2. Problem statement
World
1900-1980 death rate declined 199-0.5/100000 in
US
2008
Incidence- 9.4million(8.9-9.9)
Prevalence-11.1million (9.6-13.3)
HIV associated- 1.4 million
Deaths- 1.8million (0.52 million HIV+)
3.
4.
5.
6.
7. Multidrug resistant-0.5 million
MDR deaths- 0.15million
Extensively drug resistant- 50,000
XDR deaths- 30,000
SE Asia (34%), Africa(31%), Western Pacific (20%)
8.
9. Achievements
1995-2008
Cured - 36 million
Averted from death- 6million using DOTS
Case fatality rate 7.6% to 4%
Cure rate – 87%
10. India
20% global burden
2/3 rd cases in SEAR
Incidence – 1.8million
New smear+ -0.8 million
Deaths – 0.32 million
Annual risk – 1.5%
14. Incidence of infection ( annual infection rate)
% of population under the study who will be newly
infected among the non infected of the preceding
survey during the course of 1yr
“Tuberculin conversion index”
15. Prevalence of disease/ case rate:
% of individuals whose sputum is positive for tubercle
bacilli
“Case load”
16. Incidence of new cases
The % of new TB cases/1,000 population in 1yr
36. Revised national tuberculosis control programme
Govt. of India, WHO, world bank- 1992
Features :
i. 85% cure rate through SCC
ii. Detecting 70% of the estimated cases
iii. Involvement of NGOs
iv. Direct Observed Treatment Short course (DOTS)
38. Organisation
State Tuberculosis office State tuberculosis officer
State TB training and Director
demonstration centre
District tuberculosis centre District tuberculosis officer
Tuberculosis unit Medical officer-TB control
Senior treatment supervisor
Senior TB laboratory
supervisor
Microscopy , treatment
centres
DOTS providers
39. Laboratory network
National
Central TB
reference
division
Lab
State TB cell Intermediate
reference lab
District TB
centre
41. Initiation of treatment
Designated RNTCP microscopy centre
Each centre
1. Skilled technician – ensure quality
2. Senior TB lab supervisor ( 5 microscopy centres)
42. cough for 2wks or more
2 sputum smears
2 negatives
1 or 2
positive Antibiotics 10-14
days
Symptoms persist
Repeat 2 smear
examination
2 negative
X ray
-ve
+ ve
Non TB Smear – ve TB
43. DOTS
Political commitment
Good quality sputum microscopy
Directly observed treatment
Uninterrupted supply of good quality drugs
Accountability
44. Treatment regimen
TB category Initial phase Continuation Total duration
(daily/3 per wk) phase
I 2HRZE(S) 4HR/6HE 6/8
II 2HRZES+1HRZE 5HRE 8
III 2HRZ 4HR/6HE 6/8
IV RZE 18
ZE+S/Kmc/Am/C
pr+Cipro/Ofl+_Et
m
45. RNTCP phase II
Approved for 5yrs Oct 2006 to Sept 2011
Goal : decrease morbidity and mortality due to TB
DOTS
Access to tribal and marginalized groups
46. Drug resistance surveillance
To determine the prevalence
2005
States : AP, Delhi, Gujarat, Kerala, Maharashtra,
Orissa, UP, West Bengal – 54%
IRLs accredited
47. DOTS plus
For management of MDR-TB
MDR suspect
Ofloxacin replaced to Levofloxacin
Cat V regimen for XDR-TB patients
48. Achievements
Cure rates -87% (25% in 1998)
Death rate -4% (29%)
DTC -650
TB units -2596
DMC -12,704
NGOs-2,500
Peripheral labs-12,750
49. Public health carte providers- 5.5lacs
Master trainers – 12 states
Initiated treatment -1.1million patients
Saved lives- 2million!!!
50. Activities planned for 2011
Supporting the development of a National Strategic Plan to control
TB 2012–2017, with the planned and budgeted activities necessary
to achieve the country‟s goal of universal access.
Widening the network of quality assured laboratories and
strengthening capacity of all the state-level culture and DST laboratories to
undertake second-line DST.
Expanding the delivery of services for MDR-TB cases to all states.
Monitoring the implementation of the revised schemes for the
involvement of NGOs and private practitioners across the country.
Phased scale-up of the implementation of the intensified TB/HIV
package for nationwide coverage by 2012.
Review of all available studies and information on the TB burden, and
re-estimation of TB incidence, prevalence, and mortality in cooperation
with the Ministry of Health and national experts.
. Developing and rolling out an integrated information system for
MDR-TB services nationwide, and integrating laboratory results and
patient management with outcome analysis and reporting.