tb

1. Tuberculosis Elimination Strategies
Challenges and Road Map
Dr Shazia Anjum MBBS DNB MPH
World Health Organization
State Head Quarter Medical Consultant
National TB Elimination Programme
Karnataka, Bangalore

2. Mycobacterium Tuberculosis
• Causative agent of Tuberculosis
• Robert Koch announced discovery of M. TB on 24th March 1882
• Fairly large (2-4 μm x 0.2-0.5μm) non-motile rod-shaped bacterium
• Obligate aerobe
• Slow generation time15-20 hrs
• Has a waxy coating on cell surface due to mycolic acid
• Impervious to gram staining
• Needs acid fast stains (ZN/Auramin-O)
Mycobacterium tuberculosis scanning
electron micrograph; CDC.
Mycobacterium tuberculosis Ziehl-Neelsen
stain light microscopy CDC.
Mycobacterium tuberculosis Colonial
morphology; CDC.

3. TB disease
 A Microbiologically confirmed untreated
Pul TB case can transmit disease to at least
10 to 15 people in a year and remain
infectious for 2-3 years
 Contacts of an active case are at 10 to 60
times higher risk of developing the
disease

6. Revised National Tuberculosis Control Programme (RNTCP)
• National TB Control Programme (NTCP) was launched in 1962 on a 50:50 sharing
basis between center and state in regard to supply of Anti-TB drugs.
• Objective – To detect as many cases as possible and effectively treat them so as to
render infectious cases as non-infectious
• Expert Committee reviewed the programme in 1992

7. • RNTCP was evolved based on DOTS strategy with the
objective of curing at least 85% of new sputum cases
and then detecting at least 75% of such cases
• Directly Observed Treatment Short-course (DOTS)
strategy launched in 1997 and expanded across the
country by 2006.
• Under DOTS strategy patients swallow the drugs under
direct observations of the DOTS provider
• In 2007, GoI introduced the Programmatic
Management of Drug Resistant TB (PMDT) to combat
drug resistance and achieved full geographical
coverage by 2013.

8. India’s commitment
13 March 2018:
India committed to End TB by 2025, five years ahead of Global SDG target
Commitment required from the States/UTs for ‘TB free States/UTs’ by Dec’2024

9. The End TB strategy at a glance
Vision A world free of TB
-zero deaths, disease and suffering due to
TB
Goal End the global TB epidemic
Indicators Milestones Targets
2020 2025 SDG 2030 End TB 2025
(INDIA)
Percentage reduction in the absolute number of TB deaths
(compared with 2015 baseline)
35% 75% 90% 90%
Percentage reduction in the TB incidence rate
(compared with 2015 baseline)
20% 50% 80% 80%
Percentage of TB affected household facing catastrophic cost due 0% 0% 0% 0%

11. TB Transmission. Dynamics of Cough (droplets < 5 microns)
- Large Droplets (Pfluger)– fall fast !
- Small droplets–
…hang around floating…
…slowly evaporate…
….”crystallize” creating a
nucleus
of infectious material inside…
- 1.0 micron droplets nuclei (Wells)
will
eventually fall just 3 m. in 24 h.
!
•Large droplets  Upper Airway trapping
•1-5µ droplet nuclei reach Alveoli & cause

12. Coughing Sneezing
Speaking

13. TB Transmission. Contagious aerosols (droplets < 5 microns)

14. Presumptive Pulmonary TB
• A person with any of the symptoms and signs suggestive of TB
including cough for > 2 weeks, fever>2 weeks, significant weight loss,
haemoptysis, any abnormality in chest radiograph.
• In addition , contacts of microbiologically confirmed TB patients,
PLHIV , Diabetics, Malnourished, cancer patients, patients on
immuno- suppressants or steroids should be regularly screened for
signs and symptoms of TB

15. Diagnostic Modalities and Case Finding

16. Sputum collection: outdoors with good ventilation

17. Specimen Quality
Purulent Mucoid

18. Ziehl Neelsen Microscopy
18

19. Auramine smear Microscopy
19

20. • Xpert MTB/Rif test
• Major advantages in workflow
• fully automated with 1-step external sample prep.
• time-to-result 1 1/2 h (walk away test)
• throughput: up to 16 tests / module / run
• no bio-safety cabinet
• closed system (no contamination risk)
• scalable technology
• Performance
• specific for MTB
• sensitivity similar to culture
• detection of rif-resistance via rpoB gene
Integrated automated CBNAAT-
GeneXpert platform

21. Daily Dose Schedule for Adults (>18Y)
Weight band Number of tablets
Intensive phase Continuation phase
HRZE HRE
75/150/400/275 mg 75/150/275 mg
25-34 kg 2 2
35-49 kg 3 3
50-64 kg 4 4
64-75 kg 5 5
>=75 kg 6 6

22. Age Old Menace –Vulnerable
Population

23. Reaching the unreached

26. PRADHAN MANTRI TB MUKT BHARAT ABHIYAAN

27. SCOPE OF NI-KSHAY 2.0
Co-operative societies
Corporates
Elected Representatives
Institutions
NGOs
Political Parties
Individuals
Nutritional Support
Diagnostic
Vocational
Additional Nutritional Supplements
1 Year
2 Years
3 Years
Who can
be
Ni-kshay
Mitra?
What is the
duration of
Support?
What are the
types of
support to be
provided by
Ni-kshay Mitra?
What kind of
Geography
types to be
supported
State
District
Block
Peripheral Health Institution

28. NUTRITIONAL SUPPORT
.
1. Costs around INR 750-800 including transport/month
*Source: NIN, Hyderabad
RECOMMENDATIONS FOR MONTHLY FOOD BASKET

29. PRADHAN MANTRI TB MUKT BHARAT ABHIYAAN-KA

30. Thank You