St francis hospital natcon 2011

Impact of in-house RNTCP DMC in NGO Hospital –a case study

Dr Neerja Arora Regional TB Project Coordinator, CBCI-CARD GFATM RCC RNTCP Project

Dr K N GuptaState TB Officer,Rajasthan

Dr Reuben SwamickanNational TB Project Coordinator, CBCI-CARD GFATM RCC RNTCP Project

CBCI-CARD GFATM RCC RNTCP PROJECT

Setting

St.Francis hospital, a 240 bedded, multi-disciplinary NGO health facility in Ajmer inRajasthan, where RNTCP-DMC was started in2009 as part of PPM DOTS initiatives,spearheaded by the Global Fund-supportedCBCI-CARD RNTCP project


CBCI-CARD GFATM RCC RNTCP project

The objective of this project is to facilitate the involvement of the Catholic Church network in RNTCP across 19 states of India

There are more than 5000 Catholic Health facilities (CHFs), including large number of Hospitals and Dispensaries in the country, 85 % of which are in rural, tribal and hard to reach areas

Under this project, by 3Q11, CHFs have signed more than 200 RNTCP schemes for NGOs of which 86 are DMCs


St Francis Hospital, Ajmer


St Francis Hospital DOT Centre

5

45 41

6152

64

8499

91 90

108

0

20

40

60

80

100

120

Cat I Cat II Cat III Total

Patients put on DOTS at St Francis Hospital DOT Centre Yr 2000-2010

85 82

98

8387 84

9387 90

514

211

2 51 3 2

10

0 05 4 7 6 6 30 0 0 0 2 1 0 1 20

20

40

60

80

100

120

Yr 2001 Yr 2002 Yr 2003 Yr 2004 Yr 2005 Yr 2006 Yr 2007 Yr 2008 Yr 2009

Success Rate Default Rate Death Rate

Failure Rate TO Rate

per

cen

tag

e

Trends in Treatment outcomes of ALL Categories of patients put on DOTS at St Francis Hospital DOT Centre

( Yr 2000 to Yr 2009 )


1116 18

14 13

2217

2329

34

24 26

1914

17 1822

15

26

51

43

53

3936

0

10

20

30

40

50

60

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

TB suspects examined Follow-up patients examined

St Francis Hospital DMC

6

Month/

Year

2010

TB

suspects

examine

d

TB

Suspect

s found

positive

TB

Suspect

s

undergo

ing

repeat

sputum

examin

ations

TB

Suspect

s found

positive

on

repeat

examin

ation

Follow-

up

patients

examine

d

Patients

positive

in

follow

up

Total

Slides

examine

d

Total

positive

slides

Total

negative

slides

Jan 11 1 0 0 19 0 60 2 58

Feb 16 0 0 0 14 2 60 4 56

Mar 18 4 0 0 17 2 70 10 60

Apr 14 3 0 0 18 2 64 8 56

May 13 5 0 0 22 1 70 11 59

Jun 22 7 0 0 15 3 74 17 57

Jul 17 6 1 0 26 3 88 17 71

Aug 23 6 0 0 51 6 148 24 124

Sep 29 7 0 0 43 1 144 15 129

Oct 34 4 0 0 53 4 174 12 162

Nov 24 3 0 0 39 6 126 18 108

Dec 26 4 0 0 36 3 124 11 113

TOTAL 247 50 1 0 353 33 1202 149 1053

St Francis Hospital Annexure M for 2010

9.

0

22 21

38.

3235.

26. 24

12 12.515

20

0

14.12 11

5

20

12

2.

8

15

8. 9

37

14 12.516

22.19

16.

1014

912

0

10

20

30

40

50

Jan Mar May Jul Sep Nov TOTAL

Sputum positivity for diagnosis sputum positvity for follow ups

Slide positivity rate

Trends in Slide positivity Rates, positivity among Diagnoses Follow-ups in Year 2010

Trends in Sputum Examinations for Diagnoses & Follow-up in Yr 2010


Objectives of the study

To evaluate the impact of in-house RNTCP-DMC services on

1. Referral of TB suspects

2. Referred patients receiving sputum test

3. TB case notification.


Methodology

Review of referral register, RNTCP laboratory register and other relevant records. The average values of the historical data for 6 years period (2004-2009), when patients were referred to nearby DMCs, was compared with the results in the year 2010, i.e. after the introduction of in-house microscopy services


Year

(A)

Total

Referred

cases

(B)

Diagnosed

at DMC

( C)

Positive

(D)

Negative

(E)

Not

reached

DMC

(F)

Proportion

of Referred

suspects

undergoing

sputum

microscopy

Yr 2004 140 77 14 63 63 55%

Yr 2005 137 84 22 62 53 61%

Yr 2006 118 73 19 54 45 62%

Yr 2007 107 55 14 41 52 51%

Yr 2008 87 38 11 27 49 44%

Yr 2009 99 58 10 48 41 59%

Yr 2010 271 263 47 216 8 97%

Trends in percentage of referred chest symptomatics undergoing sputum microscopy

Yr 2004-Yr 2010

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Yr 2004 Yr 2005 Yr 2006 Yr 2007 Yr 2008 Yr 2009 Yr 2010

Trends in Percentage of Suspected Chest Symptomatics referred at St Francis Hospital, Ajmer, undergoing sputum

microscopy Yr 2004-Yr 2010

Diagnosed Not reached


Results

With the RNTCP-DMC within the hospital complex, annually,

• The referrals for microscopy have more than doubled (115 to 271).

• There is significant reduction in the percentage of referred patients failing to reach the laboratory (44% to 3%).

• The number of suspected TB cases that received sputum examination recorded more than four-fold increase (64 to 263).

• The number of smear positive TB cases diagnosed among the referred patients tripled (15 to 47).


140 137

118

107

87

99

271

7784

73

55

38

58

263

1422 19

14 11 10

47

0

50

100

150

200

250

300

Yr 2004 Yr 2005 Yr 2006 Yr 2007 Yr 2008 Yr 2009 Yr 2010

Nu

mb

er

Trends in Referral & Diagnosis of Chest Symptomatics at St Francis Hospital, Ajmer

Yr 2004 to Yr 2010

Total Referred cases Diagnosed Positive

Start of DMC at Hospital premises


Conclusions

• Designating the laboratory of NGO hospitals, as RNTCP-DMC can significantly increase TB notification

• This would also reduce delay in diagnosis and ensure standardized treatment.

• Presence of well functioning DMCs at government or medical college facilities in the vicinity should not be a deterrent to establish DMCs in such NGO or PP hospital which are willing and which have the capacity to attain & sustain quality microscopy activities


Conclusions

• This is an example of RNTCP Partnerships promoting “Universal Access”

• There is scope for replicating and scaling up similar models across the country in other private & NGO hospitals having self-sustainability

CBCI-CARD GFATM RCC RNTCP PROJECT 14

THANK YOU

St francis hospital natcon 2011

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