RNTCP.pptx

important

1. Revised National Tuberculosis Control Programme

2. What is Tuberculosis? Tuberculosis (TB) is an infectious disease caused by the bacterium Mycobacterium tuberculosis (MTB) Tuberculosis generally affects the lungs , but can also affect other parts of the body One patient with infectious pulmonary TB if untreated can infect 10-15 persons in a year

3. Risk factors Malnutrition Diabetes HIV infection Low body weight Severe kidney disease Other lung diseases (silicosis) Substance abuse etc. Overcrowding Inadequate ventilation Enclosed living/working conditions Occupational risks Environmental Medical

4. Possible TB Disease Symptoms Night Sweats Fever Chills Weakness or fatigue Weight loss No appetite Cough lasting longer than 3 weeks Pain in the chest Coughing up blood or sputum (phlegm from inside the lungs) 4

5. Global TB Burden -2018 Global India Incidence 1,00,00,000 (132/lakh) 26,90,000 (199/lakh) Deaths 15,00,000 (16/lakh) 4,40,000 (32/lakh) HIV TB cases 8,62,000 (11/lakh) 92,000 (6.8/lakh) HIV TB deaths 3,74,000 (5.0/lakh) 12,000 (0.7/lakh) Estimat e d MDR/RR cases 484000 (6.4/lakh p o p u l a tio n ) 1,30,000 (9.6/ lakh p o p u l a tio n )

6. India has highest burden of both TB and MDR TB and second highest of HIV associated TB based on estimates reported in Global TB report 2015. An estimated 71,000 cases of MDR TB emerge annually from the notified cases of Pulmonary TB in India. 3% among new TB cases, 12-17% among previously treated TB cases have MDR TB. An estimated 1.1 Lac HIV associated TB occurred in 2014 & 31,000 estimated number of patient died among them.

7. TB kills more adults in India than any other infectious disease. In India every day – More than 6000 develop TB disease More than 600 people die of TB (i.e. 2 deaths every 5 minutes )

8. EVOLUTION OF TB CONTROL IN INDIA 1950 s- 60s 1962 1992 Important TB research at TRC and NTI National TB Programme (NTP) Programme Review 1993 1998 2 01 2004 2006 only 30% of patients diagnosed; of these, only 30% treated successfully RNTCP pilot began RNTCP scale-up 450 million population covered >80% of country covered Entire country covered by RNTCP

9. STOP TB STRATEGY, 2006 Vision: A world free of TB Goal: To dramatically reduce the global burden of TB by 2015 in line with Millennium Development Goals and the Stop TB Partnership targets

10. STOP TB PARTNERSHIP TARGETS By 2005: At least 70% people with sputum smear positive TB will be diagnosed. At least 85% cured. By 2015: Global burden of TB (prevalence and death rates) will be reduced by 50% relative to 1990 levels. Reduce prevalence to <150 per lakh population Reduce deaths to <15 per lakh population Number of people dying from TB in 2015 should be less than 1 million, including those co-infected with HIV By 2035: Global incidence of TB disease will be less than or equal to 1 case per million population per year Government of India preponed END TB Strategy

11. Revised National TB Control Programme (RNTCP) nomenclature changed To National TB Elimination Programme (NTEP) from January 2020

12. At the start of 2020 the central government of India renamed the RNTCP the National Tuberculosis Elimination Program (NTEP). 12

13. OBJECTIVES OF THE PROGRAM

14. NATIONAL STRATEGIC PLAN 2017 - 2025 The MOHFW in consultation with over 150 national and international experts working in the field of public health, program managers, donor agencies, technical partners, civil societies, affected community representatives and other stakeholders of TB control both from public as well as private sector finalized the new National Strategic Plan for TB 2017-2025 (NSP). 14

15. WHAT IS NSP? The NSP for TB elimination 2017–25 is a framework to guide the activities of all stakeholders including the national and state governments, development partners, civil society organizations, international agencies, research institutions, private sector, and many others whose work is relevant to TB elimination in India . It is a 3 year costed plan and a 8 year strategy document. It provides goals and strategies for the country’s response to the disease during the period 2017 to 2025 and aims to direct the attention of all stakeholders on the most important interventions or activities that the RNTCP believes will bring about significant changes in the incidence, prevalence and mortality of TB . • The NSP will guide the development of the national project implementation plan (PIP) and state PIPs, as well as district health action plans (DHAP) under the national health mission (NHM). 15

16. VISION,GOALS and TARGETS VISION:- TB-Free India with zero deaths, disease and poverty due to tuberculosis. GOALS:- To achieve a rapid decline in burden of TB, morbidity and mortality while working towards elimination of TB in India by 2025.  TARGETS:- The requirements for moving towards TB elimination have been integrated into the four strategic pillars of “Detect – Treat – Prevent – Build” (DTPB). 16

17. DETECT Early identification of presumptive TB cases, at the first point of care be it private or public sectors, and prompt diagnosis using high sensitivity diagnostic tests to provide universal access to quality TB diagnosis including drug resistant TB in the country. 17

18. How it can be achieved? 1. LABORATORY SYSTEMS 2. CASE FINDINGS 3. PATIENTS IN PRIVATE SECTORS 18

19. TREAT What does it mean? Provide sustained, equitable access to high quality TB treatment, care and support services responsive to the community needs without financial loss thereby protecting the population especially the poor and vulnerable from TB related morbidity, mortality and poverty. 19

20. What does it entail? 1. Providing daily regimen using FDCs to all TB patients. 2. DST guided treatment for DR TB. 3. Patient centric approach to treatment. 4. Prevent loss at cascade of TB care . How it can be achieved? 1. Treatment services 2. Key affected populations 3. Patient support system 20

21. STRATEGIES  1. Initiation of appropriate treatment for all diagnosed TB patients. • 2. Implementation of TB treatment services in health facilities and communities. • Regular and long term follow up and rehabilitation of all treated TB patients. 21

22. The principles of treatment for TB 1. Screen all patients for Rifampicin resistance and additional drugs wherever indicated. 2. For drug sensitive TB, administer daily fixed dose combinations of first line Antituberculosis drugs in appropriate weight bands for all forms of TB and in all ages, including four drug FDC in the intensive phase and three drug FDCs in the continuation phase. 3. All Rifampicin Resistant /Multi Drug Resistant TB patients are subjected to baseline Kanamycin and Levofloxacin all across the country. In addition country has introduced extended DST to all second line drugs in a phased manner. 22

23. 4. RR/MDR TB patients without additional drug resistance are treated with standard short course treatment regimen for MDR TB. And in those with mixed patterns of resistance, standard MDR TB regimens were modified as per revised guidelines. 5. Where DST patterns for extended DST are available, the management protocol will follow essential optimized regimen for patients diagnosed with drug resistance other than MDR and XDR TB. 6. Minimize leakage across the care cascade and maximize adherence through innovative patient support strategies and real time monitoring. 23

24. PREVENT What does it entail? 1. Scale up air-borne infection control measures at health care facilities. 2. Treatment for latent TB infection in contacts of bacteriologically-confirmed cases . 3. Addressing social determinants of TB through intersectoral approach . 24

25. How it can be achieved? 1. AIR BORNE INFECTION CONTROL 2. CONTACT TRACING 3. LTBI TREATMENT 25

26. AIR BORNE INFECTION CONTROL CHALLENGES AT COMMUNITY LEVEL  - Social habits • Cough etiquettes not being followed • Indiscriminate spitting • Sneezing without covering face • Alcoholics and mentally challenged patients • Delay in reaching health facility for specific diagnosis Special groups • Migrant population, back ward areas and tribal pockets Old age homes, poor homes, children homes, jails, hard to reach areas • Delay in diagnosis in co-morbid conditions like Diabetes, HIV, Cancers, etc. 26

27. CHALLENGES AT INSTITUTIONAL LEVEL  Outpatient facility • Patients with chest infection at outpatient settings • Overcrowding - mixing of patients in queues and waiting areas • Poor ventilation in the facilities In patient facility • Cough screening, separation, fast-tracking, mask and counseling provision missing • Infectious patients getting admitted at General wards • Cough etiquettes not followed in wards • Overcrowding in the wards – no restricted entries 27

28. SOLUTIONS AT INSTITUTIONAL LEVEL 1. Certification of Health facility for AIC Compliance 2. Develop cough corners/counters - Cough screening, separation, fast-tracking, mask and counseling 3. Posting of specific staff for fast tracking and providing masks 4. Providing N 95 masks to the Hospital staff in High risk settings 5. ACSM at OPD and other settings like Posters, Clippings etc 6. Implementation of AIC in all settings 7. In house AIC complaint facility for treating nomads, destitutes , homeless patients 8. Separate IP facility for bacteriological positive DS/DR TB patients and other airborne infectious patients in major institutions 28

29. 9. Proper infection control measures in ART centres. 10. Proper follow up of daily reported cases 11. Proper disposal of sputum and infected materials 12. Early diagnosis and initiation of treatment 13. PPE for concerned staff 14. Wet mopping and disinfection 15. Periodic screening of staff 16. Proper ventilation, renovation if necessary 17. Facility risk assessment and reporting 18. Periodic trainings 19. Ongoing monitoring dashboards/checklist for AIC practices at all levels . 29

30. CONTACT TRACING;- In RNTCP contact screening has been a clinical function with cursory programmatic monitoring. In this NSP contact tracing will be made more rigorous, expansive and accountable. The end result expected is that most TB pts will have their contacts screened, with secondary cases detected and treated. 30

31. PREVENTIVE THERAPY/ LATENT TB INFECTION TREATMENT :- TB infection is the seed bed for developing TB disease and continued transmission. The lifetime risk of reactivation of LTBI in healthy HIV-uninfected individuals is 10%, with 5% developing TB disease during the first 2 to 5 years after infection. ART reduces the risk of TB by approximately two thirds. 31

32. BUILD What does it means in term of NSP? Undertake critical management reforms, restructuring of HR and financial norms, pathways for private sector participation, in order to improve efficiency, effectiveness and accountability of the health system for an improved response to the TB epidemic. 32

33. What does it entail? 1. Build synergies with existing health service delivery mechanism under Urban Health Mission and plan for integration of services 2. Reform and restructure HR in TB programme to align with the enhanced programme needs for surveillance, participation of private sector and community participation. 3. Strengthen RNTCP’s regulatory capacity to control TB drugs through appropriate laws, regulations, and policies. 4. Position TB high on the health and development agenda of the nation to ensure adequate resources, greater demand for and universal access to TB care services 33

34. How it can be achieved? • URBAN TB CONTROL SYSTEMS • HEALTH SYSTEM STRENGTHENING • ADVOCACY, COMMUNICATIONS AND SOCIAL MOBILIZATION • SURVEILLANCE, MONITORING AND EVALUATION • RESEARCH AND TECHNICAL ASSISTANCE 34

35. Tuberculosis unit It is the nodal point for TB control activities in the sub-district. In urban areas 1 TU per 2,00,000 population (range 1.5-2.5laks) Manned by designated Medical Officer –Tuberculosis Control (MO-TC) Senior Treatment Supervisor (STS) Senior TB Laboratory Supervisor (STLS per 5 lakh population 1 TBHV per 1 lakh urban population

36. Continued….. TU will have one Designated Microscopy Centre (DMC) for every 1 lakh population (50,000 in tribal, desert, remote and hilly region) Microscopy centres are also located in Medical Colleges, Corporate Hospitals, ESI, Railways, NGOs, private hospitals.

37. PRESUMPTIVE TB CASES Presumptive Pulmonary TB – Cough for > 2 weeks Fever for > 2 weeks Significant weight loss Haemoptysis Any abnormality in Chest Radiograph Note – Contacts of Microbiologically confirmed TB patients, PLHIV, Diabetics, Malnourished, Cancer patients, patients on immune –suppressants or steroid should be regularly screen for signs and symptoms of TB

38. Presumptive Extra Pulmonary TB Organ specific symptoms and signs like swelling of Lymph node, pain and swelling in joints, neck stiffness, disorientation. Constitutional symptoms like – significant weight loss, persistent fever for ≥ 2 weeks, night sweats.

39. Presumptive Paediatric TB Persistent fever > 2 weeks Cough > 2 weeks Loss of weight / no weight gain History of contact with infectious TB case Loss of weight is define as loss of > 5% body weight as compared to highest weight recorded in last 3 months

40. Presumptive DRTB (As per TOG 2016) Patients who are found positive on any follow up sputum smear examination during treatment with FLD, previously treated TB cases TB patients with HIV co–infection TB patients who failed treatment with FLD Paediatric TB non responders TB patients who are contact of DR-TB (or Rif resistance)

41. CASE DEFINITIONS Microbiologically confirm TB case – Biological specimen positive for AFB or positive for Mycobacterium tuberculosis on culture or positive for tuberculosis through quality assured rapid diagnostic molecular test.

42. Clinically diagnosed TB case A presumptive TB patients who is not microbiologically confirmed but diagnosed with a active TB by a clinician on the basis of X-ray abnormalities, Histopathology or Clinical signs with a decision to treat the patient with a full course of ATD.

43. It is same as the old one Previously called relapse Previously called only failure

44. New Pyramid of TB diagnostics Characteristic Symptom Microbiologic confirmation with U-DST C o nv e nt i onal Radiology T uber c ulosi s Skin Test/ IGRA Spe c if i cit y Sensitivit y Yield of test and robustness of diagnosis can be improved by better characterisation of symptoms and interpretation of radiology!!

45. NTEP Implementation Arrangement 45

46. 46

47. 99D O TS

48. 2 pi l ls 5 4 3 pi l ls 99DOTS Envelopes

49. 99DOTS: Accurate Monitoring at Very Low Cost 101

50. How can the Patient data be accessed? Different ways of accessing the patient data – Web dashboard ( www.99dots.org ) Every center will be given their own login ID and Password to access their patients Different logins for ART center, DTC and field staff (with limited permissions) SMS Alerts for Staff and Treatment Supporters to take immediate action in case of default .

51. Benefits of 99DOTS Less travel Increased convenience Pa t ients Focused and more efficient care Field Staff/Supervisors Easy monitoring Accurate reports Program Officers

52. Nikshay

53. Nikshay Nikshay is an Integrated ICT (Information Communication Technology) system for TB patient management and care in India Real-time, case-based, web-based surveillance tool Unified interface for public and private sector health care providers Nikshay webpage - https://Nikshay.in Android mobile App - Google Play Store Demo site – https://beta.nikshay.in

54. Modalities of notification Submission of hardcopies to DTO Reporting into Nikshay web portal/mobile application Reporting via Nikshay Sampark (1800 11 6666)

55. Incentives to Patients for Social Protection “ Nikshay Poshan Yojana ”- Launched from 01 st April 2018 Nutritional support through Direct Benefit Transfer of 500 INR per month For all patients on TB treatment throughout duration of treatment Patient need to be registered in the Nikshay portal Tribal patient incentive

56. Incentives to Providers Private Provider Incentive 500 INR at notification & 500 INR on reporting treatment outcome Informant incentive Incentive of 500 INR to informant for notification of patients in public sector Incentive for Treatment support New Case: 1000 INR at completion of treatment Drug Resistant Case: 2000 INR at completion of intensive phase, 3000 INR at completion of treatment

57. Take Home Message……… For microbiologically confirmed TB cases we must follow Universal DST (Drug Susceptibility Testing) For clinically diagnosed TB cases– it is the test of experts not to over diagnose TB as well as not to under diagnose TB cases Repeated counselling for regular adherence and completion of ATD course is necessary

58. NIKSHAY Nikshay is an integrated Information and Communication Technology system for tuberculosis patient management and care in India. Nikshay was  launched in 2012  and has evolved significantly to make patient management easier and more effective for health care providers and their support staff. NI-KSHAY-(Ni=End, Kshay =TB) is the web enabled patient management system for TB control under the National Tuberculosis Elimination Programme (NTEP). 59

59. It is developed and maintained by the Central TB Division (CTD), Ministry of Health and Family Welfare, Government of India, in collaboration with the National Informatics Centre (NIC), and the World Health Organization Country office for India. Ni- kshay is used by health functionaries at various levels across the country both in the public and private sector, to register cases under their care, order various types of tests from Labs across the country, record treatment details, monitor treatment adherence and to transfer cases between care providers. It also functions as the National TB Surveillance System and enables reporting of various surveillance data to the Government of India. 60

60. Salient Features of Nikshay 2.0 Nikshay is an Integrated ICT system for TB patient management and care in India. Nikshay was launched in 2012 and since then, various improvements have been made in the system Nikshay Version 2 has been launched in September 2018. Nikshay provides- A Unified interface for public and private sector health care providers Different types of Logins like State, District, TU, PHI, Staff logins, Private providers, Chemist, Labs and PPSA/JEET Logins Integrates all adherence technologies such as 99DOTS and MERM Unified DSTB and DRTB data entry forms Mobile friendly website with mobile app

61. Nikshay 2 is accessible either via web browser ( https://Nikshay.in ) or mobile App called ‘Nikshay’ that can be downloaded from Google Play Store ( log in page in web browser) ( log in page in mobile App)

62. Diagnostic work up Based on CBNAAT result patient will be categorized as Microbiologically confirmed drug sensitive TB or RIF resistance TB

63. In case of RIF indeterminate result an additional CBNAAT will be done to get a valid result. If indeterminate on second occasion an additional specimen will be sent to nearest IRL or C &DST centre for L P A or li q uid c ul t ure a n d DST as appropriate

64. 66 DIAGNOSTIC ALOGRYTHM FOR EXTRA PULMONARY TB

65. Recommendations for LTBI interventions under NTEP 3 rd National Technical Working Group(TWG) on Latent TB Infection Management in India held on 12 th May, 2020 Eligible population Strategy Treatment option People living with HIV (Adults and children >12 months) Infants <12 months in contact with active TB Household contacts below 5 years of pulmonary TB patients Treating all after ruling out active TB 6-months daily isoniazid Three months of daily rifampicin plus isoniazid (Alternative in household contacts - 14 years (up to 25 kg weight) in limited geographies) Household contacts 5 years and above of pulmonary TB patients (testing would be offered whenever available) Treating all after ruling out active TB 3-month weekly Isoniazid and Rifapentine Children/Adult on immunosuppressive therapy Testing and 3-month weekly Isoniazid and Rifapentine

66. HIV & Tuberculosis

67. Ideally all presumptive TB patients have to undergo HIV screening. This is important to ensure all HIV positive TB patients receive ART irrespective of CD 4 count and Chemo Prophylaxis (CPT) . HIV & Tuberculosis

68. First Line ART for HIV - TB Second Line ART for HIV - TB

69. TB-HIV Collaboration – Single Window Delivery of HIV-TB care at ART centres Rapid molecular diagnosis CBNAAT Daily FDC for HIV and TB ICT based adherence support (99 DOTS) Phar m aco v igilance (AMC) Isoniazid Preventive Therapy Progress Training completed by NACO and CTD Drugs supplied in Oct-Nov’16 10,031 HIV-TB patients initiated on treatment

70. Adjustment of Anti TB drugs in renal insufficiency Drugs Recommended dose and frequency for patients with creatinine clearance <30 ml/min or for patients receiving haemodialysis (unless otherwise indicated dose after dialysis) Isoniazid No adjustment necessary Refiampicin No adjustment necessary Pyrazinamide 25-35 mg/kg per dose three times per week ( not daily) Ethambutol 15-25 mg/kg per dose three times per week ( not daily) Rifabutin Normal dose can be used, if possible monitor drug concentrations to avoid toxicity. Streptomycin 12-15mg/kg per dose two or three times per week (not daily) Capreomycin 12-15mg/kg per dose two or three times per week (not daily) Kanamycin 12-15mg/kg per dose two or three times per week (not daily) Amikacin 12-15mg/kg per dose two or three times per week (not daily) Ofloxacin 600-800mg/kg per dose three times per week (not daily) Levofloxacin 750-1000mg per dose three times per week (not daily) Moxifloxacin No adjustment necessary Cycloserine 250mg once daily or 500mg/ dose three times per week Terizidone Recommendations not available

71. Torizidone Recommendations not available Prothinamide No adjustment necessary Ethionamide No adjustment necessary Para- am i no s alic y lica c i d 4g/dose twice daily maximum dose Bedaquiline No dosage adjustments required in patients with mild to moderate renal impairment (dosing not established in severe renal impairment, use with caution) Linezolid No adjustment necessary Clofazimine No adjustment necessary Amoxicilin /clavulanate For creatinine clearance 10-30ml/min dose 1000mg as amoxiciline component twice daily For creatinine clearance <10ml/min dose 1000mg as amoxicilin component once daily Imipenem /cilastin For creatinine clearance 20-40ml/min dose 500mg every hours For creatinine clearance <20-40ml/min dose 500mg every 12 hours Meropenem For creatinine clearance 20-40/ml/min dose 750mg every 12 hours For creatinine clearance <20/ml/min dose 500mg every 12 hours High dose isoniazid Recommendations not available Adjustment of Anti TB drugs in renal insufficiency

72. 75 40 crore infected 35 lakh estimated TB patients annually 4.2 lakh deaths Due to TB annually In India…….

73. India: MDG6 TB target TB EPIDEMIC REVERSED Rate per 100,000 population 50% DROP IN TB MORTALITY 35 lakh additional lives saved 50% DROP IN TB Prevalence New cases declining All cases reduced by half Deaths reduced by half HIV WHO Global TB Report 2016 465  195 per lakh pop ( 58% reduction) 38  17 per lakh pop ( 55% reduction) 216  167 per lakh pop ( 23% reduction) Achieved

74. Vision: A world free of TB Zero TB deaths, Zero TB disease, and Zero TB suffering Goal: End the Global TB Epidemic (<10 cases per 100,000 population) Sustainable Development Goals (SDG)   INDICATORS   TARGETS SDG 2030 Reduction in number of TB deaths compared with 2015 (%) 90% Reduction in TB incidence (new case) rate compared with 2015 (%) 80% TB - affected families facing catastrophic expenditures due to TB (%) Zero

75. TB Free India India has committed to End TB by 2025 , 5 years ahead of the global SDG target Prime Minister of India launched TB Free India campaign at ‘Delhi End TB Summit’ on 13 th March, 2018 The campaign calls for a social movement focused on patient-centric and holistic care driven by integrated actions for TB Free India

76. 79 National Strategic Plan (2017-25)

77. Organizational structure Supporting Facilities National Institutes (6) National Reference Laboratories (6) Intermediate Reference Laboratories (29) State TB Training and Demonstration Centres (26) Culture and DST Laboratories (49) DR-TB Centres (148) CBNAAT Laboratories (1180)

78. Key Services Free diagnosis and treatment for TB patient Provision of rapid diagnostics Testing of all TB patients for drug resistance and HIV Management of associated diseases Treatment adherence support Nutrition assistance to TB patients Preventive measures

79. Strategy to find

80. Treat

81. Direct Benefit Transfer (DBT) schemes Existing schemes: Honorarium to Treatment Supporters – For provision of treatment support to TB patients (Adherence, ADR monitoring, counselling @Rs.1000/- to Rs.5000/-) Patient Support to Tribal TB Patients (Financial Patient Support @Rs750/- ) New Schemes: Nutritional Support to All TB patients (Financial Support to Patients @Rs.500/-month) Incentives to Private Providers (Rs.500/- for Notification & Rs.500/- for Follow-up with Treatment Outcome @ Rs . 500) Incentives to Informant ( Rs . 500/- is given on diagnosis of TB among referrals from community to public sector health facility)

82. Prevent Air borne infection control measures Strengthen Contact Investigation Preventive treatment in high risk groups Manage Latent TB Infection Address determinants of disease

83. Increased Access to Diagnostic Services Expansion of microscopy centres to improve access Phase 1 - PHCs where a Laboratory Technician (LT) is available Phase 2 – Other PHCs Current Status – Policy Update in RNTCP, 2018 Microscopy Centres in 2017 16.1 lakh TB patients notified in public sector (  12% in 2018) 1 microscopy centre at ~75,000 population

84. Universal Drug Susceptibility Testing All TB patients to be tested for Rifampicin Resistance Current Status – 60% of target DR-TB patients diagnosed (  54% from 2017) Policy Update in RNTCP, 2018

85. Paradigm shift in management of Drug Resistant TB > 20,000 patients on Shorter regimen > 4,600 patients on BDQ containing regimen 62 patients on DLM containing regimen Policy Update in RNTCP, 2018

86. Injection Free Regimen Policy Update in RNTCP, 2018 Treatment for Previously Treated TB Patients Treatment for INH Resistant TB Patients

87. Gazette on TB Notification Mandatory Notification of TB patients Public Health Actions Provisions of Sections 269 and 270 of the Indian Penal Code (IPC) Policy Update in RNTCP, 2018 Provider RNTCP Patient 48 Cities in JEET & others 90 Cities approved in PIP

88. Multi-sectoral Engagement Panchayati Raj Indian Post Home Affairs Financial Services Defence Labour & Employment Policy Update in RNTCP, 2018 TB - A social problem & needs multi-sectoral approach

89. Community Engagement Transformation of TB survivors to TB champions Capacity building and mentoring programme Engagement of existing community groups like PRI, SHG, VHSNC, MAS, Youth Club Grievance redressal mechanism Involvement of community representatives in different forums

90. Call Centre 1800-11-6666 Outbound & Inbound Time – 7 to 11 Languages – 14 100 call centre agents Pan-India coverage Citizen – Patient - Providers Policy Update in RNTCP, 2018

91. Subnational Certification for TB Free District / State Accelerate efforts Contextual strategies Generate healthy competition Recognition for achieving “Disease Free” status through monetary and non-monetary awards Policy Update in RNTCP, 2018 TB Free

92. Award Categories Criteria Decline in incidence rate compared to 2015 Monetary Award for District (in Rs .) Non-Monetary Recognition Bronze 20% 2 lakhs Certification and Felicitation at the National Level Silver 40% 3 lakhs Gold 60% 5 lakhs TB Free Status 80% 10 lakhs State District Award Categories State/ Uts with population <50 lakh State/ Uts with population 50 lakh – 5 Cr State/ Uts with population >5 Cr Non-Monetary Recognition Bronze 10 lakhs 15 lakhs 25 lakhs Certification and Felicitation at the National Level Silver 20 lakhs 35 lakhs 50 lakhs Gold 40 lakhs 60 lakhs 75 lakhs TB Free Status 60 lakhs 75 lakhs 1 Crore

93. State TB Index Policy Update in RNTCP, 2018

94. Under reporting and uncertain care of TB patients in private sector Reaching the unreached – Slums, Tribal, vulnerable Drug Resistant TB Co-morbidities – HIV, Diabetes Undernutrition, overcrowding Lack of awareness and poor health seeking behaviour lead to delay in diagnosis Key Challenges

95. Key Take Away Improve TB notification rate Ensure mandatory TB notification from private sector Active TB Case Finding to reach the unreached Optimum utilization of CBNAAT machines Expand Universal Drug Susceptibility Testing coverage Expansion of newer treatment regimens (daily regimen, bedaquiline , delamanid , shorter MDR TB regimen) NIKSHAY Poshan Yojana to every TB patients 100% reporting through NIKSHAY Collaboration with Line Ministries to tackle social determinants of TB Community participation for TB Elimination

96. Thank You Bending the Curve Accelerating towards a TB free India Thank You