NTEP(Prevent)

2
AIR BORNE INFECTION CONTROL
• Acute respiratory infections are the leading cause of morbidity and mortality
from infectious diseases worldwide

3
 • Cough etiquette not being followed

CHALLENGES
• Indiscriminate spitting
• Sneezing without covering face
• Alcoholics and mentally challenged patients
• Delay in reaching health facility for specific diagnosis

Social Habits

At
Community
Level
• Migrant population, backward
areas, and tribal pockets
• Old age homes, poor homes,
children’s homes, jails, hard-to- Special Groups
Environmental • Environmental
Aspects
reach areas pollution
• Delay in diagnosis of a co-
morbid condition like DM, HIV,
Cancers, etc.
4
CHALLENGES

At Institutional Level

Outpatient In Patient
Facility Facility

1. Cough screening, separation, fast

1. Patient with chest infection at tracking, mask and counselling
outpatient settings provision missing
2. Overcrowding – mixing of patients 2. Infectious patient getting admitted
in queues and waiting areas at general wards
3. Poor ventilation in the facilities 3. Cough etiquette not followed in
wards
4. Overcrowding in the wards- no
restricted enteries

5
Solution at Institutional Level
• Certification of Health facility for AIC Compliance
• Develop cough corners/counters - Cough screening, separation, fast-tracking, mask and
counseling.
• Posting of specific staff for fast-tracking and providing masks
• Providing N 95 masks to the Hospital staff in High-risk settings
• ACSM at OPD and other settings like Posters, Clippings, etc
• Implementation of AIC in all settings
• In-house AIC complaint facility for treating nomads, destitute, and homeless patients
• Separate IP facility for bacteriological-positive DS/DR TB patients and other airborne
infectious patients in major institutions
• Proper infection control measures in ART centers.
• Proper follow-up of daily reported cases
6
• Proper disposal of sputum and infected materials
• Early diagnosis and initiation of treatment
• PPE for concerned staff
• Wet mopping and disinfection
• Periodic screening of staff
• Proper ventilation, renovation if necessary
• Facility risk assessment and reporting
• Periodic training
• Ongoing monitoring dashboards/checklists for AIC practices at all levels.
• Community Level- LSG, PHI field staff
• Institutional level- Nurses, heads of institutes
7
CONTACT TRACING
• It is a component of active case finding.
• End result expected is that most TB patients have their contacts
screened, with secondary case detected and treated.
• Contact investigation should be done for-
• 1. All close contacts, especially household contacts will be screened for TB
using Chest X Ray
• 2. In case of paediatrics TB case, reverse contact tracing should be done.
• 3. Particular attention will be paid to contacts with highest susceptibility to
active TB infection.

8
• The highest priority contacts for active screening are-
• 1. Person with symptoms suggestive of TB infection
• 2. Children aged <6years
• 3. Contacts with known or suspected immune-compromised patient,
particularly HIV infection.
• 4. Contacts with DM
• 5. Contacts with other higher risk like pregnancy, alcoholics and smoker etc.
• 6. Contacts of patient with DR-TB

9
LATENT TB INFECTION
• The lifetime risk of reactivation of LTBI in healthy HIV-uninfected individuals is
10%, with 5% developing TB disease during the first 2-5yrs of infection
• Risk of reactivation is increased in
• Immunosuppressed patient
• Patient with HIV infection
• The risk group that will be prioritized for screening investigation to rule out TB
and treatment are-
1. People living with HIV
2. Child PTB contacts
3. Patients with silicosis
4. All patients where clinically indicated like patients in immunosuppressants
5. High-risk adult contacts

10
LTBI Treatment
• It is recommended that key population groups should receive treatment for latent
TB
• Currently 3 regimens are recommended:
 INH daily or twice weekly for 9 months
 INH plus rifapentine once weekly for 12 weeks
 Rifampicin or rifabutin daily for 4 months (with this regimen DOTS must be used)
• WHO recommends other 2 regimens also:
 INH + Rifampicin daily for 3 or 4 months
 INH daily for 6 months
• Due to adverse events with INH, it was recommended that in patients without
contraindication, Rifampicin is likely to be the safest TB treatment option

11
TB PREVENTIVE THERAPY
• In 2022, introduction of TPT was done in states and districts after release of
guidelines for programmatic management of TPT (PMTPT) in India in August 2021
by Hon’ble Union Health Minister.
• By the end of 2022, 722 districts(94%) have expanded TPT as per national
guidelines. (246 districts have developed TBI testing services and 476 districts
have expanded TPT in eligible HHC after ruling out active TB)
• Global funds supported TPT model projects- JEET2.0 & Axshya Plus
• These are implemented by non- government principal recipients(WJCF, FIND and the Union)
and their sub-recipients in 194 districts in 22 states.

7
21

12
13
TB PREVENTIVE THERAPY

Target Population Therapy

• People living with HIV • 6 months daily INH (6H)
 Adults and children > 12 months
 Infants < 12 months with HIV in • 3months weekly isoniazid and
contact with active TB rifapentine (3HP) in persons older
• HHC < 5yr of contact with PTB patients than 2 yrs
• HHC of 5yrs and above with contact • 3HP
with PTB patients • 6H
• Children/ adult on
immunosuppressive therapy, silicosis, • 3HP
anti-TNF treatment, dialysis, • 6H
transplantation

14
CONTRAINDICATIONS OF TPT
• Active TB disease (absolute)
• Acute or chronic hepatitis
• Concurrent use of other hepatotoxic medications (such as nevirapine)
• Regular and heavy alcohol consumption
• Signs and symptoms of peripheral neuropathy like persistent tingling, numbness
and burning sensation in the limbs
• Allergy or known hypersensitivity to any drugs being considered for TPT

15
• Following are not a contraindication for TPT
• Pregnancy
• A previous history of TB

16
Choice of Drug

TPT initiated by
Medical Officer 6H

Inform to LTBIC so that

3HP they can conduct their
follow-up visits

17
Dosage of 3HP Regimen

18
Dosage of 6H Regimen

19
Algorithm for TB Screening and TPT
HIV positive Household contact Other risk group 3

Any symptom1 of Symptomatic?2

current cough or fever or weight loss or
night sweats
YES NO

NO YES <5 years 5 years +

Investigate for active TB

No active TB TST or IGRA

Preventive treatment
Positive or unavailable Negative
contraindicated?4

Abnormal
YES NO CXR6
Normal or
unavailable
Defer preventive Give preventive treatment5
treatment

Follow-up for active TB as necessary, even for patients who have completed preventive treatment 20
21