Review Meeting-Mission Directors, NRHM States & UTs on 31 st October, 2012. Revised National TB Control Programme (RNTCP)
RNTCP - Components of DOTS Strategy (Directly Observed Treatment- Shortcourse) • Political commitment • Diagnosis by microscopy • Adequate supply of Short Course drugs • Directly Observed Treatment TB Register • Accountability
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.
State-wise New Sputum Positive Case Detection Rate & Treatment Success Rate
State-wise Performance (2011) New Smear Positive Case Detection Rate (NSP CDR) Performance States Good A &N , AP, Arunachal Pradesh, Chandigarh, (NSP CDR >= 70%) Delhi, Gujarat, HP, Jharkhand, Meghalaya, (15 states/UTs) Nagaland, Rajasthan, Sikkim, UP, Puducherry Moderate Chhattisgarh, D & N Haveli, Goa, Haryana, (NSP CDR 50 - 70%) J&K, Karnataka, Kerala, MP, Maharashtra, (18 states/UTs) Manipur, Mizoram, Orissa, TN, Tripura, Uttarakhand, Punjab, Assam, West Bengal Poor Bihar, Daman and Diu, Lakshadweep (NSP CDR < 50%) (3 states/Uts)
State-wise Performance (2010) New Smear Positive Treatment Success Rate (NSP TSR) Performance States Good AP, Arunachal Pradesh, Chandigarh, Delhi, (NSP TSR >= 85%) Gujarat, HP, Jharkhand, Nagaland, (27 states/UTs) Rajasthan, UP, Puducherry, Chhattisgarh, Haryana, J&K, MP, Maharashtra, Manipur, Mizoram, Orissa, TN, Tripura, Uttarakhand, Punjab, West Bengal, Bihar, Daman and Diu, Lakshadweep. Poor Sikkim, D & N Haveli, Karnataka, A &N , (NSP TSR < 85%) Assam, Meghalaya, Goa, Kerala, (8 states/Uts)
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
No. of Districts with NSP Case No. of Detection Rate (2011) States/UTs Districts >=70% 50-70% <50% A&N Islands 0 0 1 1 Andhra Pradesh 24 19 4 1 Arunachal Pradesh 14 8 5 1 Assam 24 6 8 10 Bihar 38 2 12 24 Chandigarh 0 0 1 1 Chhattisgarh 16 3 7 6 D & N Haveli 0 0 1 1 Daman & Diu 0 0 2 2 Delhi 0 25 17 8 Goa 0 0 2 2 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
No. of Districts with NSP Case No. of Detection Rate (2011) States/UTs Districts >=70% 50-70% <50% 0 0 Lakshadweep 1 1 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 0 Puducherry 1 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
No. of Districts with NSP Treatment Success Rate (2010) Total no. of States/UTs Districts >=85% 75-85% <75% A&N 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 0 1 1 0 Chhattisgarh 16 10 5 1 D & N Haveli 1 0 1 0 Daman & Diu 0 2 2 0 Delhi 25 12 12 1 Goa 0 2 1 1 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
No. of Districts with NSP Treatment No. of Success Rate (2010) States/UTs Districts >=85% 75-85% <75% 0 Lakshadweep 1 1 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
Uttar Pradesh: District-wise Annual New Smear Positive Case Detection Rate in 2011
Uttar Pradesh: District-wise Annual New Smear Positive Treatment Success Rate in 2010
Madhya Pradesh: District-wise Annual New Smear Positive Case Detection Rate in 2011
Madhya Pradesh: District-wise Annual New Smear Positive Treatment Success Rate in 2010
Bihar: District-wise Annual New Smear Positive Case Detection Rate in 2011
Bihar: District-wise Annual New Smear Positive Treatment Success Rate in 2010
Maharashtra: District-wise Annual New Smear Positive Case Detection Rate in 2011
Maharashtra: District-wise Annual New Smear Positive Treatment Success Rate in 2010
Tamil Nadu: District-wise Annual New Smear Positive Case Detection Rate in 2011
Tamil Nadu: District-wise Annual New Smear Positive Treatment Success Rate in 2010
Orissa: District-wise Annual New Smear Positive Case Detection Rate in 2011
Orissa: District-wise Annual New Smear Positive Treatment Success Rate in 2010
Punjab: District-wise Annual New Smear Positive Case Detection Rate in 2011
Punjab: District-wise Annual New Smear Positive Treatment Success Rate in 2010
Status of PMDT Services (Oct ’12) PMDT Services Jam m u & Kas hm ir introduced in Aug 2007 DR TB Centres Chandigarh Himac hal Pradesh All 35 State/UTs have Punjab Uttaranc hal introduced PMDT Haryana Arunachal Delhi Pradesh services of which 25 Sikk im Uttar Pradesh Rajas than Assam have achieved Nagaland Meghalaya Bihar Manipur complete geographical Jhark hand Tripura W est Madhya Prades h Gujarat Mizoram coverage Bengal Chhatis garh 901 million (73%) pop Dam an & Diu Oriss a D&N H aveli Maharas htra have access to services % Population with across 527 districts Andhra access to PMDT services Pradesh Goa 1 % - 25 % 74 DR-TB Centers are Karnataka 26 % - 50 % functional (70% in 51 % - 75 % A&N Is lands 76 % - 99 % Medical Colleges) 100 % Tam il Nadu Lak shadweep Kerala
RNTCP Culture & DST Labs Network (October, 2012) Jammu & Kashmir A Certified : N=44 Himachal Pradesh NDTC - 30 / 43 RNTCP AIIMS-2 Punjab LRS Chandigarh supported labs Uttaranchal Haryana - 14 Additional Delhi Gurgaon Sikkim Arunachal Pradesh Uttar Pradesh JALMA Rajasthan Assam Nagaland Bihar SLDST - 3 NRLs Meghalaya Manipur Jharkhand West Bengal Madhya Pradesh Mizoram Tripura Gujarat Chhatisgarh Orissa Daman & Diu D&N Haveli IRL (Certified ) Maharashtra IRL (Under Process) Med Col / NGO / Private Labs (Certified) Andhra Pradesh By Technology Med Col / NGO / Private Labs (Under Certification ) Goa National Reference Labs - Solid culture:35 - LPA: 31 Karnataka TRC NTI - Liquid Culture:10 Pondicherry Tamil Nadu A&N Islands Lakshadweep Kerala
Critical Gaps for PMDT by States 1. State PMDT Committee meetings not held regularly 2. Slow scale up of PMDT services in few states with limited access • UP (15%), BI (38%), CG (44%), TR (47%), MP (54%), HP (58%), AS (56%), HR (63%), JH (68%) 3. Laboratory capacity limited • PB (0), HP (0), JK (0), UP (2), WB (2), KA (2), RJ (2), BI (1) 4. Deficit of DR TB Centers against norm (1/10million population) with service gaps • UP (2/20), BI (1/11), MP (2/8), TN (3/7), WB (4/9), AS (1/3), HR (1/3), CG (1/2) 5. High % of confirmed MDR TB Cases not put on treatment in 2012 • WB (48%), MH (40%), RJ (28%), HP (35%), HR (28%), GU (27%)
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, 2 nd 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
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.
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