NTEP sakthi senthi siddarth and vasanthi

regarding ntep

1. NTEP National Tuberculosis Elimination Programme BY Senthi Velayutham Sakthi Ahathian Siddarth singh

2. INTRODUCTION NTEP visit Dated- 22/01/2025 Place of visit- GH Karaikal (TB unit) ,Pulmonary Medicine Ward Briefing done by- Dr.Indhu , Dr.Mahadevan and Health assistants in GH Current burden of TB cases in Karaikal- 140 Registered cases 8 new cases were diagnosed this month(January 2025)

3. 3 Evolution of NTEP

4. Difference between RNTCP and NTEP RNTCP NTEP RNTCP aimed to control TB by increasing detection and ensuring treatment success under the Directly Observed Treatment Short-course (DOTS) strategy NTEP targets elimination, which means reducing the incidence of TB to less than one case per 100,000 population by 2025 Under RNTCP, the emphasis was on passive case detection NTEP expanded to active case finding in vulnerable and high-risk groups RNTCP relied heavily on sputum microscopy NTEP introduced advanced diagnostic tools like CBNAAT/ Truenat NTEP introduced the Nikshay portal RNTCP primarily focused on public health facilities NTEP emphasizes collaboration with private healthcare providers to increase case notification and ensure uniform treatment protocols

5. OBJECTIVES (NSP) Find all drug sensitive and resistant TB cases. Initiate and sustain all patients on Anti-TB treatment. Prevent the emergence of TB in susceptible population. Build and strengthen policies, institution, additional human resources, with adequate financial resources.

6. STRATEGIES (NSP) Private sector engagement. Active case finding Drug resistant TB case management Addressing social determinants including nutrition Robust surveillance system Community engagement and multisectorial approach

7. National Strategic Plan (2017-2025) Treat Prevent Build Detect Find all TB cases with an emphasis on reaching every TB patient in the private sector Treat all TB cases with high quality anti TB drugs Prevent the emergence of TB in susceptible populations and stop catastrophic expenditure due to TB by all Build & strengthen supportive systems including enabling policies, empowered institutions & human resources

8. EXPECTED OUTCOMES Aim – TB elimination by 2025. 80% reduction in TB incidence 90% reduction in TB mortality 0% patients having catastrophic expenditure

9. ORGANOGRAM

10. Staffing Pattern in Karaikal 1 State TB Officer (Pondicherry) 1 District TB Officer 1 Senior treatment supervisor 2 TB Health Workers (1 currently present)

11. Key Services In Karaikal Free diagnosis and treatment for TB patient Public health action- contact tracing, testing for co-morbidities etc. Treatment adherence support Nutrition assistance to TB patients (DBT- Nikshay Poshan Yojana and Nikshay Mithra) Preventive measures Compilation of reports, monthly 11

12. CASE DEFINITION Presumptive TB Any one of the following are the signs and symptoms , Cough more than 2 weeks Hemoptysis Fever more than 2 weeks Significant weight loss Chest x ray abnormal

13. CASE DEFINITION (CONT.) Microbiologically confirmed TB Any one of the below Sputum smear positive for AFB Culture positive ( liquid culture) Rapid molecular testing positive ( CBNAAT, TruNAAT , LPA) Clinically confirmed TB – Chest xray and clinical findings positive Microbiologically negative Sputum sent for CBNAAT

14. DEFINITIONS 4S screening : Screening for 4 symptoms (cough, fever, weight loss and night sweat Contact : Is any individual who is exposed to a person with active TB disease. Contact investigation : Is a systematic process for identifying previously undiagnosed people with TB disease and TB infection among contacts of an index TB patient and/or other comparable settings where transmission occurs. It consist of identification, clinical evaluation and/or testing and provision of appropriate anti-TB treatment or TB preventive treatment.

15. TB preventive treatment (TPT ): Treatment offered to individuals who are considered to be at risk of developing TB disease, in order to reduce that risk. Tuberculosis infection (TBI): Is a state of persistent immune response to stimulation by M. tuberculosis antigens with no evidence of clinically manifest TB disease.

16. CLASSIFICATION OF TB Based on location Pulmonary Extrapulmonary Based on resistance Mono drug resistance Poly drug resistance Multidrug resistance Pre extensive drug resistance Extensive drug resistance

17. CLASSIFICATION (CONT.) PREVIOUSLY TREATED Recurrent Lost to follow up Treatment after failure Other previously treated

18. CLASSIFICATION (CONT)

19. RISK OF DEVELOPMENT OF TB Infection with no risk factor - 10% over lifetime Infection with DM - 30% over lifetime Infection with HIV - 7-10% yearly P a tients diagnosed with TB are also tested for DM HIV

20. TB DIAGNOSTIC ALGORITHM

21. Diagnosed with TB MO at DMC Collect complete address Collect at least one mobile number Counsel the patient- Need for complete treatment, cough hygiene, Drug side-effects, screening contacts Referral to Screen for 1. HIV 2. Diabetes Mellitus 3. Drug Sensitivity Testing Referral for ATT Primary Health Centre nearest to address given by patient WHAT HAPPENS TO A PATIENT WITH TB?

22. NTEP- patient Identity card

23. DIAGNOSTIC SERVICES AVAILABLE AT KARAIKAL Chest X- Ray Microbiological testing - fluorescence microscopy Truenat Tuberculin skin test aka Mantoux test Extrapulmonary samples sent to INTERMEDIATE REFERENCE LABORATORY (pondicherry)

24. SPUTUM COLLECTION In Karaikal GH, Early morning sample is followed by Spot sample On the day of OP visit the patient is asked to bring early morning sample Falcon tube is given and instructions for sample collection is given One sputum sample after intensive phase One sputum sample after continuation phase

25. FLUORESCENT MICROSCOPY

26. TRUENAT

27. MANTOUX TEST

28. NIKSHAY Government of India declared tuberculosis as a notifiable disease in 2012 All public and private health providers shall notify TB cases in NIKSHAY portal Direct bank transfer of Rs. 500/month under NIKSHAY POSHAN YOJANA

29. PUBLIC HEALTH ACTION ( PRIVATE SECTOR ) Once private practioner notifies TB patient information, following action will be taken by local public health staff and entered in NIKSHAY, Patient home visit Counselling of TB patients and family members Treatment adherence and follow up support, ensure treatment completion Contact tracing, symptoms screening, evaluation of TB symptomatic patient and offering TPT to eligible patients Random blood sugar testing HIV testing, drug susceptibility testing linking with available social welfare & support schemes

30. How patients /citizens are involved in NTEP

31. NIKSHAY MITHRA NGOs provide nutritional supplements For a period of 1 year From Sept 2022 – Aug 2023 as a part of PRADHAN MANTRI TUBERCULOSIS MUKT BHARAT ABHIYAN PROGRAM Register in NIKSHAY MITHRA Each month one NGO

32. TREATMENT

33. Follow Up

34. Treatment card

35. ADULT ATT

36. PEDIATRIC ATT

37. Specimen examination request form

38. Post TB sequelae 1. Pulmonary fibrosis 2.Bronchiectasis 3.Lung damage/reduced lung capacity 4.Post-TB arthritis 5.Spinal deformities (Pott’s disease) 6.Post-TB meningitis (neurological issues) 7.Renal damage 8.Ototoxicity (hearing loss) 9.Mental health problems (depression, anxiety, PTSD) 10.Social stigma and isolation 11.Nutritional deficiencies 12.Lymphadenitis (swollen lymph nodes) 13.Cardiovascular issues (e.g., pericarditis)

39. Differentiated TB care

40. Differentiated TB care Recognizes that " one size doesn’t fit all " and emphasizes personalizing TB care

41. Goal: T imely and appropriate management of TB in diverse patient populations .

42. 1.Stratification of Patients: Patients are categorized into different groups based on key factors: Clinical needs : Drug-susceptible TB (DS-TB), drug-resistant TB (DR-TB), Comorbidities (HIV, diabetes), or Complications . Treatment phase: Intensive vs. continuation phase. Patient characteristics: Age, socioeconomic factors, adherence risks, or stigma issues.

43. 2. Care Package Customization The treatment, follow-up, and support services are designed to address the needs of each group: Stable patients : Simplified follow-ups and community-based care. High-risk patients : Intensive clinical monitoring, hospitalization if required, and multidisciplinary care. Socially vulnerable patients : Additional social support, counseling, and nutritional supplementation .

44. 3. Service Delivery Models: These models aim to decentralize and integrate TB services: Facility-based care: For severe cases or patients with complications. Community-based care : Directly observed treatment (DOT), home visits, or digital adherence technologies. Integrated care: Combining TB services with HIV or diabetes clinics.

45. INTERVENTIONS TO IMPROVE TREATMENT ADHERENCE Directly observed treatment Health facility Community treatment supporter ( DOTS provider ) Family DOT ICT based adherence Pill counting Pill box Self reporting ( call centre SMS reminder

46. Observations about TB unit Kkl POSITIVE FACTORS Proper documentation and registration of cases Proper drug dispensing and follow up. NIKSHAY Portal is being used. NEGATIVE FACTORS No CBNAAT available Extrapulmonary sample are sent to Pondicherry. Sputum collection SOP is not followed.

47. TB diagnosis in CHC- Thirunallar Sputum microscopy is available But sputum sample is collected and sent to GH Kkl because 100 day program BCG vaccine is not administered in CHC thirunallar Any presumptive TB case is referred to GH-KKL for diagnosis and treatment initiation Health inspector distributes ATT to public population

48. Facilities in PHC kovilpattu Early morning samples are collected and sent to GH- Kkl ATT are not distributed in this facility

49. TN-KET Tamil nadu kasanoi irrapilla thittam to reduce TB deaths The key is to use this information for local level action to reduce TB deaths. Local level means PHI level first, TB unit level if PHI MISSED taking local action. The main objective of the Program is “Screening for Severe Illness at Diagnosis to Prevent Early TB Deaths thereby reducing mortality due to TB”.

50. THANK YOU