Hhh

2. Snapshot:
- Introduction & Origin
- TB – Statistics
- Threats
- Strategic Plan
- Prevention
- Nurses Role

3. Introduction:
-Tuberculosis , one of the most ancient diseases of mankind & is one of
the ten major causes of mortality worldwide. The trend of increasing TB
cases and drug resistance in India is very disturbing.
India has engaged in TB control activities more than 50 years. Yet TB
continues to be India’s severest health crisis. TB kills an estimated
480,000 Indians every year & more then 1,400 every day. India also has
more than a million ‘missing’ cases every year that are not notified & most
remain either undiagnosed or unaccountably & inadequately diagnosed
& treated in the private sector . This tragic loss of life, continued suffering,
poverty need to end with concerted efforts from all of us.
3

4. Historical Background:
4
-On March 24, 1882 – Dr. Robert Koch
discovered ‘Mycobacterium tuberculosis’
the bacteria that causes TB.
-A century later, March 24 was
designated World Tb Day : a day to
educate the public about the impact of
TB around the world.

5. What is Tuberculosis?
Tuberculosis (TB) is an infectious disease caused by the bacterium
Mycobacterium tuberculosis (MTB) which generally affects the
lungs, but can also affect other parts of the body.
One patient with infectious pulmonary TB if
untreated can infect 10-15 persons in a year.
o Malnutrition
o Diabetes
o HIV infection
o Poor immunity
o Severe kidney disease
o Other lung diseases
e.g. silicosis
o Substance abuse etc.
o Overcrowding
o Inadequate
ventilation
o Enclosed living/
working conditions
o Occupational risks
Risk factors:

6. TB – Statistics :
▹ Over 8.8 million are infected & 1.4 million die every year. 95% of TB
infections & deaths occur in low- & middle income countries.
▹ 2021- == 11.6 million diagnosed with TB……1.7 million died.
▹ TB is the 13th leading cause of death & the 2nd leading infectious
killer after Covid- 19.
▹ Nearly 82% of global TB deaths among HIV (-)ve people occurred
in the South Asia & African regions.
▹ The reported number of people newly diagnosed with TB fell from
7.1 million in 2019 to 5.8 million in 2020.
▹ There was a partial recovery to 6.4 million in 2021, but this was still
well below pre- pandemic levels.
6

7. Why we failed to control / eradicate TB ? Back to the Future ?
Threats to Control TB
▹ Poor Primary Health Care Infrastructure
▹ Unregulated Private Health Care / Suboptimal Quality of Care
▹ Irrational use of anti- Tb drugs
▹ Spreading HIV infection
▹ Poverty & inadequate nutrition
▹ Low investment / Lack of access to healthcare
▹ Corrupt Administration / Corruption
7

8. Cont….
▹ Lack of a short & highly active sterilizing TB treatment regimen.
▹ Weak programme implementation & management
▹ Drug resistance /Multi- drug regimen (
▹ Poor compliance /Failure to stop drug toxicity.
▹ Unsanitary condition
▹ Insufficient advocacy
8

9. Vision: A world free of TB
Zero TB deaths, Zero TB disease, and Zero TB suffering
Goal: End the Global TB Epidemic (<10 cases per 100,000 population)
Sustainable Development Goals (SDG)
INDICATORS
TARGETS
SDG 2030
Reduction in number of TB deaths compared
with 2015 (%)
90%
Reduction in TB incidence (new case) rate
compared with 2015 (%)
80%
TB-affected families facing catastrophic
expenditures due to TB (%)
Zero

10. TB Free India
▹ India has committed to End TB by 2025, 5
years ahead of the global SDG target
▹ Prime Minister of India launched TB Free
India campaign at ‘Delhi End TB Summit’ on
13th March, 2018.
▹ The campaign calls for a social movement
focused on patient-centric and holistic care
driven by integrated actions for TB Free
India.

11. More & more States committing to Ending TB
Chhattisgarh
Tamil Nadu
State level commitment 14 State/UT
Himachal Pradesh Kerala
Lakshadweep
Jharkhand
2020- Kerala
2021- Himachal Pradesh
2022- Gujarat, Lakshadweep &
Sikkim
2025- Bihar, Chhatisgarh, Daman &
Diu and Dadra & Nagar Haveli,
Jammu & Kashmir, Jharkhand,
Madhya Pradesh, Puducherry, Tamil
Nadu and Andaman & Nicobar
Islands

12. 12
Strategies
Private
sector
engagement
Active
Case
Finding
TB
Co-
morbidities
Multi-
sectoral
response
Drug
Resistant
TB
ICT Tools
for
adherence
and
monitoring
Preventive
Measures
Community
Engagement
National Strategic Plan (2017-25)

13. Organizational structure
Supporting Facilities
 National Reference
Laboratories (6)
 Intermediate Reference
Laboratories (31)
 Culture and DST Laboratories
(81 including IRL/NRL)
 CBNAAT Laboratories (1268)
 DRTB Centres- 703

14. Key Services
1. Free diagnosis and treatment for TB patient
2. Public health action- contact tracing, testing
for co-morbidities etc.
3. Treatment adherence support
4. Nutrition assistance to TB patients (DBT-
Nikshay Poshan Yojana)
5. Preventive measures

15. Strengthening Case Finding in the Public Sector
Chest X Ray:
Clinically diagnosed
TB increased from
8.8 lakhs in 2017 to
12.7 lakhs in 2019
Revised Diagnostic
Algorithm for TB:
Increase in DR-TB cases
from 38,000 in 2017 to
66,000 in 2019
Upfront Rapid
Molecular Testing:
Increased from 5.23
lakhs upfront tests
in 2017 (16% yield)
to 11.34 lakhs in
2019 (17% yield)
Intensive Case Finding in Health
facilities- Screening for TB
among:
-DM patients increased from
11.5 L in 2018 to ~20 L in 2019
- ICTC/ART referrals increased
from 3.35 L in 2017 to 3.94 L in
2019
Active Case Finding in
vulnerable population: from 5.5
crore population screened in
2017 to 28 crores screened in
2019. Yield increasing from
~27,000 to ~63,000 TB patients.
Leveraging Outreach of
other Healthcare
Programmes: 8.3 lakhs
referrals from Health &
Wellness Centres .
PASSIVE APPROACH TO CASE FINDING
ACTIVE APPROACH TO CASE
FINDING

16. Strengthening Case Finding in the Private Sector
Schedule H1 Implementation:
The number of chemists registered in
Nikshay increased from 15221 in 2017 to
over 43000 chemists notifying 20,609 TB
cases in 2019.
Mandatory Notification of TB: Gazette
notification issued in March 2018;
Provisions of Sections 269 and 270 of the
Indian Penal Code (IPC) in 2019
Patient Provider Support Agency through
JEET and Domestic Resources: From 48
PPSAs in 2017 to 220 PPSAs in 2019 and
266 PPSAs in 2020.
77%
Increase in
private
sector
notification
from 3.8
lakhs in
2017 to 6.8
lakhs in
2019.

17. Treat
Treatment
Patient
Centric Care
Reduce Out-
of-pocket
Expenditure
• Daily Regimen
• Shorter Regimen
• Newer Drugs
• IT Enabled
Adherence Support
• Comorbidity
management
• Financial incentives
• Direct Benefit Transfer

18. Direct Benefit Transfer (DBT) schemes
1.Honorarium to Treatment Supporters – For provision of
treatment support to TB patients (Adherence, ADR monitoring,
counselling @Rs.1000/- to Rs.5000/-)
2.Patient Support to Tribal TB Patients (Financial Patient Support
@Rs750/-)
3.Nutritional Support to All TB patients (Financial Support to
Patients @Rs.500/-month)
4.Incentives to Private Providers (Rs.500/- for Notification &
Rs.500/- for reporting of Treatment Outcome
5.Incentives to Informant (Rs. 500/- is given on diagnosis of TB
among referrals from community to public sector health facility)

19. Prevent
▹ Air borne infection
control measures
▹ Strengthen Contact
Investigation
▹ Preventive treatment in
high risk groups
▹ Manage Latent TB
Infection
▹ Address determinants of
disease

20. Identifying ‘High –Risk”
20
 Certain groups of people are more likely to develop
tuberculosis. These groups include:
 the elderly
 people born in areas of the world where TB is more common
(e.g., Asia, Africa, the Caribbean, and Latin America)
 alcoholics
 the homeless
 intravenous drug users
 the institutionalized
 people with chronic diseases, such as HIV, cancer and
diabetes
 People taking biologic immunosuppressive drug therapy

21. 21
Airborne Isolation Rooms
(Negative Pressure Rooms)
A patient known or suspected to have TB must be
placed in a negative pressure airborne isolation room.
This keeps TB germs from traveling to other areas of
the hospital.

22. 22
Airborne Isolation Rooms
- An Airborne Isolation Sign will placed on the patient door.
- The patient’s door must always remain closed to allow the airflow
of the negative pressure room to work correctly.
- When a suspected TB patient is admitted, the Facilities Department
must be notified to ensure that the negative pressure is working as
intended.

23. Patient Placement: Use a PRIVATE ROOM that has:
A HOSPITAL-APPROVED RESPIRATOR
must be worn to enter this room.
• Monitored negative air pressures,
• 6-12 air changes per hour,
• Discharge of air outdoors or HEPA
filtration if recirculated.
Patient must remain in room with door closed.

24. Respiratory Protection Program
▹ By law, all hospital personnel caring for a patient
with TB must wear a fit-tested respirator (N-95
mask).
▹ Employees must wear appropriate make, model, and
size of the respirator they were fit-tested for to be
adequately protected.
▹ Regular surgical masks do not adequately protect
workers from TB.
▹ Designated job codes in the TB Prevention Plan are
required to be fit-tested each year. Check which
month your department is scheduled to be fit-tested.

25. Patient Care Measures – Respiratory Etiquette
▹ Encourage patients to cough into a tissue.
▹ Discard tissues promptly into appropriate trash
receptacle.
▹ Encourage and assist with patient hand
hygiene.

26. Patient Care Measures
▹ TB patients must wear a surgical mask [not an N95] if they leave
their room.
▹ They are no longer considered contagious when:
▸ their cough subsides AND
▸ 3 successive sputum smears are negative
▹ This usually happens approximately14 days after therapy begins
▹ The health department and hospital policy determine when a
patient may be removed from Airborne Isolation Precautions

27. Multi-sectoral Engagement
TB care services
in health
infrastructure
Socio-economic
support &
Empowerment
Infection Prevention
Address
Determinants
Information
Education
Communication
Prevention and
Care at Work
Place
Corporate
Social Responsibility
TB - A social problem & needs multi-sectoral approach

28. Inter-Ministerial Coordination
AYUSH (Ayurveda, Yoga & Naturopathy, Unani, Siddha and
Homoeopathy)
•1st meeting of National Technical Expert Group on NTEP-AYUSH
Collaboration & e-consultation of experts held
•2nd draft of Policy Document and Joint Letter drafted
Railways
• Joint Working Group to be formed to monitor implementation
Defence
•Action Plan developed.
•95 Ex- Servicemen Contributory Health Scheme (ECHS) Polyclinics registered
in Nikshay, remaining underway
Labour and Employment
• MoU signed in September 2020

29. Community Engagement
 Transformation of TB survivors to TB
champions
 Capacity building and mentoring programme
 Engagement of existing community groups
like PRI, SHG, VHSNC, MAS, Youth Club
 Grievance redressal mechanism
 Involvement of community representatives in
different forums
TB Forums at the National,
State and District level to
provide a platform for all
stakeholders, including the
community, to voice their
views

30. Call Centre- Nikshay Sampark
 1800-11-6666
 Outbound & Inbound
 Time – 7 to 11
 Languages – 14
 100 call centre agents
 Pan-India coverage
 Citizen – Patient - Providers
Counselling
Treatment
Adherence
Grievance
Redressal
Follow
Up
TB
Notification
Information
Nikshay
Poshan
Yojana
Policy Update in RNTCP, 2018

31. 1. Under reporting and uncertain care of TB patients in
private sector
2. Reaching the unreached – Slums, Tribal, vulnerable
3. Drug Resistant TB
4. Co-morbidities – HIV, Diabetes
5. Undernutrition, overcrowding
6. Lack of awareness and poor health seeking behaviour
lead to delay in diagnosis
Key Challenges

32. Opprtunities for TB Contol
▹ Improve TB notification rate Ensure mandatory TB
notification from private sector
▹ Active TB Case Finding to reach the unreached
▹ Optimum utilization of CBNAAT machines
▹ Expand Universal Drug Susceptibility Testing coverage
▹ NIKSHAY Poshan Yojana to every TB patients
▹ 100% reporting through NIKSHAY
▹ Collaboration with Line Ministries to tackle social
determinants of TB
▹ Community participation for TB Elimination

33. Cont….
▹ Strengthening & Improving the quality of basic
DOTS services.
▹ Align with health system under NRHM
▹ Deploying improved rapid diagnosis at the gross
root level.
▹ Expand urban TB control
▹ Improve communication & outreach
▹ Use IT & AI / ML technology
33

34. Cont…
▹ Improvement of social conditions & co-
morbidities that fuel the TB.
▹ Strengthening Private Sector: Research indicates
that a substantial gap between what doctors
know & what they actually practice.
▹ Boosting TB policy making & programme
planning – Community support.
▹ Media advocacy.
34

35. Role of Nurse:
▹ Outreach care
▹ Nurse led TB clinics
▹ Contact tracing
▹ New Immigrant screening
▹ Education / Teaching/ Research / audit
▹ Support & management
▹ Guidance & Counseling
▹ Home visits to provide holistic care
▹ BCG vaccination
35

36. Summary & Conclusion:
▹ TB is a contagious disease caused by M Tuberculosis. It
mainly affects the lungs and also other organs also.
Clinical symptoms include a cough, weight loss, night
sweats & fever . Tb can almost be cured. It can be
prevented by the practice of healthy living skills and by
barrier techniques.
36

37. Thank You
Bending the Curve
Accelerating towards a TB free India
Thank You