NATIONAL TB
ELIMINATION PROGRAMME
Central TB Division
Ministry of Health & Family Welfare
TB DISEASE
✔ Untreated TB case can transmit disease to
at least 10 to 15 people in a year
✔ Contacts of an active case are at 10 to 60
times higher risk of developing the
disease
Appropriate use of Mask
Covering mouth with a handkerchief
TUBERCULOSIS while coughing or sneezing
Hand washing after coughing or
APPROPRIATE sneezing
BEHAVIOUR Maintain good nutritional status
Adequate ventilation in households
and workplaces
TB BURDEN – COMPARISON WITH OTHER DISEASES
Estimated Case Fatality Rate for TB is 17% (2019)
Tuberculosis is (India)-
• Leading cause of death among communicable
diseases
• 5th leading cause of death among all diseases
Deaths attributed to disease
Source: IHME, Global disease burden
TB DISEASE BURDEN IN INDIA
• Estimated incidence rate of TB 🡻 193 cases / lakh population
• Estimated TB cases in 2019 in India 🡻 26.4 lakh
• Reported TB cases 🡻 24 lakh (2019) 🡻 18 lakh (2020) 🡻 12.8 lakhs (So far-Aug’21)
2% HIV-Positive 33% Urban
Men Women Children
62% 38% 6%
Drug
2.5% 58% Rural
Resistant
15-45 years
65% 9% Tribal
(Age)
EVOLUTION OF NTEP
2021
TB Mukt Bharat Abhiyaan 2020
In January 2020, GoI revised RNTCP to National
TB Elimination Program (NTEP)
2017 – 25
NSP (2017 – 25) – patient centric care for 2012 -17
TB elimination National Strategic Plan (2012 -17) - mandatory
notification of TB, rapid molecular testing, active
case finding and integration of the program with
National Health Mission
2005 – 11
Second phase of RNTCP – Pan India coverage
and improved quality and scale up of services 1997
GoI revised NTP to RNTCP – introduction of
DOTS (Directly Observed Treatment Short
1993 course)
WHO declares TB as a global 1962
emergency Govt. of India launched the National TB Program
and set up District TB Centres
INDIA’S COMMITMENT FOR END TB
India has committed to 18 State/UTs – committed
India’s
commitment
commitment
States’
End TB by 2025, five and developed state
years ahead of the global specific strategic plan
SDG target
END TB TARGETS – TB INCIDENCE AND MORTALITY
2015 2020 2023 2025
ROAD TO REALIZE TB FREE VISION
Scenario
Scenario 01: 04:Scenario
Sustained SDG
Scenarioservice
02: 03: Reaching
Population
Scale-up
delivery
ofat undetected
prevention
currently
the and
current TB tools
infection
available
trends control
with available tools
217
Scenario
Scenario 01
01
01 02
02 03
03 04
Presumptive TB
Presumptive
Presumptive TB
TB
Presumptive TB
Examination rate
Examination
Examination rate /// lakh
rate lakh
lakh 600 1200 1800
600 1200
1200 2400
170 Examination rate
population/year
/ lakh 600 1800
population
population
148 population
120
Notification /// Estimates
Notification
Notification Estimates
Estimates 85% 100%
85%
85% 100% 100% 100%
With upscaling interventions to their Notification / Estimates 85% 100% 100%
fullest capacity, we may achieve
LTBI
LTBI (%
LTBI (% coverage
(% coverage of
coverage of
of
incidence of 100 LTBI (% population)
coverage of 15% 48%
15% 48% 70% 90%
targeted
targeted population)
targeted population)
population) 15% 48% 70%
targeted
44 PPSA
PPSA (districts
(districts with
with
PPSA (districts with
interface agencies
agencies for
interface agencies for 150
150 350
150 350 400 600
interface
private
for 400
private sector
private sector engagement)
sector engagement)
engagement)
Introduction
Introduction ofof vaccines
vaccines
and non-health
and non-health
---
interventions like
interventions like ++ ++ ++++
undernutrition, poverty,
undernutrition, poverty,
living conditions, etc
living conditions, etc
NATIONAL STRATEGIC PLAN (2017-2025)
Find all TB cases with an emphasis on reaching every TB patient in
the private sector
Treat all TB cases with high quality anti TB drugs
Detect Treat
Prevent the emergence of TB in susceptible populations and stop
Preve
Build catastrophic expenditure due to TB by all
nt
Build & strengthen supportive systems including enabling
policies, empowered institutions & human resources
Decentralize TB screening Technology 2014 2021
to AB-HWC levels
Microscopy 13,657 21,717
Scale up Molecular
Diagnostics to the Rapid Molecular
119 3164
Peripheral Levels Test
Culture lab
(for drug 50 87
Early Detection of DRTB-
DETECT Universal DST
resistance test)
Active case finding
through mobile
Vulnerability Mapping & medical van
Active case finding
Patient Provider Support Agency
2018 : 48 large cities (JEET)
Private Sector
Engagement 2019 – 156 (domestic)+95 (JEET)
2020 – 266 (domestic) + 109 (JEET)
Daily regimen
–Fixed Dose
Combination
Sustain Treatment
Success Rate of >
90%
TREAT
Injection free
>4 lakh ASHA & Community ICT based adherence
treatment regimens Volunteer as DOT provider
• 800 treatment
Scale up of Newer centre for DR-TB
drugs/regimens • Bedaquline &
Delamaind
Sustaining COVID
appropriate behavior
Contact tracing and
screening of all
Contact Tracing & TB household contact
Preventive Treatment and TB Preventive
Treatment
PREVENT
Airborne Infection 1.64 lakh 11 lakh Expansion
• Child <5 • People of policy in
Control in community household
years in living with
& Health Facilities contact of HIV/AIDS contacts
TB given TPT for all age
treated group
with TPT
Community
Mobilization & People’s
Movement
IEC National
Training on
Tuberculosis
Capacity Building at NIRT
Human Resources TB Arogya Saathi App
Development
Multisectoral
BUILD Collaboration
Case based web-based
Digital Interventions surveillance for TB
Surveillance
Procurement & Supply
Chain Management Nikshay Poshan Yojana:
DBT of > Rs.1200 Cr Engaging line ministries
INDIA INDONESIA
Impact of MONTHLY AVG. 2019
COVID 19
on TB
notificatio
n&
recovery
PHILLIPINES
status SOUTH AFRICA
(2020)
4 High
Burden
Countries
Source: https://www.who.int/publications/m/item/impact-of-the-covid-19-pandemic-on-tb-detection-and-mortality-in-2020
TB Notification Progress
21.02 24.02
18.12
2021:Jan-Aug : Source - Nikshay
HIV Status Known: 92%
UDST: 67%
PROGRAMME
PERFORMANCE-N MDR TB Treatment Initiation:86%
TEP 2020
IPT among children: 34%
TPT among PLHIV:47%
NIKSHAY Poshan
Yojana
• Rs. 500/- per month given to
NIKSHAY PFM
every TB patient through S
Patien
DBT for duration of t
treatment
Ban
• Scheme rolled out from April k
2018 46
Coverage
lakh TB patients Public sector
• Rs. 1204 Cr of amount provided – 73%,
benefit •Private – 39%
disbursed to beneficiaries
Period - April 2018 to June 2021
NIKSHAY POSHAN YOJANA (NPY)
Proportion of TB patients paid out of those eligible
Total
Public Private
Year (Pub + Pvt)
(%) (%)
(%)
2018 61 70 22
2019 67 78 38
2020 73 80 55
2021
75 82 54
(Jan-Mar)
Year Current Bank Bank Paid at
Patients details details least once
available validated
2020 18.13 14.60 13.67 13.22
(In lakhs) (81%) (75%) (73%)
2019 24.00 22.95 17.56 16.08
(In lakhs) (96%) (73%) (67%)
Mechanisms for Monitoring and Evaluation
Internal External
• Quarterly Review meeting at
National, State and District levels
• Central & State Internal Evaluations • State Health Index report by NITI
• External and Internal Quality Aayog (Annual)
assessment of labs by IRLs and • World Bank review mission
NRLs
• Annual Common Review Mission as
(6 monthly)
part of NHM • Joint monitoring mission by WHO
• Sub National TB free certification (once in 3 years)
Proposed Activity
Joint supportive supervision by deputing central teams
State wise review by HFM
TB Score dashboard – State level
TB Score dashboard –District level
TB Notification Dashboard – Option to view 3 views
Summary View Geographic View Table View
Monitoring Indicators National, State & District
• Trend in
Notification
• Public
• Private
• Treatment care
cascade
• Age Sex Pyramid
• Patient Type
• HIV status
• UDST status
• Treatment Outcome
Sub National TB Free Certification
August 31 March 24
Successful
States submit Independent
MoHFW invites Districts submit claims
claims to Agency (ICMR)
Claims claims to State awarded on
MoHFW verifies claims
World TB Day
Verification Awards Bronze Silver Gold TB Free
• Community survey to find out Criteria 🡻 20 🡻 40 🡻 60 🡻 80
(Incidence
incidence & under-reporting decline) % % % %
• Interviews & FGDs with private State Awards 25 50 75 100
doctors & chemists to verify drug sale (Rs In lakhs)
• Review of records & patient District Awards 2 3 5 10
(Rs In lakhs)
interviews to verify TB score
SUB NATIONAL CERTIFICATION-2020 AWARDS
TB FREE
State of Kerala and UT of • Lahul Spiti, Himachal • District Diu of • UT of Lakshadweep,
Puducherry and 29 Districts Pradesh, DNH&DD • District Budgam of
across 11 States. • Kolhapur District of J&K
Maharashtra
• Parel (ward) of
Mumbai,
• West Tripura District of
Tripura
COMMUNITY LED RESPONSE
TB Forum – platform for community
TB Forum – Composition Institutional Structure
TB
Champions National TB Forum
NTEP & State TB Forum
Corporate SACS
Sectors TB Officials
Forums District TB Forum
Block TB Forum
Civil Society Public Health
Institute TB Champion Patient Support
TB CHAMPION INITIATIVE
Transformation of TB survivor to TB Champion
Treatment
Activities
Support
National Conférence of TB Champions
TB Toolkit for involvement of PRIs, in TB
Advocac
Champions Referral
y
Linkages Compendium of SOPs for involvement of
Community Volunteers, SHGs, TB Champions, TB
Forum
Peer Guidance Document on Community Engagement
Counselling
TB – A SOCIAL DISEASE Tribal Affairs, PRI,
SHG, Rural Devp,
Vulnerable
Rural & Urban WCD
Development
Poor
housing
Elderly,
children
& women
Sustain COVID
appropriate behaviour
Malnutrition Overcrowding
Nikshay Poshan Yojana, National
Food Security Act, WCD, Tribal
TB REGIMENS, DURATION AND COST PER COURSE
Per patient cost
Type of TB No. of patients Duration of Treatment
(In Rs)
17,55,000
Drug Sensitive TB 6 - 8 months 2,100
(97% of TB patients)
49,679
Drug Resistant TB 9-11 / 18-20 months 9,768 – 1,19,617
(3 % of TB patients)
Procurement:
• Drugs are procured from CMSS (Domestic) & GDF (Global Drug Facility) centrally
• Procurement of diagnostics are also now decentralised to State level
Railways
Diagnosis and treatment through Railway hospitals/ dispensaries
Mapping of Railway Health Facilities in Nikshay
Use of NTEP IEC Material in Railway premises
Tribal Affairs
Support towards upgradation of health infrastructure using MoTA funds
Involvement of NGOs under MoTA in TB
Joint Tribal Action Plan for TB in notified Tribal districts
INTER-MINISTERIAL
COLLABORATION
Ministry of Labour & Employment
TB Free Workplace policy
Diagnosis and treatment through ESIC hospitals/ dispensaries
Network of Training Institutes under MoLE to reach out to work places
21 Ministries are prioritized for addressing
non health determinants
6 MoUs signed with Railways, Defence, AYUSH, Labour &
Employment, CII and DONER
INTER MINISTERIAL COLLABORATION
Labour
Tribal
Railways &
Affairs
Empl.
- Diagnosis and treatment through - Support towards upgradation of
- TB Free Workplace policy
Railway hospitals/ dispensaries health infrastructure using MoTA funds
- Diagnosis and treatment through
- Mapping of Railway Health Facilities - Involvement of NGOs under MoTA in
ESIC hospitals/ dispensaries
in Nikshay TB
- Network of Training Institutes under
- Use of NTEP IEC Material in Railway - Joint Tribal Action Plan for TB in
MoLE to reach out to work places
premises notified Tribal districts
Proposed Committee under HFM with Ministers of Prioritized Ministries- Sep/Oct 2021
6 MoUs signed with Railways, Defence, AYUSH, Labour & Employment, CII and DONER
124 Corporates have taken TB Pledge to fight against
CORPORATE TB PLEDGE Disease
Industries facilitated TB screening of more than 20 lakh
people
3 Mobile X-ray Vans, 6 CBNAAT Machines and 15 Microscopy
Centers for community screening contributed
6 Regional Roundtables conducted bringing together key policy
makers and healthcare providers in 6 States
Silver Gold Platinum Diamond
1. NALCO 1. Adani Foundation 1. Gail India 1. BEST Mumbai
2. Corning India 2. Ambuja Cement 2. Becton Dickinson India 2. Apollo Tyres Foundation
3. RITES Limited 3. Bata India Ltd., Patna Private Limited 3. Medanta
4. Sandoz Private Limited 4. Panasonic Life 3. HCL Foundation 4. TCI
5. Sanofi India Limited Solutions 4. Johnson & Johnson 5. Goodricke Group
5. GMR Varalakshmi Private Limited 6. Fuji Films
Foundation 5. Parry Agro Industries
Ltd.
TB Harega Desh Jeetega
