NTEP

National Tuberculosis Elimination Programme (NTEP) Chandigarh

TB is NOW A NOTIFIABLE DISEASE!!!! (Vide letter no. Z-28015/2/2012-TB date 7th May, 2012 of Govt. of India)

Inorder to ensure proper TB diagnosis and case management, reduce TB transmission and address the problem of emergence and drug resistant tuberculosis, it is essential to have complete information on all TB cases. Therefore all health care providers should notify each and every TB case to local health authorities.

Serological Test has been banned by Central TB Division, New Delhi ( Click here to download the copy of letter - Central TB Division, GOI)

• Serological tests available privately banned for diagnosis of tuberculosis!!!!
• Banning on Serological testing

INTRODUCTION

India has had a National Tuberculosis Programme (NTP) since 1962. A comprehensive review of the NTP in 1992 found that the NTP had not achieved its aims or targets. Based on the recommendations of the 1992 review, the Revised National Tuberculosis Control Programme (RNTCP), incorporating the components of the internationally recommended DOTS strategy for the control of TB, was developed. RNTCP has now been implemented in the country for more than a decade, and has been expanded geographically to achieve nation-wide coverage in March 2006. Today, RNTCP is the largest TB control program in the world, placing more than 100,000 patients on treatment every month. Approximately 75 new smear positive PTB cases occur per Lakh population per year. It is also estimated that nationwide, about 2,76,000 people die due to TB annually.
The spread of human immuno-deficiency virus (HIV) during the last two decades, emergence of various forms of drug resistant TB and unregulated vast private sector pose additional challenges in effective TB control.

RNTCP IN CHANDIGARH

In Chandigarh, RNTCP was launched on 25th January 2002. With the consistent efforts of all the heath care workers involved in the program, Chandigarh has been ranking among the top performing states of the country with ever improving case detection rate of more than 90% and among those, the cure rate being more than 85% each year.

• Infrastructure:
  RNTCP in Chandigarh covers the whole UT including the Urban, Rural and Slum population falling under the map by virtue of :
  -3 Tuberculosis Units (TU)
  -17 Designated Microscopy Centres (DMC) + 1 DMC in private sector under Public Private Mix.
  - More than 171 DOTS centers including Government as well as Private DOTS Centres.
• ADMINISTRATIVE SET-UP OF STATE TB CONTROL SOCIETY, CHANDIGARH (click here to view)

Salient Features of the Programme

Chandigarh awarded for Best Performance in TB prevention & control among Union Territories during year 2015 (National summit on Good and Replicable Practices and Innovations in Public Health Care Systems in India , Tirupati , Andhra-Pradesh during 29th  to 31st August , 2016)

Chandigarh awarded Rank 2nd for best performance in control of TB among UTs (National summit on Good and Replicable Practices and Innovations in Public Health Care Systems in India July 02 to 04 , 2015)

• Diagnosis and treatment of Tuberculosis is provided free of cost at all the Government Dispensaries and Hospitals.
• After the launch of the program in Chandigarh, there is consistent improvement in the case detection rate (>70%) and cure rate (>85%).

RECENT ADVANCES IN RNTCP

1. Programmatic management of Drug Resistant Tuberculosis (PMDT):

• DOTS- Plus program has been launched in Chandigarh in October 2010 to address the emerging issue of Drug Resistant Tuberculosis (DRTB). The diagnostic services were launched in Oct 2010 and the treatment services were initiated from Jan 2011.
• DOTS plus site has been created at GMCH-32 for the effective management and treatment initiation of DR-TB Patients.
• For the diagnosis of DR-TB, RNTCP lab at the Microbiology Department of PGIMER- Chd has been accredited for Line Probe Assay (LPA) testing. Liquid Culture facilities for the DR-TB patients is also available under RNTCP in the same lab. FIND (Foundation for Innovative New Diagnostics -India) has been funding RNTCP for all these diagnostic facilities.
• Till date more than 100 DR-TB patients are undergoing treatment in various parts of the city.
  ** Link to PMDT Guidelines May 2012 (Click Here to view the guidelines)

2. TB/HIV Co-infection:
Countrywide, the total prevalence of TB/HIV co-infection is 4-5%. To address this issue, RNTCP and NACP have developed a comprehensive package of services, TB/HIV Intensified Package, for better detection and treatment of co-infected patients. Components of TB/HIV Intensified Package are:
Offer VCT to all tuberculosis patients.

• Provision of CPT to all TB/HIV co-infected patients.
• Refer HIV infected TB patients to ART centre.
• Monitoring and Supervision.
• - In Chandigarh, this TB/HIV Intensified Package of services was launched in April 2010. Since then, RNTCP and NACP are working hand in hand by means of:
• Referral of all TB patients to nearest ICTC for HIV counselling and testing.
• Referral of HIV Positive patient with symptoms of tuberculosis to nearest DMC for sputum testing.
• Provision of CPT to all the co-infected patients.
• Linking all the Co-infected patients to ART centre at PGIMER.
• Joint monitoring and supervision by joint touring of RNTCP and C-SACS officials to various DMCs and ICTCs across the city.
• Till date more than 100 co-infected patients have effectively completed their treatment for Tuberculosis.
• ** LINK TO TB/HIV INTENSIFIED PACKAGE (Click Here to view the guidelines)

3. TB- A Notifiable Disease: From 7th May 2012, TB has been declared as a notifiable disease. For details refer to www.tbcindia.nic.in. Notification of TB Cases - Applicable to all Health Care Providers. Reporting Format(Click here to download)

4. NIKSHAY: It is a web based program wherein the detail of each and every TB patient is entered online.

5. Banning on Serological testing: http://www.tbcindia.nic.in/pdfs/Letter_Serodiagnosis.pdf

• Seven NGOs from different areas of Chandigarh have been signed MOUs.  These NGOs have been involved basically for slum areas in which they will provide DOTS free of cost to TB patients of their respective areas .
• Through sensitization and creating awareness about TB seven NGOs have been involved in Programme i.e.

NGOs Area Of Work Schemes

• YUVSATTA Colony No.4 SlumScheme&AdherenceSheme
• Mother Teresa Home Sector-23 AdherenceScheme
• Pingalwara Charitable Society Palsora AdherenceScheme
• Surya Foundation Vikas Nagar, Maulijagran AdherenceScheme
• Godwine Education Society Hallo Majra Slum Scheme

Bharat Vikas Parishad(Mani Majra) Indira Colony,Mani Majra Transport Scheme

Under slum Shceme , NGOs has to carry out IEC activities & Provide Anti TB  treatment to respective area people free of cost under DOTs and under Adherence Scheme, NGOs has to provide Anti TB treatment free of cost under DOTS.

Ø IMA Doctors Involvement

31 IMA doctors are following the Adherence Scheme with RNTCP wherein they are providing DOTS to patients who are unable to come to the health institution for their treatment. M/s Malhotra Pvt. Ltd. is the working as a private DMC for the convenience of sputum testing under RNTCP. IMA representative and RNTCP officials are regularly touring together to various private medical practitioners working in the city

• Supervision and Monitoring

Yearly Internal Evaluation of the program is done regularly, according to the guidelines of CTD. Quarterly review meeting of the program is carried out under the chairmanship of Mission Director.Monthly meeting of the Medical officers of DMCs is conducted by STO to review the individual performance and achievements of RNTCP in their respective DMCs

Ø IEC Activities

Frantic IEC is used for the awareness regarding the disease and the program among the general public.IEC activities are held in each nook and corner of Chandigarh in a phased and planned manner. Various activities that are being undertaken to spread the awareness are:

• Wall paintings at prominent places in the community.
• Performing Street Plays. - Magic Shows.
• Audio Visual media- Documentaries on Tuberculosis.
• Health fares.
• Informative Lectures at prominent community places.
• Information pamphlets and Booklets on Tuberculosis and RNTCP in Chandigarh.
• Slum Intervention Committee has been formed to cover exclusively the slum population.

• Active involvement from the community is enhanced through Community meetings and Patient Provider meetings. This also provides a platform for addressing the patient issues regarding treatment, if any.

Apart from this, NGOs, Private Practitioners, Social Activists etc have also been actively involved in the program.

Special Campaign undertaken under the program

Ø World TB Day is celebrated every year to generate awareness.  All segments of Society are involved in the program.

• Special Slum Intervention Scheme has been launched in slum intervention.
• Informative & Educative Exhibitions are installed during Health Melas.
• Special Meetings were organized in Schools located in slum areas and staff members were addressed to sensitized them about symptoms of TB & availability of diagnosis and treatment free of cost at every Govt. Health Institution

Innovations

• Self addressed post cards are given to each patient who is being referred out of Chandigarh for intimation regarding the start of treatment.
• Self inking stamps for the OPD cards with message of TB has been circulated among the dispensaries.
• Pamphlets in Hindi, Punjabi and Urdu are being circulated.
• Wall paintings in Urdu on the message on Tuberculosis have been developed at Mosque in Mani Majra and Bapu Dham colony for the Urdu speaking population.

Zoning of Tuberculosis Units

Activities photographs/Videos

• Photographs are being enclosed and the Video i.e. Documentary on TB is available with the RNTCP Office.

Contact Details of Programme Officer :

Dr. Rajesh Rana
Programme Officer-RNTCP
GMSH, Sector 16, Chandigarh