Revised National TB Control Programme

1. Revised National TB Control Programme

2. Content • State TB Score • Community Engagement • Private Sector Engagement • HR vacancy

3. State tb score indicators total score 100

4. National status

5. State tb score (jan – jun 19)

6. 1. TB Notification % of Target achieved in TB notification

7. Change in TB notification rate (2019 v/s 2018) Significant reduction in TB notification as compared to 2018 in Lakshdweep, Manipur, Sikkim,Jammu & Kashmir, Arunachal Pradesh Significant increase in TB notification as compared to 2018 in Telangana, Delhi, Chandigarh, Puducherry, Uttarakhand

8. Pointers to improve notifications • Establish microscopy centres at PHCs – Make microscopes and laboratory technicians available. • Establish sample transport system • Take up active TB case finding among high risk groups. • Make X-ray facilities available under the free diagnostics initiative or through other measures. • Enforcement of mandatory TB notification and Schedule H1 • Operationalization of PPSA for private sector engagement

9. 2. HIV testing % of patients with known HIV status

10. 3. Universal Drug susceptibility testing % of eligible TB patients tested for UDST

11. Pointers to improve DST • Establish robust sample transportation system both in public and private sector • The state may consider any of the sample transport mechanism like hub and spoke, PPP, postal services, human carrier etc. • State may do flexible mapping of catchment area of the CBNAAT laboratory and manage LT and logistics accordingly

12. 4. Treatment success rate % of treatment success rate *DS TB patients notified during Jan to June 2018

13. Pointers to improve treatment outcome • Review and address the gap in treatment initiation • Follow up of TB patients to be ensured by the STS • Treatment outcome reporting to be ensured in NIKSHAY for patients in public and private sector

14. 5. Nikshay Poshan yojana % of eligible beneficiaries paid

15. Pointers to improve npy • Update payment status in NIKSHAY for payment made externally by 30thSep 2019 • Payment to be done only through NIKSHAY. • Verify bank account details as intimated via risk assessment report and take corrective actions • Prepare for Aadhaar seeding and Aadhaar authentication • For acceleration of payment, following actions to be undertaken • Centralized payment from a state level account. • Authorize DTOs as PFMS users to reduce delays. • Use of digital signatures to obviate the need for physical PPA and further reconciliation • State/UT with < 60% bank account seeding • Delhi, Goa, Bihar, Sikkim, Telangana • States/UTs with <40% amount paid out of amount of payable • Delhi, Bihar, Sikkim, Goa, Nagaland, Rajasthan, Mizoram, Chandigarh, Uttar Pradesh, Manipur, Meghalaya, Maharashtra

16. 6. % of MDR patients put on treatment % MDR patients initiated on treatment

17. Pointers to improve management of DR-TB • Revised guideline for DR TB management 2019 - status • Implemented in 3 states – Kerala, Puducherry, Tamil Nadu • Waiting for the approval - 3 states Gujarat, Karnataka, Delhi • 8 states have completed state level trainings • Operationalize district level DR-TB centres • Make pre-treatment investigation available free at district level • Ensure travel support to DR-TB patients • Establish linkages of DR-TB patients diagnosed in private sector to DR-TB centres

18. 7. Chemoprophylaxis to contact children • Ensure visit of all TB patients by STS for contact investigation • Sensitize all Medical Officers to get contacts’ history about symptoms and record in treatment card at time of treatment initiation • Ensure smooth supply of INH to all PHCs to provide preventive treatment Top 3 States – Puducherry (98%), Tripura (91%), Andaman & Nicobar (90%)

19. 8. TB Preventive treatment to Plhiv • Joint monitoring by SACS and STC • Bi-directional information flow • Ensure availability and supply of INH and Pyridoxine at all ART centres Top 3 States – Gujarat (76%), West Bengal (53%), Jammu & Kashmir (51%)

20. 9. Expenditure on tb • Expedite release of funds from treasury to State NHM • Expedite release of funds to districts • Monitor line time wise expenditure at all level Top 3 States – Manipur (39%), Nagaland (35%), Gujarat (32%)

21. Private sector engagement Provider Patient Provider Support Agency (PPSA) RNTCP Patient

22. Private sector engagement Provision of RNTCP FDC to TB patients notified from private sector DST among TB patients notified from private sector Top 3 States (>=50% DST) Top 3 States (>=10% FDC) Bottom 3 States (=<5%DST) Bottom 3 States (<1% FDC) All Group 2 and 3 (except Delhi) have not provided RNTCP FDC

23. Community engagement Status of TB Forum – for community engagement • All States have constituted State TB forums • 675 district TB forums have been constituted

24. Laboratory HR transition

25. Vacancy Position

26. Vacancy Position

27. Vacancy Position

28. Vacancy Position

29. Dashboard for TB score

30. TABLE VIEW: Allows user to monitor performance of tb index & other important tb indicator across states Available soon on  https://reports.nikshay.in/

31. MAP VIEW: Allows user to track the performance of individual indicator across states

32. MAP VIEW: On selection, single state in the table will be highlighted for further drill down to district level

33. MAP VIEW: for a selected state, district level performance will be available for each tb indicator

34. Key priorities • States to prepare and launch their TB Elimination Plan • So far: Kerala – 2020; Himachal Pradesh – 2021; Sikkim & Lakshadweep – 2022; Tamil Nadu – 2025; Chhattisgarh – 2025 • Latent TB Management – Contacts, PLHIV and HRGs • Strengthen delivery systems –Use health systems approach • e.g. – largely only TB staff is engaged in DBT work which is an administrative function. • Seek support for additional HR\ Male MPW • Fill up vacancies

35. Key priorities • Prepare for Sub-national certification of TB free status. • Aadhar seeding and authentication of TB patients • Implementation of all oral regimen for DRTB • Rate contracts for diagnostics and drugs (specially for DRTB)

36. Thank you