% expenditure of funds released

5. Performance

6. RNTCP Performance: Maharashtra As per the “Annual Risk of TB Infection” estimate (1.6)

7. Suspect Examination Rate & Annualized Total Case Detection Rate (Expected:- Suspect- 220/lakh/quarter, Total CDR- 194/lakh/year) Suspect- 220/lach/qtr Total CDR- 194/lakh/qtr

8. District wise Trend in Suspects Examination Rate per lakh per quarter: Maharashtra: 1Q14 State average: 202 Expected: 220 N a n d u r b a r G o n d i y a N a g p u A m r a v a t i B h a n d a r a D h u l e J a l g a n A k o l a W a r d h a B u l d a n a C h a n d r a p ur N a s h i k W a s h i m Y a v a t m a l Thane A’bad J a l n a H i n g o l i G a d c h i r o l i A h m a d n a g a r P a r b h a n i B i d Nanded R a i g a r h O s m a n a b a d P u n e R u r a l L a t u r S o l a p u r S a t a r a R a t n a g i r i S a n g l i K o l h a p u r S i n d h u d u r g

9. Districts: Trend in TB Suspect examination (<202 - State average) Below state average

10. Total TB Case Detection Rate- Maharashtra, 1Q14 State avg. – 119 per lakh per year Jalgoan Corp Dhule Corp Amravati Corp Malegaon Corp A’bad Corp Nagpur Corp Akola Corp Ahmednagar Corp N a n d u r b a r G o n d i y a Nashik Corp N a g p u r A m r a v a t i B h a n d a r a D h u l e Bhiwandi J a l g a n A k o l a W a r d h a NMMC B u l d a n a MBMC C h a n d r a p ur N a s h i k W a s h i m Y a v a t m a l UMC Thane A’bad J a l n a H i n g o l i KDMC G a d c h i r o l i A h m a d n a g a r P a r b h a n i TMC M u m b a i Nanded Corp B i d Nanded P u n e R a i g a r h O s m a n a b a d P u n e R u r a l L a t u r S o l a p u r S a t a r a PCMC R a t n a g i r i S’pur Corp S a n g l i K o l h a p u r Sangli Corp K’pur Corp S i n d h u d u r g

11. Rural Districts: Total Case Detection Rate(Districts arranged with increasing Annualized Total Case Detection per lakh population for 1q14 – Expected 194 per lakh population) Below state average

12. Status of X-ray at Health Care Settings *Data as reported by districts for review meeting

13. Steps to improve case detection • Medical officers from PHC to identify TB suspects from OPD & refer to DMC • Respective THO/DHO to review periodically • Superintendent of RH/SDH to monitor OPD/Suspects referral through the MOs by doctor wise referral every weekly • X-rays functional and utilized – help to increase NSN cases • See that non-functional X-rays are functional in all RH/SDH/CH • Utilize functional X-ray for diagnosis of Sputum Negative TB- MS of RH/CS to monitor • All DMCs should be functional in the district • PHCs High OPD with LT can be taken up for DMC- proposal can be sent to STO • Sputum Collection and Transportation Mechanism to be established in PHC, where DMC is not available: • Establishing sputum collection and transportation System at non- DMC PHI • Ensure quality of sputum collection and transportation to DMCs • Involvement of PP/NGO in referral and DMC • Ensure screening of all contacts of TB patients for symptoms of TB • Minimize Initial Default • Follow up of each TB patients under PHC/RH in fortnightly visits. • Monitor PHI-Wise referral monthly at DHO/CS Meeting

14. Treatment outcomes New Smear PositiveTB Patients registered-1Q13 N = 13565

15. Districts with poor NSP treatment outcome reported in 1q13 Districts marked in red are not matching the state average

16. Treatment Outcomes of RT Sm+ve Cases reported in 1Q13 N = 4146

17. Districts with Poor Treatment Outcome among Sm+ RT Cases reported in 1Q13

18. Status of Nikshay Implementation(Web Based Case Based Recording and Reporting)

19. Poor Performing Districts in Nikshay Implementation

20. Points for Action in Nikshay • Include Nikshay training as a part of district level training for Data Entry Operators of PHC/ RH/ SDS/CH, which is being or will be organised. A slot of at least 1-2 hours can be given to Nikshay. • All medical officers and MS/THOs to be sensitized on Nikshay data entry monitoring and they should be reviewed regularly on completeness of Nikshay entry at their level by DHO and CS.

21. Status of TB Notification till date

22. Districts with Poor TB Notifications from Private Sector

23. Action Points on TB Notification • DHO and CS in coordination with DTO to arrange and address CME on TB Notification for private health practitioners at district head quarter. • MS of RH and THO should participate in block level CMEs on TB Notification. • DHO to monthly review on block wise progress. District officials of IMA, NIMA to be called and reviewed regarding progress of TB Notification.

24. Programmatic Management of Drug Resistant TB (PMDT)

25. Maharashtra:- Trend of MDR/XDR TB Case finding and treatment • Since implementation (2008) • - 62063MDR Suspects examined, • - 10930 MDR TB diagnosed • - 9252 put on treatment. • Total XDR Diagnosed in Maharashtra- 190 ( 140 - Mumbai)

26. Action points for PMDT • Send MDR suspects samples to C&DST lab within 7 days of suspect identification • Initiate diagnosed MDR TB cases on treatment within 7 days of diagnosis. • Availability of Sr Creatinine facility at RH/SDH level. If not available reimburse Sr. Creatinine if done in private lab. • Management of mild adverse drug reactions (ADR) by local MO’S & referral for serious ADR to DRTB centre. • Prompt travel reimbursement to the MDR TB patients. • Provide linkages for MDR TB patients with appropriate social welfare schemes , nutritional support. • Get all the Medical officers trained in PMDT

27. Newer Initiatives In TB HIV • From April 2014, all ‘TB suspects’ should be offered HIV Counselling and Testing by Medical Officers for early identification of HIV. • HIV testing done at ICTC/Facility Integrated ICTC/Whole Blood testing Facility • DHO/CS to instruct trained staff for Whole Blood testing to undertake HIV testing for TB suspect or TB Patient along with ANC.

28. State Health Society Maharashtra-RNTCP(Financial Performance up to Mar. 2014)

30. State Health Society, RNTCP - Maharashtra Poor Performing Districts: 2013-14 (Figures in Lakh)

31. Thank You