The document summarizes India's Revised National Tuberculosis Control Programme (RNTCP). It discusses the burden of TB in India, the evolution of TB control programs from the National TB Programme (NTP) to the current RNTCP. It outlines the goals and strategies of the RNTCP and the National Strategic Plan (NSP) 2017-2025 to eliminate TB in India through improved detection, treatment, prevention, and building of infrastructure and resources. Key approaches include engaging private providers, active case finding, drug-resistant TB management, addressing social determinants, and strengthening surveillance and community engagement.
This ppt contains all the information about Revised NationalTuberculosis Control programme (RNTCP) It is useful for students of the medical field learning Preventive and social medicine, Swasthavritta (Ayurved) and everyone who is interested in in knowing about it.
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.
This ppt contains all the information about Revised NationalTuberculosis Control programme (RNTCP) It is useful for students of the medical field learning Preventive and social medicine, Swasthavritta (Ayurved) and everyone who is interested in in knowing about it.
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.
Integrated Disease Surveillance Project (IDSP) was launched by Hon’ble Union Minister of Health & Family Welfare in November 2004 for a period upto March 2010. The project was restructured and extended up to March 2012. The project continues in the 12th Plan with domestic budget as Integrated Disease Surveillance Programme under NHM for all States with Budgetary allocation of 640 Cr.
A Central Surveillance Unit (CSU) at Delhi, State Surveillance Units (SSU) at all State/UT head quarters and District Surveillance Units (DSU) at all Districts in the country have been established.
Objectives:
To strengthen/maintain decentralized laboratory based IT enabled disease surveillance system for epidemic prone diseases to monitor disease trends and to detect and respond to outbreaks in early rising phase through trained Rapid Response Team (RRTs)
Programme Components:
Integration and decentralization of surveillance activities through establishment of surveillance units at Centre, State and District level.
Human Resource Development – Training of State Surveillance Officers, District Surveillance Officers, Rapid Response Team and other Medical and Paramedical staff on principles of disease surveillance.
Use of Information Communication Technology for collection, collation, compilation, analysis and dissemination of data.
Strengthening of public health laboratories.
National leprosy eradication program CHNNehaNupur8
Leprosy is a chronic infectious disease caused by ‘Mycobacterium Leprae’ an acid fast , rod shaped bacillus.
The disease mainly affects the skin , the peripheral nerves , mucosa of the upper respiratory tract and also eyes.
Cardinal Features:-
° Hypopigmented patch
° Loss of cutaneous sensation
° Thickened Nerve
° Acid fast bacilli
Leprosy has been regarded by tbe community as a contagious , mutilating and incurable disease.
Leprosy is curable and treatment provided in the early stages averts disability.
Multidrug Therapy (MDT) treatment has been made available by WHO free of charge to all patients worldwide since 1995, and provides a simple yet highly effective cure for all typesof leprosy.
India is the highest TB burden country in the world & accounts for nearly 1/5th (20 per cent) of global burden of tuberculosis, 2/3rd of cases in SEAR. Every year approximately 1.8 million persons develop tuberculosis, of which about 0.8 million are new smear positive highly'- infectious cases.Annual risk of becoming infected with TB is 1.5 % and once infected there is 10 % life-time risk of developing TB disease
Integrated Disease Surveillance Project (IDSP) was launched by Hon’ble Union Minister of Health & Family Welfare in November 2004 for a period upto March 2010. The project was restructured and extended up to March 2012. The project continues in the 12th Plan with domestic budget as Integrated Disease Surveillance Programme under NHM for all States with Budgetary allocation of 640 Cr.
A Central Surveillance Unit (CSU) at Delhi, State Surveillance Units (SSU) at all State/UT head quarters and District Surveillance Units (DSU) at all Districts in the country have been established.
Objectives:
To strengthen/maintain decentralized laboratory based IT enabled disease surveillance system for epidemic prone diseases to monitor disease trends and to detect and respond to outbreaks in early rising phase through trained Rapid Response Team (RRTs)
Programme Components:
Integration and decentralization of surveillance activities through establishment of surveillance units at Centre, State and District level.
Human Resource Development – Training of State Surveillance Officers, District Surveillance Officers, Rapid Response Team and other Medical and Paramedical staff on principles of disease surveillance.
Use of Information Communication Technology for collection, collation, compilation, analysis and dissemination of data.
Strengthening of public health laboratories.
National leprosy eradication program CHNNehaNupur8
Leprosy is a chronic infectious disease caused by ‘Mycobacterium Leprae’ an acid fast , rod shaped bacillus.
The disease mainly affects the skin , the peripheral nerves , mucosa of the upper respiratory tract and also eyes.
Cardinal Features:-
° Hypopigmented patch
° Loss of cutaneous sensation
° Thickened Nerve
° Acid fast bacilli
Leprosy has been regarded by tbe community as a contagious , mutilating and incurable disease.
Leprosy is curable and treatment provided in the early stages averts disability.
Multidrug Therapy (MDT) treatment has been made available by WHO free of charge to all patients worldwide since 1995, and provides a simple yet highly effective cure for all typesof leprosy.
India is the highest TB burden country in the world & accounts for nearly 1/5th (20 per cent) of global burden of tuberculosis, 2/3rd of cases in SEAR. Every year approximately 1.8 million persons develop tuberculosis, of which about 0.8 million are new smear positive highly'- infectious cases.Annual risk of becoming infected with TB is 1.5 % and once infected there is 10 % life-time risk of developing TB disease
Revised National Tuberculosis Control Programe , 1997 . Reference from DK Taneja's Health Policies & Programmes in India , 16th edition by Jaypee Publication
Standards for TB care in India, RNTCP challenges: India, Maharashtra & Mumbai...Amol Patil
This presentation contains TB statistics- Global, India, Maharashtra and Mumbai till 2015.
Details of TB control strategies will be covered in Subsequent parts.
Similar to Revised National Tuberculosis Control Program- Dr. Atul MD, PGIMER (20)
Severe Acute Malnutrition (SAM) and Nutrition Rehabilitation Centre (NRC)- Dr...Yogesh Arora
A presentation on severe acute malnutrition and nutritional rehabilitation center. Various preventive, promotive, and curative aspects of SAM are discussed in this presentation.
Health and wellness center by Dr. Jitender, MD PGIMERYogesh Arora
Health and wellness center is one of the two component of Ayushmann Bharat. HWC ensures comprehensive, quality, and affordable care to be achieved by all.
Breast Cancer, Cervical cancer, and Oral Cancer Screening according to Nation...Yogesh Arora
A brief description on screening of breast, cervical, and oral cancer and their various components including who to screen, when to screen, where to screen, who will screen, and what will be the consequences if comes screen positive
A short take on different generations and their link with public health development through the ages.
Mindset of different age groups and their qualities are mentioned in relation to public health.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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!
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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.
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 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
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
2. OUTLINE OF PRESENTATION
Introduction
Burden of disease
Evolution of TB control in India
National Tuberculosis Programme
Revised National Tuberculosis Control Programme (RNTCP)
Paradigm Shift in Tuberculosis Control
National Strategic Plan (NSP) 2017-25
Status in Punjab and Chandigarh
Challenges
3. INTRODUCTION
Tuberculosis is one of the leading causes of mortality in India-
killing - 2 persons every three minute, nearly 1,000 every day.
Tuberculosis (TB) is a contagious disease caused by
Mycobacterium tuberculosis.
Left untreated, each person with infectious pulmonary TB will
infect an average of between 10 and 15 people every year.
Emergence of Multi Drug Resistance and co-infection with HIV
has weakened the battle against the disease.
Source- The global tuberculosis situation and the new control strategy of the World Health Organization
4. BRIEF HISTORY OF TUBERCULOSIS
Robert Koch:
- 1882 : Isolated and cultured M.
Tuberculosis (24th March)
- 1890: Developed staining
methods used to identify
the bacteria
- 1905: Received Nobel Prize
Kumar P. Journey of tuberculosis control movement in India: National tuberculosis programme to
revised national tuberculosis control programme. Indian J tuberc. 2005;52:63-71.
5. BURDEN OF DISEASE
Indicator India Global
statistics
Incidence of TB
(including HIV)
27,90,000 1,04,00,000
Mortality due to TB
(Excluding HIV)
4,23,000 13,00,000
Incidence of
MDRTB / RR
1,47,000 6,01,000
Incidence of
HIV-TB
87,000 10,30,000
Mortality due to
HIV-TB co-morbidity
12,000 3,74,000
6. SOURCE: GLOBAL TB REPORT 2018
Series1, India,
2,740,000, 31%
Series1,
China,
889,000,
10%
Series1, Indonesia,
842,000, 10%
Series1,
Philippines,
581,000, 7%
Series1, Pakistan,
525,000, 6%
Series1, Nigeria,
418,000, 5%
Series1,
Bangladesh,
364,000, 4%
Series1, South
Africa, 322,000, 4%
Series1, Other
10 HBC,
1,570,000, 18%
Series1, Non HBC,
468,000, 5%
Global burden of TB
7. BURDEN OF DISEASE …CONTD…
Globally, TB incidence is falling at about 2% per year. This needs to
accelerate to a 4–5% annual decline to reach the 2020 milestones of
the End TB Strategy.
An estimated 54 million lives were saved through TB diagnosis and
treatment between 2000 and 2017.
Ending the TB epidemic by 2030 is among the health targets of the
Sustainable Development Goals.
SOURCE: GLOBAL TB REPORT 2018
8. EVOLUTION OF TB CONTROL IN INDIA
1962 - National Tuberculosis Programme (NTP) started
1992 - NTP Reviewed
1993 - RNTCP formulated, adopted Directly Observed Treatment
Short course (DOTS) strategy.
1997 - Large-scale implementation of the RNTCP with DOTS
2006 - Entire country covered by RNTCP on 24th march
9. EVOLUTION OF TB CONTROL IN INDIA - CONTD….
2006 - India adopts the STOP TB Strategy
2008 - NACP & RNTCP have developed “National framework of
TB/HIV Collaborative activities”
2012-17 - National Strategic Policy
2017-22 - National Strategic Policy
10. NATIONAL TUBERCULOSIS PROGRAMME (1962)
Based on strategic principles of domiciliary treatment
Use of a self-administered standard drug regimen of initially 12-18
months duration. --------- Treatment free of cost
Priority to newly diagnosed patients over previously treated patient
Treatment organization decentralized to district level.
The NTP created an extensive infrastructure for TB control, with a
network of 446 district TB centres and 330 TB clinics.
Kumar P. Journey of tuberculosis control movement in India: National tuberculosis programme to revised
national tuberculosis control programme. Indian J tuberc. 2005;52:63-71.
11. FAILURE OF NTP
Results:
Low rates of case detection and treatment completion (30%),
Continuing high mortality (50 per 100,000)
High rates of default (40–60%)
Reasons
More emphasis on case detection rather than cure
Shortage of drugs
Emphasis on x-ray diagnosis resulting in inaccurate diagnosis
Poor quality sputum microscopy
Multiplicity of treatment regimens.
Kumar P. Journey of tuberculosis control movement in India: National tuberculosis programme to revised
national tuberculosis control programme. Indian J tuberc. 2005;52:63-71.
12. REVISED NATIONAL TUBERCULOSIS CONTROL
PROGRAMME(1993)
Goals
• To reduce mortality and morbidity from tuberculosis
• To interrupt chain of transmission.
Objectives
• To cure at least 85% of all newly detected infectious (NSP)
cases of Pulmonary tuberculosis
• To detect at least 70% of estimated new smear positive
pulmonary tuberculosis
13. RNTCP (1993)
Major additions to the RNTCP:
Sub-district supervisory unit, known as a TB Unit.
Decentralization of diagnostic and treatment services.
Treatment given under DOTS (directly observed treatment).
Provision of quality assured sputum smear microscopy services.
Patient-Wise Boxes
14. DOTS (1997)
Emphasizes on:
Political and administrative commitment.
Good quality diagnosis.
Good quality drugs.
Directly observed treatment short-course chemotherapy
Systematic monitoring and accountability.
Kumar P. Journey of tuberculosis control movement in India: National tuberculosis programme to revised national
tuberculosis control programme. Indian J tuberc. 2005;52:63-71.
15. PARADIGM SHIFT IN TUBERCULOSIS CONTROL
Significant changes in the definition of cases as per New
Guidelines:
Microbiologically confirmed : : Presumptive TB patient with
1. Biological specimen positive for AFB
2. Positive for M.tuberculosis on culture
3. Positive for TB through quality assured rapid diagnostic
molecular test
Technical and operational guidelines for TB control in India, 2016
16. Clinically diagnosed TB case
Presumptive TB who is not microbiologically confirmed
Has been diagnosed with active TB by a clinician on the basis of
X ray abnormalities
Histopathology
Clinical signs
With decision to treat the patient with full course of ATT
Technical and operational guidelines for TB control in India, 2016
CONTD…
17. CONTD..
Mono-resistance: Resistant to one first line anti - TB drug only.
Poly drug resistance : More than one first line anti -TB drug,
other than both INH and Rifampicin.
Rifampicin resistance (RR) : Resistance to Rifampicin
MDR : Both INH and Rifampicin with or without resistance
other first line ATD
XDR : MDR TB + Fluroquinolone (FQ) and a second line
injectable ATD.
Technical and operational guidelines for TB control in India, 2016
18. PARADIGM SHIFT IN TUBERCULOSIS CONTROL
CONTD..
Previous Guidelines New Guidelines
3 categories for treatment (I , II ,
III )
2 categories ( New and
Previously treated )
Extension of IP No extension of IP
Intermittent regimen FDC Daily regimen as per
weight bands
Streptomycin in Cat II , IP No streptomycin*
Introduction of new medicines
( Bedaquiline and Delamanid )
* Notification / MOHFW dated 18 / 12 / 2018
19.
20. NSP 2017- 2025
Goal :
To achieve a rapid decline in burden of TB, morbidity and mortality
while working towards elimination of TB in India.
Objectives:
1. Find all Drug Sensitive TB and Drug Resistant TB cases with an
emphasis on reaching TB patients seeking care from private
providers and undiagnosed TB in high-risk populations
Source - National strategic plan for tuberculosis elimination 2017–2025
21. NSP 2017- 2025
2. Initiate and sustain all patients on appropriate anti-TB treatment
wherever they seek care, with patient friendly systems and social
support.
3. Prevent the emergence of TB in susceptible populations.
4. Build and strengthen enabling policies, empowered institutions,
additional human resources with enhanced capacities, and provide
adequate financial resources.
Source - National strategic plan for tuberculosis elimination 2017–2025
22. NSP 2017- 2025
Key Strategies:
1. Private sector engagement
2. Active Case finding
3. Drug resistant TB case management
4. Addressing social determinants including nutrition
5. Robust Surveillance system
6. Community engagement & Multi- sectoral approach
Source - National strategic plan for tuberculosis elimination 2017–2025
23. NSP 2017- 2025
Expected Outcomes:
80% reduction in TB incidence (i.e. reduction from 211 per lakh
to 43 per lakh)
90% reduction in TB mortality (i.e. reduction from 32 per lakh to
3 per lakh)
0% patient having catastrophic expenditure due to TB
Source - National strategic plan for tuberculosis elimination 2017–2025
24. NSP 2017- 2025
Four strategic pillars of TB elimination
Detect Treat
Prevent Build
25. DETECT HOW DO WE DO IT?
Find all DS-TB and DR-TB cases
with an emphasis on reaching TB
patients seeking care from
private providers and
undiagnosed TB in high-risk
populations.
Laboratory systems
Case findings
Patients in private sectors
26. STRATEGIES
1. To use high efficiency diagnostic tools for early and accurate
diagnosis linked treatment across the country
2. Purchasing services and ensuring notification through
laboratories from the private sector and link to laboratory
surveillance
3. To promote research for new diagnostic tools
4. To build capacity for diagnosis of LTBI
Source - National strategic plan for tuberculosis elimination 2017–2025
28. CASE FINDINGS
Early identification of people with a high probability of having
active TB (presumptive TB) is the most important activity of the
case finding strategy.
Screening and diagnosing patients with appropriate tests and
strategies will largely determine the response to appropriate
treatment.
ACF - primary objective of detecting TB cases early in targeted
groups and to initiate treatment promptly.
Active case finding guidelines – MOHFW June 2017
29. ACTIVE CASE FINDING
Screening strategies
1. Community screening can be done by:
a. Inviting people to attend screening at a mobile facility or a
fixed facility. Invitations may target specifically people
within a given vulnerable group, those who have had recent
close contact with someone who has TB and people with
symptoms of TB.
b. Going door to door to screen households .
Active case finding guidelines – MOHFW June 2017
30. CONTD….
2. Institutional screening:
a. In Health care facilities : Active screening of vulnerable
individuals attending hospitals and other health care
institution.
b. In congregate settings: Active screening of vulnerable
individuals in shelters, old age homes, refugee camps,
correctional facilities and other specific locations such as
workplaces.
Active case finding guidelines – MOHFW June 2017
31. PATIENTS IN PRIVATE SECTORS
80% of people with TB first attend the private sector or Quacks
Diagnosis and treatment are of variable quality.
Diagnostic delays occur,
Patients from low-income households lose several months of
their income in the process of paying for inappropriate
diagnostics and treatments before starting approved therapy.
Source - National strategic plan for tuberculosis elimination 2017–2025
32. THE INCENTIVES
Rs 250/- on notification of a TB case diagnosed as per Standards
for TB Care in India.
Rs 500/- on completion of entire course of TB treatment.
For notification and correct management of a drug-resistant case
over 24 months as per STCI, a private provider will be eligible to
receive Rs 6750/-
Source - National strategic plan for tuberculosis elimination 2017–2025
33. THE INCENTIVES
For Patients :
500/- month for nutritional
support for DS TB cases
1000/- month for nutritional
support for MDR TB
Source - National strategic plan for tuberculosis elimination 2017–2025
34.
35. TREAT HOW DO WE DO IT?
Initiate and sustain all
patients on appropriate anti-
TB treatment wherever they
seek care, with patient
friendly systems and social
support.
A. Providing daily regimen using FDCs
to all TB patients
B. DST guided treatment for DR TB.
C. Patient centric approach to
treatment.
36. THE PRINCIPLES OF TREATMENT FOR TB IS:
1. Screen all patients for RR and additional drugs wherever
indicated.
2. For drug sensitive TB ---- daily FDC of first line ATT drugs in
appropriate weight bands for all forms of TB and in all ages.
4 drug FDC in IP and 3 FDC in the CP.
3. All RR /MDR TB patients are subjected to baseline Levofloxacin
sensitivity. In addition extended DST to all second line drugs in a
phased manner.
Source - National strategic plan for tuberculosis elimination 2017–2025
37. FDC DRUGS BY WEIGHT
WEIGHT
CLASS
# OF PILLS
# STRIPS FOR 28
DAYS
< 25 kgs
Does not receive FDCs or
99DOTS
0
25 – 39 kgs 2 pills per day 2
40 – 54 kgs 3 pills per day 3
55 – 70 kgs 4 pills per day 4
> 70 kgs 5 pills per day 5
Operational Guidelines Daily Regimen in first-line TB treatment under RNTCP
38. Using mobile phones to monitor and improve adherence to
tuberculosis medications
Goal: to provide 99% of the benefits of dots at a fraction of the
cost and inconvenience to patients
Source - National strategic plan for tuberculosis elimination 2017–2025.
39. Anti-TB drugs wrapped in envelopes printed
with hidden numbers behind the pills
Patients dispense a dose, reveal a hidden
TOLL FREE number ----- call
Call reflects on the 99DOTS dashboard and
the 99 DOTS Android Mobile App
immediately as a taken dose.
Training module 99 DOTS - 2018
40. SMS ALERTS FROM 99DOTS
Analytics and Reports for Program
SMSMessage:
[0000] Please
takepills
Notification of new patients
New patient
(740XXXXXX) enrolled,
Yelahanka district
Two of your
patients have
missed doses
Raj (979XXXXXX)
& Om (812XXXXXX)
SMSMessage:
Twoof your
patientshave
misseddoses
today: Raj&
Om
[0000]
Please
take pills
SMSMessage:
[0000] Please
takepills
Reminders to Patients Alerts to Staff
Training module 99 DOTS - 2018
41. Benefits of 99DOTS
• Less travel
• Increased convenience
Patients
• Focused and more efficient care
Field Staff /
Supervisors
• Easy monitoring
• Accurate reports
Program Officers
Training module 99 DOTS - 2018
42. PREVENT HOW DO WE DO IT ??
Prevent the emergence
of TB in susceptible
populations
Scale up air-borne infection control
measures at health care facilities.
Testing and treatment for latent TB
infection in contacts of bacteriologically
confirmed cases and in individuals at
high risk of getting TB disease
Address social determinants of TB
through intersectoral approach
43. AIR BORNE INFECTION CONTROL:
CHALLENGES AT COMMUNITY LEVEL :-
Cough etiquettes not being followed
Indiscriminate spitting
Sneezing without covering face
Alcoholics and mentally challenged patients
Delay in reaching health facility for specific diagnosis
Delay in diagnosis in co-morbid conditions like Diabetes, HIV,
Cancers etc.
Source - National strategic plan for tuberculosis elimination 2017–2025
44. CONTD….
CHALLENGES AT INSTITUTIONAL LEVEL
Outpatient facility
• Patients with chest infection at outpatient settings
• Overcrowding - mixing of patients in queues and waiting areas
• Poor ventilation in the facilities
In patient facility
• Cough screening, separation, mask and counseling provision
missing
• Infectious patients getting admitted at General wards
• Cough etiquettes not followed in wards
• Overcrowding in the wards – no restricted entries
Source - National strategic plan for tuberculosis elimination 2017–2025
45. CONTACT TRACING
All close contacts, especially household contacts will be
screened for TB using Chest X Rays.
In case of pediatric TB patients, reverse contact tracing for
search of any active TB case in the household of the child must
be undertaken.
Since transmission can happen from index case to the contact
any time (before diagnosis or during treatment) all contacts of TB
patients must be evaluated.
Source - National strategic plan for tuberculosis elimination 2017–2025
46. LTBI TREATMENT
The lifetime risk of reactivation of LTBI in healthy HIV-uninfected
individuals is 10%, with 5% developing TB disease during the first
2 to 5 years after infection.
ART reduces the risk of TB by approximately two thirds.
Source - National strategic plan for tuberculosis elimination 2017–2025
47. BUILD HOW DO WE DO IT ??
Build and strengthen
enabling policies,
empowered institutions,
human resources with
enhanced capacities, and
financial resources to
match the plan.
•Urban TB control systems
• Health system strengthening
• Advocacy, communications and
social mobilization
• Surveillance, monitoring and
evaluation
• Research and technical assistance
48. A web based solution for monitoring of TB patients launced on
15th May 2012 by
Developed by NIC (National Informatics Centre)
The data entry of the individual TB cases at the block level
DEOs (data entry operator) of NHM
The system has been extended to include drug resistant TB
cases, online referral and transfer of patients
49. TB-HIV COLLABORATIVE ACTIVITIES
Establishment/Strengthening NACP-RNTCP coordination
mechanisms at national, state and district level in 2001
Joint M&E including standardized reporting shared between the
two programmes
Training of the programme and field staff on HIV/TB
TB and HIV service delivery co-ordination
India TB Report 2018
50.
51.
52. TB AND DIABETES CO-MORBIDITY
About 10% of TB cases globally are linked to diabetes.
People with a weak immune system (diabetes) are at a higher risk
of progressing from latent to active TB.
People with diabetes have a two to three times higher risk of
getting infected with TB, compared to people without diabetes.
People with TB and coexisting diabetes have a four times higher
risk of death during TB treatment and higher risk of TB relapse
after treatment.
National framework for joint TB-Diabetes collaborative activities
53. PUBLIC PRIVATE PARTNERSHIP
Several organizations and Projects like Programme for
Appropriate Technology in Health (PATH), The Union, Foundation
for Innovative New Diagnostics (FIND), World Vision India –
Project Axshya, Project Saksham Pravaah etc are actively
involved in the programme.
At present around 1,900 NGOs collaborations are involved in the
programmes in different schemes.
India TB Report 2018
54. STATUS IN PUNJAB
District TB Centers ( DTCs) - 22
TB units (TU) - 134
Designated Microscopy Centers (DMCs) - 274
Culture and Drug Sensitivity lab ( C& DST ) - GMC Faridkot
Liquid Culture Labs for 2nd line DST - TB Hospital Patiala
CBNAAT labs - 29
Bedaquiline treatment for DR TB - All 3 medical Colleges
55. STATUS IN CHANDIGARH
Designated Microscopy Centers (DMCs) - 17
Designated Microscopy Centers (DMCs) - 15
with HIV testing
CBNAAT labs - 2 ( PGI and GMCH 32)
Bedaquiline & Delamanid treatment for DR TB - GMCH 32
Total notification of TB cases in 2018 - Around 6000
57. STATUS IN PGIMER
Culture & DST Laboratory (Research Block A)
Gene Xpert and LPA - available
Solid culture and DST for First Line DST (RIF + INH + STR + ETM) - 2011
Line Probe Assay For First Line DST (RIF+ INH) - April 2013
Liquid culture and DST for First Line DST (RIF + INH + STR + ETM) – Feb
2015
Liquid culture and DST for Second Line DST (OFLx + AMK + KAN + CAP)
– Sept 2015
58. CHALLENGES
Collection of appropriate specimens from children and EPTB.
Transportation of specimens from hard to reach areas (hilly,
tribal, deserts, etc.)
The paper based system of monitoring (recording and reporting)
is tedious leading to delayed reporting.
Retention of trained staff and compensation packages is a barrier
for sustainability for ensuring consistent performance.
59. CHALLENGES
Lack of awareness in the community on TB diagnostic facilities in
the programme
Case finding is largely passive
New diagnostic algorithm will require additional resources for
CXR, and molecular tests.
Ensuring active case finding in at risk groups and repeating the
activity periodically.