Background
Tuberculosis is one of the world’s deadliest infectious diseases, killing more than 1.4 million people in 2019. More people have died from TB, in the history of mankind, than other infectious diseases like Smallpox, Malaria, Plague, Influenza, Cholera or AIDS. While it’s been well known human disease for millennia the causative agent was not known till 24th March, in1882 when Dr. Robert Koch astounded the scientific community in Berlin,about TB Bacillus (Mycobacterium tuberculosis) as the cause of disease.
TB, unfortunately continues to be the major public health problem in India despite the fact that the National Tuberculosis Control Programme (NTCP) of India was initiated in 1962.
In 1992, the Government of India, together with the World Health Organization (WHO) and Swedish International Development Agency (SIDA), reviewed the national programme and concluded that it suffered from managerial weakness, inadequate funding, over-reliance on x-ray, non-standard treatment regimens, low rates of treatment completion, and lack of systematic information on treatment outcomes. As a result, a Revised National Tuberculosis Control Programme (RNTCP) was designed, incorporating the components of the internationally recommended Directly Observed Treatment Short-course (DOTS) strategy for the control of TB.
RNTCP was implemented in phased manner with nation-wide coverage in March 2006. The spread of Human Immuno-Deficiency Virus (HIV), emergence of various forms of drug resistant TB and unorganised and unregulated vast private sector was recognised to be the main challenges in reducing the disease burden, otherwise as per WHO Global TB report 2019, the incidence of TB reduced from 300/ lakh population in 1990 to 199/lakh population in 2018, and mortality reduced from 76/ lakh population in 1990 to 32 /lakh population in 2018.
Current TB Burden:
|
Estimates
of TB Burden (2019) |
Global (Million) |
India |
%
of Global Burden in India |
|
Incidence
TB Cases |
10 |
2.64 Million |
26% |
|
Incidence
MDR TB |
0.5 |
124,000 |
27% |
|
Mortality
of TB(HIV Negative) |
1.2 |
436,000 |
36% |
|
Incidence
of HIV TB |
0.82 |
71,000 |
8.7% |
|
Mortality
of HIV TB |
0.21 |
9,500 |
4.6% |
The Government of India has committed to achieve the SDG goal of eliminating Tuberculosis in the country by 2025, five years ahead of the Global Target. In light of this ambitious target and to accelerate momentum towards the ultimate goal, an appropriate and representative change in the name of the programme was imperative, and it was decided to rename the programme as “National Tuberculosis Elimination Program (NTEP)” from Revised National Tuberculosis Control Program (RNTCP), on 1st January, 2020.
Brief Note
Political and administrative commitment, good quality diagnosis, uninterrupted supply of best quality anti TB drugs, treatment under direct observation, robust recording, reporting, supervision, monitoring and evaluation strategy, the five key components of erstwhile RNTCP, better known as DOTS, were aimed to reduce the transmission of TB by early diagnosis and effective treatment of (infectious) sputum positive TB cases.
Under the National Health Mission the diagnostic and treatment services of TB not only expanded manifolds, many newer initiatives were undertaken. TB services now offered to even private sector TB patients, development of Standard for TB Care in India, nutritional support to TB patients, case based TB notification system – NIKSHAY, making the TB notification mandatory from medical practitioners, clinics, hospitals, nursing homes, laboratories, addressing TB comorbidities, inclusion of anti TB drugs into Schedule-H1 to keep the track of TB patients through sale of anti TB drugs by chemists, are the key interventions towards realization of the goals and objectives set in National Strategic Plan for Tuberculosis:2017-20a25.
New, approach and interventions integrated into the four strategic pillars of “Detect – Treat – Prevent – Build” are aimed to further accelerate the rate of decline of incidence of TB many fold, to more than 10-15% annually.
Vision: TB-Free India with zero deaths, disease and poverty due to TB
Goal: To achieve a rapid decline in burden of TB, morbidity and mortality while working towards elimination of TB in India by 2025.
Detect
Find all DS-TB and DRTB cases with an emphasis on reaching TB patients seeking care from private providers and undiagnosed TB in high-risk populations.
• Scale-up free, high sensitivity diagnostic tests and algorithms
• Scale-up effective private provider engagement approaches
• Universal testing for drug-resistant TB
• Systematic screening of high risk populations
Treat
Initiate and sustain all patients on appropriate anti-TB treatment wherever they seek care, with patient friendly systems and social support.Prevent the loss of TB cases in the cascade of care:-
• Free TB drugs for all TB cases
• Universal daily regimen for TB cases and rapid scale-up of short-course regimens for drug-resistant TB and DST guided treatment approaches.
• Patient-friendly adherence monitoring and social support to sustain TB treatment
• Elimination of catastrophic costs by linking eligible TB patients with social welfare schemes including nutritional support
Prevent
Prevent the emergence of TB in susceptible populations
• Scale up air-borne infection control measures at health care facilities
• Testing and treatment for latent TB infection in contacts of bacteriologically-confirmed cases and in individuals at high risk of getting TB disease
• Address social determinants of TB through intersectoral approach
Build:
Build and strengthen enabling policies, empowered institutions, human resources with enhanced capacities, and financial resources to match the plan.Translate high level political commitment to action through supportive policy and institutional structures:
• National TB Elimination Board with 4 divisions instead of the current administrative set up at the national level and matching structures at state level
• National TB Policy and Act
• Restructure RNTCP management structure and implementation arrangement: Substantially augmented HR and HR reforms to include unified programme supervisory cadre (merger of STS/STLS/TBHV) and dedicated staff for TB surveillance network in the country
• Scale up Technical Assistance at national and state levels.
• Align and harmonize partners’ activities with programme needs to prevent duplication
Guideline
NTEP is highly technical programme; based on evidences, and guidelines tend to change at shorter intervals. Therefore it is imperative to keep important documents and guidelines accessible to everyone. There is exhaustive list however important ones listed below are available on, https://tbcindia.gov.in/index1.phppage=1&ipp=All&lang=1&level=1&sublinkid=4571&lid=3176
Guideline for Training
i. Training of Trainers (State level) in Revised Guidelines on Programmatic Management of Drug Resistant Tuberculosis, India (March, 2021), 14-18, June, 2021
ii. Training of Community Health Officers of Health & Wellness Centre, June, 2021
iii. Introducing Shorter Oral Bedaquiline containing MDR/RR TB regimen for Drug Resistant Tuberculosis, August 2021
iv. Introducing TB Preventive Treatment under Joint Effort for Elimination of Tuberculosis (JEET Project) in collaboration with William J Clinton Foundation. September, 2021
v. Engaging Patient Provider Support Agency (PPSA)for improving TB notification and quality of care in private sector. 15 districts, October, 2021
Guidance
Document on Community Engagement under National Tuberculosis Elimination
Programme [15383 KB]
Guidelines
for Programmatic Management of Tuberculosis Preventive Treatment in India [12633 KB]
Guidelines
for Programmatic Management of Drug Resistant Tuberculosis in India-2021 [47110 KB]
Operational
Guidelines for TB services at Health & Wellness Centres [22142 KB]
Guidelines
for use of Delamanid for treatment of DR-TB in India [3851 KB]
Guidelines
on HIV and TB interventions in Prisons and other closed settings - Reg [4519 KB]
National
Framework for a Gender-Responsive approach to TB in India_311219 [2875 KB]
National
Strategic Plan 2017-2025 for TB Elimination in India
Guideline for PMDT in India 2017
Technical
and Operational Guidelines for TB Control in India 2016
INDEX-TB
GUIDELINES [3851 KB]
Guidelines for
Use of Bedaquiline in RNTCP PMDT in India
Guidelines
for Prevention and Management of Adverse Reaction associated to Anti TB drug
Guidelines
on Prevention and Management of Tb in PLHIV at ART Centres [602 KB]
GeneXpert
SOP Xpert processing EPTB specimens [136 KB]
SOP for
Extra Pulmonary TB [301 KB]
PMDT guideline [7187 KB]
RNTCP Lab
Network Guidelines [592 KB]
SLD storage
guidelines [127 KB]
Operational
Handbook on Advocasy Communication and socila mobilization for RNTCP [7804
KB]
IEC Material
Key Beneficiaries
|
SL No. |
Schemes |
Description |
|
1 |
Incentive for referral of
presumptive TB patients to public health facility |
·
Rs. 500 to informant for referral of
presumptive TB patient to public health facility, to be paid only on
diagnosis as TB. |
|
2 |
Honorarium to Treatment Supporters:
|
·
Honorarium to treatment supporter to
be disbursed upon completion or cure of TB patient. ·
Rs. 1000 for Drug Susceptible TB
patients ·
Rs. 5000 for Drug Resistant TB
patients (including shorter regimen, MDR and XDR TB patients or as per latest
programme guidelines):- Rs. 2000 for I.P. and Rs. 3000 for C.P. ·
Paid only to such workers who are not
salaried employees ofthe Central/State Government. This would include among
others Anganwadi workers, trained dais, village health guides, community
volunteers, ASHA, private providers, private chemists, family members etc. |
|
3 |
Incentives to Private Providers
for notification and reporting of treatment outcome. |
·
Rs. 1000 will be provided to Private Providers
for notification and reporting of treatment outcome. ·
lncentives will be given in two
instalments:- Rs. 500 at notification and Rs. 500 on reporting treatment
outcome |
|
4 |
Patient support&
transportation charges: |
·
Patients from tribal / hilly/
difficult areas to be provided an aggregate amount of Rs. 750 to cover travel
costs of patient and attendant ·
Travel cost to DR-TB patient to District
DR-TB Centre or Nodal DR TB Centre for diagnosis or follow up as per actual
cost per visit through public transport within district upto Rs. 400/ visit,
outside district upto Rs. 1000/ visit or norms approved by State Health
Society for such visits. |
|
5 |
Nutrition Support to all
notified TB patients of public & private sector under Nikshay Poshan Yojna |
·
Financial incentive to TB patient
through DBT for nutritional support, to prevent catastrophic expenditure
andincentivize treatment adherence. ·
Nutrition support at an @ Rs. 500 per
month till completion of treatment since 01.04.2018 |
Events / News
Health data
| Annual Report 2020 | Public Sector | Private Sector | Total | ||||||
| Indicators* | Target | Achievement | Percentage (%) | Target | Achievement | Percentage (%) | Annual Target | Achievement | Percentage (%) |
| Notification (% Achievement) | 90000 | 51920 | 58% | 100000 | 47516 | 48% | 190000 | 99436 | 52% |
| HIV testing (100% of net Notified) | 54888 | 46051 | 84% | 47265 | 38079 | 81% | 102153 | 84130 | 82% |
| DM testing (100% of net notified) | 54888 | 33681 | 61% | 47265 | 34297 | 73% | 102153 | 67978 | 67% |
| UDST (82% of net notified) | 45008 | 33602 | 75% | 38757 | 23730 | 61% | 83765 | 57332 | 68% |
| NPY (eligible patient % paid at least one incentive) | 53879 | 31992 | 59% | 46746 | 21100 | 45% | 100625 | 53092 | 53% |
| Treatment Success (>90% ) | 77326 | 59455 | 77% | 45652 | 37403 | 82% | 122798 | 96858 | 79% |
