Presentation on theme: "Tuberculosis in India Dr Ashwini Kalantri Current Status: Dr BS Garg"— Presentation transcript:
1Tuberculosis in India Dr Ashwini Kalantri Current Status: Dr BS Garg ModeratorDr BS Garg
2History of TB Control in India 1906 : Open air sanatorium in Ajmer1929 : King George V Thanksgiving Fund for TB control1939 : TB Association of India (TAI)1946 : Plan for TB Clinic in every district: National survey by ICMR1959 : National TB Institute (NTI) to develop the national TB control programme.
3History of TB Control in India 1961 : NTP pilot tested in Andhra Pradesh1962 : NTP launched1978 : NTP covered 390 districts (81%)1983 : Short-course chemotherapy (compliance improved only marginally): DOTS pilot (RNTCP)1997 : RNTCP launched2007 : DOTS Plus (PMDT) for Drug resistant TBProgrammatic Management of Drug-resistant TB
4The Stop TB Strategy 2006 - 15 : Second Global Plan to Stop TB Roadmap and budget to reach MDGs
6Sanatorium vs Domiciliary care SeriesTotal PatientsFavorable Response (%)Relapse (%)Total contactsAttack rate (%)Home82861424510.5Sanatorium81921226411.5This was a land mark study in the management of tuberculosis. All patients with smear positive tuberculosis and their contacts who were living with the patients were systematically followed up for a period of 5 years and as can be seen in the slide, there was no difference either in terms of immediate response to treatment, relapse during a follow up period of 4 years. Also the close contacts of patients who were treated at home were at no additional risk of developing disease.A concurrent comparison of home and sanatorium treatment of pulmonary tuberculosis in South India. Bull World Health Organ. 1959;21(1):
7The Revised National TB Control Programme 100% centrally sponsoredFree of cost diagnosis and treatment with anti-TB drugs13,000+ microscopy centers4,00,000+ DOTS treatment centersRNTCP an integral part if the NRHM
8Components of DOTS Political commitment Diagnosis by microscopy Adequate supply of the right drugsDirectly observed treatmentAccountability
9Population Coverage and Patients Registered A brief history of tuberculosis control in India. Geneva, Switzerland: World Health Organisation; 2010.
10RNTCP ObjectivesTo achieve 85% cure rate for the newly diagnosed sputum smear positive TB patientsTo detect at least 70% of the new smear-positive patients
11Treatment outcomes 1994 to 200685A brief history of tuberculosis control in India. Geneva, Switzerland: World Health Organisation; 2010.
12Unfavourable Treatment Outcomes 1994 to 2006 A brief history of tuberculosis control in India. Geneva, Switzerland: World Health Organisation; 2010.
13PrevalenceA brief history of tuberculosis control in India. Geneva, Switzerland: World Health Organisation; 2010.
15Revised National TB Control Programme Achievements
16Achievements of RNTCP Evaluated 55 million+ persons for TB Initiated treatment for 15.8 million+ TB patients.2.8 million lives savedTB/HIV services in 18 statesMDR-TB services in 132 districtsSuccessful medical college involvementARTI reduced from 1.5% to 1.1%
17Achievements during 11th FYP IndicatorsPlannedAchievedNo of TB suspects examined(millions)23.7227.5Total number of patients to beput on treatment (millions)5.046.4New Smear Positive patients tobe put on treatment (millions)2.342.46No of MDR TB patients to beput on treatment (000)54.2Success Rate in New SmearPositive patients in RNTCP (%)≥85%87%Estimated Annual Prevalence perlakh populationReduced from 299 to 250Annual Risk of TB Infection (%)Reduced from 1.5% to 1.1%
18Objectives for the 12th FYP Early detection and treatment of at least 90% of all type of TB casesReduction in default rate of new TB cases to less than 5% and re-treatment TB cases to less than 10%Screening for drug-resistant TB and provision of treatment services for MDR-TB patientsHIV Counseling and testing for all TB patientsExtend RNTCP services to patients diagnosed and treated in the private sector.National Strategic Plan for the 12th five year plan4 times the budgetary allowance.
19Targets for the 12th FYPDetection & treatment of about 87 lakh Tuberculosis patients during 12th FYPDetection & treatment of at least 2 lakh MDR-TB patients during 12th FYPReduction in delay in diagnosis and treatment of all types of TB casesIncrease in access to services to marginalized and hard to reach populations and high risk and vulnerable groups
20Economic Impact of TB Each case of TB Each death due to TB US$ 12,2354.1 DALYsEach death due to TBUS$ 67,30521.3 DALYs29.2 million DALYs and US$ 88.1 billion gained due to RNTCP
26Annual New Smear Positive Case Detection Rate, 2012 RNTCP, Annual Status Report 2013
27Cure Rate of New Smear Positive Cases, 2011 RNTCP, Annual Status Report 2013
28Composite Indicators India Maharashtra Wardha Human Resources (65) 68% 54%87%Financial Management (20)71%79%100%Drugs and Logistics (30)67%64%0%Case Finding Efforts (20)30%39%40%Quality of Service (115)57%59%Composite Score (250)66%63%RNTCP, Annual Status Report 2013
29Case Detection RNTCP Designated Microscopy Center (DMC) 2 Sputum smear examination (spot and morning)ZN smear exam under bright field binocular microscopesDrug resistant TB – solid/liquid culture DSTsCBNAAT being used in 18 sites
30TreatmentINH (H), Rifampicin(R), Pyrazinamide (Z), Ethambutol (E) and streptomycin (S)Category I : 6 months2 months Intensive Phase: HRZE thrice weekly4 months Continuation Phase: HRCategory II : 8 months3 months Intensive Phase: 2 months HRZES and 1 month HRZE5 months Continuation Phase: HRE
31TreatmentAll doses of intensive phase and first dose of each week of continuation phase are given under supervision.Follow-up sputum examination at the end of intensive phase, 2 months into the continuation phase and at the end of treatment
32Drug Resistant TB By 2015: DST for all smear positive cases MGIMS, Sevagram certified for solid culture and DST.Genexpert (CBNAAT) introduced in 12 TUsRational Use of anti-TB drugs
33Drug Resistant TB Treatment For MDR-TB : Daily DOT includes (6-9m) Kanamycin, Levofloxacin, Cycloserine, Ethionamide, Pyrazinamide, Ethambutol / (18m) Levofloxacin, Cycloserine, Ethionamide, EthambutolFor XDR-TB : (6-12m) Capreomycin, PAS, Moxifloxacin, High dose INH, Clofazimine, Linezolid, Amoxy- Clavulanic Acid / (18m) all the above drugs except Capreomycin
35TB/HIV Latent TB Active TB 2001: TB/HIV collaboration ICTC : Intensified TB case finding has been implemented nationwide at all HIV testing and ART centresHIV testing of TB patients is now routine through provider initiated testing and counselling (PITC)
36TB/HIV 2012 : 56% TB patients screened, 5% positive HIV-positive given free HIV care at the antiretroviral treatment (ART) centresPolicy decision taken expand coverage of whole blood finger prick HIV screening test at all DMC
37TB and DiabetesPeople with a weak immune system, as a result of chronic diseases such as diabetes, are at a higher risk of progressing from latent to active TB.Diabetics have a 2-3 times higher risk of TB10% of TB cases globally are linked to DiabetesLonger time of sputum conversion
38TB and Diabetes High chances of drug resistance, mortality and relapse Good glycemic control in TB patients has better outcomePolicy to screen all TB patients for DM in the 100 districts where NPCDCS has been implemented
39Childhood TBThe newer weight bands are 6-8 kg, 9-12 kg, kg, kg, kg and kg.Chemoprophylaxis for children under 6 years: isoniazid (5mg/kg) for 6 monthsRifampicin10-12 mg/kg (max 600 mg/day)Isoniazid10 mg/kg (max 300 mg/day)Ethambutol20-25mg/kg (max 1500 mg/day)PZA30-35mg/kg (max 2000 mg/day)Streptomycin15 mg/kg (max 1gm/day)
40Childhood TBIf sputum sample not available, alternative specimen (Gastric lavage, Induced sputum, bronco-alveolar lavage) should be collected under pediatric supervision.Tuberculin skin test / Mantoux : 10 mm or more induration
41Revised National TB Control Programme Newer initiatives
44Other Initiatives Composite Indicator Ban of sero-diagnostic tests Availability of free quality assured anti-TB drugs through local chemists
45ReferencesA brief history of tuberculosis control in India. Geneva, Switzerland: World Health Organisation; 2010.Revised National TB Control Program : Annual Status Report New Delhi: Central TB Division, 2013.A concurrent comparison of home and sanatorium treatment of pulmonary tuberculosis in South India. Bull World Health Organ. 1959;21(1):