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St francis hospital natcon 2011
St francis hospital natcon 2011
St francis hospital natcon 2011
St francis hospital natcon 2011
St francis hospital natcon 2011
St francis hospital natcon 2011
St francis hospital natcon 2011
St francis hospital natcon 2011
St francis hospital natcon 2011
St francis hospital natcon 2011
St francis hospital natcon 2011
St francis hospital natcon 2011
St francis hospital natcon 2011
St francis hospital natcon 2011
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St francis hospital natcon 2011

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  • 1. Impact of in-house RNTCP DMC in NGO Hospital –a case studyDr Neerja Arora Dr K N Gupta Dr Reuben SwamickanRegional TB Project State TB Officer, National TB ProjectCoordinator, Rajasthan Coordinator,CBCI-CARD GFATM RCC CBCI-CARD GFATM RCCRNTCP Project RNTCP Project
  • 2. SettingSt.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
  • 3. CBCI-CARD GFATM RCC RNTCP projectThe objective of this project is to facilitate the involvement of the Catholic Church network in RNTCP across 19 states of IndiaThere 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 areasUnder this project, by 3Q11, CHFs have signed more than 200 RNTCP schemes for NGOs of which 86 are DMCs CBCI-CARD GFATM RCC RNTCP PROJECT
  • 4. St Francis Hospital, Ajmer CBCI-CARD GFATM RCC RNTCP PROJECT
  • 5. St Francis Hospital DOT Centre120 108 99100 91 90 84 80 64 61 60 52 45 41 120 40 100 98 20 5 93 90 85 87 84 87 80 82 83 0 percentage 60 40 Cat I Cat II Cat III Total 20 14 11 10 7 Patients put on DOTS at St Francis Hospital 5 5 4 5 6 6 3 3 0 0 0 2 0 0 2 1 1 0 1 2 DOT Centre Yr 2000-2010 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 Trends in Treatment outcomes of ALL Categories of patients put on DOTS at St Francis Hospital DOT Centre ( Yr 2000 to Yr 2009 ) CBCI-CARD GFATM RCC RNTCP PROJECT
  • 6. St Francis Hospital DMC Trends in Sputum Examinations for St Francis Hospital Annexure M for 2010 Diagnoses & Follow-up in Yr 2010 60 53 TB 51 TB Suspect 50 43 Suspect s Follow- Patients 39Month/ TB TB undergo s found up positive Total Total Total 40 34 36 suspects Suspect positive Slides 29 Year ing patients in positive negative 26 26 examine s found on examine 30 23 24 2010 d positive repeat repeat examine follow d slides slides 22 22 sputum d up 19 1817 18 17 examin 20 1614 14 15 examin 11 13 ation ations 10 Jan 11 1 0 0 19 0 60 2 58 0 Feb 16 0 0 0 14 2 60 4 56 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Mar 18 4 0 0 17 2 70 10 60 TB suspects examined Follow-up patients examined Apr 14 3 0 0 18 2 64 8 56 Trends in Slide positivity Rates, positivity among May 13 5 0 0 22 1 70 11 59 50 Diagnoses Follow-ups in Year 2010 Jun 22 7 0 0 15 3 74 17 57 40 38. Jul 17 6 1 0 26 3 88 17 71 35. Aug 23 6 0 0 51 6 148 24 124 30 32 26. 24 Sep 29 7 0 0 43 1 144 15 129 22 21 22. 20 20 19 20 Oct 34 4 0 0 53 4 174 12 162 14. 14 16 16. 15 15 14 12 12.5 11 12 12 12.5 12 Nov 24 3 0 0 39 6 126 18 108 10 9. 10 9 9 7 8 8. 3 5 Dec 26 4 0 0 36 3 124 11 113 2. 0 0 0TOTAL 247 50 1 0 353 33 1202 149 1053 Jan Mar May Jul Sep Nov TOTAL Sputum positivity for diagnosis sputum positvity for follow ups Slide positivity rate CBCI-CARD GFATM RCC RNTCP PROJECT 6
  • 7. Objectives of the studyTo evaluate the impact of in-house RNTCP-DMC services on1. Referral of TB suspects2. Referred patients receiving sputum test3. TB case notification. CBCI-CARD GFATM RCC RNTCP PROJECT
  • 8. MethodologyReview of referral register, RNTCP laboratoryregister and other relevant records. Theaverage values of the historical data for 6years period (2004-2009), when patients werereferred to nearby DMCs, was compared withthe results in the year 2010, i.e. after theintroduction of in-house microscopy services CBCI-CARD GFATM RCC RNTCP PROJECT
  • 9. Trends in percentage of referred chest symptomatics undergoing sputum microscopy Yr 2004-Yr 2010 Trends in Percentage of Suspected Chest Symptomatics referred at St Francis Hospital, Ajmer, undergoing sputum Proportion microscopy Total Not of Referred Yr 2004-Yr 2010 Diagnosed Referred Positive Negative reached suspects Year at DMC cases (D) (E) DMC undergoing (A) ( C) 100% (B) (F) sputum microscopy 90% 80% 70%Yr 2004 140 77 14 63 63 55% 60% 50%Yr 2005 137 84 22 62 53 61% 40% 30%Yr 2006 118 73 19 54 45 62% 20%Yr 2007 107 55 14 41 52 51% 10% 0%Yr 2008 87 38 11 27 49 44% Yr 2004 Yr 2005 Yr 2006 Yr 2007 Yr 2008 Yr 2009 Yr 2010Yr 2009 99 58 10 48 41 59% Diagnosed Not reachedYr 2010 271 263 47 216 8 97% CBCI-CARD GFATM RCC RNTCP PROJECT
  • 10. 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). CBCI-CARD GFATM RCC RNTCP PROJECT
  • 11. 300 Trends in Referral & Diagnosis of Chest Symptomatics at St Francis Hospital, Ajmer 271 263 Yr 2004 to Yr 2010 250 Start of DMC 200 at Hospital premisesNumber 150 140 137 118 107 99 100 84 87 77 73 55 58 47 50 38 22 19 14 14 11 10 0 Yr 2004 Yr 2005 Yr 2006 Yr 2007 Yr 2008 Yr 2009 Yr 2010 Total Referred cases Diagnosed Positive CBCI-CARD GFATM RCC RNTCP PROJECT
  • 12. 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 CBCI-CARD GFATM RCC RNTCP PROJECT
  • 13. 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 YOUCBCI-CARD GFATM RCC RNTCP PROJECT 14

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