TB notification
Jan 19, 2016
TB notification
Background - I
• TB is a major health public health problem accounting for substantial morbidity and mortality in the country.
• I n order to ensure TB diagnosis and case management, reduce TB transmission and address the problems of emergence and spread of drugs resistance TB.
It is essential to have complete information of all TB cases. Therefore, the health care providers shall notify every TB cases to local authority.
Background - II
• Large nos. of TB pts availing services from private sectors are not reported to the program me.
• A large nos. of pts are not benefitted with program me services which leads to non adherence, incomplete, inadequate treatment leading to M/XDR TB.
• If TB pts diagnosed and treated in Pvt. Sectors are reported to public Health authority, the mechanism available in this system can be extended to these pts ensuring treatment adherence and completion.
• To prevent the impending epidemic of M/XDR TB and to curve the situation Govt. of India declared Tuberculosis a notifiable disease on 7th May 2012.
Objectives
1. To have establish Tuberculosis surveillance system in the country.
2. To extend mechanisms of TB treatment adherence and contact tracing to pts treated at Pvt. Sector.
3. To ensure proper TB diagnosis and case management and further accelerate reduction of TB transmission.
4. To mitigate the impeding drug resistant TB epidemic in the country
Minimum information requirement for TB notification
• TB pts name• Age/gender• GoI-issued personal unique identification nos.• Detailed address of TB case with pin code.• Phone Number• Basis of diagnosis: Microbiologically confirmed TB case/Clinical
TB case.• Patient category: New/Recurrent TB case/ treatment Change. • Site of disease: pulmonary/EP only.• Rifampicin resistance: Resistance/Sensitive/not available (&
other drug resistance pattern by laboratories)
Definition of TB cases for purpose of Notification
• Microbiologically confirmed TB Cases: pts diagnosed with at least one sputum positive or a culture positive or RNTCP approved rapid diagnostic molecular test for MTB.
• Clinical TB case: pts clinically diagnosed TB without Microbiologic confirmation & initiated on anti-TB drugs.
RNTCP endorsed TB diagnostics
• Smear Microscopy (for AFB).• FM with Fluorescence stains. SOLID CULTURE:• Solid media (L J media)• Liquid media ( Middle Brook) using manual,
semiautomatic or automatic machines e.g. Bactec, MGIT etc.
• RAPID MOLECULAR TEST: Conventional PCR based Line Probe Assay for MTB complex or Real Time PCR based NNAT e.g. GeneXpert.
Health care providers for TB notification
• clinical establishments run or managed by the Government (including local authorities)
private or NGO sectors and/or individual practitioners.
• The healthcare providers shall notify every TB case to local authorities i.e. District Health officer/CMO of a district/ Municipal Corporation/Municipality in every month in given format.
Registration of Health establishments for TB notification
• Health establishment is divided into three categories : 1.Laboratories 2.Private practitioner/Clinic (single) 3.Hospital/Clinic /Nursing Home (multi)• Each of the Health Establishment will be registered for TB
notification by submitting a simple registration form mentioning the details of the establishment. The registration form can be availed from the nodal officers for TB notification can be down loaded from tbcindia.nic.in.
• Each health establishment will receive the unique number.
Mechanism of TB notification
Route for information transmission: Submission by:1. Hard copy to the nodal officer for TB notification. a)
by post b) by courier c) by hand.2. Soft copy by authorized Email.3. By authorized mobile: phone call/IVRS/SMS *4. Uploading of information directly to Nikshay portal
under construction. In future direct online TB information transmission from CBNAAT or MGIT etc may include.
TB Notification using Nikshay
TB Notification using mobile app
HEALTH FACILITY REGISTRATION
SL No
District Type Registered
Hospital/Clinic/Nursing Home
Laboratory
1 CCP 1 Nil (1)
2 Imphal East 2 1 (3)
3 Imphal West 5 4 (9)
4 Tamenglong Nil 1 (1)
5 Thoubal 1 1 (2)
6 Ukhrul 3 Nil (3)
7 Chandel Nil Nil Nil
8 Senapati Nil Nil Nil
9 Bishnupur Nil Nil Nil
State 12 7 19
State District TBUnit HFIDNO Health Facility
Address Pinno Type No. of Notified Patients
Manipur CCP DTC 67113 MSF CCP 795158 Clinic 86
Imphal West
DTC-TU 75211 IMPHAL HOSPITAL
Imphal West
795001 DTC 14
75214 Shija Hospital
Imphal West
795001 Hospital 4
75208 ADARSH Lab 17
75054 Omega Uripok 795001 Lab 3
TML TML 75145 DTC TML 795141 Lab 20Thoubal Kak_TU 75204 Jivan
HospitalKAKCHING 795103 Hospital 4
Ukhrul Ukhrul 2247 Leishiphu Christ.
Hospital
UKL 795142 Hospital 29
Total notified patients as on 25th August 2014 177
No. of Notified Patients 2Q14
Health Facility Who Have Not Initiated Patient Data Entry Report
SL No Name Type Sector
IMPHAL EASTJNIMS Hospital/Clinic/Nursing Home Public
Babina Diagnostics Laboratory Private
Public Hospital and Research Institute
Hospital/Clinic/Nursing Home Private
THOUBAL SUPRIYA DIAGNOSTIC CENTRE THOUBAL
Private
UKHRUL Comprehensive Health Services and Research Centre
Private
Health Facility Who Have Not Initiated Patient Data Entry Report
SL No Name Type Sector
IMPHAL WESTMona Laboratory X-ray Laboratory Private
Sky Hospital Hospital/Clinic/Nursing Home Private
Padma Diagnostic Centre Laboratory Private
Raj Medicity Hospital/Clinic/Nursing Home Private
Districts which do not have private health facilities1. Senapati2. Tamenglong3. Bishnupur4. Chandel
TB notification status
TB notification status
Responsibility of the district level nodal officer/Local public health authority
• Disseminate information• Provide formats• Ensure registration of all HE by Dec 2012 and given
the unique ID• Maintain a list of HE with details & IDs• Capacity building of MOs and health staff• Ensure all notified cases are entered in the NIKSHAY
portal within two weeks from submission of reports • Routinely review the progress
Responsibility of the health worker -I
• Regular visit all HE & promote understanding and requirement about TB notification
• Provide formats of TB notification & registration forms to all HE
• Collect, collate and upward submit the TB notification reports submitted by the HEs
• Ensure that all TB cases notified by the HEs are entered in NIKSHAY portal
Responsibility of the health worker -II
• Visit the TB patients notified by HEs in consultation with them for timely & public health action:
a) COUNCELING of TB pts for treatment adherence & Follow up to ensure treatment completion
b) TB contract tracing ,screening for symptoms referral for evaluation for TB
c) Offering INH chemoprophylaxis d) Family members counselinge) Offering TB treatment under RNTCP if desired by the pts d) Advising on ICTC services, further testing of C&DST, if desirable
Challenges
• Sensitization of huge no. of private health care providers with inadequate HR is a big challenge.
• Following up notified cases as a public health responsibility in manner acceptable to pts and community.
• Managing huge information at different level and creating a national TB register.