End TB Strategies of INDIA

1. END TB : SAVE LIVES
DR. NILIMA SONAWANE
PhD(N), MPhil, PGDDM, PGDEM, MBA ( Health care Management)
PROFESSOR CUM PRINCIPAL
INSTITUTE OF NURSING EDUCATION, MUMBAI

2. End TB : Save Lives

3. GOLBAL TB BURDEN
• TB is one of the top 10 cause of death worldwide. It is
also the leading killer of people with HIV and a major
cause of deaths related to antimicrobial resistance.
• Estimated 10 million new TB cases diagnosed
worldwide, of which 5.8 million are men, 3.2 million
women and 1 million children.
• People living with HIV accounted for 9% of the total.

4. • Eight countries accounts 66% of the new cases: India, China,
Indonesia, the Philippines, Pakistan, Nigeria, Bangladesh, and
South Africa.
• +1.6 million people died from TB, including 0.3 million among
people with HIV.
GLOBAL TB BURDEN

5. TB BURDEN IN INDIA
• TB continues to be India's severest health crisis.
• Mortality due to TB is the third leading cause of years of life lost
(YLLs).
• TB kills an estimated 480,000 Indians every year and more than
1,400 every day.
• Approximately 5% of the TB cases have co-morbidity with HIV.
• India accounts for 1,47,000 estimated MDR-RR cases which is
24% of the Global cases.

6. WHAT IS TUBERCULOSIS
Tuberculosis (TB) is a potentially serious
infectious disease that mainly affects the
lungs. The bacteria that cause tuberculosis
are spread from person to person through
tiny droplets released into the air via
coughs and sneezes.
Tuberculosis (TB) is caused by a
bacterium called Mycobacterium
tuberculosis.

8. SIGNS AND SYMPTOMS OF ACTIVE TB
•Coughing for three or more
weeks
•Chest pain, or pain with
breathing or coughing
•Coughing up blood or mucus
•Unintentional weight loss
•Fatigue
•Fever
•Night sweats
•Chills
•Loss of appetite

9. INVESTIGATION IN TB
• History
• Clinical Examination
• Mantoux Test or tuberculin test
• X Ray Chest /MRI
• Sputum test

10. MOST COMMON TB DRUGS
DOTS
Directly Observed Treatment Short Course
The most common medications used to treat
tuberculosis include:
•Isoniazid
•Rifampin
•Ethambutol
•Pyrazinamide

11. END TB
• The National TB Programme (NTP) was launched by the
Government of India in 1962
• In 1978, BCG (Bacille Calmette-Guerin) vaccination was shifted
under the Expanded Programme on Immunisation.
• The Government of India revitalized NTP as Revised National TB
Control Programme (RNTCP) in the same year.
• DOTS was officially launched as the RNTCP strategy in 1997 and
by the end of 2005 the entire country was covered under the
programme.

12. • TB was the leading cause of illness and death among
persons living with HIV/AIDS and large number of
multidrug resistant TB (MDR-TB) cases were reported
every year.
• Long term vision of a “TB free India”
• National Strategic Plan (NSP) for TB 2012-2017 the goal
of ‘universal access to quality TB diagnosis and treatment
for all TB patients in the community’.
END TB

13. ‘National strategic plan for tuberculosis elimination
2017-2025’-
RNTCP has released a ‘National strategic plan for tuberculosis
2017-2025’ (NSP) for the control and elimination of TB in India by
2025. According to the NSP TB elimination have been integrated
into the four strategic pillars of “Detect – Treat – Prevent –
Build” (DTPB).

15. Detect
 Notification of TB cases
 NIKSHAY
 Public Private Partnership

16. Treat
 Fixed dose combinations (FDCs)
 For new TB cases
Intensive phase (IP) consists of 8 weeks of
Isoniazid (INH),
Rifampicin,
Pyrazinamide
Ethambutol
Continuation phase(CP) three drug FDCs-
Rifampicin, Isoniazid, and Ethambutol (HRE) are continued
for 16 weeks.

17.  For previously treated cases of TB
Intensive Phase is of 12 weeks, where injection streptomycin is
given for 8 weeks along with four drugs (INH, Rifampicin,
Pyrazinamide and Ethambutol) and after 8 weeks the four drugs
(INH, Rifampicin, Pyrazinamide and Ethambutol) in daily doses as
per weight bands are continued for another four weeks.
Continuation phase Rifampicin, INH, and Ethambutol are
continued for another 20 weeks as daily doses.
Treat

18. On the basis of the drug susceptibility profile, a standard first-line
treatment regimen (2HRZE/4HR) can be repeated if no resistance is
documented; and if rifampicin resistance is present, shorter regimen
for MDR-TB (multi drug resistant TB) regimen should be prescribed
according to WHO’s recent drug resistant TB treatment guidelines.
RNTCP has introduced Bedaquiline CAP for MDR-TB under
conditional access programme in 2016 across six sites, with a country
wide scale up plan in 2017-2020.

19. Prevent
With the objective to prevent emergence of TB in susceptible
population various measures are indicated as:
 Scale up air-borne infection control measures at Health Facilities
 Treatment for latent TB infection
 Compliance to TB Treatment
 Prevent MDR-TB
 Address social determinants of TB through inter-sectoral
approach.

20.  Social Awareness
 Air borne infection control measures
 Contact tracing
 BCG vaccination
 Addressing social determinants of TB
Prevent

21. Build
Health system strengthening for TB control under the National
Strategic Plan 2017-2025 is recommended in the form of building
and strengthening enabling policies, empowering institutions and
human resources with enhanced capacities.

22. Conclusion
• The global public health and TB community is shifting its focus from
control of the TB epidemic towards elimination.
• India has committed to END TB and is at a critical stage with the
national momentum expected to accelerate after the increased
political commitment and heightened community awareness about
public health and hygiene and the threat of communicable disease
following the COVID-19 pandemic.

23. References
• tbcindia.gov.in/index1&lid=3578
• https://www.nhp.gov.in/revised-national-tuberculosis-
control-programme_pg
• https://www.who.int/southeastasia/news/detail/24-03-
2022-world-tuberculosis-day-invest-to-end-tb.-save-lives
• https://communitysupport.nikshay.in/
• https://reports.nikshay.in/Reports/TBNotification#
• https://tbcindia.gov.in/index1.php?lang=1&level=2&subli
nkid=5507&lid=3528

24. END TB , SAVE LIVES