- World TB Day is observed annually on March 24th to raise awareness about tuberculosis. This year's theme is "Reach the 3 Million: Reach, Treat, Cure Everyone". - TB incidence and mortality rates have declined globally since 1990, though some regions have met targets faster than others. Treatment success rates are above 85% globally. - India accounts for one fourth of global TB cases, with over 2 million cases estimated in 2012. The RNTCP program coordinates TB control efforts through a network of laboratories, treatment centers, and community workers. - Challenges remain in fully funding TB programs, treating multidrug-resistant TB, and integrating TB and HIV services. The post-2015 strategy aims

1. WORLD TB Day
2015
24 th March
"Reach the 3 Million:
Reach, Treat, Cure Everyone“
Dr.Shailja Sharma

3. History of world tb day
• In 1982, on the one-hundredth
anniversary of Robert Koch's
presentation, the International
Union Against Tuberculosis and
Lung Disease (IUATLD)
proposed that March 24 be
proclaimed an official World TB
Day. This was part of a year-
long centennial effort by the
IUATLD and the World Health
Organization (WHO) under the
theme “Defeat TB: Now and
Forever.

4. MDG 6, Target 6c. To halt and
reverse the incidence of TB
• The Millennium Development Goal (MDG)
framework includes five indicators:
• TB incidence,
• TB mortality,
• TB prevalence,
• the case detection rate for new TB cases and
• the treatment success rate for new TB cases.

5. global TB mortality rate
• By 2013, it had fallen by 45% compared with a
baseline of 1990.
• The 50% reduction target has already been met in
three WHO regions: the Region of the Americas,
the South-East Asia Region and the Western
Pacific Region.
• The other three regions (the African Region, the
Eastern Mediterranean Region and the European
Region) are unlikely to reach the target.

6. global TB prevalence rate
• By 2013, it had fallen by 41% since 1990
• The 50% reduction target has been met in two
WHO regions (the Region of the Americas and
the Western Pacific Region) and the SouthEast
Asia Region appears on track to reach it.

7. treatment success rate
• Treatment success rates were above 85%
globally in 2012, in three of six WHO regions
and in most HBCs.
• Globally, the case detection rate was 64% in
2013.

8. India
• one fourth of the global incident TB cases
occur in India annually
• In 2012, out of the estimated global annual
incidence of 8.6 million TB cases, 2.3 million
were estimated to have occurred in India
• In the year 2013 the RNTCP put 1416014
patients on treatment

9. • As per the Government
regulations Tuberculosis is a
Notifiable disease and it is the
Responsibility of every
Physician treating the
Tuberculosis patients

10. • Total case notification rate per 1,00,000
population was 113 which is decreasing since
last 5 years.
• Incident TB case notification rate is also
declining since last 5-6 years and in 2013 it
was 91 per 1,00,000 population.
• Overall success rate of new and retreatment
TB cases is 88% and 70% respectively

11. • New indicators on TB notification by private
sectors have been included e.g. number of private
health facilities (laboratories, clinics, hospitals
etc) registered with RNTCP as well as number of
TB patients notified by these private health
facilities.
• This inclusion of notification from private sector
is also in sync with the World TB Day theme on
missing three million, one million of which are
estimated to be in India.
4/7/2015 11

12. 4/7/2015
RNTCP Organization structure: State level
Health Minister
Health Secretary
MD NRHM Director Health
Services
Additional / Deputy / Joint
Director
(State TB Officer)
State TB Cell
Deputy STO, MO, Accountant,
IEC Officer, SA,
DEO, TB HIV Coordinator etc.,
State Training and Demonstration
Center (TB)
Director, IRL Microbiologist, MO,
Epidemiologist/statistician, IRL LTs etc.,
12

13. One/ 100,000
(50,000 in hilly/ difficult/
tribal area)
One/ 500,000
(250,000 in hilly/
difficult/ tribal area)
Nodal point for
TB control
TB Health Visitors (TBHV),
DOT Provider
(MPW, NGO, PP, ASHA,
Community Volunteers)
Medical Officer, paramedical staff
And Laboratory Technician (20-50%)
Medical officer-TB Control,
Senior Treatment supervisor(STS),
Senior TB Laboratory Supervisor(STLS)
District Health Services
District TB Centre
Tuberculosis Unit
Microscopy Centre
Structure of RNTCP at district levels
Chief Medical Officer and
other supporting staff
District Administration District Magistrate/
District Collector
DTO, MO-DTC (15%), LT, DEO,
Driver, Urban TB Coordinators,
TBHVs, Communication Facilitators
4/7/2015 13

14. RNTCP Laboratory Network
4 NRLs
27 IRLs
>12,000 DMCs
(one per 50,000-100,000
population)

15. • As on December 2013, Five laboratories which include
three NRLs (NIRT-Chennai, NTI-Bangalore and NITRD-
New Delhi),
• One IRLs (Gujarat and Kerala) and
• one NGO laboratory (P D Hinduja) are performing the
second line DST in solid and liquid culture.
• The RNTCP has identified additional laboratories for
performing second line DST which include IRLs in
Andhra Pradesh, Delhi, Nagpur- Maharashtra, Rajasthan,
JALMA-Agra; and SMS Jaipur and JJ Hospital Mumbai
medical colleges.
4/7/2015 15

16. RNTCP response to the challenge of
drug resistant TB
• Focus is to prevent its emergence by providing
• quality DOTS diagnostic and treatment
services,
• increasing the visibility and reach of the
programme services and
• promoting adherence to International
Standards of TB care and Standards of TB
Care in India by all healthcare providers.
4/7/2015 16

17. Diagnosis of drug resistant TB
• DST for 2nd line drugs is done at 3 National
Reference Labs (NIRT-Chennai, NTI-
Bangalore, LRS-Delhi).
• DST to second-line drugs will be offered to all
confirmed MDR TB cases at diagnosis as the
lab capacity becomes increasingly available in
all 33 labs being developed for liquid culture
and DST in a phased manner up to 2015.
4/7/2015 17

18. Achievements of programmatic management
of drug resistant TB during 2013
• As on February 2014,PMDT services are
available in all 35 states of the country across
704 districts covering the entire population
(100%) of the country
• 110 DR TB wards established with airborne
infection control measures by end of 2013.
• A total of 51 C-DST labs were established
using various technologies- 37 Solid culture
labs, 12 Liquid culture labs and 41 LPA labs.
4/7/2015 18

19. Addressing the co-epidemics of TB
and HIV
• In 2013, 48% of TB patients globally had a
documented HIV test result, but progress in
increasing coverage has slowed.
• At country level, 61% of TB patients knew
their HIV status which has increased from 11%
in 2008.
4/7/2015 19

20. • Globally in 2013, 70% of TB patients known
to be HIV-positive were on ART
• India- Among HIV-infected TB patients 91%
were put on (co-trimoxazole preventive
therapy (CPT).
• The coverage of ART among TB patients who
were known to be HIV-positive reached 86%
in patients registered in 2012 up from 49% in
2008.
4/7/2015 20

21. Developments in TB-HIV
• Isoniazid Prevention Therapy (IPT)
implementation plan approved by NTWG.
• The policy recommends the use of a simplified
clinical algorithm for TB screening that relies on
the absence or presence of four clinical symptoms
(current cough, weight loss, fever and night
sweats) to identify people eligible for IPT or for
further diagnostic work-up of TB.)
• This is being implemented in phase wise manner.
4/7/2015 21

22. • The eligibility for receiving ART has been
revised from CD4 level of 350 to 500 for all
PLHIV.
• This step will ensure that HIV positive persons
are initiated on treatment at an early stage and
while enhancing their longevity and
productivity, it will contribute to preventing
new infections as well.
4/7/2015 22

23. Partnerships
• To achieve “Universal access to TB care and
treatment for all,” RNTCP has taken steps to
reach the unreached through synergising the
efforts of all partners and stakeholders
• At present RNTCP has established 2569 NGO
partnerships and 13150 collaborations with
private practitioners and other private sector
entities.
4/7/2015 23

24. Involvement of Medical Colleges in
RNTCP
• medical colleges are currently divided into six
zones North, East, West, South 1, South 2 and
North-East Zones.
• At present over 330 medical colleges both
public and private medical colleges have been
involved in TB control in India
4/7/2015 24

25. TB surveillance in India with
Nikshay
• Central TB Division (CTD) in collaboration
with National Informatics Centre (NIC)
undertook the initiative to develop a Case
Based Web online (cloud) application named
Nikshay.
4/7/2015 25

26. World TB Day
• This day is designed to help focus public
attention on tuberculosis and serve as a
reminder of the fact that TB continues to be an
epidemic in many parts of the world to this
day, especially our own country –2,74,000
people die from TB each year in India.
4/7/2015 26

27. OUR Aim everyone to access to
treatment
Make believe and work with
dedication that no one should
be left behind in the fight
against TB. This World TB
Day, we call for a global effort
to find, treat and cure the three
million and accelerate progress
towards zero TB deaths,
infections, suffering and
stigma.

28. Challenges
• US$ 2 billion funding gap per year for
implementation of existing TB interventions.
There is an additional gap of US$ 1.39 billion
for research.
• 3 million people with TB are missed by health
systems every year and therefore may not get
adequate care they need
4/7/2015 28

29. • TB/HIV response needs acceleration
Antiretroviral treatment, treatment of latent TB
infection and other key interventions still need
further scale-up
• MDR-TB remains a crisis Widening gaps
between people diagnosed with MDR-TB and
those put on treatment. This could compromise
recent gains
4/7/2015 29

30. • Global strategy and targets for
tuberculosis prevention, care
and control after 2015
4/7/2015 30

31. Post-2015 Global Tuberculosis
Strategy Framework
• Vision- A WORLD FREE OF TB
ZERO deaths, disease, and suffering due to TB
• Goal- end the global TB epidemic
4/7/2015 31

32. 4/7/2015 32

33. Thank You