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Review Meeting with State Health Secretaries on 11th

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Review Meeting with State Health Secretaries on 11th & 12th September, 2012. Revised National TB Control Programme (RNTCP) NIKSHAY (Case Based Web Based Recording ... – PowerPoint PPT presentation

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Title: Review Meeting with State Health Secretaries on 11th


1
Review Meeting with State Health Secretaries on
11th 12th September, 2012.Revised National TB
Control Programme (RNTCP)
2
RNTCP - Components of DOTS Strategy(Directly
Observed Treatment- Shortcourse)
  • Political commitment
  • Diagnosis by microscopy
  • Adequate supply of Short Course drugs
  • Directly Observed Treatment
  • Accountability

3
RNTCP Goal and Objectives
  • Goal
  • 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 newly detected smear positive cases

Moving towards Universal Access i.e. detection of
90 of all estimated TB cases (including Drug
Resistant HIV-TB) in the community and
successful treatment of at least 90 of the TB
patients registered.
4
State-wise New Sputum Positive Case Detection
Rate Treatment Success Rate
5
State-wise Performance (2011) New Smear Positive
Case Detection Rate (NSP CDR)
Performance States
Good (NSP CDR gt 70) (15 states/UTs) A N , AP, Arunachal Pradesh, Chandigarh, Delhi, Gujarat, HP, Jharkhand, Meghalaya, Nagaland, Rajasthan, Sikkim, UP, Puducherry
Moderate (NSP CDR 50 - 70) (18 states/UTs) Chhattisgarh, D N Haveli, Goa, Haryana, JK, Karnataka, Kerala, MP, Maharashtra, Manipur, Mizoram, Orissa, TN, Tripura, Uttarakhand, Punjab, Assam, West Bengal
Poor (NSP CDR lt 50) (3 states/Uts) Bihar, Daman and Diu, Lakshadweep
6
State-wise Performance (2010) New Smear Positive
Treatment Success Rate (NSP TSR)
Performance States
Good (NSP TSR gt 85) (27 states/UTs) AP, Arunachal Pradesh, Chandigarh, Delhi, Gujarat, HP, Jharkhand, Nagaland, Rajasthan, UP, Puducherry, Chhattisgarh, Haryana, JK, MP, Maharashtra, Manipur, Mizoram, Orissa, TN, Tripura, Uttarakhand, Punjab, West Bengal, Bihar, Daman and Diu, Lakshadweep.
Poor (NSP TSR lt 85) (8 states/Uts) Sikkim, D N Haveli, Karnataka, A N , Assam, Meghalaya, Goa, Kerala,
7
New TB Case Detection during 2011 v/s 2010
27 States/UTs have shown a decline/no improvement
in New TB Case Detection in 2011 v/s 2010
Relatively better performing States
8
States/UTs No. of Districts No. of Districts with NSP Case Detection Rate (2011) No. of Districts with NSP Case Detection Rate (2011) No. of Districts with NSP Case Detection Rate (2011)
States/UTs No. of Districts gt70 50-70 lt50
AN Islands 1 1 0 0
Andhra Pradesh 24 19 4 1
Arunachal Pradesh 14 8 5 1
Assam 24 6 8 10
Bihar 38 2 12 24
Chandigarh 1 0 1 0
Chhattisgarh 16 3 7 6
D N Haveli 1 1 0 0
Daman Diu 2 0 2 0
Delhi 25 17 8 0
Goa 2 2 0 0
Gujarat 30 18 10 2
Haryana 21 8 11 2
Himachal Pradesh 12 4 4 4
Jammu Kashmir 14 6 6 2
Jharkhand 24 11 11 2
Karnataka 31 13 16 2
Kerala 14 3 5 6
9
States/UTs No. of Districts No. of Districts with NSP Case Detection Rate (2011) No. of Districts with NSP Case Detection Rate (2011) No. of Districts with NSP Case Detection Rate (2011)
States/UTs No. of Districts gt70 50-70 lt50
Lakshadweep 1 1 0 0
Madhya Pradesh 50 15 17 18
Maharashtra 55 11 27 17
Manipur 9 3 4 2
Meghalaya 7 2 1 4
Mizoram 8 5 2 1
Nagaland 11 3 4 4
Orissa 31 9 15 7
Puducherry 1 0 0 1
Punjab 20 9 10 1
Rajasthan 33 21 10 2
Sikkim 4 1 3 0
Tamil Nadu 31 5 19 7
Tripura 4 2 2 0
Uttar Pradesh 71 34 36 1
Uttarakhand 13 6 6 1
West Bengal 19 3 8 8
Grand Total 662 252 274 136
10
States/UTs Total no. of Districts No. of Districts with NSP Treatment Success Rate (2010) No. of Districts with NSP Treatment Success Rate (2010) No. of Districts with NSP Treatment Success Rate (2010)
States/UTs Total no. of Districts gt85 75-85 lt75
AN Islands 1 0 1 0
Andhra Pradesh 24 23 1 0
Arunachal Pradesh 14 9 4 1
Assam 24 7 15 2
Bihar 38 29 9 0
Chandigarh 1 1 0 0
Chhattisgarh 16 10 5 1
D N Haveli 1 0 1 0
Daman Diu 2 2 0 0
Delhi 25 12 12 1
Goa 2 1 1 0
Gujarat 30 28 2 0
Haryana 21 14 7 0
Himachal Pradesh 12 12 0 0
Jammu Kashmir 14 13 1 0
Jharkhand 24 19 5 0
Karnataka 31 9 21 1
Kerala 14 3 11 0
11
States/UTs No. of Districts No. of Districts with NSP Treatment Success Rate (2010) No. of Districts with NSP Treatment Success Rate (2010) No. of Districts with NSP Treatment Success Rate (2010)
States/UTs No. of Districts gt85 75-85 lt75
Lakshadweep 1 1 0 0
Madhya Pradesh 50 46 4 0
Maharashtra 55 30 23 2
Manipur 9 8 1 0
Meghalaya 7 4 2 1
Mizoram 8 5 3 0
Nagaland 11 11 0 0
Orissa 31 23 7 1
Puducherry 1 1 0 0
Punjab 20 18 2 0
Rajasthan 33 33 0 0
Sikkim 4 2 1 1
Tamil Nadu 31 20 11 0
Tripura 4 3 1 0
Uttar Pradesh 71 68 3 0
Uttarakhand 13 11 2 0
West Bengal 19 10 9 0
Grand Total 662 485 166 11
12
Uttar Pradesh District-wise Annual New Smear
Positive Case Detection Rate in 2011
13
Uttar Pradesh District-wise Annual New Smear
Positive Treatment Success Rate in 2010
14
Madhya Pradesh District-wise Annual New Smear
Positive Case Detection Rate in 2011
15
Madhya Pradesh District-wise Annual New Smear
Positive Treatment Success Rate in 2010
16
Bihar District-wise Annual New Smear Positive
Case Detection Rate in 2011
17
Bihar District-wise Annual New Smear Positive
Treatment Success Rate in 2010
18
Maharashtra District-wise Annual New Smear
Positive Case Detection Rate in 2011
19
Maharashtra District-wise Annual New Smear
Positive Treatment Success Rate in 2010
20
Tamil Nadu District-wise Annual New Smear
Positive Case Detection Rate in 2011
21
Tamil Nadu District-wise Annual New Smear
Positive Treatment Success Rate in 2010
22
Orissa District-wise Annual New Smear Positive
Case Detection Rate in 2011
23
Orissa District-wise Annual New Smear Positive
Treatment Success Rate in 2010
24
Punjab District-wise Annual New Smear Positive
Case Detection Rate in 2011
25
Punjab District-wise Annual New Smear Positive
Treatment Success Rate in 2010
26
Status of PMDT Services (Programmatic Management
of Drug-Resistant TB)
  • PMDT Services introduced in Aug 2007
  • All 35 State/UTs have introduced PMDT services of
    which 18 have achieved complete geographical
    coverage
  • 802 million (65) pop have access to services
    across 435 districts
  • 67 DR-TB Centers are functional

0-25
26-50
51-75
76-99
100
27
Culture Drug Sensitivity Testing (DST) Labs
Network
Certified N42 29 RNTCP supported labs 13
Additional
NDTC
AIIMS-2
LRS
Gurgaon
JALMA
IRL (Certified )
IRL (Under Certification)
TRC
  • Technology
  • Solid culture34
  • - Line Probe Assay 29
  • - Liquid Culture10

IRL (Equipment's being procured)
NTI
Med Col / NGO / Private Labs (Certified)
Med Col / NGO / Private Labs (Under
Certification )
Med Col / NGO / Private Labs (Preparatory)
National Reference Labs
28
Critical Gaps in PMDT
  • State PMDT Committee meetings not held regularly
  • Slow scale up of PMDT services in few states
  • UP (15), ASSAM (16), BIHAR (22), KA (31), MP
    (54)
  • Laboratory capacity limited
  • UP (2), WB (2), KA (2), RJ (2), MP (3), BI (0),
    PB (0), HP (0), JK (0)
  • Deficit of DR TB Centers against norm
    (1/10million population) with service gaps
  • UP (2/20), BI (1/11), MP (2), KA (1/6), TN (3/7),
    WB (3/9), AS (1/3), HR (1/3), CG (1/2)
  • High of confirmed MDR TB Cases not put on
    treatment in 2012
  • WB (48), MH (40), RJ (28), HP (35), HR (28),
    GU (27)

29
Action Points (1)
  • Strengthening the quality of basic DOTS services
  • Ensure sanctioned posts are filled and all staff
    trained.
  • Ensure availability of quality diagnostic and
    treatment services.
  • Ensure availability of free X-Ray services linked
    with all facilities.
  • Ensure quality drug supply for first-line, 2nd
    line ATT drugs and antibiotics.
  • Bringing services closer to the community with
    the help of ANM, MPW, ASHA.
  • Strengthening supervision and monitoring
  • Use COMPOSITE INDICATORS
  • Implement Focused Action Plan in
    Under-performing Districts
  • Use of online case-based reporting system for
    data entry.
  • Identifying areas with low suspect examination
    and prioritize case finding

30
Action Points (2)
  • Promoting community screening of suspects and
    referral.
  • TB diagnosis and treatment facilities at all
    Nutritional Rehabilitation Centers (NRCs).
  • Referral linkages for diagnosis of EP-TB cases.
  • Focused attention for Urban areas.
  • Expanding efforts to engage all care providers.
  • Innovative approaches to engage the private
    sector.
  • Need based involvement with accountability.
  • Timely payment of dues.
  • Active case finding in high risk population
    TB-HIV, TB-Diabetes.

31
Action Points for PMDT - (1)
  • State PMDT Committee meetings to be held every
    quarter to review progress and address local
    challenges
  • Expedite 100 coverage to PMDT services in the
    states by Dec 12
  • Complete establishment of DR-TB centers, Labs
    and Drug Stores upgrades, Staffing Trainings,
    Central Appraisals in remaining districts
  • Expedite lab capacity enhancement to enable move
    towards universal DST
  • Complete Civil works, equipment installation
    AMC, power backup, HR, proficiency testing in
    various technologies in all remaining labs in the
    states.

32
Action Points for PMDT (2)
  • 4. Expedite scale up of DR TB Centres (norm _at_
    1/10 million population)
  • Upgrade for airborne infection control, provide
    nurses and ward attendants
  • Free beds, investigations, ancillary drugs, food
    etc.
  • 5. Improve coordination b/w labs, districts,
    field staff and DR TB centre for prompt treatment
    of confirmed MDR TB cases in the states

33
RNTCP - Newer Initiatives
  • All States/UTs need to ensure all out efforts
    towards implementation of
  • TB Notification Order dated 7th May 2012.
  • Patient-wise data entry in Nikshay for all TB
    cases detected with effect from 1st January 2012
    (Case Based Web Based Recording Reporting
    System).
  • The Gazette Notification dated 7th June 2012 on
    the banning the import, manufacture, sale,
    distribution and use of All Serological Tests
    for TB Diagnosis.
  • Enforcement of Schedule H All ANTI-TB drugs are
    under Schedule H (i.e. should be sold only on the
    prescription of registered medical practitioner).

34
NIKSHAY (Case Based Web Based Recording
Reporting System)
35
  • www.tbcindia.nic.in

Thank You
36
Assam District wise Annual New Smear Positive
Case Detection Rate, 2011 (in age)
37
Assam District wise Annual New Smear Positive
Treatment Success Rate, 2010 (in age)
38
Jharkhand District wise Annual New Smear
Positive Case Detection Rate, 2011 (in age)
39
Jharkhand District wise Annual New Smear
Positive Treatment Success Rate, 2010 (in age)
40
West Bengal District wise Annual New Smear
Positive Case Detection Rate, 2011 (in age)
41
West Bengal District wise Annual New Smear
Positive Treatment Success Rate, 2010 (in age)
42
Chhattisgarh District wise Annual New Smear
Positive Case Detection Rate, 2011 (in age)
43
Chhattisgarh District wise Annual New Smear
Positive Treatment Success Rate, 2010 (in age)
44
Karnataka District wise Annual New Smear
Positive Case Detection Rate, 2011 (in age)
45
Karnataka District wise Annual New Smear
Positive Treatment Success Rate, 2010 (in age)
46
Action Points (3)
  • Improving communication and outreach.
  • focused strategies, targeting hard-to-reach
    groups.
  • innovative communications strategies to generate
    demand from patients, and
  • improving cooperation from the private sector.
  • State and District TB-HIV Coordination Committee
    Meetings not being conducted regularly in many
    States/Districts, the frequency of which should
    be ensured.

47
Airborne Infection Control (1)
  • National Guidelines for Airborne Infection
    Control in Health Care and Other settings
    developed and disseminated (available on
    www.tbcindia.nic.in ) that covers
  • Managerial responsibilities at State, District
    and Facility level
  • Administrative, Environmental Engineering,
    Personal Protective Controls
  • Infection control measures at congregate and
    community level
  • Prioritized implementation across DR TB Centres
    and TB C-DST Laboratories.

48
Airborne Infection Control (2)
  • Pilot implementation to assess operational
    feasibility underway at 35 health care facilities
    (Primary to Tertiary care including 10 ART
    centres) in 3 states (GU, AP, WB)
  • Pilot results will guide refinement of the
    national guidelines
  • Future scale up of the guidelines implementation
    proposed through integration with NRHM, NCDC
    NIHFW with technical support from CTD in
  • Capacity building of state teams
  • Integration as a chapter in the Infection Control
    Plans and Strategies of Health care facilities.

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