The document provides an overview of tuberculosis (TB) in India, including key terminology, disease burden statistics, milestones in the country's TB program, and details of the current National Tuberculosis Elimination Program (NTEP). It notes that India accounts for over a quarter of global TB cases. The NTEP aims to eliminate TB in India by 2025 through strategies like improving diagnosis, ensuring appropriate treatment, preventing at-risk populations from developing TB, and strengthening related policies and resources. It outlines diagnostic protocols, treatment regimens, and initiatives to engage private providers and provide social support to patients.

1. Moderator:
Dr.Nayana S
Assistant professor
Presentor:
Dr. Vanmathi A
Post graduate

2.  Introduction
 Terminologies
 Burden of the disease
 Milestones
 NTEP
 SWOC analysis
 Conclusion

3. INTRODUCTION

5. TERMINOLOGIES
 Presumptive TB  Mono resistance
 New patients  Polydrug residtence
 Relapse patients  Multidrug resistance
 Treatment after failure  Extensive drug resistance
 Treatment after loss to follow up  Cured patient
 Treatment completed

6. BURDEN OF THE DISEASE
 A total of 1.5 million people died from TB in 2020 (including 214 000 people with
HIV. Worldwide,
 The WHO TB statistics for India for 2021 give an estimated incidence figure of
2,590,000 million cases. this is a rate of 188 per 100,000 population

7.  in Karnataka the rate is about 135 per
100,000 populaton

8. MILESTONES IN INDIA
 1939: TB association India
 1959: National TB Institute (NTI) in Bangalore
 1962: Govt. of India launched the National TB Programand set up DistrictTB Centres
 1997:GoI revised NTP to RNTCP – introduction ofDOTS
 2006 – 11:Second phase of RNTCP
 2012 -17:National Strategic Plan

9.  2017 – 25:NSP (2017 – 25)
 2020:In January 2020, GoI revised RNTCP to NationalTB Elimination Program
(NTEP)
 2021:TB Mukt Bharat Abhiyaan

10. DOTS
Components:
 Political will and commitment
 Diagnosis by quality assured sputum smear microscopy
 Directly observed treatment
 Adequate supply of quality-assured short course chemotherapy
 Systemic monitoring and accountability

11. RNTCP
Objectives:
Achieve at least 85% cure rate among new smear-positive cases initiated on Rx
Case detection rate of at least 70% of such cases

12. END TB STRATEGY:
Vision:
A world free of tuberculosis – zero deaths, disease
and suffering due to tuberculosis
Goal:
End the global tuberculosis epidemic
Indicators:
•95% reduction by 2035 in the number of TB deaths compared with 2015.
•90% reduction by 2035 in TB incidence rate compared with 2015.
•Zero TB-affected families facing catastrophic costs due to TB by 2035.

13. NATIONAL STRATEGIC PLAN
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.

14. Detect
Find all DS-TB and DRTB cases with an
emphasis on reaching TB patients seeking
care from private providers and undiagnosed
TB in high-risk populations.
Scale-up free, high sensitivity diagnostic
tests and algorithms
Scale-up effective private provider
engagement approaches
Universal testing for drug-resistant TB
Systematic screening of high risk
populations

15. Elimination of catastrophic costs by
linking eligible TB patients with social
welfare schemes
Treat
Initiate and sustain all patients on
appropriate anti-TB treatment wherever
they seek care, with patient-friendly systems
and social support.
• Prevent the loss of TB cases in the
cascade of care with support systems
Free TB drugs for all TB cases
Universal daily regimen for TB cases
Patient-friendly adherence monitoring
and social support

16. Address social determinants of TB
through intersectoral approach
Testing and treatment for latent TB
infection in contacts
Scale up air-borne infection control
measures at health care facilities
Prevent
Prevent the emergence of TB in
susceptible populations

17. Align and harmonize partners’ activities
with programme needs to prevent
duplication
Scale up Technical Assistance at national
and state levels.
Translate high level political commitment
to action
Build
Build and strengthen
enabling policies,
empowered institutions,
human resources with
enhanced capacities, and
financial resources to match
the plan
Restructure RNTCP management
structure and implementation
arrangement:

18. NTEP
 In view of the end TB strategy, RNTCP has been renamed as National TB
elimination programme in the year 2020
 It functions as a flagship component of NHM

19. Rebranding RNTCP
Red colour:
beginning,
emotions &
energy
yellow colour:
protection
Objectivity
Swirl of flag:
Pride of all
Focus of the
programme
Human figure:
celebration,
positivity &
success
Signifies bigger
picture

20. MoHFW
Central TB Division(CTD)
State TB Cell
District TB Centre (DTC)
TB Unit (TU)
Designated microscopy
centres
Peripheral health institute
ORGANOGRAM
National level
State level
District level
Sub-district level
PHC
National TB
Elimination
Board
State TB
Elimination
Board
District TB
Elimination
Board
Block TB
Elimination
Board

21. Ministry of health and family welfare
Secretary(H&Fw)
Director general of health services
Additional secretary
Additional Director General of health
services
Joint secretary
Central TB cell

22. State TB officer
Deputy director
WHO consultants
District tb officer
District Programme coordinator District Programme officer
Nikshay officer accountant

23. Medical officer
Senior treatment supervisor Senior Lab Supervisor
Tb health visitor
Community volunteers
Counsellor
Lab technician
DOTS provider

24. Facilities Number
Public health facilities PHI:171
Subcentres:348
Privalte health facilities Hospitals:1801
Labs:212
DMC Public:33
Private:01
NAAT CBNAAT:4
TRUNAAT:6
Tuberculosis Unit 10

25. TU Public Private Total
H D Kote 215 3 218
Hunsur 80 16 96
K R Nagara 126 4 130
Mysore 23 17 40
Mysore East 221 95 316
Mysore South 1 1 2
Nanjangudu 165 20 185
Piriyapatna 62 19 81
PKTB Mysore 1234 523 1757
T.Narsipura 90 3 93
Total 2722 986 2918

26. DIAGNOSTIC PROTOCOLS
 Diagnosis of TB
 Smear microscopy
 CBNAAT
 Additional Tests like CXR, TST used for
supporting diagnosis
 Cytology, Histopathology, Radio-imaging
are used for supporting extra-pulmonary
TB diagnosis
 Diagnosis of Drug Resistant TB
 All TB patients to be tested for drug
susceptibility (at least for Rifampicin)
 All Rifampicin Sensitive TB patients tested
for First Line Drug Susceptibility (mainly
Isoniazid)
 All Rifampicin Resistant TB patients tested
for second line drug susceptibility

32. *A=Adult FDC(HRZE=75/150/400/275)

33. PMDT

34. NEW INITIATIVES
 TB notification
 NIKSHAY
 Ban on TB serology
 Direct benefit transfer

35. NIKSHAY
https://reports.nikshay.in/Reports/TBNotification

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

37. Cont.
 Daily regimen for pediatric tb
 Daily regimen for all forms of tb
 Pilots for universal access to TB cases
 Universal drug susceptibility testing
 Shorter regimen and bedaquiline
 Campaign mode- Active case finding

48.  ICF: Intensi ed (TB) case nding (ICF) at ICTC, ART centres and Link ART Centres
(LAC)
 IC-AIC: Air-borne infection control measures for prevention of TB transmission at
HIV care settings
 IPT: Implementation of Isoniazid preventive treatment (IPT) for all PLHIV (On ART +
Pre-ART)
 Provision of ART for HIV-infected TB patients

49. I. Expand scope and improve effectiveness of joint DM and TB screening
campaigns, including Population Based screening.
II. Linkage of ICT based platforms of NTEP and NPCDCS – Messaging to provide
effective linkage to TB and DM management services.
III. Engagement with Indian Diabetic Association in screening for TB/increasing
awareness of risk of TB among diabetics

50. I. Develop collaborative mechanism between NTEP and MCH for addressing TB among
pregnant women.
II. Ensure screening and detection of active TB cases among pregnant and postpartum
women.
III. Providing appropriate counselling to address nutrition and lifestyle aspects.
IV. Strengthen referral linkages between NTEP and MCH program
V. Augment treatment of TB among pregnant women.
VI. Address TB and obstetric complications.

51. SWOC ANALYSIS
Strength:
1. Highest level of political and administrative commitment with deep engagement in the TB
elimination efforts of the country.
2. State Strategic plans based on the NSP
3. Availability of much greater financial resources for TB elimination
4. Availability of new drugs, regimens, diagnostics, approaches and strategies to end TB.
5. Rapid adoption of global best practices

52. Weakness:
1. Insufficient human resource .
2. Competing priorities in the states result in lack of focus and thrust on TB care activities
3. Significant provision of TB care continues to be provided by a fragmented and
relatively unregulated private sector.
4. Low coverage of basic program services for patients accessing care in the private
sector, and weak systems for contracting partners

53. Opportunities:
1. The COVID-19 pandemic response by the government focuses attention on
communicable diseases and the necessity of strengthening public health systems at all
levels. Also, the current momentum to fix the long-standing problems of the Indian
health system presents a good opportunity for NTEP to further improve the national
response.
2. Potential of leveraging the programmes of other ministries to complement NTEPs actions
to end TB

54. 4. Increased enforcement of mandatory notification / Schedule H-1
5. Emerging business models: consolidation, chains, e-pharmacies, etc. for
engaging the private sector
6. Expansion of Ayushman Bharat and Pradhan Mantri Jan Arogya Yojana
(PMJAY) to cover TB

55. Challenges:
1. The socio-cultural-economic effects. The stigmas associated with TB
2. impact of COIVD19 isn’t yet well understood however it has the potential to derail the TB
programme which will have an impact on reaching the targets of END TB.
3. Economic slowdown owing to the pandemic
4. Repurposing of infrastructure and existing TB human resources for emergent needs
5. Rapid urbanization, poor living conditions, ever-increasing migrant population

56. World tb day –march 24
CONCLUSION

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Banarsidas Bhanot; 2021
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https://tbfacts.org/tb-statistics-india/
3. The end TB strategy [Internet]. Who.int.. Available from:
https://www.who.int/teams/global-tuberculosis-programme/the-end-tb-strategy
4. NTEP training modules [Internet]. Gov.in. Available from:
https://tbcindia.gov.in/WriteReadData/NTEPTrainingModules1to4

58. 5. Revised national tuberculosis control programme NATIONAL STRATEGIC PLAN FOR
TUBERCULOSIS ELIMINATION 2017-2025 [Internet]. Gov.in. Available from:
https://tbcindia.gov.in/WriteReadData/NSP%20Draft%2020.02.2017%201.pdf
6. Taywade M, Pisudde P. New National Tuberculosis Elimination Program (NTEP) logo:
Observation and comments. Indian Journal of Tuberculosis. 2021 Jan 1;68(1):146-8.
7. Nikshay Ecosystem Login [Internet]. Nikshay.in. [cited 2022 Jun 28]. Available from:
https://sso.nikshay.in/v1/sso/login?returnUrl=https://www.nikshay.in/Home&clientId=1

59. Thank You