Presentation on prevalence and incidence of tuberculosis in world wide

1. Chapter 3: National strategic plan for
universal access to quality diagnosis
and treatment of DR-TB

2. Content
• History of PMDT expansion
• Vision of NSP
• PMDT expansion plan and progress
• PMDT objective in NSP
• PMDT indicator

3. History of PMDT expansion
• Initiated in 2007 – country wide coverage March 13
• National PMDT and lab scale-up plans (2009-2014)
• National Drug Resistance Survey (NDRS)
• RNTCP Technical and Operational Guidelines-2016
• expansion of CBNAAT services
• use of Bedaquiline under conditional access in
RNTCP PMDT

4. National Strategic Plan (2017-25)
• National PMDT Scale up Plan for 2017- 2025,
– Developed by consolidating the state wise PMDT micro-plans
– Developed during the series of regional PMDT review meetings
• Objectives to align the RNTCP vision for PMDT scale up plan
with state plans
• Outputs include
– Laboratory scale-up requirements,
– National training
– District appraisal
– Scale up plan of Bedaquiline, Delamanid, Shorter MDR-TB Regimen
and DST guided treatment.

5. RNTCP PMDT Vision
Vision:
• Promptly diagnose
• Effectively treat all TB patients
• Decentralized DST and PMDT treatment services
Approach:
• Scale and cost
• A phased approach has been adopted

6. Specific objectives of NSP
• By end 2017
– Complete nationwide geographical coverage of access to
baseline second line DST using SL-LPA, access to Shorter
MDR-TB Regimen and newer drugs like Bedaquiline
• By 2017-25
– Universal access to rapid molecular DST for all diagnosed
TB patients
– Universal access to DST guided treatment

7. Estimates for NSP- (2017-25)

8. Specific strategies for early diagnosis, prompt and
appropriate treatment as well quality care, social
support and protection
Prevention of
DR-TB
Quality care DS-TB
patients;
Rational use of anti-TB
drugs; and
implement infection
control measures.
Stopping
transmission of
DR-TB
Ensure early diagnosis
and prompt treatment
Improve laboratory
capacity
DST guided treatment
Laboratory
systems for drug-
resistant TB
Universal DST
Strengthen surveillance
systems
Laboratory information
management system
(LMIS)

9. Specific strategies for early diagnosis, prompt and
appropriate treatment as well quality care, social
support and protection
Treatment of DR-
TB
Decentralize DR-TB treatment
Manage H mono/poly DR-TB
patients
Shorter MDR-TB regimen
Newer drugs
Social protection &
supportive systems
Palliative care
Re- imbursement of cost to
the patient
Nutritional assessment and
supplementation
National Health Protection
Scheme (NHPS)

10. Specific Indicators of NSP
• Proportion of notified TB patients offered DST
• No. of MDR/RR TB patients notified
• No. of H mono-poly resistant TB patients notified
• No. of pre XDR TB patients notified
• No. of XDR TB patients notified
• Treatment success rate for RR TB
• Proportion of notified TB patients (including DR-TB) receiving
financial support through DBT
• Number of District DR-TB Centre established
• No. of rapid molecular laboratories established
• Percentage of districts covered for call center support for
treatment adherence (including ICT intervention districts)

11. National Plan for Universal Access to
Quality Diagnosis and Treatment of DR-TB
• Diagnostic services
– Upfront CBNAAT for Key population
– Revised diagnostic algorithm
– Rapid diagnostic technologies such as CBNAAT, First &
Second Line LPA
– Universal access to Rifampicin susceptibility testing
• Treatment regimen
– Introduction of Shorter regimen
– Management of Mono and poly resistant
– Introduction and expansion of newer drugs
– Decentralised DR TB treatment
– DST guided treatment

12. Way forward
– Implementation of revised diagnostic algorithm
– Rapid diagnostic technologies such as CBNAAT,
First & Second Line LPA with full utilization
– Universal access to Rifampicin susceptibility
testing
• Introduction of Shorter regimen
• Management of Mono and poly resistant
– Expansion of newer drugs
– DST guided treatment
– Decentralised DR TB treatment

13. Thank you