The document summarizes recent advances in India's tuberculosis (TB) programme. It provides an overview of the burden of TB in India, the timeline of India's TB control efforts since 1962, goals and strategies of the National Strategic Plan 2020-2025, and initiatives to strengthen the program like establishing governance structures, direct benefit transfers, engaging the private sector and communities, and expanding digital technologies and research. The overall aim is to accelerate progress towards achieving TB elimination targets through a multisectoral approach with community involvement.
National programme for prevention and control of cancer npcdcsanjalatchi
A non-communicable disease (NCD) is a disease that is not transmissible directly from one person to another. NCDs include Parkinson's disease, autoimmune diseases, strokes, most heart diseases, most cancers, diabetes, chronic kidney disease, osteoarthritis, osteoporosis, Alzheimer's disease, cataracts, and others.
WORLD TUBERCULOSIS DAY 2023 AWARENESS.pptxanjalatchi
World TB Day 2023, with the theme 'Yes! We can end TB!', aims to inspire hope and encourage high-level leadership, increased investments, faster uptake of new WHO recommendations, adoption of innovations, accelerated action, and multisectoral collaboration to combat the TB epidemic.
National framework for malaria elimination in indiaAparna Chaudhary
outlines India’s strategy for elimination of the disease by 2030. The framework has been developed with a vision to eliminate malaria from the country and contribute to improved health and quality of life and alleviation of poverty.
After the successful NSP 2017-2025,Goi is lauching NSP 2017-2025 for elimination of TB on 24th march( World TB day ) 2017. Module is on MOHFW site but i have try to keep it brief,hope its ll be useful specially for academic and administrative purposes.
National programme for prevention and control of cancer npcdcsanjalatchi
A non-communicable disease (NCD) is a disease that is not transmissible directly from one person to another. NCDs include Parkinson's disease, autoimmune diseases, strokes, most heart diseases, most cancers, diabetes, chronic kidney disease, osteoarthritis, osteoporosis, Alzheimer's disease, cataracts, and others.
WORLD TUBERCULOSIS DAY 2023 AWARENESS.pptxanjalatchi
World TB Day 2023, with the theme 'Yes! We can end TB!', aims to inspire hope and encourage high-level leadership, increased investments, faster uptake of new WHO recommendations, adoption of innovations, accelerated action, and multisectoral collaboration to combat the TB epidemic.
National framework for malaria elimination in indiaAparna Chaudhary
outlines India’s strategy for elimination of the disease by 2030. The framework has been developed with a vision to eliminate malaria from the country and contribute to improved health and quality of life and alleviation of poverty.
After the successful NSP 2017-2025,Goi is lauching NSP 2017-2025 for elimination of TB on 24th march( World TB day ) 2017. Module is on MOHFW site but i have try to keep it brief,hope its ll be useful specially for academic and administrative purposes.
National Health Policy of 1983, 2002 and 2017nirupama mishra
An presentation on National Health Policy, whose initiation taken during 1983 committed to attain the goal of Health for all by the year 2000AD and further matters added from to time considering present scenario.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
3. In 2019, an estimated 10 million people fell ill with
TB worldwide
1.4 million people died from TB
Eight countries account for two thirds of the total,
with India leading the count
TB incidence is falling at about 2% per year
Present rate of ~3% annual
decline needs to be accelerated
to ~11% to achieve 2030 SDG
targets by 2025
5. TIMELINE
1962
National TB Control Program started
with the aim to detect cases at earliest
& treat them
1992
WHO and SIDA evaluated the NTCP
1993 • NTP revised to RNTCP
• WHO declared TB as global
emergency
• DOTS strategy adopted
1997 Large scale implementation of
RNTCP began in phased
manner
1998
• Phase I RNTCP (1998-2005)
• Focus: Expansion of quality
DOTS services to the entire
country
• Sep: RNTCP implemented in
Imphal, Manipur
2002
RNTCP covered state of
Manipur
2006
• India achieved country wide
coverage under RNTCP in
March
• Phase II RNTCP (2006-2012)
• DOTS PLUS
2012
• Phase III RNTCP (2012-2017)
• National Strategic Plan (NSP)
2012-2017 was documented with
the goal of ‘universal access to
quality TB diagnosis and
treatment for all TB patients in
the community’
• Mandatory notification of TB
• NIKSHAY
2017
NSP 2017-2025
2018
13th March:
“TB Free India
Campaign”
2018
25th Sep:
“TB Harega, Desh
Jeetega”
2019
11th – 22nd Nov:
WHO-GoI
JMM two week
intensive review
of TB program
in India
2020
• 1st Jan:
RNTCP
renamed
NTEP
• NSP 2020-
2025
9. Adaptation of the strategy and targets at country level, with global
collaboration
Protecting & promoting human rights, ethics and equity
Building a strong coalition with civil society & communities
Gvt. Stewardship & accountability, with monitoring & evaluation
Integrated,
patient-
centred TB
care and
prevention
Bold policies
& supportive
systems
Intensified
research &
innovation
Pillars
Principles
11. • To cure ≥ 85% of all newly detected infectious
cases of pulmonary TB
• To detect ≥ 70% of estimated new smear +ve
pulmonary TB cases
OBJECTIVES
• To reduce mortality and morbidity from TB
• To interrupt chain of transmission until TB
ceases to be a public health problem in India
GOALS
12. To reduce incidence of TB & mortality due to TB
To prevent emergence of drug resistance & effectively manage drug
resistant TB
To improve outcomes among HIV-infected TB patients
To involve private sector
To decentralize & align RNTCP management units with NHM block
level units within general health system
NEW OBJECTIVES
14. GOAL:
To achieve a rapid decline in
burden of TB, morbidity &
mortality to achieve the SDG of
80% ↓ in incidence and 90% ↓ in
deaths by 2025
VISION:
TB-Free India with zero deaths,
disease and poverty due to TB
16. OBJECTIVES
Build, strengthen and sustain enabling policies,
empowered institutions, multi-sectoral collaborations,
engaged communities, and human resources with
enhanced capacities to create a supportive ecosystem
Prevent the emergence of TB in vulnerable
populations
Initiate & sustain, equitable access to free high quality
TB treatment, care and support services
Early identification of presumptive TB, at the
first point of contact & prompt diagnosis
B-P-D-T
(NSP 2020-2025)
D-T-P-B
(NSP 2017-2025)
19. USD 201 million
(Jan 2018 – March 2021)
USD 280 million
(April 2021 – March 2024)
“RNTCP World Bank IBRD
USD 500 million” project
moving towards elimination of
TB 2018-2025
20. Update terms of reference (TOR)
Leverage Health System
Training
Human resource recruitment agencies
Health worker surveillance
National fellowship & experiential learning program
21. National TB Policy & TB bill
• Accelerate efforts
• Contextual strategies
• Generate healthy competition
• Recognition
Sub-national certification of disease
free status
22. Sub-national certification of disease free status
Award
categories
Criteria: decline
in incidence rate
compared to 2015
Monetary
award for
district (Rs)*
Monetary
award for
state (Rs)*
Non-monetary
award
Bronze 20% 2 lakh 25 lakh Medal &
felicitation at
national level
Silver 40% 3 lakh 50 lakh
Gold 60% 5 lakh 75 lakh
TB Free
State/
District
80% 10 lakh 1 crore
Certification &
felicitation at
national level
*For states/ UTs with population <50 lakh & districts <2 lakhs, award shall be 50% of
the amounts considered
One district (Budgam, J&K) and one UT (Lakshadweep)
were declared TB Free on 24 Mar 2021
23. National TB Policy & TB bill
Sub-national certification of disease free status
Gazette on TB notification
• Provision of 269 &
270 IPC
• Jail from 6 months
to 2 yrs or a fine or
both
Direct benefit transfer schemes
24. Nikshay Poshan Yojana
(NPY)
Incentive to Treatment
supporters/ DOTS
providers
Transport incentive to
Tribal TB patients
Notification incentive to
private providers
DBT
Introduced in April 2018
Beneficiary
All notified TB patients for
duration of treatment
Objective
To provide financial incentive
for nutritional support to TB
patients from time of
notification
Benefit
amount
Rs 500/month during course of
treatment
Incentive to Treatment
supporters/ DOTS
providers
Beneficiary
Community Treatment
supporters
Objective To provide honorarium
Benefit
amount
• Rs 1000 on update of
outcome for drug sensitive
TB patients
• Rs 2000 on completion of
IP & Rs 3000 on
completion of CP
Notification incentive to
private providers
Beneficiary
Private providers who notify TB
patients to NTEP
Objective To provide financial incentives
Benefit
amount
• Rs 500 as one- time payment
on notification
• Rs 500 for updating patient’s
treatment outcome
Transport incentive to
Tribal TB patients
Beneficiary
All notified TB patients from
Notified Tribal areas
Objective
To provide financial support for
transportation
Benefit
amount
Rs 750 as one-time payment at
time of notification
Fast tracking DBT under NTEP:
• CTD introduced Digital Signature Certificate
(DSC) in year 2019, to ensure that DBT
beneficiaries get their due benefits much quicker
• 82% districts have implemented DSC
25. National TB Policy & TB bill
Sub-national certification of disease free status
Gazette on TB notification
Expedite setting up of governance & management structures to
State & district level
Direct benefit transfer schemes
26. MoHFW
Central TB Division
State TB Cell
District TB Centre (DTC)
TB Unit (TU)
TB Diagnostic Centres
(TDCs)
TB treatment centres (DOT)
ORGANOGRAM
National level
State level
District level
Sub-district level
PHC/BPHC
HWCs
National TB
Elimination
Board
State TB
Elimination
Board
District TB
Elimination
Board
Block TB
Elimination
Board
27. “MISSION MODE”
25th Sep, 2020:
M/o Labour & Employment
8th Oct, 2020:
M/ o Department of North Eastern
region
Two latest MoUs signed
28. Incentives through DBT
Joint Effort for Elimination of TB (JEET)
15th May, 2018 (Delhi launch)
OBJECTIVE:
To set up effective and sustainable structures to
strengthen existing systems and seamlessly extend
quality TB care to patients in the private sector
JEET efforts during COVID-19:
• Advocacy & facilitation of case finding strategies
Bidirectional screening
Outreach
Establishing linkages
• Treatment services
• Patient support services
• Direct Benefit Transfer (DBT)
29. Incentives
Joint Effort for Elimination of TB (JEET)
15th May, 2018 (Delhi launch)
Corporate TB Pledge (CTP) initiative (April, 2019)
Silver
Commitment
Gold
Commitment
Awareness
Platinum
Commitment
Awareness
Investment
Diamond
Commitment
Awareness
Investment
Champion
Offers a tiered approach for
corporates to use their
resources (human and
financial), to combat TB, raise
awareness & ultimately
improve TB health outcomes
30. Apollo Tyres Foundation organized
“TB free transhipment locations”
campaign for reaching out to trucking &
migrant communities of India
• 2 week campaign at 31 different
locations in 19 states
• Of 1310 TB facilitated during
campaign, 52 TB patients were
identified and put on treatment
31. Institutional mechanism of
community led response
•These forums have
representation of
people affected by
TB, elected
representatives,
policy makers,
CSO/ NGOs &
program managers
By end of 2019, TB forums constituted in >700 (99%)
districts across country
TB
treatment
literacy Advocacy
Counselling
&
mentoring
Health
financing
Programme
planning
Implementation
Monitoring
& review
TB champions
TB survivors
Engaging
existing
community
groups
33. In partnership with NTEP,
working towards integrating TB
services at AB-HWCs
Operational guidelines
launched on 28th Dec, 2020
Collaborative framework for
management of TB in
pregnancy (to be launched in
2021)
Learning resource package
for training of CHOs
(to be rolled out in 2021)
Vulnerability score cards for
differential TB care
34. 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
35. Rebranding RNTCP
National photo exhibition “Courage & Resilience”
Media engagement-National media sensitization workshop
Television
New India
Sankalp-2 on TB
(12th Feb,2020)
MTV NISHEDH
“Alone Together”
27th Nov, 2020
Radio: Popularizing Free diagnosis, drugs & NPY
Advocacy for industry
17th Aug, 2020
Nikshay Patrika Newsletter
Nikshay Patrika Newsletter:
A significant
communication tool to
build, motivate, raise
awareness, learnings &
achievements
Pledge for TB Free India
CTD collaborated with MyGov
platform for all citizens to
pledge to make every village,
district, state and country TB
free under initiative “TB
Harega, Desh Jeetega”
36. Online review of program performance to
overcome impact of COVID-19
National TB prevalence survey: 25th Sep, 2019
• Buses will serve as fully-
equipped mobile clinics,
with trained staff , backed
by a chain of reference
laboratories
State TB Index: A composite measure of the program’s performance
has been developed
• CTD assesses the states/UTs achievements & performances
using 9 key indicators
• Maximum total score of 100
37. 1. Studies on strengthening surveillance & TB notifications
2. Studies for improvement of TB disease burden estimation; improved TB
diagnostics including childhood TB and EPTB
3. Studies on TB transmission and its interruption
4. Related to systematic screening of high-risk groups and intensified case findings
5. DR-TB management
6. Cascade of care in public & private sector
7. Preventive therapy
8. Socio-economic impact & poverty alleviation
9. Strengthening NTEP management
10. TB therapeutics (recurrent re-infection TB)
11. Co-morbidity studies
12. Lab, supply chain, sample transportation
13. ACSM
14. Collaborative studies with other ministries
RESEARCH PRIORITIES 2020
(MoHFW)
CTD
ICMR
NIRT
Non-
NTEP
ITRC
BRICS
66 proposals were received
by 20th Noc,2020
a. DST on newer drugs
b. NTBP Survey
c. Accuracy of 99 DOTS
d. Phase III RCT to evaluate
efficacy & safety of two
vaccines
VPM1002
Immuvac (Mw)
e. Airborne Infection Control
(AIC) practices in health
facilities
a. TB STAMP (TB Screen,
Track & Map Project)
b. Value TB project
c. RATIONS (Reducing
Activation of TB by
Improvement Of
Nutritional Status)
4 thematic areas:
1. Therapeutics
2. Diagnostics
3. Vaccines
4. Implementation Research
BRICS Countries (Brazil, India, China,
Russia & South Africa) established
collaborative TB research network
38. Nikshay Aushadhi
Launched on 24th
March, 2018:
Electronic drug
distribution
management system
To enable real time
visibility into stock
status at all levels and
enable forecasting,
quantification &
further distribution of
TB drugs and
diagnostics
Procurement &
supply chain
managemnet Quantification
and Forecasting
Monitoring and
Distribution
Recording and
Reporting
Data
Management
and Analysis
Training and
Capacity
Building
3PL system (Third party logistic system)
39. NSP 2020-2025 will aggressively pursue the
expansion of the digital information
ecosystem over the next five years
Vision: To create a digital information ecosystem where information is
captured in real time, processed and visualized, enabling efficient service
delivery and responsive program management, driving TB Elimination in
India and all over the world
NIKSHAY SAMPARK
• National TB Call Centre for TB helpline
managed by CTD (May 2018)
• Operating from two sites
Noida
Mumbai
• 7 days/ week (7am to 11pm)
Services provided:
Resolving queries related to TB
Reporting & management of TB services related grievances
Resolving queries related to Hepatitis under NVHCP
Tele-counselling
Feedback on NTEP services
COVID-19 (Toll Free 1075 since 16th March, 2020)
40. Sep 2018, CTD launched enhanced vision of Nikshay
Establish the National
Knowledge Cell under
Central TB Division
41. Strengthening TSN & make TA responsive
to emerging TB landscape in India
Extend TA to other ministries
Expedite establishment of planned TSUs
Create a platform to enlist & provide information on available TA
experts
All partner organizations (health economics, digital health etc) under
one umbrella of WHO-TSN consultants network
42. • To aim for equitable, rights-based TB services for women, men and
transgender persons by adopting a gender-specific programmatic approach at
all levels
• To mobilise, empower and engage women, men and transgender persons in
the TB response at the health system and community levels
Framework for addressing stigma
43. Data from Nikshay TB
notification system for
April to Aug 2020, in
comparison to similar
data for 2019
Number of patients with
TB registered on DOTS
and completed
treatment, in India’s
NHM-HMIS for the Jan
to June 2020 period, in
comparison to similar
data for 2019
Modelling analysis project:
Additional 6.3 mil cases of TB
& 1.4 mil TB deaths
attributable to COVID-19
between 2020 & 2025
Manipur
Total notification Jan-Feb 2020 (A) 430
Total notification Mar-April 2020 (B) 207
Total notification May-Dec 2020 (C) 926
% decrease between B & A 52%
% increase between C & B 11%
45. TB FREE INDIA
TB Preventive Treatment (TPT) &
Programmatic Management of TPT
(PMTPT)
Airborne Infection Control (AIC)
46. TB Preventive Treatment (TPT) & Programmatic Management of TPT
(PMTPT)
In September 2018, countries committed to
provide TPT to at least 30 million individuals
by 2022, including 24 mil household contacts
of TB patients and 6 mil PLHIV
47. TB Preventive Treatment (TPT) & Programmatic Management of TPT
(PMTPT)
In 2020, NTEP plans saturation of TPT & monitoring in:
• PLHIV
• Paediatric contact of active TB patients
• Additional inclusion of
Asymptomatic contact of all ages
Patient with silicosis
Immunosuppressive therapy
Anti-TNF treatment
Dialysis
Transplantation
Fast track approvals & phase wise capacity augmentation for
detection of LTBI:
• TST
• 4th generation IGRA
Rapidly adopt & scale-up use of shorter rifamycin based TPT
regimen:
• 3HP (3 months of Isoniazid + Rifapentine)
• 1HP ( 1 month of Isoniazid + Rifapentine)
• 3HR (3 months of Isoniazid + Rifampicin)
• 4R (4 months of Rifampicin)
• Rapid scale up to reach 5 mil/yr
• Establish TB prevention cell at national & state level
• Integrate TB preventive services in all ACF efforts
• Financial incentives for complete coverage
• Strengthening monitoring & evaluation by ensuring capture of
data for TPT in:
Nikshay platform
Scaling of digital tools: LTBI mobile app
48. Airborne Infection Control (AIC)
Revise AIC
guidelines
in line with
NTEP
AIC as
necessary
clause in
NABH
accreditation in
private sector
Leverage
ongoing
initiatives
(HWCs,
Kayakalp)
AIC
helpdesk
Sustained
national
campaign in
education
institutions
Provide
AIC kits
to all TB
patients
51. TB Co morbidities
Launch by MoHFW and MoTA with technical
assistance by USAID
In the tribal districts of the states under fifth
schedule and tribal districts of NE states under
sixth schedule
TB vulnerability mapping and periodic TB-
Active case finding drives of all individuals in
all tribal districts
52. Provision of Isoniazid preventive
therapy(IPT)
Improving the operational efficiency of
Village Health Sanitation
Nutrition days
Jan Arogya Samiti plateform
Jan Andolan initiative
Engaging TB champions
Training of faith healers
53. Linking of Swasthya with Nikshay
Notified TB patient get Rs.750 at the time of notification
54. Join TB-Diabetes collaboration
• Collaboration with NTEP and NPCDCS
• Bidirectional screening of TB and Diabetes Mellitus
• TB patient linked to anti diabetic treatment
55. Join TB-HIV collaboration
• Collaboration with NTEP and NACO
• In 2019, TB-HIV collaboration committee was restructured by MoHFW to
form a TB Co-morbidity collaborative committee at National, State and
District level
• Bidirectional screening of TB and HIV
• During the routine outreach services of HIV, team member screen HRG and
bridge populations for TB symptoms and refer to the nearest TB center for
diagnosis and treatment
56. • “Single window” services for TB and HIV
• Gazette notification by GoI dated 28th October 2020 about the
mandatory requirement of ART centers and Drug resistant TB services
in all Medical colleges
TB-Tobacco
• Collaboration between NTEP and NTCP
• Tobacco used status were identified among TB patient and linked to
tobacco cessation services
57. Childhood TB
• NTEP collaboration with Child Health Programme in the country (RBSK and
RKSK)
• Screening of children in the age group(0-18 years) will be done through
Mobile health teams of RBSK and Adolescent Friendly Resource centres of
RKSK
60. Classification of TB diagnosis
1. Drug sensitive TB
2. H mono/ poly DR-TB
3. MDR/RR TB
4. XDR TB
61. National strategic plan(2020-2025)
Diagnosis
• Rapid transition of TB diagnosis from smear microscopy to molecular testing
using NAAT right up to the Block level
• Introduction of Point of care (POC) sequencing platform
• Roll out the use of novel skin test like C-Tb to support the diagnosis of
pediatric TB( replacement for PPD based TST)
• Introduction of next generation whole genome sequencing
62. Treatment
Pan country roll out of injectible free regimen for DS-TB
Post treatment follow up till 2 years after completion of the anti-TB
treatment
Digital adherence technologies to inform and enable more
differentiated patient care
70. Shorter oral bedaquiline-containing MDR/RR-TB regimen
Inclusion criteria
1.DST based inclusion criteria
Rifampicin resistance detected/inferred
MDR/RR-TB with H resistance detected/ inferred based on InhA mutation
only or based on KatG mutation only (not both)
MDR/RR-TB with FQ resistance not detected
71. 2.Other inclusion criteria
Children, aged 5 years to less than 18 years of age and weighing at least
15 kg, given their special needs, in consultation with the pediatrician
No history of exposure to previous treatment with second-line medicines
in the regimen(Bdq, Lfx, Eto or Cfz) for > 1 month
No extensive TB disease
No severe extra-pulmonary TB
Women who are not pregnant or lactating
72. Exclusion criteria
1. DST based exclusion criteria
MDR/RR-TB patients with H resistance detected with both KatG and
InhA mutation; and
MDR/RR-TB patients with FQ resistance detected
73. Exclusion criteria
2.Other exclusion criteria
If result for FL-LPA, SL-LPA and DST to Z,BDQ & Cfz is not available
after pre-treatment evaluation is completed and it is a time to initiate the
first dose of the regimen, then, excluded those with history of exposure
for>1 month to Bdq, Lfx, Eto or Cfz
Intolerence to any drug or risk of toxicity from a drug in shorter oral
Bedaquiline containing MDR/RR-TB regimen
74. Extensive TB disease found in presence of bilateral cavitary disease or
extensive parenchymal damage on chest radiography
In children aged under 15 yrs, presence of cavities or bilateral disease on
chest radiography
Severe EP-TB disease where there is a presence of military TB or TB
meningitis or CNS TB. In children aged under 15 yrs, extrapulmonary
forms of ds other than lymphadenopathy
Pregnant and lactating women
Children below 5 years
75. Shorter oral bedaquiline-containing MDR/RR-TB regimen
• From start to end of 4 months-Bdq, Lfx, Cfz, Z, E, Hh ,Eto
• From start of 5 months to end of 6 months-(If IP not extended)
-Bdq, Lfx, Cfz, Z, E
• From start of 6 months to end of 9 months-Lfx, Cfz, Z, E
• If the IP is extended upto 6 months then all 3 drugs Bdq, Hh and Eto are
stopped together
(4-6) Bdq(6 m), Lfx, Cfz, Z, E, Hh, Eto (5)Lfx, Cfz, Z, E
76. Grouping of anti-TB drugs & steps for designing long MDR-TB regimen
Groups & Steps Medicine Abbreviation
Group A Levofloxacin or Lfx
Include all three medicines Moxifloxacin Mfx
Bedaquiline Bdq
Linezolid Lzd
Group B Clofazimine Cfz
Add one or both medicines Cycloserine or Cs
Terizidone Tr
77. Grouping of anti-TB drugs & steps for designing long MDR-TB regimen
Groups & Steps Medicine Abbreviation
Group C Ethambutol E
Add to complete the
regimen and when
medicines from group A &
B cannot be used
Delamanid Dlm
Pyrazinamide Z
Imipenem-cilastatin or Ipm-Cln
Meropenem Mpm
Amikacin Am
(or Streptomycin) S
Ethionamide or Eto
Prothionamide Pto
p-aminosalicylic acid PAS
78. Longer oral M/XDR-TB regimen
• It is of 18 -20 months with no separate IP or CP
• Dose of Lzd will be tapered to 300 mg after the initial 6-8 months of treatment
• Bdq will be given for 6 months and extended beyond 6 months as an exception
• Pyridoxine to be given to all DR-TB patients as per weight band
• For XDR-TB patients the duration of longer oral XDR-TB regimen would be for
20 months
(18-20) Lfx, Bdq(6 month or longer), Lzd, Cfz, Cs
80. Bedaquiline,Pretomanid,Linezolid (BPaL) regimen
• Bpal regimen for MDR-TB with additional fluoroquinolones resistance
• Duration: 6-9 months
• Used under operational research conditions to TB patient who have either no
previous exposure to bedaquiline and linezolid or have been exposed for no
more than 2 weeks
81. Bedaquiline,Pretomanid,Linezolid (BPaL) regimen
Dosage
• Pretomanid - 200 mg once daily for 26 weeks
• Bedaquiline - 400 mg once daily for the first 2 weeks and then 200 mg three
times/ week for 24 weeks
• Linezolid – 1200 mg once daily for 24 weeks
83. 170
148
120
199
44
0
50
100
150
200
250
2019 2020 2021 2022 2023 2024 2025
Inciddence
rate
(cases
per
100,000
population)
Scenario I Scenario II Scenario III Scenario SDG
NTEP impact modelling
Scenario 1: Sustained service delivery at the current trends with available tools
Scenario 2: Scale-up of existing strategies and introduction of newer tools
Scenario 3: Accelerated expansion of existing and newer tools
Scenario SDG: Newer vaccine, drugs, diagnostics, and non-pharmaceutical interventions
84. - Highest level of political &
administrative commitment
- State strategic plans based on NSP
- Much greater financial resources
- Availability of new drugs, regimens,
diagnostics, approaches
- Insufficient human resources
- Low coverage of basic program services
for those accessing care in private sector
- Addressing social determinants of TB
- COVID-19 pandemic response focus
attention on Respiratory Diseases
- Integration with other ministries
- Enforcement of mandatory notification
- Expansion of AB-PMJAY to cover TB
- Innovative solutions
• - Insufficient budgetary outlay for
health in national budgets
• - COVID-19 derailing efforts of TB
programs
• - Economic slowdown owing to
lockdown
SWOT
85. 1. MoHFW. National multisectoral action framework for TB- free India. New Delhi:MoHFW;2020 [cited
2021 May 15]. Available from: https://tbcindia.gov.in/showfile.php?lid=3525
2. MoHFW. Guidelines on Airborne Infection Control in Healthcare and Other Settings. New
Delhi:MoHFW;2010 [cited 2021 May 14]. Available from:
https://tbcindia.gov.in/index1.php?lang=1&level=1&sublinkid=4519&lid=3015
3. Ministry of tribal affairs government of India. Improving the cascade of TB care and support services
among Tribal Populations in India. New Delhi:MoHFW;2020.[cited 2021 May 16]. Available from:
https://tbcindia.gov.in/WriteReadData/l892s/5883826004Tribal%20TB%20Initiative.pdf
4. MoHFW. Guidelines for programmatic management of drug resistant tuberculosis in India. New
Delhi:MoHFW;2021. [cited 2021 May 16]. Available from:
https://tbcindia.gov.in/showfile.php?lid=3590
REFERENCES
86. 5. Sachdeva KS. Nikshay patrika. New Delhi:MoHFW. 2020 December;4(3):1-20. Available from:
https://tbcindia.gov.in/showfile.php?lid=3576
6. Shrinivasan R, Rane S, Pai M. India’s syndemic of tuberculosis and COVID-19. BMJ Global
Health. 2020;5:e003979. Available from: doi:10.1136/bmjgh-2020-003979
7. 7. MoHFW. National strategic plan for tuberculosis: 2017-25 elimination by 2025. New
Delhi:MoHFW; 2017. [cited 2021 May 16]. Available
from:https://tbcindia.gov.in/WriteReadData/NSP%20Draft%2020.02.2017%201.pdf
8. 8. Sharma DC. India launches tuberculosis prevalence survey. Lancet Respir Med. 2019;S2213-
2600(19)30377-7. Available from: https://www.thelancet.com/pdfs/journals/lanres/PIIS2213-
2600(19)30377-7.pdf
9. Kuldeep Singh Sachdeva (2020): TB free India by 2025: hype or hope. Expert Review of
Respiratory Medicine. 2020 July; 10.1080/17476348.2021.1826317. Available from:
https://www.tandfonline.com/doi/full/10.1080/17476348.2021.1826317
WHO s post 2015 end TB strategy, adopted by WHA in 2014, aims to end global TB epidemic as part of SDG. The NSP adapts this END TB strategy framework for designing its national strategic framework.
multi-pronged approach to engaging with the private sector, as part of the NSP mantra of “go where the patients go”.
25 VANS
Best performing states: himachal Pradesh, Gujarat, Tripura, Sikkim, puducherry, daman and diu
India: 514,370 cases & 151,120 deaths will be added in India btw 2020-2025 owing to 2 month lock down & 2 month restoration periods.