2. कार्य अबको , क्षर्रोग अन्त्यको
It’s time for action! It’s time to End TB
3. Vision: TB Free Nepal
Goal:
To reduce the mortality, morbidity and transmission of tuberculosis until it is no
longer a public health problem and ultimately to eliminate TB.
Objective:
- To reduce the incidence of TB by 20% by 2021 and 90% by 2035
- To reduce the TB deaths by 35% by 2020 and 95% by 2035
- To reduce the catastrophic cost to families due to TB to 0% by 2035
With Regards to SDG, target are:
Vision, Goal and Objectives of NTP
2015 2019 2022 2025 2030
SDG targets: 3.3.2
Tuberculosis
incidence (per
100,000 population)
158 85 67 55 20
4.
5. 14%
21%
24%
7%
20%
4%
10%
Distribution of TB cases by
Province (%)
Province-1
Province-2
Bagmati
Province
Gandaki
Province
Province-5
Karnali
Province
Sudurpaschi
m Province
3%
25%
59%
13%
TB case Notification by
ecological belt (%)
Mountain Hill
Terai Kathmandu Valley
7. 34112
32056
31764
32474
32043
123
112
111
112 109
50
100
150
200
250
300
30500
31000
31500
32000
32500
33000
33500
34000
34500
2071/72 2072/73 2073/74 2074/75 2075/76
CNR
per
100,000
Total
TB
case
notified
(In
Number)
Axis Title
Trend of TB case Notification and CNR
Notified TB Cases CNR
Case Notification in Rates and Numbers (National)
Annual Trend
• Globally, an estimated 10.0 million people fell ill with TB in 2075/76.
• Nepal population contributed to 0.35% of the global population, but with regards to TB,
Nepal accounted for 0.5% of global TB cases.
• Among 32043 reported case, 82% of pulmonary cases were bacteriologically confirmed
10. 30% 20% 10% 0% 10% 20% 30%
65+
55-64
45-54
35-44
25-34
15-24
5-14
0-4
Age
group
Distribution of TB cases (in percent)
by Age and Sex
% Of Female % Of Male
64%
36%
Distribution of notified TB cases by Age and Sex
(FY 2075/76)
• Most cases were reported in the middle age group with the highest of 48 % in 15-44 years of age
hints towards age shifting to higher age meaning a healthier younger population and improving TB
program
• Men were 1.77 times more than women among the reported TB case. (aligns to Global estimates)
11. Five years trend on type of TB
• Bacteriological confirmation improving than previous year Nearly 78% of those
bacteriological testing are through rapid DST (Xpert MTB/RIF testing), better than previous
year testing of only 57%)
12. TB HIV testing and enrollment in treatment
Improved HIV testing among TB cases :
• Among all TB cases, 0.7% were people living with HIV (PLHIV), which was lower than the
global context as Nepal is a low HIV prevalent country.
• The percentage of notified TB patients who had a documented HIV test result in 2075/76
was 69%, up from 67% in previous year.
13. 91
91 91 91
91
90
90
90 90
90
88.5
89
89.5
90
90.5
91
91.5
92
FY 71/72
(14/15)
FY 72/73
(15/16)
FY 73/74
(16/17)
FY 74/75
(17/18)
FY 75/76
(18/19)
TSR
in
%
Treatment Success Rate (Annual Trend)
Success Rate (All forms) PBC (New+Relapse) Success Rate
Treatment Success Rate (%)
48%
43%
1%
3%
3%
2%
National Treatment Outcome (in %)
Cured Completed Failure
Died Lost to Follow-up Not Evaluated
Sustained High treatment success rates in Nepal
Among reported, 32313 TB cases were successfully treated (TSR >90%) better than global
commitment of 85% or more.
14. DR Case notification, treatment coverage and outcome
• 392 reported cases of RR MDR; 0.6% new TB cases and
20% previously treated case (compared to 3.4% of new
TB and 18% of previously treated cases globally)
possible under detection in Nepal
• Some progress in testing, detection, and treatment of
MDR/RR-TB
• TB were tested for rifampicin resistance, up from
57% in 2074/75 to 78% in 205/76.
• The coverage of testing was 79% for new and
74% for previously treated TB patients.
• 71% were successfully treated (compared to
global TSR of 56 %).
• 5% of MDR TB were treated with the new shorter
regimen with 65% success rates.
• Key Challenge nearly 38% are lost to follow up.
15. TB Preventives
Services
NTP recommends TB
preventive treatment for:
• PLHIV
• household contacts under
5 years of bacteriologically
confirmed pulmonary TB
cases.
A total of 2026 PLHIV were
started on TB preventive
treatment in 2075/76, based
on data from NCASC.
TBPT for children under five
years who are the contacts of
TB cases increased by 4-fold
compared to FY 74/75 to
2,397.health
BCG vaccination is being
provided as part of national
childhood immunization
programmes. The coverage of
BCG vaccine was 92% in FY
74/75.2075/76, 2 397 children and 2
026 PLHIV received the TB preventive
therapy which has improved since
2074/75. BCG vaccine can also confer
protection, but mostly from severe
forms of TB in children. BCG coverage in
Nepal was more than 90%.
16. Key facts regarding Facilities
Treatment Facilities
Facilities Current
DOT Centers 4382
Urban DOT 96
MDR Treatment
Centers
21
MDR Treatment
Sub Centers
86
DR Home 1
Laboratory facilities
Facilities No. Services
Microscopy
Centers
604 Microscopy Centers
GeneXpert
facility
56 Uses sputum sample, Result in
2 hour
Culture labs
and DST
2 Duration of test is 2 month
Line Probe
Assay(LPA)
2 Confirmation of DR TB from
sputum positive samples, in 2
days
17. National TB Prevalence
Survey, 2018-19
Key findings
• The first ever nationally
representative TB survey to
understand the actual TB disease
burden in the general population
in Nepal.
• Also measured the health-care
seeking behaviour and service
utilization among survey
participants.
• 99 Cluster , 55 districts,
around 500-600 population
per cluster, total of 57 589
sample size.
18. Burden estimates – based
on results of Prevalence
survey
• According to the survey, TB
burden is much higher than
previously estimated
• currently over 117 000
people are living with TB
disease in Nepal.
• Likewise, 69 000 people
developed TB in 2018.
• TB burden is 1.6 times higher
than previously estimated
Annually missing cases nearly
54%
• Most diagnosed by use of X-
ray (more 70%) , and use of
Xpert
• Prevalence higher among
Men, higher in elderly (≥65
years) and in all terrains (not
only in Terai and KTM which
reported highest no. of cases
to NTP)
• Burden still high , but
Successful TB program – 3 %
annual decline estimated
since last decade.
19. • Current practice of TB symptom screening using single question of cough
more than 2 weeks can miss cases. 5.8% TB cases had cough <2 weeks but
additional other symptoms.
• Chest x-ray found to be a better screening tool for TB: More than 70% of the
confirmed TB cases had no symptom but only X-ray suggestive of TB.
• GeneXpert (molecular technology for the diagnosis of TB) detected more TB
cases as compared to smear microscopy, making it more reliable and efficient
test.
• DOTS, essential for sustaining high TB treatment success rate: Survey finding
shows more than 80% of participants had been adhering to treatment as a
result of direct supervision. Hence, DOTS need to be scaled up community
level to sustain the current excellent (91%) treatment success rate.
• High trust on Govt. health facilities: Patients had high trust in the
government health facilities; it provides opportunity to strengthen quality of
care in the government health facilities complemented by private sector.
• TB and migration: Significant number of people seek TB services across the
country.
National TB Prevalence Survey, 2018-19
Key findings
20. NTP achievements
o Domestic resources have been increased in the program 27% in 2013/14 and 55%
in 2017/18.
o 3% decline of incidence per year, but gap still high.
o Treatment success rate for DSTB above 90% and DRTB- nearly 70%.
o Successfully completion of National TB prevalence survey in Nepal
o Expansion of sensitive molecular diagnostic tools (Genexpert) in the country
from 22 Xpert centers in 2014 and 63 centers currently.
o DRTB patients are covered under health insurance (no premium needed).
o Tertiary hospital for TB program under construction.
o Initiated a shorter treatment regimen (9 months) for DRTB patients all over the
country from 2017 and transition into all oral longer regimen as recommended by
WHO.
21. Way Forward
Ensure high-level political commitment to END TB.
• Essential to mobilize other sectors beyond health such as industries, education,
finance, private sectors, communities to engage in TB care and support.
• Sustain the TB and MDR-TB response through high-level political commitment,
strong leadership across multiple government sectors, partnerships and adequate
investments in TB, including cross border collaboration.
Improve access to quality TB service.
• Ensure better access to more sensitive screening and diagnostic tools such as
(chest X-ray and Xpert MTB/RIF. LPA, LAMP etc) to ensure early detection of TB.
• Better and tertiary treatment services (complete central TB hospital -2020)
• Ensure quality and patient friendly treatment services both at health facilities and
in communities (e.g. Community Based DOT, family-based DOT etc).
22. Way Forward
Engage private sector in provision of high-quality TB services
• Improve roles of the private sector and hospitals in TB control to deliver high quality
TB care and services.
• Implement mandatory case notification
Increase awareness and create demand for quality TB services
• Empower communities with proper knowledge of TB and generate demand for
quality TB services.
• Provide patients and their families with appropriate supports including social support
and contact tracing.
Ensure increased investment in TB, both financial and human resources, to meet the Global
commitment to #ENDTB#
• Commit to increase domestic investment for TB.
Domestic resource increased from 27% in 2014/15 to 55% in 2017/18, but still
hugely underbudgeted.
Ensure around 15 billion NPR for next 2021-25 NSP if end TB is to be reached as
committed.
• Advocate for increased donor investment for TB.
• Ensure adequate human resources at all levels.
• Ensure NO out of pocket expenditure by TB affected families.
23.
24. TB is a Global Issue
with
Global impact and
only by working together we can eliminate it.
