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NATIONAL TUBERCULOSIS ELIMINATION PROGRAMME
National tuberculosis elimination programme (NTEP) Tuberculosis is a contagious disease caused by Mycobacterium Tuberculosis. This primarily affects lungs, also intestine, meninges, bones, joints, lymph glands, skin etc. Symptoms: fever, fatigue, weight loss, productive cough, blood sputum, night sweats, SOB, chest pain. TYPES OF TB CASES A. Smear-positive pulmonary TB B. Smear-negative pulmonary TB C. Extra-pulmonary TB In 1992, NTCP programme was reviewed by experts and RNTCP was evolved. Objectives: Achievement of at least 85% cure rate of infectious cases of TB through DOTS Augmentation of case finding activities through quality sputum microscopy to detect at least 70% of estimated cases. Strategy of RNTCP: Political commitment Sputum microscopy as primary tool of diagnosis Short course chemotherapy DOTs Accountability During intensive phase of chemotherapy all drugs would be administered in periphery under direct supervision called as “direct observed therapy short term” / DOTs. Anti-TB drugs would be directly administered by DOTs agents such as health workers, voluntary health guides, Anganwadi workers, teachers etc. DOTS STRATEGY: COMPONENTS Political will and administrative commitments. Diagnosis by quality assured sputum smear microscopy. Adequate supply of quality assured short course chemotherapy drugs. Directly observed treatment Systematic monitoring and accountability STOP TB STRATEGY: Vision: A TB free world Goal: to reduce the global burden of TB by 2015 Objectives: Achieve universal access to high quality care for all people with TB. Reduce human suffering and socioeconomic burden associated with TB. Support development of new tools and enable their timely and effective use. Strategies: pursues high quality DOTS expansion and enhancement addressing TB-HIV, MDR-TB and the needs of poor and vulnerable populations. contributes to health system strengthening based on primary health care engages all care providers Empowers people with TB and communities through partnership enables and promote research END TB STRATEGY: 2014 The World Health Organization's (WHO) End TB Strategy is a global plan to end the tuberculosis epidemic by 2035, aiming for zero TB deaths, disease, and suffering. It is built on three strategic pillars: Patient-centred care and prevention bold policies and supportive systems intensified research and innovation. NIKSHAY Nikshay is India's web-based patient management system for Tuberculosis (TB), developed by the Central Tuberculosis Division of the Ministry of Health and Family Welfare and the National Informatics Centre (NIC). Nikshay is a centralized, integrated system that records and monitors TB patients, their treatment, and healthcare services across India. It helps track TB patients nationwide, enabling stakeholders to access patient data. Additionally, through the Nikshay Poshan Yojana, patients receive financial assistance for nutritional support during their treatment.
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NATIONAL TUBERCULOSIS ELIMINATION PROGRAMME
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- 2. National tuberculosis eliminationprogramme (NTEP) Tuberculosis is a contagious disease caused by Mycobacterium Tuberculosis. This primarily affects lungs, also intestine, meninges, bones, joints, lymph glands, skin etc. Symptoms: fever, fatigue, weight loss, productive cough, blood sputum, night sweats, SOB, chest pain. TYPES OF TB CASES A. Smear-positive pulmonary TB B. Smear-negative pulmonary TB C. Extra-pulmonary TB
- 3. INCIDENCE ● As per2022, 10.6 million people fell ill with TB worldwide. Tuberculosis is one of India's major public health problems. According to World Health Organization (WHO) estimates, India has the world's largest tuberculosis epidemic. ● In 2020, India accounted for 26% of the incident TB cases across the globe. India accounted for 24% of global gap between estimated TB incidence and the number of people newly diagnosed with TB and reported. ● 21.4 Lakh TB cases notified in India in 2021, 18% higher than 2020. ● According to the World Health Organisation’s (WHO) Global TB report 2023, India accounted for the highest number of tuberculosis (TB) cases in the world in 2022, representing a staggering 27% of the global burden. ● 5th leading cause of death among all diseases.
- 4. EVOLUTION OF TBELIMINATION PROGRAMMES
- 6. RNTCP In 1992, NTCPprogramme was reviewed by experts and RNTCP was evolved. Objectives: ● Achievement of at least 85% cure rate of infectious cases of TB through DOTS ● Augmentation of case finding activities through quality sputum microscopy to detect at least 70% of estimated cases. Strategy of RNTCP: ● Political commitment ● Sputum microscopy as primary tool of diagnosis ● Short course chemotherapy ● DOTs ● Accountability
- 7. DOTS During intensive phaseof chemotherapy all drugs would be administered in periphery under direct supervision called as “direct observed therapy short term” / DOTs. Anti-TB drugs would be directly administered by DOTs agents such as health workers, voluntary health guides, Anganwadi workers, teachers etc. DOTS STRATEGY: COMPONENTS ● Political will and administrative commitments. ● Diagnosis by quality assured sputum smear microscopy. ● Adequate supply of quality assured short course chemotherapy drugs. ● Directly observed treatment ● Systematic monitoring and accountability
- 8. intensive phase continuation phase 2-3months duration. Pt swallow medicine under observation of the health worker. Meds are taken 3 times a week on alternate days. If sputum is ve- for bact. After IP, the continuation phase is started. • 4-5 months duration. • Pt is provided with a weekly pack to take home. • The medicines from pack are taken on alternate days 3 times/week in the remaining days, vitamin tablets are taken. • Empty packs are collected to ensure that the medicines are taken at home by patient. Two phases in DOTS treatment
- 9. Category Type ofpt Treatment regimen Duration of month colour code red New sputum smear ve+ Serious ill sputum ve- Serious ill extra pulmonary 2 HRZE 4 HR 6 4-6 Colour code blue Sputum ve+ relapse Sputum ve+ failure Sputum ve+ treatment after default 2 HRZES 1 HRZE 5 HRE 8 colour code green Sputum ve- Extrapulmonary not serous ill 2 HRZ 4HR 6
- 10. SPUTUM POSITIVE SMEAR:TB bacteria are seen under microscope in a stained sputum sample. Indicates patient is infectious and can transmit TB to others. They are highest priority for treatment under programs like DOTS. SERIOUS ILL SPUTUM NEGATIVE SMEAR: A negative sputum test suggests that TB bacteria are not present in the lungs, but it doesn't completely rule out TB. If you have symptoms like a persistent cough, chest pain, or unexplained weight loss, or if you have a weakened immune system (e.g., HIV), a negative sputum test may not be enough to exclude TB. Further tests such as chest X- ray, blood tests, or a sputum culture (which is more sensitive than a sputum smear) may be needed to get a definitive diagnosis. SERIOUS ILL EXTRA PULMONARY: TB infection is outside the lungs like lymph nodes, pleura, kidneys etc. and patient condition is severe or life threatening. Such patients are given priority for starting full TB treatment.
- 11. SPUTUM POSITIVE RELAPSE:A patient who had TB before and was declared ‘cured’ or ‘treatment completed’. But later, disease comes back and sputum smear is again positive for TB bacilli. SPUTUM POSITIVE FAILURE: A TB patient who was sputum ve+ at start of treatment. But remains sputum positive after finishing the course of treatment. It shows that treatment is not working maybe due to drug resistance, poor adherence or wrong regimen. SPUTUM POSITIVE – TREATMENT AFTER DEFAULT: A patient stopped TB treatment for 1 month or before completing it. If such a patient returns with TB symptoms and sputum smear is again positive for TB bacilli. EXTRA PULMONARY TB BUT NOT SERIOUS ILL: these patients are still TB cases, so they need full anti-TB treatment. They are not classified as ‘ seriously ill’ because their disease is limited and not immediately life-threatening. A follow-up is needed to prevent progression into serious forms.
- 12. DRUGS IN DOTS A.ADULTS
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- 14. A. First-line drugs:Isoniazid, Rifampicin, Pyrazinamide, Ethambutol, Streptomycin B. Second-line drugs: Kanamycin, ethionamide, levofloxacin, cephamycin H= Isoniazid R= Rifampicin E= Ethambutol S= streptomycin Z= pyrazinamide
- 15. STOP TB STRATEGY ●Vision: A TB free world ● Goal: to reduce the global burden of TB by 2015 ● Objectives: - Achieve universal access to high quality care for all people with TB. - Reduce human suffering and socioeconomic burden associated with TB. - Support development of new tools and enable their timely and effective use. ● Strategies: a. pursues high quality DOTS expansion and enhancement b. addressing TB-HIV, MDR-TB and the needs of poor and vulnerable populations. c. contributes to health system strengthening based on primary health care d. engages all care providers e. Empowers people with TB and communities through partnership f. enables and promote research
- 16. END STRATEGY: 2014 TheWorld Health Organization's (WHO) End TB Strategy is a global plan to end the tuberculosis epidemic by 2035, aiming for zero TB deaths, disease, and suffering. It is built on three strategic pillars: • Patient-centred care and prevention • bold policies and supportive systems • intensified research and innovation.
- 17. Integrated, patient- centered TBcare and prevention: ● Focuses on early diagnosis, prompt treatment, and access to care for all, including people with drug-resistant or HIV-associated TB. ● Emphasizes integrated services, preventative treatment, and palliative care. Bold policies and supportive systems: ● Requires strong government commitment, political will, and adequate financing for TB control. ● Advocates for universal health coverage, social protection, and strong collaboration between health and other sectors. ● Promotes human rights, equity, and anti-stigma campaigns to protect those affected by TB
- 18. Intensified research and innovation ●Calls for new and improved diagnostics, drugs, and vaccines to accelerate progress towards the global targets. ● Requires continued investment in research to develop better tools and strategies.
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- 21. NEW INITIATIVE NIKSHAY Nikshay isIndia's web-based patient management system for Tuberculosis (TB), developed by the Central Tuberculosis Division of the Ministry of Health and Family Welfare and the National Informatics Centre (NIC). Nikshay is a centralized, integrated system that records and monitors TB patients, their treatment, and healthcare services across India. It helps track TB patients nationwide, enabling stakeholders to access patient data. Additionally, through the Nikshay Poshan Yojana, patients receive financial assistance for nutritional support during their treatment.
- 22. Nikshay Poshan Yojana(Nutritional Support for TB Patients): • Financial assistance: This scheme provides a monthly financial incentive of ₹500/- to TB patients for nutritional support throughout their treatment. • Eligibility: All TB patients who are notified on or after April 1, 2018, and are registered on the Ni-kshay portal are eligible for this support. • Delivery: The financial support is provided through Direct Benefit Transfer (DBT) to patients' Aadhaar-enabled bank accounts.