Standards for TB care in India, RNTCP challenges: India, Maharashtra & Mumbai-Part 1

“Standards for TB care in India, RNTCP Challenges & Organizational

Structure in MCGM”

PG Student : Dr Amol Kinge PG Guide: Dr Kamaxi Bhate

In This SeminarFindings of Global TB report, Annual TB

report 2015 India, MCGM Annual TB Statistics.

Standards of TB care in IndiaOrganizational structure of TB care in

MCGM

In this PresentationIntroductionGlobal Scenario of TBIndian Scenario of TBStatistics of TB in MaharashtraStatistics of TB in MumbaiPublic Health concerns

Introduction

TB was declared as a global health emergency in 1993

RNTCP as a Pilot project: 1993RNTCP Phase-1: 1999–2006RNTCP Phase-II: 2006-2011TB: A leading cause of Death in PLHIVFive year plan of “TB Free India”

Global TB reportFrom 205 countries and territories (>99% of the

world’s population)

Main findings and messages:Advances: TB mortality has fallen 47%

The MDG target: Achieved on a worldwide basis, in each of the 6 WHO regions and in 16 of the 22 high-burden countries that collectively account for 80% of TB cases.

Global TB reportGlobally, TB incidence has fallen by an

average of 1.5% per year since 2000 and is now 18% lower than the level of 2000.

In 2014, TB killed 1.5 million people (1.1 million HIV-negative and 0.4 million HIV-positive).

Men: 890 000 men, Women: 480,000 and 140,000: Children.

Of the 9.6 million new TB cases in 2014, 58% were in the South-East Asia (SEAR) and Western Pacific regions.

India, Indonesia and China had the largest number of cases: 23%, 10% and 10% of the global total, respectively.

From 2016, the Goal is to end the global TB epidemic by implementing the End TB Strategy.

Global TB report

The Target of Halving the TB Mortality rate by 2015 (compared with 1990) met in 4 WHO regions

- The Region of the Americas, - The Eastern Mediterranean Region, - The South-East Asia Region, - The Western Pacific Region &

Global TB report

All three of the 2015 targets (for incidence, prevalence and mortality) were met in:

Brazil, Cambodia, China, Ethiopia, India, Myanmar, the Philippines, Uganda and Viet Nam.

Global TB report

IndiaIndia: 2nd most populous countryAccounts for a Quarter of the world's annual

incidence of TB. Every year in India: 2 million- Develop TB in India & 300,000- Die of TB.Treated: Over 15 million patients and Lives saved: 3 million, by the Revised National TB Control Programme (RNTCP) over the last decade.

Statistics-2014In 2014, RNTCP covered a population of

12,656 lakh. TB suspects examined by sputum smear

microscopy: 87.83 lakhCases Registered for treatment: 14.44 lakhRegistered TB cases Knowing their HIV

status: 72%HIV infected TB patients were initiated on

CPT: 94% Initiated on ART: 91%

Making TB a notifiable disease in India

With the aim of improving the collection of patient care information, in 7 May 2012 India declared TB to be a notifiable disease.

Indicators

Burden of Tuberculosis

Case finding activities & Notification rates

12th Five year Plan (2012-17)Budget: 4500 CroreTheme: Universal Access for Quality Diagnosis

& Treatment for all TB patients in the community and a target of “Reaching the Unreached”.

Goal: “Universal access to TB care and treatment for all”

Vision 2020: To significantly reduce TB burden in India by ensuring universal access to quality assured TB care as per Standards for TB Care in India (STCI).

Contd…To ensure Notification of all TB cases in Nikshay

(incremental step to close the gap of missing TB cases in India)

13,000 microscopy centers for sputum smear microscopy and Culture and DST laboratories.

62 RNTCP certified Culture and DST laboratories in the country which includes laboratories from Public sector (IRL, Medical College), Private and NGO laboratories.

Currently 89 Cartridge Based Nucleic Acid Amplification Test (CBNAAT)

sites provide rapid decentralized diagnosis of MDR-TB, TB in high risk group PLHIV and Pediatric presumptive including EP-TB case

First National anti TB Drug Resistance Survey (NDRS) is being conducted across 120 TB Units in the country and will test drug resistance to drugs other than Rifampicin and Isoniazid.

Contd…

Successful PartnershipsIndian Medial Association (IMA), Catholic Bishops’ Conference of India

(CBCI), Foundation for Innovative New Diagnostics

(FIND), World Vision, The International Union

against Tuberculosis and Lung Diseases (The UNION) &

The Clinton Health Access Initiative (CHAI)

More than 330 Medical Colleges are involved with RNTCP through the task force mechanism and are contributing in diagnosis, management and formulating policies for the program.

Mumbai37,501 people died due to

TB (Since last 5 years)21 Deaths / day (Since

last 5 years)6496 Deaths (2014-15)Every year TB has killed

8.08 Mumbaikars

Public Health ConcernThe decline in TB incidence: SlowMortality- Unacceptably High and Emergence of Drug-Resistant TB: Major

public health concern.

Challenges:Prompt, accurate diagnosis and effective

treatment of TB.Uninterrupted supply of DrugsEngaging the private sector effectively.

Private sector health careA source of mismanagement of TB and

hence of drug resistance.- Use of incorrect Diagnostics- Incorrect regimes- Lack of supervision- Lack of regulation for over the counter

drugs for TB

There are many reasons why people in India seek care from the private sector. These include:

- poor knowledge about TB- poor knowledge about services available through the national programme- the convenience of services- a desire for confidentiality- a desire for personalized care.

Private sector health care

TB drug supplies in India

More than 1.5 million people currently receive free drugs at the 13,000 Indian government centres.

In June 2013 reported shortages of the Paediatric doses used to treat children with TB.

Drug shortages: Rifampicin, streptomycin and kanamycin

“Many people are unaware that all the medicines needed to treat TB patients are available free of cost at Indian government hospitals. Most people tend to spend huge amounts in private hospitals.”-Bhalchandra Chorghade (Sr Correspondent DNA)

ReferencesNational Strategic Plan for Tuberculosis

Control 2012–2017; RNTCPTBFACTS.ORG; Information about

TuberculosisTB India 2015; Annual Status ReportGlobal Tuberculosis Report 2015 by WHOStandards for TB Care in India Manual by

WHO.

THANK YOU…