Global and Indian National Strategic Plan to End TB

1. INNOVATION AND ACTION TO END TB
END TB STRATEGY
1
World TB day
24th March 2018
Dr.Rama shankar
Assistant Professor
Department of Community Medicine

2. !2
I am a
Head of State
Minister of Health
Doctors and Civil Society
advocate. I am
leading efforts to end
TB.
Inviting Leaders For a TB Free India

3. !3
I am a Pharmacist,
Health Worker, Nurse
and Childhood TB Survivor.
I am leading efforts to
end TB.
Inviting Leaders For a TB Free India

4. Honourable Prime Minister addressing the keynote presentation on Delhi END-TB
Summit.!4

5. Key political Leaders of India and world along with representation
from WHO, STOP TB Partnership and other civil society.
!5

6. Honourable Prime Minister called for multi-sectoral engagement and participation
of all stake holders at every level to create “ TB-free village, panchayat, district and
state”, noting that frontline TB physician and workers can make a major
contribution in this direction.!6

7. Fact Sheet on TB
• TB is the ninth leading cause of death worldwide.
• In 2016, 10.4 million TB cases reported, and 1.7 million died from the
disease. In India, 2.7 million people fell ill with TB and 435,000 died from
the disease
• Seven countries account for 64% of the total, with India leading the
count, followed by Indonesia, China, Philippines, Pakistan, Nigeria, and
South Africa
• In 2016, 1 million children became ill with TB and 250,000 children died
of TB
• MDR-TB remains a health security concern. 600,000 new cases with
resistance to rifampicin – the most effective first-line drug, of which 490
000 had MDR-TB.
!7

8. !8
Global
India
Source: Global TB Report 2017

9. !9
Global
India
TB Burden (rate/ lakh population) 2016
Source: Global TB Report 2017

10. !10
Incidencerate
0
2.75
5.5
8.25
11
Numberinthousand
0
175
350
525
700
Global India
Incidence of
MDR/RR-TB
Rate`
11
8.1
147
601
MDR/RR-TB Burden ( 2016)
Source: Global TB Report 2017

11. !11
1994
2006
2015
THE DOTS
STRATEGY
THE STOP TB
STRATEGY
THE END TB
STRATEGY
1. Government commitment
2. Diagnosis by sputum smear
microscopy
3. DOT
4. Adequate supply of short course
chemotherapy drugs
1. Pursue quality DOTS-expansion and
enhancement
2. Adress TB/HIV and MDR-TB
3. Health system strengthening
4. Engage all care providers
5. Empowering patients and communities
6. Promote Research
Developed in context of UN SDG and is
paradigm shift from past global TB
strategies.
EVOLUTION OF END TB
STRATEGY

12. !12
THE END TB STRATEGY
VISION
A world free of TB- Zero deaths, disease and suffering
due to TB
GOAL End the global TB Epidemic
INDICATORS
Milestones SDG END TB
2020 2025 2030 2035
Reduction in number of TB
deaths ( Compared with
2015 (%)
35% 75% 90% 95%
Reduction in number of TB
incidence rate (Compared
with 2015 (%)
20%
(<85/100,000)
50%
(<55/100,000)
80%
(<20/100,000)
90%
(<10/100,000)
TB- affected families facing
catastrophic cost due to
TB (%)
0% 0% 0% 0%

13. !13
IncidenceRate/100,000/year
0
25
50
75
100
2015 2020 2025 2030 2035
Optimise use of
current & new tools
emerging from
pipeline, pursue
UHC and social
protection
Introduce new tools:
vaccine new drugs &
treatment regimen for
treatment of active TB
disease and latent TB
Infection and point of
care test
Current global trend decline -1.5%/year
-10% /year by 2025
-5%/year
-17%/year
DESIRED DECLINE IN GLOBAL TB INCIDENCE RATES
TO REACH THE 2035 TARGETS
<10/lakh pop

14. !14
Adaptation of the Strategy and targets at country level,
with global collaboration
Protecting and promoting human rights,
ethics and equity
Building a strong coalition with civil society
and communities
Government stewardship & accountability,
with monitoring & evaluation
PILLAR 1
Integrated Patient-
Centered TB care
& prevention
PILLAR 2
Bold policies and
supportive
systems
PILLAR 3
Intensified
Research &
Innovation

15. !15
Early Diagnosis of
TB and screening
of contacts and
high risk groups
Treatment of
DST & DRT
and
Patient
support
Management
of co-morbidities
Preventive
treatment
of persons at
high risk;
& vaccination
against TB
PILLAR 1
Integrated
Patient- Centered
TB care &
prevention

16. !16
PILLAR 2
Bold policies
and supportive
systems
Strong Political
Commitment
Engagement of
Private care
provider
Social
Protection
UHC policy and
regulatory
framework for
case notification

17. !17
PILLAR 3
Intensified Research
& Innovation
Discovery development
of new tools, interventions
and strategies
Research
to promote
innovations

18. A PARADIGM SHIFT IN THE FIGHT AGAINST TB
!18
Reach at least As a part of this approach, reach at least Achieve at least
90%
OF ALL PEOPLE WITH TB
(90)%
OF THE KEY POPULATIONS
90%
TREATMENT SUCCESS RATE
and place all of them on
appropriate therapy- first
line, second line, and
preventive therapy as
required.
the most vulnerable, underserved, at-risk
population
for all people diagnosed with
TB through affordable
treatment services adherence
to complete and correct
treatment and social support.
• Global Plan aims to achieve an incidence rate of 10 new
people with TB /100,000 population per year.
• Current 1.5% annual decline in TB incidence is unacceptable
and feasible to accelerate the decline to 10% per year.

19. India National Strategic Plan for TB Elimination 2017-2025
!19
• NSP 2017-2025 crafted on in line with NHP, WHO end TB strategy and
SDGs
• Elimination is based on 4 Pillars called as “DTPB”
DETECT TREAT
PREVENT BUILD
Find all DS-TB & DR-TB cases
with focus on TB patient
seeking care from private
providers
Initiate and sustain all patients
on appropriate ant- TB
treatment wherever they seek
care with patient friendly system
and social support
Strengthen enabling policies,
empowered institutions, and
HR with enhanced capacities
Prevent the emergence of TB
in susceptible population

20. !20
VISION
TB free India with zero deaths, disease and poverty
due to TB
GOAL
To achieve a rapid decline in burden of TB, morbidity
and mortality while working towards elimination of
TB in India by 2025
IMPACT INDICATORS Baseline Target
2015 2020 2023 2025
To reduce estimated TB
incidence rate (100,000)
217 142 77 44
To reduce estimated TB
Prevalence rate (100,000)
320 170 90 65
To reduce estimated mortality
due to TB ( per 100,000)
32 15 6 3
To achieve zero catastrophic
cost for affected families due to
TB
35% 0% 0% 0%
India National Strategic Plan for TB Elimination 2017-2025

21. Patients in Private Sector
• The incentive to the Private Sector TB
Care Provider are as follows;
• Rs 250/- on notification of a TB case
diagnosed as per STCI
• Rs 250/- on completion of every
month of treatment
• RS 500/- on completion of entire
course of TB treatment
• Rs 2750/- for notification and
management of a drug-sensitive
patient over 6-9 months as per STCI,
• Rs 6750/-For notification and correct
management of a drug-resistant
case over 24 months as per STCI,
!21
Management unit
with enhanced
capacity & ICT
support
Provision
of Diagnostic
& drug
Services
Surveillance
& quality
improvement
Patient
Support
Notification
of all TB by
effective provider
engagement
Option for free diagnostic services and
Treatment.

22. !22

23. !23

24. !24

25. !25

26. !26
Out of
Pocket
Expenditure
Cost of
Travel
Universal Health Coverage
Loss of Wages
NutritionCost of
Treatment
Cost of
Diagnosis

27. Summary
• TB is the ninth leading cause of death worldwide.
• Period of 2016-2035: WHO’s END TB STRATEGY and UN SDGs
share a common aim: to end the global epidemic
• NSP-2017-2025 is a framework to guide the activities of all
stakeholders to TB elimination in India.
• Activities envisaged should be backed by high visibility
advocacy and communication programme, ” TB Mukt Bharat
( the “national sweep out TB”) campaigns.
• National annual review of the programme will be undertaken
by the TB elimination board chaired by PMO.
!27

28. !28
Thank You
राष्ट्रिपता महात्मा गांधी ने कहा था िक कोई भी योजना सफल है या असफल,
ये इस बात पर िनभर्र करता है िक उससे अंितम जरूरतमंद व्यिक्त को िकतना
लाभ हो रहा है। हम आशा करते है िक आिखरी जरूरतमंद व्यिक्त तक पहुंचें
और उसकी Ease of Living बढ़ाये. आज इस अवसर पर हर व्यिक्त, हर
संस्था, िसिवल सोसायटी से जुड़े हर प्रितिनिध से भी ये संकल्प लेने का आग्रह
करता हूं िक वो TB के उस अंितम व्यिक्त तक पहुंचने में और टीबी मुक्त भारत
बनाने में सिक्रय भूिमका िनभाए।
टीबी मुक्त भारत का संकल्प, टीबी मुक्त िवश्व के संकल्प को भी पूरा करने में
सहयोग करेगा।