World-TB-Day-2023_Presentation_English.pptx

National Tuberculosis Program
Overview of
National
Tuberculosis
Program
NATIONAL TUBERCULOSIS
CONTROL CENTER
“Yes! We can END TB!”
“हो ! हामी क्षयरोग अन्त्य गर्छौ
!”
1
3/21/2024 3/21/2024 1
3/21/2024 1

3/21/2024 2
3/21/2024 2
World TB day 2023
“Yes! We can END TB”
“हो ! हामी क्षयरोग अन्त्य गर्छौ ”
National TB Control Center

3/21/2024 3
3/21/2024 3
1937 - Tokha Sanatorium
1951 - Central Chest Clinic (CCC)
1965 - TB Control Programme
o Case-findings
o BCG vaccination
o Distribution of drugs.
1989 – National TB Control Center , Thimi
 1st NTP director – Dr. Narayan Govinda Amatya
History of TB -Nepal
• Discovered the Tubercle
bacillus in
24 March 1882 AD (वि.सं
१९३८ चैत्र १३)
• 24 March: Celebrate as
World TB day

3/21/2024 4
3/21/2024 4
Milestones of National TB program
Establishment of Tokha
Sanatorium
NTC and RTCestablished.
NTP reviewed and
recommended DOTS policy
DOTS implementation as
pilot
“DOTS All Over” achieved
GLC recommended MDR TB
management as a pilot
Stop TB Strategy adopted
Adoption of PPM/ISTC
Use of fixed dose
combimation(6 months
regimen)
Expansion of MDR TB
management
XDR TB management
programme started
CB-DOTS…
Adoption of End TB strategy
1937 1989 1995 1996 2001 2005 2005 2008 2008 2009 2010 2014 2016

3/21/2024 5
3/21/2024 5
NSP
2016-21
Prevalence
Survey
2018
NSP
2021-26
TB Free
Initiatives
Momentum after adoption of End TB Strategy

3/21/2024 6
3/21/2024 6
Evolution of TB Strategies

3/21/2024 7
3/21/2024 7
2014 - WHO End TB strategy established
2015 - UN SDGs adopted
2017 - WHO Global Ministerial Conference on
Ending TB in the Sustainable Development Era
Nov-2017 - The Moscow declaration to End TB
Mar-2018 - The Delhi TB Summit
Sep-2018 - UN High-Level meeting on TB
Dec-2018 - Commitment from Nepal Parliamentarians
International and National Commitments to END TB

3/21/2024 8
3/21/2024 8
Guiding Principles
• National Strategic Plan of TB
• TB Free Initiative- TB Free Palikas (753)
• Sustainable Development Goal (SDG) 2016-2030
• End TB Strategy, WHO
• TB Prevalence Survey, 2018
• Country for High Burden of DR TB (Global TB
Report 2021)

3/21/2024 9
3/21/2024 9
SDG
Target
3.3
By 2030, end the epidemics of AIDS, TB, malaria and neglected tropical diseases, and combat
hepatitis, water-borne diseases and other communicable diseases
MILESTONES
TARGETS
SDG* END TB
2020 2025 2030 2035
Reduction in number of TB Death
Compare with 2015 (%)
35% 75% 90% 95%
Reduction In TB Incidence Rate
Compare with 2015 (%)
20%
(<85/100 000)
50%
(<55/100 000)
80%
(<20/100 000)
90%
(<10/100 000)
TB-Affected families facing catastropic
due to TB (%)
0% 0% 0% 0%
* Sustainable Development Goals (SDGs)
SDG and END TB targets

3/21/2024 10
3/21/2024 10
VISION,
GOALS &
OBJECTIVE OF
NSP 2021-26
Vision
• TB Free Nepal
Goals
• Decrease incidence rate from 238 in 2020/21 to 181 per 100,000 population by 2025/26
• Decrease mortality rate from 58 in 2020/21 to 23 per 100,000 population by 2025/26
• Reduce the catastrophic cost of TB affected family to zero
• End TB epidemic by 2035
• Eliminate TB by 2050
Objective
Objective 1: To build and strengthen political commitment, sustainability and patient-friendly health system to
end TB
Strategy 1.1
Universal Health Coverage
Community Engagement (TB Free Palika)
Digitalized case-based surveillance system
Objective 2: To ensure the identification, diagnosis, quality treatment and prevention of TB
Strategy 2.1
Strengthen quality assured TB lab network,
Strategy 2.2
Improve case notification by strengthening facility and active case finding activities
Private Sector Engagement
Multi-sectorial approach.

3/21/2024 11
Expected
outcomes from
NSP 2021-2026
• Decrease TB Incidence rate from 238 of 2020/21 to 181/100,000 population
by 2026
• Decrease Morality rate of TB from 58 to 23/100,000 population by 2026
• TB-affected families facing catastrophic costs due to TB (%) = 0%
• Increase domestic funding up to 70% by 2026
• 50% of TB cases managed and supported by community by 2026
• 100% health facilities using digitalized case-based surveillance system by
2026
• 100% Drug-susceptibility testing (DST) coverage for TB patients by 2026
• ≥ 90% coverage of Latent TB infection (LTBI) treatment coverage among
eligible children < 5 yrs, among PLHIV and vulnerable groups by 2026
• Decrease 85% and 90% case notification gap for DS TB and DR TB
respectively by 2026.
• 30% TB notification contributed by private sectors by 2026.
• 100% Documentation of HIV status among TB patients by 2026
• ≥ 90% Treatment Success Rate for DS TB and throughout 2021-26
• ≥ 85% Treatment Success Rate for DR TB by 2026
• TB in emergency / pandemic plan available and funded

3/21/2024 12
3/21/2024 12
Year Incidence (all forms) Prevalence (all
Mortality
(HIV -ve & +ve)
2018 New estimates 69,000 (245 per 100k)
1,17,000 (416 per
100k)
17,003 (9,000-
26,000)
2018 Prior estimates 42,000 (151 per 100k) 60,000 (215 per 100k)
5,500 (3,900 -
7,400)
Revised burden,
higher by:
1.6 1.8 3.1
Burden of TB in Nepal (Findings of National TB PS
2018/19)

3/21/2024 13
3/21/2024 13
Every
Year
(DSTB
Estimated)
Every
Year
(DRTB
Estimated)
37,861 DSTB cases and 659
DRTB cases Notified
Almost half of
Nepal's
population are
infected with TB
(Latent Infection)
TB is the
major
leading
causes of
death in
Nepal
Male: 67%
Female:
33%
69,000 New TB
Cases
17,000
Death
2800 New DRTB
cases
>2000 DR TB cases
Missed
31000 TB
cases Missed
Nepal is a
High Burden
Country
Burden of TB in Nepal- 2021/22

3/21/2024 14
3/21/2024 14
TB Case Notification Rate-2078/79

3/21/2024 15
3/21/2024 15
127
65
58
0
20
40
60
80
100
120
140
0
5000
10000
15000
20000
25000
30000
35000
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
TB Mortality Rate
Estimated Death Mortality Rate
417
268 260
229
0
50
100
150
200
250
300
350
400
450
0
5000
10000
15000
20000
25000
30000
35000
40000
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
TB Notification and Incidence Rate
Notificatio of TB (New and Relapse)
Estimated Incidence Rate( 100,000)
Incidence Rate and TB Notification from 2000 to 2021
(WHO Estimation)

3/21/2024 16
3/21/2024 16
0%
5%
10%
15%
20%
25%
30%
0-14 15-24 25-34 35-44 45-54 55-64 65+
2055/56 2060/61 2062/63 2063/64 2065/66 2066/67 2067-68) 2068-69 2069-70
2070-71 2071/72 2072/73 2073/74 2074/75 2075/76 2076/77 2077/78 2078/79
Distribution of TB by Age Group

3/21/2024 17
3/21/2024 17
31764 32474 32043
27745
28677
37861
0
20
40
60
80
100
120
140
0
5000
10000
15000
20000
25000
30000
35000
40000
FY 2016/17 FY 2017/18 FY 2018/19 FY 2019/20 FY 2020/21 FY 2021/22
Numbers
FY
Trends of Case Notification
13%
10.5%
15%
1 Province
1
2 Madhesh
Province
3 Bagmati
Province
4 Gandaki
Province
5 Lumbini
Province
6 Karnali
Province
7
Sudurpashc
him
Province
FY 2016/17 4014 6447 7763 2188 6605 1688 3059
FY 2017/18 4072 6585 7841 2181 7036 1631 3128
FY 2018/19 4356 6844 7714 2260 6347 1374 3148
FY 2019/20 3828 5709 6586 1977 5665 1243 2737
FY 2020/21 3559 6641 6664 1876 5921 1191 2825
FY 2021/22 4433 8981 8832 2449 8090 1652 3424
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
Numbers
TB case Notification_Province Wise Trends
Trend of TB Notification at National and Province
level

3/21/2024 18
3/21/2024 18
0
5000
10000
15000
20000
25000
PBC PCD EP
FY 2016/17 FY 2017/18 FY 2018/19
FY 2019/20 FY 2020/21 FY 2021/22
TB Notification in 2021/22
PBC PCD EP
57%
28%
15%
Trend of Distribution of TB by Types

3/21/2024 19
3/21/2024 19
36% 36% 36% 37% 38% 38%
64% 64% 64% 63% 62% 62%
0%
10%
20%
30%
40%
50%
60%
70%
FY 2016/17 FY 2017/18 FY 2018/19 FY 2019/20 FY 2020/21 FY 2021/22
Male- Female Ratio (%)
Female Male
5.6 5.5 5.5
6.0
6.6
8.8
0
1
2
3
4
5
6
7
8
9
10
FY 2016/17 FY 2017/18 FY 2018/19 FY 2019/20 FY 2020/21 FY 2021/22
Trends of Child TB notification (%)
Trend of Male Female and Child TB Ratio

3/21/2024 20
3/21/2024 20
10198
9472
12373
9552 9916
8277
9381 9468 9710
11828 11460
14573
0
2000
4000
6000
8000
10000
12000
14000
16000
1st Trimester 2nd Trimester 3rd Trimester
Impact of Covid19 on TB case notification - Trimester Wise Trends
FY 2018/19 FY 2019/20 FY 2020/21 FY 2021/22
49.44%
Impact of C19 in the TB Notification

3/21/2024 21
3/21/2024 21
90.3
91.4
92.4
90.1
90.6 90.6 90.5
91.5
80
82
84
86
88
90
92
94
96
1 Province 1 3 Bagmati Province 5 Lumbini Province 7 Sudurpashchim
Province
Trend of DS TB Treatment Success Rate
FY 2016/17 FY 2017/18 FY 2018/19
FY 2019/20 FY 2020/21 FY 2021/22
70
67
70
75
73
74
62
64
66
68
70
72
74
76
FY
2016/17
FY
2017/18
FY
2018/19
FY
2019/20
FY
2020/21
FY
2021/22
Trend of DR TB Treatment Success Rate
Treatment Success Rate

3/21/2024 22
3/21/2024 22
Culture/DST
laboratory
Koshi
Province
Madhesh
Province
Bagmati
Province
Gandaki
Province
Lumbini
Province
Karnali
Province
Sudurpaschim
Province
16 20 21 8 23 7 10
83 94 260 61 171 47 180
896
105
1. National Tuberculosis Control
Center
2. NATA/GENETUP
3 Culture Lab: Under Establishing (BPKIHS, Pokhara, Surkhet)
GeneXpert site
Microscopy
center
2
Diagnostic Services

3/21/2024 23
3/21/2024 23
DR Center
DR Sub-
center
DOTS center
4 3 2 3 3 2 5
12 18 24 10 13 2 2
Koshi
Province
Madhesh
Province
Bagmati
Province
Gandaki
Province
Lumbini
Province
Karnali
Province
Sudurpaschim
Province
980 1073 1187 792 841 458 640
DR Hostel
1 1 1 1 1 0 1
7
81
22
5971
TB Treatment Services

3/21/2024 24
3/21/2024 24
• To achieve the End TB goals and targets NSP 2021-2026 developed and endorsed
• Various Guidelines such as ACF, CSS, PPM, Laboratory and TB free initiative guidelines developed for the
successful implementation of NSP
• Rapidly expanded mWRD test- from 27 GX sites in 2016 to 125 by 2021
• Reformed and initiated NRL for culture/DST services in NTCC
• Expansion of >1000 DOTS Center from 2016 to 2021
• TB Free Initiatives rolled out to >125 Palikas
• All GeneXpert and DR Centers adopted NTPMIS and all DOTS Center DHIS2/HMIS
• Web and Case based reporting of DS TB has been rolled out up to HF levels
• Introduces Shorter regimen for the treatment of DR TB cases
• Global Fund and GoN are the prime source of Funding to NSP, however there is still around 40% funding
gap to fully implement NSP
• Save the Children International supporting as a PR of Global Fund Grant to implement TB Program in
Nepal.
• WHO is providing technical support actively to implement NSP
• GoN and Different NGOs are supporting to implement NTP activities in the country
• Damien Foundation, IOM and other organizations are also supporting to implement TB programs in the
country.
Response
by National
TB Program

3/21/2024 25
3/21/2024 25
Source Budget(USD)-In Million %
2021/22 2022/23 2023/24 2024/25 2025/26 Total
Total costs for TB control 37.27 37.29 38.65 37.51 41.12 191.84 100%
GoN 8.23 10.05 17.00 17.05 18.46 70.78 36.9%
Global Fund 10.50 6.00 3.99 9.04 9.04 38.56 20.1%
WHO 0.10 0.04 0.03 - - 0.17 0.1%
Estimated/Available 18.83 16.09 21.02 26.08 27.49 109.52 57.1%
Funding GAP 18.44 21.20 17.62 11.43 13.63 82.32 42.9%
NSP Budget and Gap

3/21/2024 26
WHO Key technical partner
The Global Fund (GF)/Save
the Children (SCI)
Key financial partner
including technical support
NATA, BNMT, JATA, BWSN,
JANTRA, KIDS, Trisuli
Plus.
Key national partner to
increase TB case notification
Damien Foundation,
NATA/Genetup, TB Nepal
Key partners for diagnosis
and management of DR TB
Partner’s engaged
with National TB
Program

3/21/2024 27
NTP
Challenge
s and Way
forward
Issues/Challenges Way forward
Insufficient resources for TB both
HR and Budget
1. Establish and mobilize End TB Committee at national, provincial and local level for
sufficient resources both HR and budget
2. Implementation of Micro Planning
Quality Implementation of the
program
1. Capacity building of PLG and LLG in TB Program Management
2. Expansion of TB Free initiatives
Meaningful engagement of private
sectors and community in TB
diagnosis and management
100% notification of TB from private sector engaged in PPM intervention.
Expansion of PPM in other big Municipalities
Capacity building of community in TB diagnosis and Management,
Expansion of community and family-based DOTS
Expansion, maintenance, and
utilization of rapid molecular
diagnostic test- GeneXpert
Procurement of sufficient supply and timely distribution, mapping and relocation of
GX, develop referral linkage between GX sites and periphery health facilities.
Effective mechanism for timely collection and exchange of broken modules.
Nationwide scale-up of digitized
case base surveillance and full
integration with HMIS
Training and internet facility to all HFs in collaboration with HMIS and Full coverage of
eTB Register. Interoperability between HMIS and NTPMIS (eTB, DR TB, GX)
High number of Initial Defaulters
Mobilization of GX centers, ORWs for tracing initial defaulter cases, develop
biomatrices in GX services to avoid duplicate tests

3/21/2024 28
3/21/2024 28
NTP
Challenges
and Way
forward
Issues/
Challenge
s and Way
forward
Issues/Challenges Way forward
Big gap in treatment coverage (TB case
notification agist estimated incident TB cases)
Mapping of highly affected communities and locations and develop
catchup plan for TB diagnosis
Find appropriate measures to motivate HWs, community people and
mobilize for TB cases finding.
Operational research to identify and address
programmatic gap
Find different programmatic topics involving NTP stakeholders and
conduct ORs and develop mitigatation plan
Restoration of QC system for sputum
microscopy and mWRD (GX test)
Capacitate PPHL to lead the QC activities- trainings, equipment,
refurbishments and establish a mechanism for slide/sample
collections to QC centers
Quality reporting of NTP services from HMIS-
timely, complete and accurate
Capacity building of HWs in reporting of NTP services from DHIS2,
upgrade DHIS2 with more validation rules. Supply
computers/internets to HFs
Logistic and Management
Sufficient drug and Cartridges
Capacity building of provincial and district stores for proper
management of logistics (use of ELMIS system)

3/21/2024 29
3/21/2024 29
Opportunities
High level political commitment at all levels
Nation wide strong NTP structures
Federalism and Decentralization- Ownership
Strong leadership and support system including EDPs and
Donors

3/21/2024 30
TB is a Global Issue
with
Global impact and
only by working together we can eliminate it.

World-TB-Day-2023_Presentation_English.pptx

Recommended

Recommended

More Related Content

Similar to World-TB-Day-2023_Presentation_English.pptx

Similar to World-TB-Day-2023_Presentation_English.pptx (20)

Recently uploaded

Recently uploaded (20)

World-TB-Day-2023_Presentation_English.pptx

Editor's Notes