TB Programme India

1962 National TB Programme

1992 Programme Review
<30% diagnosed
<30% treated
1993 Pilot RNTCP
1997 Large scale implementation of RNTCP
2006 Entire country covered in a phased manner
2010 Universal Access to TB Care
2012-2017 National Strategic Plan
2017-2025 National Strategic Plan
2020 National Tuberculosis Elimination
Programme
<1 TB case/million
 National Tuberculosis Elimination
Programme
January 2020
Vision
TB-Free India with zero deaths, disease and poverty due
to TB
Goal

To achieve a rapid decline in burden of TB,

morbidity and mortality to achieve the Sustainable
Development Goals of 80% reduction in incidence
and 90% reduction in deaths by 2025; five years
earlier of the global targets
 National Tuberculosis Elimination
Programme
Objective 1: Build, strengthen and sustain enabling policies,
empowered institutions, multi-sectoral collaborations, engaged
communities, and human resources with enhanced capacities to create
a supportive ecosystem which accelerates PREVENT – DETECT – TREAT
pillars to END TB.
Objective 2: Prevent the emergence of TB in vulnerable populations.
Objective 3: Early identification of presumptive TB, at the first point of
contact (private or public sectors), and prompt diagnosis using high
sensitivity diagnostic tests to provide universal access to quality TB
diagnosis including drug resistant TB in the country.
Objective 4: Initiate and sustain, equitable access to free high quality
TB treatment, care and support services responsive to the community
needs thereby protecting the population especially the poor and
vulnerable from TB related morbidity and mortality..
 Proposed NTEP
structure
 State level NTEP
Organogram

Figure 26: State TSU organogram

District level NTEP
Organogram
Figure 16: Pillars and strategies of the NSP
2020-25
Prevention among
1. PLHIV
2. Household contacts irrespective of age
3. Close contacts at workplace
4. Patients –

immunosuppressive therapy,
dialysis,
anti-TNF treatment,
transplant and
silicosis
TPT Regimens
1. INH daily – 6-9 months

2. INH+Rifapentine weekly – 3 months

3. INH+Rifampicin daily- 3 month

4. INH+Rifapentine daily – 1 month

5. Only Rifampicin daily- 4 months

High transmission setting: 36 months of TPT

in HIV+
Laboratory network
National Reference Labs (NRLs): NIRT, NTI,
JALMA
RMRC, BMHRC,
NITRD
Intermediate Reference Labs (IRL): state
level (31)
Culture & DST Labs
TDC – 1 per lakh population
Air Infection
control

Cough
etiquette
Sputum
disposal
NABH
IPHS
PPEs
Infrastructure
CTD National
Committees State
National District State TB
R. Lab (DTC) Cell
STDC
Subdistrict -TU SDS
MO-TC, STS, STLS IRLs
TDC -100,000

TB
register

PH
I
 Laboratory Network

Quality assured laboratory services : for

carrying out sputum microscopy with
external quality assessment
Includes :
i. Internal quality control
ii. On site evaluation (OSE)
iii. External quality control
- Panel testing
- random blinded rechecking
 TB Case finding
Systematic screening of high risk groups in HI
Through outreach and community based
approaches
Using DXR & other sensitive tests
Hotspot identification and vulnerability
mapping
Active case finding (ACF) among vulnerable
Urban
Rural
Tribal
In campaign mode thrice a year
Large scale IEC
Intensified contact tracing
 Prioritization of vulnerable groups
Priority Urban area Rural area Tribal area
1 Slum Difficult to reach villages Difficult to reach villages and
hamlets
2 Prisons inmates Mine workers Villages with known
higher case load

3 Old Age homes Stone crusher workers Tribal school hostels

4 Construction site Populations groups with high Areas with high malnutrition
workers malnutrition
5 Refugee camps NACO/SACS identified high risk Villages seeking care from
group for HIV traditional healers
6 Night shelters Weaving and Glass industrial Tribal areas with little
workers ventilated huts
NACO/SACS
identified high risk
7 group for HIV Cotton mill workers

8 Homeless Unorganized labour

9 Street children Tea garden workers
10 Orphanages Villages largely seeking care from
traditional healers
11 Homes for destitute
12 Asylums
Shorter MDR regimen

All oral
Bedaquiline based regimen
1. (6 Bdq plus 4–6 Lfx/ Mfx-Cfz-Eto-)-Hh-E-Z /
5 Lfx/Mfx-Cfz-E-Z.
2. BPaL regimen
Bedaquiline, Pretomanid and Linezolid
6-9 months
Operational research condition only
 99DOTS- MERM
A low-cost approach for monitoring and
improving TB medication adherence
Supplement to existing DOTS programs-
enable remote observation of doses
administered by patients or their family
members
Each anti-TB blister pack -hidden phone
numbers that are visible only when doses
are dispensed
After taking daily medication, patients
make a free call to the hidden phone
number
 Cont..
As treatment progresses sequence of
numbers called is checked against the
blister designs, thereby verifying that the
patient is taking medication as intended.
99DOTS patients receive a series of daily
reminders (via SMS and automated calls)
Missed doses trigger SMS notifications to
care providers, who follow up with personal,
phone-based counseling
Other initiatives

2012- notifiable disease

Nation-wide DR survey
Centre of excellence for EPTB
TB surveillance by NIKSHAY- case based
online
Nikshay Aushadhi
Nikshay Sampark
PFMS- DBT (nutritional support)
PP – 500 on notification and 500 on Tt
Reducing the out of pocket
expenditure for TB patients
Cont..
 Indicator 2019 2025
Total number of beneficiaries to be initiated on TB Preventive
1. 8,03,846 40,00,000
therapy
2. No of presumptive TB cases to be tested 1,31,22,971 3,00,00,000
Proportion of presumptive TB cases tested with molecular
3. 16% 30%
technology
4. Total TB patients notified 24,04,815 25,00,000

5. Public sector (notification) 17,31,680 14,50,000

6. Private sector (notifications) 6,73,431 10,50,000

Proportion of microbiologically confirmed TB patients in private
7. 20% 40%
sector
Proportion of notified TB cases with known HIV status (Including
8. 81% >95%
private sector)
Number of priority population screened for TB through ACF
9. 19 35
annually (in Cr)
10. Proportion of notified TB patients offered DST 59% 70%

11. No of MDR/RR TB patients notified 66,255 99,375

 Indicator 2019 2025
Proportion of patients from private sector who are provisioned
12. 8% 40%
free for anti TB drugs
13. Treatment success rate of TB Pts in the private sector 71% 90%
14. Treatment success rate for DS TB 84% >90%
15. Treatment success rate for RR TB 48% 65%
Proportion of notified TB patients receiving financial support
16. 70% 90%
through DBT for NPY
17. Proportion of notified TB – HIV cases initiated on ART 94% 95%
18. No of rapid molecular laboratories established 1530 7942
19. No of laboratories with first line DST established 54 100
20. No of second-line DST (SLDST) laboratories established 85 120
21. Proportion of sanctioned positions filled at State level 70% 95%
22. Proportion of sanctioned positions filled at district level 80% 95%
Number of districts covered under patient provider support
23. 130 350
agency (PPSA)
Proportion of PHIs reporting notification and drug consumption
24. 50% >90%
directly in Nikshay
25. No. of districts covered under District Level Annual Survey 0 700
Proportion of notified TB patients experiencing any stigma
26. 40% ↆↆↆ
associated with TB disease
27. No. of TB champions trained and engaged in NTEP 300 5000
Annual proportions of successful treatment
outcome among new sputum-smear positives,
previously treated, and drug-resistant TB patient
cohorts– India, 2012–2018*
Number of and rate examinations amongst
presumptive TB patients – India, 2000–2019.
Thank You