1. Status of RNTCP in Gujarat
Dr. PV Dave
State TB Officer
Gujarat
2nd Quarter 2013

2. What is Tuberculosis ?
Tuberculosis (TB) is a highly infectious bacterial disease caused by Mycobacterium tuberculosis. TB can affect any part of the body. When it affects the lungs it is called pulmonary TB. The commonest form of TB is pulmonary TB. TB in any other part of the body (i.e. other than lungs) is called extra pulmonary TB.

4. HEALTH IN THE MILLENNIUM DEVELOPMENT GOALS
Goal 6: Combat HIV/AIDS, malaria and other diseases
Target 6c: Halt and begin to reverse the incidence of malaria and other major diseases including TB.
Indicator 6.9: Incidence, prevalence and death rates associated with TB
Indicator 6.10: Proportion of TB cases detected and cured under DOTS
Stop TB Partnership targets
By 2005: At least 70% of people with sputum smear-positive TB will be diagnosed (i.e. under the DOTS strategy), and at least 85% successfully treated. The targets of a case detection rate of at least 70% and a treatment success rate of at least 85% were first set by the World Health Assembly of WHO in 1991.
By 2015: The global burden of TB (per capita prevalence and death rates) will be reduced by 50% relative to 1990 levels.
By 2050: The global incidence of active TB will be less than 1 case per million population per year.

5. RNTCP – Goal and Objectives
The goal of TB control Programme is to decrease mortality and morbidity due to TB and cut transmission of infection until TB ceases to be a major public health problem in India.
Objectives:
To achieve and maintain a case detection of at least 70% of new sputum positive TB patients
To achieve and maintain a cure rate of at least 85% in such patients 5

6. Directly Observed Treatment, Short-course
(DOTS) – a five point strategy
Political and Administrative commitment
Good Quality Diagnosis by Sputum smear microscopy
Uninterrupted supply of good quality drugs
Directly observed treatment (DOT)
TB Register
Systematic monitoring and accountability
Note: Directly Observed Treatment (DOT) is only one of the five components of DOTS strategy 6

7. Annual Risk of TB Infection (ARTI) - 1
One of the key epidemiological indicators of the tuberculosis situation in a community
It represents the proportion of population that gets newly infected (or re-infected) with tubercle bacilli over the course of one year.
Currently the average ARTI in the country as a whole is estimated to be 1.5%.

8. Annual Risk of TB Infection (ARTI) - 2
It has been estimated that for every one percent annual risk of tuberculosis infection, there are about
50 new pulmonary sputum smear positive (NSP) cases
50 new pulmonary sputum smear negative (NSN) cases
25 re-treatment pulmonary cases
10 extra-pulmonary cases
Totaling to 135 cases …………..per 100,000 population per year.
This means that, with an ARTI of 1.6% for West Zone (including Gujarat), there will be
80 new smear positive cases,
80 new smear-negative cases,
40 re-treatment cases, and
16 extra-pulmonary cases,
totaling to 216 cases ……………per 100,000 population per year.

9. Estimated. Incidence of TB in India (No
Estimated* Incidence of TB in India (No. of NSP Cases per 100,000 population, per year)
* Estimated from ARTI survey
North
West
East
National 75
North Zone 95
East Zone
65**
West Zone 80
South Zone
50**
South
** For programme monitoring purpose estimated cases in East & South zones have been kept at the national level of 75

10. Structure of RNTCP State TB Cell District TB Centre
Central TB Division,
DGHS, New Delhi
DDG-TB, CMO-TB
STO, Deputy STO,
MO, Accountant, ,IEC Officer,
TB-HIV Coordinator, SA, DEO
Designated IRL and
DOTS-Plus site
State TB Cell
DTO, MO-DTC,
LT, DEO, Driver
Nodal point for TB control
District TB Centre
Urban TB Coordinators, Communication Facilitator
One/ 5 lakh (2.5 lakh in hilly/ difficult/ tribal area)
Tuberculosis
Unit
MO-TC
STS, STLS
One/ lakh (0.5 lakh in hilly/ difficult/ tribal area)
Designated Microscopy Centre
MO, LT
DOT Provider – MPW,
NGO, PP, Community Volunteer
TBHV
DOT Centre

11. RNTCP Infrastructure in Gujarat
State TB Cell, Gandhinagar 1
State TB Training & Demonstration Centre / Intermediate Reference Laboratory - Ahmedabad
District TB Centers (reporting units) 30
TB Units
144
Designated Microscopy Centers
749
Peripheral Health Institutes (PHIs)
1940
DOTS providers
43618

12. Human Resource – State level, 2nd Quarter 2013
Name of the post
Number sanctioned
Number in Place
Percentage in Place & trained
STO 1
100%
Medical Officer STC
1(regular)
STDC Director
Assistant Program Officer/Epidemiologist NA
TB –HIV coordinator
IEC officer
State Accountant 2
State DEO
IRL Microbiologist
Urban TB –Coordinators
DEO (IRL)
Sr LT - IRL
Statistician *
Statistical Assistant * 3
Highlight vacancies with Bold & red colour
Data source: 3q11 State PMR
* STC+STDC 12

13. Other Human Resource in the state under TB cadre
Name of the post
Level *
Number sanctioned
Number (%) in Place
Percentage in place & trained
TB Supervisor
State TB Cell 3
100.00
Research Officer
STDC 1 NA
Research Assistant
Statistical Assistant
Computer 2
Treatment Organizer
District TB Centre/ADTC 9 66 57 23 14
Health Visitor 28 15
Level: STC/ STDC/DTC/ADTC/periphery
This will include regular posts under state govt. including the staff sanctioned for clinical activities e.g. ward in STDC may have posts of nursing staff,
Statisticians, statistical assistants, social workers, field workers, BCG technicians, BCG leaders, treatment Organizers, Computer,
* Level: STC/ STDC/DTC/ADTC/periphery 13

14. Human Resource – District Level, 1st Quarter 2013
Name of the post
Number sanctioned
Number in Place
% vacant
Percentage in place & trained
DTO 30 17
43%
100
Senior DOTS Plus TB-HIV Supervisor 29 3% 90
District DEO 0%
Part time Accountant
MOTC
144
143
0.6% 97
STS
134 7% 88
STLS
140 96
TBHV
203
185 4% 98 LT
748
708
5.3%
Highlight vacancies with Bold & red colour
Data source: 3q11 State PMR & district PMRs 14

15. Composite Score – 1 Q 2013 State - Gujarat
S.No.
Thematic Area
Scores
Remarks 1
Human resource management
41/45
(91%) 2
Financial management
20/20 (100%) 3
Case finding efforts
28/40 (70%) 4
Quality of services
85/145
(58%)
Total
174/250 (70%)

16. District – wise Composite Score – 1Q 2013

18. Achievements at a Glance
2nd Quarter 2013
Gujarat state has been in the target zone, consecutively since last more than Seven Years
26 / 30 (87%) reporting units are in the target zone
113/143 (79%) TUs in target zone
TB Suspects Examined – 2Q13 : 1,06,668
New Smear Positive Case Detection Rate – 2Q13 : 75%
New Smear Positive Cure Rate – 2Q12 : 86%
Total TB patients put on treatment : 18,864
New Smear Positive Cases put on treatment : 9334
Since the inception of RNTCP up to
Total TB suspect Examined : 45,56,096
Total TB Patients put on DOTS treatment, : 9,69,093
New Smear Positive patients put on treatment : 4,15,995
Additional lives saved : 1,74,437
Identification of MDR TB Suspects : 38,421
Diagnosis of MDR TB Cases : 5,301
MDR TB Cases Put on CAT – IV : 4,173
XDR TB Cases Put on CAT – V : 56 18 18

19. Annualized New Smear Positive Case Detection Rate and Treatment Success Rate in DOTS areas of Gujarat, Q13 19 19

20. Success Rate Vs Case Detection Rate (2Q12/2Q13)

21. TB Suspects Examined per lac per quarter 2nd Quarter 2013
Expected : 150 / Lac / Qtr
Gujarat: 162
2nd Quarter 2012
Gujarat: 171
Gujarat: 159 21

22. TB Suspects Examined per lakh per quarter Gujarat: 171
Expected : 150 / Lac / Qtr
TB Units – Gujarat
2nd Quarter 2013
Gujarat: 171

23. NSP Case Detection Rate
2Q 2011
NSP Case Detection Rate
2Q 2013
Expected : 70%
Gujarat State: 77%
2Q 2012
Gujarat State: 75%
Gujarat: 75% 23

24. NSP Case Detection Rate TB Units – Gujarat
2nd Quarter 2013
Expected : 70%
Gujarat: 75%

25. NSP Conversion Rate 3Q 2012 1Q 2013 4Q 2012 Gujarat State: 92%
Expected : 90%
Gujarat State: 92%
4Q 2012
Gujarat: 92%
Gujarat: 91% 25

26. NSP Conversion Rate TB Units – Gujarat Gujarat: 91% 1st Quarter 2013
Expected : 90%
Gujarat: 91%

27. NSP Success Rate 4Q 2011 2Q 2012 1Q 2012 Gujarat State: 88%
Expected : 85%
2Q 2012
Gujarat State: 88%
1Q 2012
Gujarat State: 87%
Gujarat: 86% 27

28. NSP Success Rate TB Units – Gujarat Gujarat: 86% 2nd Quarter 2012
Expected : 85%
Gujarat: 86%

29. Rate of change in suspects examined per lakh population (compared to same quarter in previous year) 2Q13 Vs 2Q12
Gujarat State : 7.2% 29

30. Rate of change in suspects examined per s+ case diagnosed (compared to same quarter in previous year) 2Q13 Vs 2Q12
Gujarat State : 8.1% 30

31. Sputum conversion of NSP patients registered in 4th quarter 2012

32. % of PHIs referring 2-3% of new adult OPD Gujarat 2nd Quarter 201332

33. 33

34. Major indicators – Internal Evaluations-2Q13
District
Dahod
Junagadh
Bharuch
Navsari
Apr-13
May-13
June-13
Difference in NSP Cure rate b/w TB register and Quarterly Reports
0.9%
2.1%
0.3% 0%
Difference in SP-RT Cure rate b/w TB register and Quarterly Reports
1.1%
0.1%
DOT Rate in NSP interviewed
100%
90%
85%
95%
Place & Timing of DOT Convenient
Proportion of patients aware of their illness
Wrong Categorization
10% 5%
Aware about duration of Treatment
89%
Attended a PP interaction meeting or community meeting
11%
30%
Initial home visit has done
80%
63%
Eligible children received chemoprophylaxis
56%
Practicing proper cough etiquettes
37%
72%
71%
Know their HIV status
21%
35%%
32% 34

37. PP Involvement – Gujarat - since 2006 Contribution of PPs in RNTCP
1st Q 13
Patients (no)
% of total of state
PPs involved
4858
Referral of suspects
3018
2.1%
NSP patients put on DOTS
726
7.1%
Total TB patients put on DOTS
1455 37

38. Referral of TB Suspects from Health Facilities Gujarat 1st Quarter 2013

39. ESIS Referral of TB Suspects Gujarat 1st Quarter 2013

40. NGOs Involvement – Gujarat
Reporting format changed

41. Involvement - as a DOT Provider in RNTCP 2Q13

42. Status of Staffing No. of MOTCs vacant (5 / 144)
Jamnagar (2), Kheda (1), Narmada (1), VMC (1)
No. of Contractual STSs vacant (5 / 144)
Kheda (2), Surendranagar (2), VMC (1)
No. of Contractual STLSs vacant (4 / 144)
Bharuch (2), Panchmahals (1), Valsad (1)
No. of Contractual TBHVs vacant (17/203)
AMC (9), Banaskantha (1), Bharuch (1),
Dahod (1), Panchmahals (1), Porbandar (1), Rajkot (1), VMC (2)

43. Status of Training
Untrained MO-TCs (6)
Bhavnagar (1), Junagadh (1), Porbandar (1), The Dangs (1),
VMC (2)
Untrained STS (5)
AMC (1), Anand (1), Chhotaudepur (1), Surat-R (1),
Vadodara-R (1)
Untrained STLS (7)
Anand (1), Bhavnagar (1), Dahod (1), Narmada (1), Navsari (1), Panchmahals (1), Surat-R (1)
Number of DMC LTs untrained (14)
Banaskantha (2), Navsari (5), Sabarkantha (4), The Dangs (1), VMC (2)

44. Thank You