National TB Elimination Programme
Overview - Key Priorities
Vikas Sheel
Joint Secretary - Health
Ministry of Health and Family Welfare
What is Tuberculosis?
Tuberculosis (TB) is an infectious disease caused by the bacterium Mycobacterium
tuberculosis (MTB) which generally affects the lungs, but can also affect other parts
of the body
Risk factors:
o Malnutrition o Overcrowding
o Diabetes o Inadequate
o HIV infection ventilation
o Poor immunity o Enclosed living/
o Severe kidney disease
working conditions
o Other lung diseases
o Occupational risks
e.g. silicosis
o Substance abuse etc.
One patient with infectious
pulmonary TB if untreated can
infect 10-15 persons in a year
TB Notification under NTEP
35
30 28.8 28.7
27.4 26.9 26.4
25 24.04 lakhs
23.2
21.5 lakhs
20 6.8 lakhs (28%)
18.3 lakhs 5.3 lakhs (25%)
3.8 lakhs (21%)
15 12% increase in
case finding
18% increase in
10 case finding
16.1 lakhs (75%) 17.2 lakhs (72%)
14.4 lakhs (79%)
5
0
2017 2018 2019
Public Private
NTEP Target Incidence Estimate (WHO Global Report)
3
Sustainable Development Goals (SDG)
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)
TARGETS
INDICATORS
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
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 13th March, 2018
• The campaign calls for a
social movement focused on
patient-centric and holistic
care driven by integrated
actions for TB Free India
More & more States committing to Ending TB
Chhattisgarh
Tamil Nadu
State level commitment 14
State/UT
2020- Kerala
2021- Himachal Pradesh
2022- Gujarat,
Himachal Pradesh Kerala
Lakshadweep & Sikkim
2025- Bihar, Chhatisgarh,
Daman & Diu and Dadra &
Jharkhand
Nagar Haveli, Jammu &
Lakshadweep Kashmir, Jharkhand,
Madhya Pradesh,
Puducherry, Tamil Nadu
and Andaman & Nicobar
Islands
National Strategic Plan (2017-25)
Strategi
es Private
Community
sector
Engagement
engagement
Preventive Active Case
Measures Finding
ICT Tools for TB
adherence and Co-
monitoring morbidities
Multi-
Drug
sectoral
Resistant TB
response
7
Organizational structure
Supporting Facilities
National Reference
Laboratories (6)
Intermediate Reference
Laboratories (31)
Culture and DST Laboratories
(81 including IRL/NRL)
CBNAAT Laboratories (1268)
DRTB Centres- 703
Key Services
1. Free diagnosis and treatment for TB patient
2. Public health action- contact tracing, testing
for co-morbidities etc.
3. Treatment adherence support
4. Nutrition assistance to TB patients (DBT-
Nikshay Poshan Yojana)
5. Preventive measures
Strengthening Case Finding in the Public Sector
ACTIVE APPROACH TO CASE FINDING
PASSIVE APPROACH TO CASE FINDING
Intensive Case Finding in Health
facilities- Screening for TB among:
Chest X Ray: -DM patients increased from 11.5 L
Clinically diagnosed TB in 2018 to ~20 L in 2019
increased from 8.8 lakhs in - ICTC/ART referrals increased from
2017 to 12.7 lakhs in 2019 3.35 L in 2017 to 3.94 L in 2019
Revised Diagnostic Active Case Finding in vulnerable
population: from 5.5 crore
Algorithm for TB: population screened in 2017 to 28
Increase in DR-TB cases crores screened in 2019. Yield
from 38,000 in 2017 to increasing from ~27,000 to
~63,000 TB patients.
66,000 in 2019
Upfront Rapid Molecular
Testing: Increased from 5.23 Leveraging Outreach of other
Healthcare Programmes: 8.3 lakhs
lakhs upfront tests in 2017 referrals from Health & Wellness
(16% yield) to 11.34 lakhs in Centres .
2019 (17% yield)
Strengthening Case Finding in the Private Sector
Schedule H1 Implementation: The number of
chemists registered in Nikshay increased from
15221 in 2017 to over 43000 chemists notifying
20,609 TB cases in 2019.
Mandatory Notification of TB: Gazette 77% Increase
in private
notification issued in March 2018; Provisions sector
of Sections 269 and 270 of the Indian Penal notification
Code (IPC) in 2019 from 3.8
lakhs in 2017
to 6.8 lakhs in
2019.
Patient Provider Support Agency through JEET and
Domestic Resources: From 48 PPSAs in 2017 to 220
PPSAs in 2019 and 266 PPSAs in 2020.
Treat
●
IT Enabled
Reduce
Daily Out-of-
Regimen
Patient
●
●
Financial incentives
Adherence Support
Treatment
●
●
Directpocket
Shorter Regimen
Benefit
Comorbidity
Centric
Transfer Care
●
Newer Drugs
Expenditure
management
Direct Benefit Transfer (DBT) schemes
1. Honorarium to Treatment Supporters – For provision of
treatment support to TB patients (Adherence, ADR
monitoring, counselling @Rs.1000/- to Rs.5000/-)
2. Patient Support to Tribal TB Patients (Financial Patient
Support @Rs750/-)
3. Nutritional Support to All TB patients (Financial Support to
Patients @Rs.500/-month)
4. Incentives to Private Providers (Rs.500/- for Notification &
Rs.500/- for reporting of Treatment Outcome
5. Incentives to Informant (Rs. 500/- is given on diagnosis of TB
among referrals from community to public sector health
facility)
Prevent
• Air borne infection
control measures
• Strengthen Contact
Investigation
• Preventive
treatment in high
risk groups
• Manage Latent TB
Infection
• Address
determinants of
disease
Paradigm shift in management of
Drug Resistant TB
Shorter MDR TB regimen
MDR-TB Success Rate
70%
66,308
Shorter MDR TB
60% Regimen 0.6
BDQ Containing regimen
50%
46% 47% 47% 48% 12589
40%
30%
2016 2017 2018 2019 Dlm Containing regimen
Conventional MDR Regimen 445
Shorter MDR Regimen
All oral longer regimen
DR-TB Success Rate (MDR 4072
with additional resistance &
XDR) All Oral Longer Regimen Launch by AS&DG,
70% Bedaquilline Jharkhand (Jan 2020)
0.66
60% (CAP)
50%
40%
30% 36%
28% 31%
20%27%
2016 2017 2018 2019
Conventional XDR
Regimen
Multi-sectoral Engagement
TB care services in Socio-economic
health support &
infrastructure Empowerment
Infection
Information
Prevention
Education
Address
Communication
Determinants
Corporate
Prevention and
Social
Care at Work Place
Responsibility
TB - A social problem & needs multi-sectoral approach
Inter-Ministerial Coordination
AYUSH (Ayurveda, Yoga & Naturopathy, Unani, Siddha and
Homoeopathy)
• 1st meeting of National Technical Expert Group on NTEP-AYUSH Collaboration &
e-consultation of experts held
• 2nd draft of Policy Document and Joint Letter drafted
Railways
• Joint Working Group to be formed to monitor implementation
Defence
• Action Plan developed.
• 95 Ex- Servicemen Contributory Health Scheme (ECHS) Polyclinics registered in
Nikshay, remaining underway
Labour and Employment
• MoU signed in September 2020
Community Engagement
TB Forums at the National, State
Transformation of TB survivors to TB and District level to provide a
platform for all stakeholders,
champions including the community, to voice
Capacity building and mentoring their views
programme
Engagement of existing community
groups like PRI, SHG, VHSNC, MAS,
Youth Club
Grievance redressal mechanism
Involvement of community
representatives in different forums
Call Centre- Nikshay Sampark
1800-11-6666 Nikshay
Poshan
Outbound & Inbound Yojana
Time – 7 to 11 Inform Counse
Languages – 14 ation lling
100 call centre agents
TB
Treatment
Pan-India coverage Notificatio
n
Adherence
Citizen – Patient - Providers Follow Grievance
Up Redressal
Policy Update in RNTCP, 2018
Sub-National Disease Certification
District
Award Criteria Monetary
Decline in incidence Award for
rate compared to 2015 District (in Accelerate efforts
Rs.)
Bronze 20% 2 lakhs
Silver 40% 3 lakhs
Gold 60% 5 lakhs
TB Free 80% 10 lakhs Contextual strategies
Status
State
Generate healthy competition
Award State/Uts with State/Uts State/Uts
population (population population
<50 lakh 50 lakh – 5 Cr >5 Cr
Bronze 10 lakhs 15 lakhs 25 lakhs
Silver 20 lakhs 35 lakhs 50 lakhs Monetary and non-monetary awards
Gold 40 lakhs 60 lakhs 75 lakhs
TB Free 60 lakhs 75 lakhs 1 Crore
Status
State TB Index
Policy Update in RNTCP, 2018
Key Challenges
1. Under reporting and uncertain care of TB patients in
private sector
2. Reaching the unreached – Slums, Tribal, vulnerable
3. Drug Resistant TB
4. Co-morbidities – HIV, Diabetes
5. Undernutrition, overcrowding
6. Lack of awareness and poor health seeking behaviour lead
to delay in diagnosis
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
• 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
Bending the Curve
Accelerating towards a TB free India
Thank You
Thank You
