World tb day 2015

WORLD TB Day 2015

24 th March "Reach the 3 Million:

Reach, Treat, Cure Everyone“

Dr.Shailja Sharma

History of world tb day• In 1982, on the one-hundredth

anniversary of Robert Koch's

presentation, the International

Union Against Tuberculosis and

Lung Disease (IUATLD)

proposed that March 24 be

proclaimed an official World TB

Day. This was part of a year-

long centennial effort by the

IUATLD and the World Health

Organization (WHO) under the

theme “Defeat TB: Now and

Forever.

MDG 6, Target 6c. To halt and

reverse the incidence of TB

• The Millennium Development Goal (MDG)

framework includes five indicators:

• TB incidence,

• TB mortality,

• TB prevalence,

• the case detection rate for new TB cases and

• the treatment success rate for new TB cases.

global TB mortality rate

• By 2013, it had fallen by 45% compared with a

baseline of 1990.

• The 50% reduction target has already been met in

three WHO regions: the Region of the Americas,

the South-East Asia Region and the Western

Pacific Region.

• The other three regions (the African Region, the

Eastern Mediterranean Region and the European

Region) are unlikely to reach the target.

global TB prevalence rate

• By 2013, it had fallen by 41% since 1990

• The 50% reduction target has been met in two WHO regions (the Region of the Americas and the Western Pacific Region) and the SouthEastAsia Region appears on track to reach it.

treatment success rate

• Treatment success rates were above 85%

globally in 2012, in three of six WHO regions

and in most HBCs.

• Globally, the case detection rate was 64% in

2013.

India

• one fourth of the global incident TB cases

occur in India annually

• In 2012, out of the estimated global annual

incidence of 8.6 million TB cases, 2.3 million

were estimated to have occurred in India

• In the year 2013 the RNTCP put 1416014

patients on treatment

• As per the Government regulations Tuberculosis is a

Notifiable disease and it is the Responsibility of every Physician treating the Tuberculosis patients

• Total case notification rate per 1,00,000

population was 113 which is decreasing since

last 5 years.

• Incident TB case notification rate is also

declining since last 5-6 years and in 2013 it

was 91 per 1,00,000 population.

• Overall success rate of new and retreatment

TB cases is 88% and 70% respectively

• New indicators on TB notification by private sectors have been included e.g. number of private health facilities (laboratories, clinics, hospitals etc) registered with RNTCP as well as number of TB patients notified by these private health facilities.

• This inclusion of notification from private sector is also in sync with the World TB Day theme on missing three million, one million of which are estimated to be in India.

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RNTCP Organization structure: State level

Health Minister

Health Secretary

MD NRHM Director Health

Services

Additional / Deputy / Joint

Director

(State TB Officer)

State TB Cell

Deputy STO, MO, Accountant,

IEC Officer, SA,

DEO, TB HIV Coordinator etc.,

State Training and Demonstration

Center (TB)

Director, IRL Microbiologist, MO,

Epidemiologist/statistician, IRL LTs etc.,

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One/ 100,000

(50,000 in hilly/ difficult/

tribal area)

One/ 500,000 (250,000 in hilly/ difficult/ tribal area)

Nodal point for TB control

TB Health Visitors (TBHV), DOT Provider (MPW, NGO, PP, ASHA,Community Volunteers)

Medical Officer, paramedical staff And Laboratory Technician (20-50%)

Medical officer-TB Control,Senior Treatment supervisor(STS), Senior TB Laboratory Supervisor(STLS)

District Health Services

District TB Centre

Tuberculosis Unit

Microscopy Centre

Structure of RNTCP at district levels

Chief Medical Officer and other supporting staff

District Administration District Magistrate/District Collector

DTO, MO-DTC (15%), LT, DEO,

Driver, Urban TB Coordinators,

TBHVs, Communication Facilitators

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RNTCP Laboratory Network

4 NRLs

27 IRLs

>12,000 DMCs(one per 50,000-100,000

population)

• As on December 2013, Five laboratories which include three NRLs (NIRT-Chennai, NTI-Bangalore and NITRD-New Delhi),

• One IRLs (Gujarat and Kerala) and

• one NGO laboratory (P D Hinduja) are performing the second line DST in solid and liquid culture.

• The RNTCP has identified additional laboratories for performing second line DST which include IRLs in Andhra Pradesh, Delhi, Nagpur- Maharashtra, Rajasthan, JALMA-Agra; and SMS Jaipur and JJ Hospital Mumbai medical colleges.

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RNTCP response to the challenge of

drug resistant TB

• Focus is to prevent its emergence by providing

• quality DOTS diagnostic and treatment

services,

• increasing the visibility and reach of the

programme services and

• promoting adherence to International

Standards of TB care and Standards of TB

Care in India by all healthcare providers.

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Diagnosis of drug resistant TB

• DST for 2nd line drugs is done at 3 National

Reference Labs (NIRT-Chennai, NTI-

Bangalore, LRS-Delhi).

• DST to second-line drugs will be offered to all

confirmed MDR TB cases at diagnosis as the

lab capacity becomes increasingly available in

all 33 labs being developed for liquid culture

and DST in a phased manner up to 2015.

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Achievements of programmatic management

of drug resistant TB during 2013

• As on February 2014,PMDT services are available in all 35 states of the country across 704 districts covering the entire population (100%) of the country

• 110 DR TB wards established with airborne infection control measures by end of 2013.

• A total of 51 C-DST labs were established using various technologies- 37 Solid culture labs, 12 Liquid culture labs and 41 LPA labs.

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Addressing the co-epidemics of TB

and HIV

• In 2013, 48% of TB patients globally had a

documented HIV test result, but progress in

increasing coverage has slowed.

• At country level, 61% of TB patients knew

their HIV status which has increased from 11%

in 2008.

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• Globally in 2013, 70% of TB patients known to be HIV-positive were on ART

• India- Among HIV-infected TB patients 91% were put on (co-trimoxazole preventive therapy (CPT).

• The coverage of ART among TB patients who were known to be HIV-positive reached 86% in patients registered in 2012 up from 49% in 2008.

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Developments in TB-HIV

• Isoniazid Prevention Therapy (IPT)

implementation plan approved by NTWG.

• The policy recommends the use of a simplified

clinical algorithm for TB screening that relies on

the absence or presence of four clinical symptoms

(current cough, weight loss, fever and night

sweats) to identify people eligible for IPT or for

further diagnostic work-up of TB.)

• This is being implemented in phase wise manner.

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• The eligibility for receiving ART has been

revised from CD4 level of 350 to 500 for all

PLHIV.

• This step will ensure that HIV positive persons

are initiated on treatment at an early stage and

while enhancing their longevity and

productivity, it will contribute to preventing

new infections as well.

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Partnerships

• To achieve “Universal access to TB care and

treatment for all,” RNTCP has taken steps to

reach the unreached through synergising the

efforts of all partners and stakeholders

• At present RNTCP has established 2569 NGO

partnerships and 13150 collaborations with

private practitioners and other private sector

entities.

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Involvement of Medical Colleges in

RNTCP

• medical colleges are currently divided into six

zones North, East, West, South 1, South 2 and

North-East Zones.

• At present over 330 medical colleges both

public and private medical colleges have been

involved in TB control in India

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TB surveillance in India with

Nikshay

• Central TB Division (CTD) in collaboration

with National Informatics Centre (NIC)

undertook the initiative to develop a Case

Based Web online (cloud) application named

Nikshay.

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World TB Day

• This day is designed to help focus public

attention on tuberculosis and serve as a

reminder of the fact that TB continues to be an

epidemic in many parts of the world to this

day, especially our own country –2,74,000

people die from TB each year in India.

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OUR Aim everyone to access to treatment

Make believe and work with

dedication that no one should

be left behind in the fight

against TB. This World TB

Day, we call for a global effort

to find, treat and cure the three

million and accelerate progress

towards zero TB deaths,

infections, suffering and

stigma.

Challenges

• US$ 2 billion funding gap per year for

implementation of existing TB interventions.

There is an additional gap of US$ 1.39 billion

for research.

• 3 million people with TB are missed by health

systems every year and therefore may not get

adequate care they need

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• TB/HIV response needs acceleration

Antiretroviral treatment, treatment of latent TB

infection and other key interventions still need

further scale-up

• MDR-TB remains a crisis Widening gaps

between people diagnosed with MDR-TB and

those put on treatment. This could compromise

recent gains

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• Global strategy and targets for

tuberculosis prevention, care

and control after 2015

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Post-2015 Global Tuberculosis

Strategy Framework

• Vision- A WORLD FREE OF TB

ZERO deaths, disease, and suffering due to TB

• Goal- end the global TB epidemic

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Thank You