Medical College Task Force Workshop on NTEP

1. Establishment and responsibilities of DR-TB centers
in medical college
Dr Sandeep Chauhan
National Consultant DR-TB
WHO NTEP Technical Support Network
Central TB Division, MoHFW
chauhans@rntcp.org, 94284 20424

2. Gazette notification
• “Every Teaching Hospital should have Anti-Retroviral
Treatment (ART) Centre and facility for management of
MDR-TB by the time of 3rd renewal (admission of 4th Batch
of MBBS students)” – October 2020
Medical colleges : Valuable resources for India
• Clinical expertise and capacity to manage difficult-to-
treat DR-TB cases
• Educating future generation of doctors
• Advocacy media and role models for private sector
• Advocacy with professional associations like IMA, IAP,
IAPSM and FOGSI etc.
https://www.nmc.org.in/e-gazette/gazette-minimum-requirements-for-annual-m-b-b-s-admissions-regulations-2020

3. D.O. letters from Ministry of HFW, GoI
A D.O. letter from the Medical Education Division, Ministry
of Health & Family Welfare, GoI to the Secretary, National
Medical commission to ensure establishment of DR-TB
centres in all the medical colleges.
A D.O. letter from the Joint Secretary (NTEP), Ministry of
Health & Family Welfare, GoI to the Principal Secretary
Health (All states/UTs) and Principal Secretary Medical
Education (All states/UTs) to ensure the establishment of
DR-TB centres in all the medical colleges.

4. D.O. letter from Joint Secretary, GoI dated 14th Jan 2021 (Annexure)…1
Infrastructure
• Normative amount as per “Norms and basis of costing” for NTEP for
infrastructure upgradation
Human
resource
• Provision of one each
• MO-medical college, TBHV, LT for TB detection centre (TDC)
Linkage for
diagnosis
• Linkages for specimen collection and transportation
Capacity
building
• Training on NTEP/PMDT guidelines and Ni-Kshay
NHM provisions for DR-TB facilities in medical colleges

5. D.O. letter from Joint Secretary, GoI dated 14th Jan 2021 (Annexure)…2
Drugs and
logistics
• Supply of diagnostic logistics (sputum cups, conical tubes, packaging materials, cartridges/chips if NAAT available etc.)
• Stock of FL and SL drugs including drugs for TPT, Support for ancillary drugs by linkages with General Health System
Patient
support
• Identification of treatment supporters
• NPY benefits to the patients
Recording and
reporting
• Provision of recording and reporting formats and registers and access to Ni-Kshay
Financial
support
• Payments as per the partnership options
NHM provisions for DR-TB facilities in medical colleges

6. Establishment of N/DDR-TBC
Nodal DR-TB Centre (NDR-TBC)
• Manage all forms of DR-TB,
including the complex forms
• Generally, in tertiary care
setting where expertise and
facilities for management of
complex DR-TB patients are
available
• Initiate all DR-TB regimens
District DR-TB Centre (DDR-TBC)
• May be established in institutes like medical
colleges, district hospitals, TB hospitals and
private or corporate institutes
• More than one DDR-TBC can be established to
improve access
• Initiate H mono/poly DR-TB, shorter oral
Bedaquiline-containing MDR/RR-TB regimen or
longer oral M/XDR-TB regimen provided the
centre does have expertise
• Checklist for establishing DDR-TBC can be found
Annexure 1, guidelines for PMDT in India 2021

7. Checklist for DR-TB centre
• Annexure 1 in Guidelines for
PMDT in India – 2021
• Medical colleges may assess their
respective facilities

8. Requirement from the institution for establishment of N/DDR-TBC
 Preferably a tertiary/ secondary care institute
 Free of cost PTE & other services (may be procured under partnership options)
 AIC-compliant wards for male and female patients
 An AIC-compliant outpatient clinic and a separated well-ventilated waiting area
 N/DDR-TBC committee with relevant in-house specialists/ honorary members
 Availability of oxygen and ventilators for critical care support
 All experts are to be trained in the latest PMDT guidelines
 Ancillary drugs to be provided for the management of ADRs at no cost to patients
 Nursing and support staff should be available from the institute
 Records and reports to be maintained for PMDT
 Ni-Kshay entries to be done on real-time basis
 Financial requirements to be availed through institute/ state budgets or NHM

9. Provision under NTEP for establishment of N/DDR-TBC
 Existing MO-DTC or MO-medical college will provide support to the physician serving as
nodal officer of the DDR-TBC
 Remuneration of Senior Medical Officer (SMO), Statistical Assistant (SA) and counsellor as
approved in the PIP for Nodal DR-TBC.
 Senior DR-TB TB-HIV supervisor to maintain records and reports including Ni-Kshay entry
for DDR-TBC, while SA of NDR-TBC to maintain the same for NDR-TBC
 Training concerned staff
 Computer/ internet facility and Ni-Kshay login ID
 Logistics, including 12 lead automated ECG machines and drugs
9

10. Functions of N/DDR-TBC
• Pre-treatment evaluation (PTE)
• Providing counselling to patients and family members
• Treatment initiation
• Follow-up monitoring
• Management and monitoring of adverse drug events
• Recording and reporting
• Airborne infection control
• Nutritional assessment
• Mental health support
• TB intensive respiratory care support (TB-IRCU)
• Palliative care

11. DR-TB centre committee
• A DR-TB centre committee is different from the medical college core committee
• A committee of clinicians under the chairpersonship of head of the institute
• Vice chair-person should be head of the department of respiratory medicine or general
medicine as applicable
• Members should include head of the departments of the institutes especially microbiology,
pediatrics, pharmacology, cardiology (or physician), any other as required
• Head of the departments of psychiatry, Ob & Gy, ENT, dermatology may be invited as
required
• Primary role of the committee is to arrange for examination of DR-TB patients referred for
their treatment eligibility and start DR-TB regimen for all eligible patients as per national
PMDT guidelines
• Further detail can be referred from annexure 2 of the guidelines for PMDT in India 2021

12. Engagement of paediatricians in DR-TB centre committee
• A D.O. letter from DDG-TB to the STOs
(all states/ UTs) – Nov 2020
• States/ UTs to direct all the DR-TB
centres that whenever any child with
any of DR-TB need to be admitted for
pre-treatment evaluation and
management, the child should be
managed in the existing DR-TB wards
• All DR-TB centres must pro-actively
engage the available pediatricians (in-
house/ honorary) in the DR-TB centre
committee for the management of
pediatric DR-TB patients

13. To summarize…
• All the medical colleges must have functional facility for the management of DR-TB including
paediatric DR-TB
• Good coordination between the medical college and concerned district TB officer
• Establishment of DR-TB centre committee
• Junior residents of the concerned departments (Respiratory Medicine, General Medicine,
Paediatrics, etc.) can be posted in the DR-TB centre of the medical college
• A dedicated posting of UGs during their compulsory rotating internship in the DR-TB centre
can be encouraged by the institution
• Posting of nursing students in the DR-TB centre can be encouraged

14. Thank You