This document summarizes information from various reports on tuberculosis (TB) standards of care and organizational structure for TB treatment in India and Mumbai. It finds that while TB rates are declining globally and in some countries and regions, India still accounts for a large proportion of global TB cases. It outlines the Revised National Tuberculosis Control Programme (RNTCP) phases and 12th five year plan in India, and notes ongoing challenges around engaging private providers, ensuring consistent drug supplies, and reducing high mortality rates. The document also provides statistics on TB cases and deaths specifically in Mumbai.

1. “Standards for TB care in India,
RNTCP Challenges & Organizational
Structure in MCGM”
PG Student : Dr Amol Kinge
PG Guide: Dr Kamaxi Bhate

2. In This Seminar
 Findings of Global TB report, Annual TB
report 2015 India, MCGM Annual TB
Statistics.
 Standards of TB care in India
 Organizational structure of TB care in
MCGM

3. In this Presentation
 Introduction
 Global Scenario of TB
 Indian Scenario of TB
 Statistics of TB in Maharashtra
 Statistics of TB in Mumbai
 Public Health concerns

4. Introduction
 TB was declared as a global health
emergency in 1993
 RNTCP as a Pilot project: 1993
 RNTCP Phase-1: 1999–2006
 RNTCP Phase-II: 2006-2011
 TB: A leading cause of Death in PLHIV
 Five year plan of “TB Free India”

5. Global TB report
 From 205 countries and territories (>99% of the
world’s population)
Main findings and messages:
 Advances: TB mortality has fallen 47%
 The MDG target: Achieved on a worldwide
basis, in each of the 6 WHO regions and in 16 of
the 22 high-burden countries that collectively
account for 80% of TB cases.

6. Global TB report
 Globally, TB incidence has fallen by an
average of 1.5% per year since 2000 and
is now 18% lower than the level of 2000.
 In 2014, TB killed 1.5 million people
(1.1 million HIV-negative and 0.4 million
HIV-positive).
 Men: 890 000 men, Women: 480,000
and 140,000: Children.

7.  Of the 9.6 million new TB cases in 2014,
58% were in the South-East Asia (SEAR)
and Western Pacific regions.
 India, Indonesia and China had the
largest number of cases: 23%, 10% and
10% of the global total, respectively.
 From 2016, the Goal is to end the global
TB epidemic by implementing the End TB
Strategy.
Global TB report

8.  The Target of Halving the TB Mortality rate
by 2015 (compared with 1990) met in 4
WHO regions
- The Region of the Americas,
- The Eastern Mediterranean Region,
- The South-East Asia Region,
- The Western Pacific Region &
Global TB report

9.  All three of the 2015 targets (for
incidence, prevalence and mortality) were
met in:
Brazil, Cambodia, China, Ethiopia, India,
Myanmar, the Philippines, Uganda and
Viet Nam.
Global TB report

10. India
 India: 2nd most populous country
 Accounts for a Quarter of the world's annual
incidence of TB.
 Every year in India:
2 million- Develop TB in India &
300,000- Die of TB.
 Treated: Over 15 million patients and
 Lives saved: 3 million,
by the Revised National TB Control
Programme (RNTCP) over the last decade.

11. Statistics-2014
 In 2014, RNTCP covered a population of
12,656 lakh.
 TB suspects examined by sputum smear
microscopy: 87.83 lakh
 Cases Registered for treatment: 14.44
lakh
 Registered TB cases Knowing their HIV
status: 72%
 HIV infected TB patients were initiated on
CPT: 94%
 Initiated on ART: 91%

12. Making TB a notifiable
disease in India
With the aim of improving the collection of
patient care information, in 7 May 2012
India declared TB to be a notifiable disease.

13. Indicators

14. Burden of Tuberculosis

15. Case finding activities & Notification
rates

19. 12th Five year Plan (2012-17)
 Budget: 4500 Crore
 Theme: Universal Access for Quality
Diagnosis & Treatment for all TB patients in
the community and a target of “Reaching
the Unreached”.
 Goal: “Universal access to TB care and
treatment for all”
 Vision 2020: To significantly reduce TB
burden in India by ensuring universal access
to quality assured TB care as per Standards
for TB Care in India (STCI).

20. Contd…
 To ensure Notification of all TB cases in
Nikshay (incremental step to close the gap
of missing TB cases in India)
 13,000 microscopy centers for sputum
smear microscopy and Culture and DST
laboratories.
 62 RNTCP certified Culture and DST
laboratories in the country which includes
laboratories from Public sector (IRL, Medical
College), Private and NGO laboratories.

21.  Currently 89 Cartridge Based Nucleic Acid
Amplification Test (CBNAAT)
 sites provide rapid decentralized diagnosis of
MDR-TB, TB in high risk group PLHIV and
Pediatric presumptive including EP-TB case
 First National anti TB Drug Resistance Survey
(NDRS) is being conducted across 120 TB
Units in the country and will test drug
resistance to drugs other than Rifampicin and
Isoniazid.
Contd…

22. Successful Partnerships
 Indian Medial Association (IMA),
 Catholic Bishops’ Conference of India
(CBCI),
 Foundation for Innovative New Diagnostics
(FIND),
 World Vision, The International Union
against Tuberculosis and Lung Diseases
(The UNION) &
 The Clinton Health Access Initiative (CHAI)

23.  More than 330 Medical Colleges are
involved with RNTCP through the task
force mechanism and are contributing in
diagnosis, management and formulating
policies for the program.

28. Mumbai
 37,501 people died due to
TB (Since last 5 years)
 21 Deaths / day (Since
last 5 years)
 6496 Deaths (2014-15)
 Every year TB has killed
8.08 Mumbaikars

32. Public Health Concern
 The decline in TB incidence: Slow
 Mortality- Unacceptably High and
 Emergence of Drug-Resistant TB: Major
public health concern.
Challenges:
 Prompt, accurate diagnosis and effective
treatment of TB.
 Uninterrupted supply of Drugs
 Engaging the private sector effectively.

33. Private sector health care
 A source of mismanagement of TB and
hence of drug resistance.
- Use of incorrect Diagnostics
- Incorrect regimes
- Lack of supervision
- Lack of regulation for over the counter
drugs for TB

34.  There are many reasons why people in
India seek care from the private sector.
These include:
- poor knowledge about TB
- poor knowledge about services available
through the national programme
- the convenience of services
- a desire for confidentiality
- a desire for personalized care.
Private sector health care

35. TB drug supplies in India
 More than 1.5 million people currently
receive free drugs at the 13,000 Indian
government centres.
 In June 2013 reported shortages of the
Paediatric doses used to treat children
with TB.
 Drug shortages: Rifampicin, streptomycin
and kanamycin

36. “Many people are unaware that all the
medicines needed to treat TB patients are
available free of cost at Indian government
hospitals. Most people tend to spend huge
amounts in private hospitals.”
-Bhalchandra Chorghade (Sr Correspondent
DNA)

37. References
 National Strategic Plan for Tuberculosis
Control 2012–2017; RNTCP
 TBFACTS.ORG; Information about
Tuberculosis
 TB India 2015; Annual Status Report
 Global Tuberculosis Report 2015 by WHO
 Standards for TB Care in India Manual by
WHO.

38. THANK YOU…