NTEP__Phase_-III.pptx NTEP Phase Three PPT

NTEP Phase III PPT

1. National Tuberculosis Elimination Program Dr Pavan Kumar.G Associate Professor Department of Community Medicine

2. Why is TB Still a Concern? TB remains the 10th leading cause of death worldwide India contributes 27% of global TB cases Over 500,000 deaths per year in India MDR-TB and XDR-TB cases increasing TB-HIV co-infection rates rising Global goal: TB elimination by 2035

3. Global TB Burden – WHO End TB Strategy WHO TB Goals for 2035: 90% reduction in TB deaths 80% reduction in new TB cases Universal Drug Susceptibility Testing (DST) Newer TB vaccines in development High MDR-TB burden – major challenge

4. TB Burden in India – NFHS & NTEP Data India’s TB Statistics (2024 Report) 2.5 million new TB cases annually TB incidence : 210 per 100,000 TB mortality : 36 per 100,000 40% of Indians have latent TB TB-HIV co-infection on the rise India’s target: TB elimination by 2025

5. TB Epidemiology – India vs. Global Trends Metric India Global TB Incidence 210 per 100,000 133 per 100,000 TB Mortality 36 per 100,000 15 per 100,000 MDR-TB Cases 135,000 per year ~450,000 per year TB-HIV Coinfection 8% of TB cases 9% of TB cases

6. Evolution of TB Control in India – From NTP to NTEP Key Milestones in TB Control in India: 1962: National TB Program (NTP) introduced 1997: RNTCP launched with DOTS (Directly Observed Treatment Short Course) 2012: Universal Drug Susceptibility Testing (DST) introduced 2020: NTEP replaces RNTCP – goal shifts to elimination Target: TB-Free India by 2025

7. Key Changes in NTEP vs. RNTCP Component RNTCP (1997-2020) NTEP (2020-Present) Focus TB Control TB Elimination Treatment Strategy DOTS Universal DST, Patient-centered care Diagnostics Sputum Microscopy CBNAAT, TrueNat, LPA, WGS Surveillance Paper-based records Digital Ni- kshay platform

8. National Strategic Plan (NSP) 2017-2025 National Strategic Plan (NSP) – The Blueprint for TB Elimination NSP is a high-level planning document that provides a roadmap for achieving India's TB elimination goal by 2025 . It defines targets, policies, resource allocation, and strategies to guide NTEP’s implementation. Serves as the policy framework for TB elimination.

9. National TB Elimination Program (NTEP) National TB Elimination Program (NTEP) – The Implementation Framework NTEP is the operational program under which all TB control and elimination activities in India are implemented. It provides TB diagnostics, treatment, prevention strategies, patient support systems, and research advancements . Functions as the execution arm of TB control efforts.

10. How are NTEP & NSP related Component National Strategic Plan (NSP) National TB Elimination Program (NTEP) Purpose Provides a long-term strategy & policy framework Implements the strategies through health services Timeframe Developed for 5-year periods (e.g., NSP 2017-2025) Runs continuously under MoHFW Scope Sets national TB elimination goals, targets, and funding requirements Provides diagnostics, treatment, and surveillance Implementation Guides policies for health systems, community engagement, private sector integration Operates TB centers , Ni- kshay tracking, and DOTS programs Monitoring Sets indicators for TB incidence reduction, MDR-TB control, and treatment success Collects real-time data via Ni-kshay and TB surveillance Key Elements TB prevention, universal DST, shorter MDR-TB regimens, Ni-kshay, private-sector engagement DOTS strategy, Active Case Finding (ACF), Ni- kshay Poshan Yojana

11. How are NTEP & NSP related Example of Their Interdependence NSP 2017-2025 set the goal for TB elimination by 2025, requiring universal DST and Ni- kshay tracking. NTEP implemented these goals by expanding CBNAAT, TrueNat , and universal drug-susceptibility testing (DST) in all patients. NSP 2020-2025 emphasized private sector integration, so NTEP launched patient incentives and private-sector notification mandates. Summary: NSP is the "WHAT" (Strategic Vision & Targets) NTEP is the "HOW" (Implementation Framework & Execution) Together, they ensure India meets its TB-free goal by 2025 .

12. NSP 2020-2025 ( P DTB ) P REVENT – Stopping TB Before It Starts Goal: Break the chain of transmission & prevent latent TB from becoming active. Key Strategies: ✔ TB Preventive Therapy (TPT) – Isoniazid Preventive Therapy (IPT) & 3HP regimen. ✔ BCG Vaccination – Protecting newborns from severe childhood TB. ✔ Infection Control in Hospitals – Ventilation, N95 masks, UVGI disinfection. ✔ Nutritional Support – Ni- kshay Poshan Yojana providing financial aid to TB patients. ✔ Reducing TB Stigma – Community engagement & awareness programs.

13. NSP 2020-2025 (P D TB) D ETECT – Finding TB Cases Early Goal: Ensure early, accurate, and universal TB diagnosis. Key Strategies: ✔ Active Case Finding (ACF) – Mass screening in high-risk areas. ✔ Universal Drug Susceptibility Testing (DST) – Rapid molecular testing (CBNAAT, TrueNat , LPA, WGS). ✔ Ni- kshay 2.0 Digital Tracking – Real-time monitoring of TB cases. ✔ AI-Based Screening & Digital Chest X-ray – Early detection through AI-supported imaging. ✔ Private Sector Engagement – Mandatory TB case notification from private hospitals and labs.

14. NSP 2020-2025(PD T B) TREAT – Ensuring Universal & Effective TB Treatment Goal: Provide patient-centered, accessible, and free TB treatment. Key Strategies: ✔ Shorter MDR-TB Regimens – 9-month BPaL regimen ( Bedaquiline , Pretomanid , Linezolid). ✔ Newer Anti-TB Drugs – Bedaquiline , Delamanid , Pretomanid for resistant TB. ✔ Ni- kshay Digital Treatment Monitoring – Ensuring adherence and preventing treatment dropouts. ✔ Free Treatment – Available in both public & private sector partnerships . ✔ Social & Economic Support – ₹500/month financial aid under Ni- kshay Poshan Yojana .

15. NSP 2020-2025(PDT B ) BUILD – Strengthening Health Systems for TB-Free India Goal: Improve health infrastructure, TB research, and community participation. Key Strategies: ✔ Expanding TB Diagnostic Network – 450+ CBNAAT/ TrueNat centers , National Reference Labs . ✔ Community-Led TB Care – ASHA workers, NGOs, and Ni- kshay Mitras supporting TB patients. ✔ Multi-Sectoral Approach – Integrating TB with HIV, diabetes, and nutrition programs . ✔ Capacity Building of Healthcare Workers – Training doctors, nurses, and CHWs . ✔ Operational Research & AI in TB Care – AI-powered epidemiology, genome sequencing for resistance detection.

16. NTEP – Vision & Objectives Vision: - TB elimination by 2025. - Reduce TB incidence to <44 per lakh population. - Reduce TB deaths by 90% from 2015 levels. Objectives: - Universal DST for all TB patients. - 100% case notification (public & private sector). - Decentralized TB care at Health & Wellness Centers (HWCs). - Nutritional support via Ni- kshay Poshan Yojana. - Expand private-sector engagement.

17. NTEP Organizational Structure Key Levels of NTEP: - National Level: Central TB Division (CTD), MoHFW - State Level: State TB Control Societies (STCS) - District Level: District TB Centers (DTC) - Peripheral Level: CHC, PHC, DMCs - Collaboration: Private sector & NGOs

18. Functions of NTEP at Different Levels Level Key Responsibilities National (CTD, MoHFW) Policy-making, funding, research, Ni-kshay data management State (STCS, STDCs) Implementation, logistics, training, state TB reporting District (DTC, DTOs) Case notifications, private sector engagement, TB surveillance Peripheral (CHC/PHC/DMCs) TB diagnosis, DOTS implementation, treatment adherence Roles & Responsibilities of NTEP Units:

19. National Reference Laboratories (NRLs) TB Testing Facilities in India: - National Reference Labs (NRLs) – 6 facilities across India - State TB Labs (STDCs) – Quality assurance at state level - District TB Labs (DMCs) – Microscopy & CBNAAT facilities - Peripheral Labs (PHCs/CHCs) – TrueNat availability

20. TB Specimen Collection & Transport Guidelines for Sample Collection: Sputum collection: 2 samples (morning & spot) Sample transport: Cold chain maintenance Referral to State/District TB Labs Proper labeling & biohazard precautions

21. NTEP-Approved TB Diagnostics Test Purpose Advantages Sputum Microscopy Detects acid-fast bacilli Low cost, available at PHCs CBNAAT (GeneXpert) Rapid MTB/RIF testing Detects rifampicin resistance TrueNat (Portable PCR) Detects TB in 60 minutes Point-of-care testing at PHCs Line Probe Assay (LPA) MDR-TB detection Fast detection of resistance Whole Genome Sequencing (WGS) Identifies TB mutations Future surveillance tool Types of Diagnostic Tests Under NTEP:

22. GeneXpert (CBNAAT) – Rapid TB Testing Key Features of CBNAAT: Detects TB in < 2 hours Identifies rifampicin resistance High sensitivity for pulmonary & extrapulmonary TB Implemented at District & PHC levels

23. TrueNat – Point-of-Care TB Testing TrueNat Features: - Portable, battery-operated TB test - Detects TB in 60 minutes - Used in peripheral health settings - Cost-effective alternative to CBNAAT

24. Line Probe Assay (LPA) & Whole Genome Sequencing (WGS) Advanced TB Diagnostics: - LPA – Detects MDR-TB in 24-48 hours - WGS – cutting edge technology - Identifies TB mutations, track transmission patterns - Used for surveillance & treatment planning - Implemented in select National Reference Labs

25. TB Laboratory Quality Control & External Monitoring Ensuring Laboratory Quality: To ensure diagnostic accuracy - National Reference Labs (NRLs) monitor test accuracy - Proficiency testing & internal QC measures - WHO & national guidelines for lab accreditation - Continuous training for lab personnel

26. Universal Drug Susceptibility Testing (DST) Importance of DST: - Ensures correct first-line treatment - Identifies MDR-TB early - Reduces treatment failure rates - Essential for TB control strategy

27. Treatment of Drug-Susceptible TB (DS-TB) Standard First-Line Regimen (NTEP 2024): - 2HRZE/4HRE (6-month regimen) - 4-month BPaMZ regimen (under trial) - DOTS providers ensure adherence - Nutritional support via Ni- kshay Poshan Yojana

28. *Regimen: 2HRZE / 4HRE (6-month regimen) H – Isoniazid R – Rifampicin Z – Pyrazinamide E – Ethambutol Duration: 6 months Intensive Phase (IP): 2 months – HRZE ( To rapidly kill Bacteria ) Continuation Phase (CP): 4 months – HRE ( To prevent relapse ) Rationale: Isoniazid & Rifampicin: Highly effective bactericidal drugs that eliminate rapidly dividing TB bacilli. Pyrazinamide: Effective against dormant bacilli in acidic environments (intracellular & caseous lesions). Ethambutol: Prevents resistance development and supports the combination. Treatment of Drug-Susceptible TB (DS-TB)

29. Drug- Resistant TB (DR-TB) 1. Multidrug-Resistant TB (MDR-TB) ➡ TB resistant to at least Isoniazid (H) and Rifampicin (R) 2. Pre-XDR TB (Pre-Extensively Drug-Resistant TB) ➡ MDR-TB with additional resistance to fluoroquinolones (FQs) (Levofloxacin/Moxifloxacin) 3. Extensively Drug-Resistant TB (XDR-TB) ➡ MDR-TB with additional resistance to fluoroquinolones (FQs) and second-line injectables (amikacin, kanamycin, capreomycin)

30. Treatment of Drug-Resistant TB (MDR/XDR-TB) TB Type Regimen Duration MDR-TB BPaL ( Bedaquiline ( Bdq ), Pretomanid (Pa), Linezolid ( Lzd ) 9 months XDR-TB BPaLM Bedaquiline ( Bdq ), Pretomanid (Pa), Linezolid ( Lzd ), Moxifloxacin ( Mfx ) 18 months Pre-XDR-TB Individualized all-oral therapy Variable MDR-TB & XDR-TB Regimens:

31. Treatment Adherence Strategies Under NTEP Ensuring Treatment Completion: - Directly Observed Treatment Short Course (DOTS) – Supervised Treatment - Treatment adherence monitoring via Ni- kshay – Digital Tracking – identifies at risk dropout - Community-based TB care models - Private sector integration for better coverage - Patient education & counseling

32. Newer Initiatives Under NTEP Government Strategies: - Ni- kshay Poshan Yojana – ₹500/month per TB patient - TB Mukt Gram Panchayat – Community engagement - Public-Private TB Care Model Expansion - Ni- kshay Digital Platform – Patient Monitoring - Shorter MDR-TB regimens under trial

33. Newer Initiatives Under NTEP Introduction to the Updated NTEP (2025) Key Points: India aims to eliminate TB by 2025 (5 years ahead of the global SDG targets). NTEP integrates newer diagnostic & treatment strategies . Focus on patient-centered care, digital surveillance, and newer drugs .

34. Newer Initiatives Under NTEP Updated Guidelines for Drug-Resistant TB (DR-TB) Key Changes in DR-TB Management: 9-month BPaL regimen introduced for MDR-TB . Bedaquiline , Pretomanid , Linezolid recommended as core drugs. Focus on patient-centered care & drug safety monitoring . Linezolid dose optimized to 600 mg/day to minimize toxicity.

35. Newer Initiatives Under NTEP 100-Day TB Elimination Campaign (2024-2025) Key Features: Launched across 347 districts in 33 states . Enhances case detection & diagnostic services . Focus on vulnerable populations (slums, rural areas, migrant workers). Comprehensive care packages: Malnutrition, Diabetes, HIV, Substance Abuse .

36. Newer Initiatives Under NTEP Integration of Newer Anti-TB Drugs Latest Drug Inclusions in NTEP: Bedaquiline , Delamanid , and Pretomanid included in treatment protocols. Shorter, all-oral regimens for MDR/XDR-TB. New drug combinations reduce injectable usage. Ongoing research to optimize treatment duration & efficacy.

37. Newer Initiatives Under NTEP Strengthening TB Diagnostic Infrastructure NTEP's Expanded Diagnostic Capacity: Over 450 NAAT labs established (e.g., Tamil Nadu). Widespread availability of CBNAAT, TrueNat , and Whole Genome Sequencing (WGS). Universal DST (Drug Susceptibility Testing) implemented for all TB cases. Focus on reducing diagnostic delays & increasing early case detection.

38. Newer Initiatives Under NTEP Community Engagement & TB Mukt Bharat Abhiyaan Community-Based Initiatives: Ni- kshay Mitras program introduced. Over 1.5 lakh community volunteers providing nutritional & treatment support. Strengthening DOTS adherence through peer support groups. Social mobilization campaigns to reduce TB stigma.

39. TB Prevention Strategies & Contact Tracing Preventing TB Transmission: - Household contact screening - TB Preventive Therapy (TPT) expansion ( for high-risk population) - Improved ventilation & infection control (in healthcare setting to reduce transmissions) - BCG vaccination for neonates - Targeted screening for high-risk groups

40. Challenges in TB Elimination Barriers to TB Control: - Underreporting of TB cases in the private sector - Rising MDR-TB rates -Treatment non-adherence issues - Social stigma & misinformation - Limited TB diagnostic reach in rural areas

41. TB & Social Determinants of Health Key Social Factors Influencing TB: - Malnutrition & poverty - Overcrowding & poor housing - Limited healthcare access - Low health literacy & stigma - Co-existence with NCDs like diabetes

42. Future Roadmap to TB-Free India Key Action Areas for TB Elimination: - AI-based TB surveillance - Next-generation TB vaccines in trials - Decentralized TB care at the PHC level - Strengthening private sector engagement - Policy integration with NCD & HIV programs

43. Innovative Approaches to TB Control Innovations in TB Diagnosis & Management: - AI-based TB detection tools - Rapid molecular TB diagnostics - Portable chest X-ray machines - Telemedicine for remote TB consultations - Community-led awareness & engagement

44. Role of Digital Health in TB Elimination Digital Tools in TB Surveillance: - Ni- kshay Digital Platform – Patient tracking - AI-driven chest X-ray interpretation - Cloud-based TB diagnostics data sharing - Real-time TB case notifications - Integration of e-TB surveillance at PHCs

45. Challenges in Implementing TB Digital Solutions Barriers to Technology Adoption in TB Control: - Limited digital literacy at PHCs - Poor internet connectivity in remote areas - High costs of AI-based diagnostics - Data privacy & security concerns - Need for better training for healthcare workers

46. Community-Led Interventions for TB Control Community Engagement Strategies: - ASHA & CHW-led TB case detection - Community TB Champions program - Peer-support networks for adherence - Social mobilization for stigma reduction - Home-based DOTS services

47. Public-Private Partnership (PPP) in TB Control Importance of Private Sector Involvement: - Private clinics contribute to TB diagnosis - TB notifications made mandatory for private hospitals - PPPs help reduce out-of-pocket expenditure - Capacity building in private sector TB care - Corporate social responsibility (CSR) funding for TB programs

48. Patient-Centered TB Care & Support Systems Improving TB Patient Outcomes: - Ni- kshay Poshan Yojana (Nutritional Support) - Free treatment & diagnostics under NTEP - Mental health counseling for TB patients - Financial assistance for MDR-TB treatment - Reducing social stigma through awareness programs

49. Expanding TB Research & Vaccine Development Future Directions in TB Research: - Newer TB vaccines in clinical trials - Genome-based TB drug discovery - Host-directed therapies for MDR-TB - Multidrug regimens under evaluation - Strengthening TB research institutions

50. Strengthening Supply Chain & Logistics in TB Care Ensuring Uninterrupted Drug Supply: - Real-time inventory tracking - Decentralized drug distribution networks - Prevention of drug stock-outs at PHCs - Cold-chain management for drug storage - Digital tools for monitoring logistics

51. Policy Integration – TB & Non-Communicable Diseases (NCDs) TB & NCD Policy Alignment: - Integrated TB-Diabetes screening at PHCs - TB-HIV co-management strategies - TB-Nutrition policy convergence - Strengthening occupational health for TB workers - Promoting multi-sectoral collaboration

52. TB-Free India – The Road Ahead Key Milestones for TB Elimination: - Achieve 80% reduction in TB incidence by 2025 - Scale-up universal DST coverage - Expand Ni- kshay patient support services - Strengthen primary healthcare-based TB management - Encourage global TB collaborations

53. TB Funding & Financial Commitments Financial Support for TB Control: - National Health Mission (NHM) funding for NTEP - Global Fund for TB, HIV & Malaria (GFATM) contributions - Corporate social responsibility (CSR) funding - Philanthropic funding for research & innovations - Direct cash transfers under Ni- kshay Poshan Yojana

54. Role of Global Partnerships in TB Control International Support for TB Programs: - WHO & Stop TB Partnership Guidance - Global TB vaccine initiatives - International research collaborations - Cross-border TB case notification - UN Sustainable Development Goals (SDGs) alignment

55. Strengthening TB Surveillance & Monitoring Strategies for TB Surveillance: - Ni- kshay real-time case tracking - Digital dashboards for TB data analysis - Routine drug-resistance surveillance - Contact tracing & active case finding - Integration with Integrated Disease Surveillance Program (IDSP)

56. Importance of Data Analytics in TB Control Data-Driven TB Management: - Predictive analytics for TB hotspots - AI-powered TB case identification - Trend analysis for drug-resistant TB - Monitoring TB burden at district levels - Ensuring accountability in program implementation

57. Engaging Civil Society & NGOs in TB Control Strengthening Multi-Sectoral Engagement: - Community awareness campaigns - Mobilization of self-help groups - NGO-led DOTS adherence programs - Stigma reduction strategies - Policy advocacy for TB rights

58. Innovations in TB Drug Development Emerging TB Treatment Strategies: - New drug molecules under clinical trials - Shorter treatment regimens for MDR-TB - Host-directed therapies (HDTs) for TB - BPaL & BPaLM regimens replacing injectables - Genome-based personalized TB therapy

59. TB Elimination by 2025 – Progress & Challenges India’s Progress Towards TB-Free Status: - 20% reduction in TB incidence in the past 5 years - Expanded access to rapid TB diagnostics - Universal DST & MDR-TB treatment scale-up - Increased community participation - Major challenges: MDR-TB burden, stigma, underreporting

60. TB-Free India – Government Commitments Key Policy Interventions: - Strengthened TB screening at primary care level - Expansion of Ni- kshay Poshan Yojana support - Multi-sectoral collaboration for TB care - Integration with National Health Digital Mission (NDHM) - Increased budgetary allocations for TB control

61. TB in Special Populations – TB & HIV Co-Infection Challenges in TB-HIV Co-Infection: - HIV increases TB susceptibility - Higher mortality in TB-HIV cases - Drug interactions between ART & ATT - Need for integrated TB-HIV care - Routine TB screening in HIV patients

62. TB in Pregnancy – Management & Challenges Managing TB in Pregnant Women: - Risk of maternal TB transmission to newborn - Isoniazid Preventive Therapy (IPT) for latent TB - Safe use of first-line ATT drugs in pregnancy - Risk of premature birth & low birth weight - Screening for gestational diabetes & anemia

63. TB in Pediatric Age Group Key Considerations for Pediatric TB: - Non-specific symptoms make diagnosis difficult - BCG vaccine protects against severe childhood TB - Pediatric drug formulations available under NTEP - Nutritional support for children with TB - Shorter, child-friendly TB treatment regimens

64. TB in Migrant & Vulnerable Populations Addressing TB in High-Risk Groups: - Increased TB burden in urban slums & refugee camps - Mobile TB screening units for migrant workers - Ensuring uninterrupted ATT for displaced populations - Reducing stigma & discrimination - Strengthening workplace TB surveillance programs

65. Emerging Trends in TB Research & Innovation Future Directions in TB Science: - Next-generation TB vaccines in clinical trials - AI-assisted TB diagnostics & X-ray interpretation - Genome sequencing for personalized TB therapy - Host-directed therapy for drug-resistant TB - Nanotechnology in TB drug delivery

66. Conclusion & Call to Action Final Takeaways: - TB remains a major public health priority - Strengthening diagnostics & surveillance is crucial - Digital health & AI are transforming TB care - Community engagement & awareness are key - Everyone has a role in achieving TB elimination

67. T hank You