Slide 1

Status of RNTCP in Gujarat Dr. PV Dave State TB Officer Gujarat 2 nd Quarter 2013

Slide 2

What is Tuberculosis ? Tuberculosis (TB) is a highly infectious bacterial disease caused by Mycobacterium tuberculosis. TB can affect any part of the body. When it affects the lungs it is called pulmonary TB. The commonest form of TB is pulmonary TB. TB in any other part of the body (i.e. other than lungs) is called extra pulmonary TB.

Slide 3

Slide 4

HEALTH IN THE MILLENNIUM DEVELOPMENT GOALS Goal 6: Combat HIV/AIDS, malaria and other diseases Target 6c: Halt and begin to reverse the incidence of malaria and other major diseases including TB. Indicator 6.9: Incidence, prevalence and death rates associated with TB Indicator 6.10: Proportion of TB cases detected and cured under DOTS Stop TB Partnership targets By 2005: At least 70% of people with sputum smear-positive TB will be diagnosed (i.e. under the DOTS strategy), and at least 85% successfully treated. The targets of a case detection rate of at least 70% and a treatment success rate of at least 85% were first set by the World Health Assembly of WHO in 1991. By 2015: The global burden of TB (per capita prevalence and death rates) will be reduced by 50% relative to 1990 levels. By 2050: The global incidence of active TB will be less than 1 case per million population per year.

Slide 5

RNTCP Goal and Objectives Goal The goal of TB control Programme is to decrease mortality and morbidity due to TB and cut transmission of infection until TB ceases to be a major public health problem in India. Objectives: To achieve and maintain a case detection of at least 70% of new sputum positive TB patients To achieve and maintain a cure rate of at least 85% in such patients

Slide 6

Directly Observed Treatment, Short-course (DOTS) a five point strategy TB Register l Political and Administrative commitment l Good Quality Diagnosis by Sputum smear microscopy l Uninterrupted supply of good quality drugs l Directly observed treatment (DOT) l Systematic monitoring and accountability Note: Directly Observed Treatment (DOT) is only one of the five components of DOTS strategy

Slide 7

Annual Risk of TB Infection (ARTI) - 1 One of the key epidemiological indicators of the tuberculosis situation in a community It represents the proportion of population that gets newly infected (or re-infected) with tubercle bacilli over the course of one year. Currently the average ARTI in the country as a whole is estimated to be 1.5%.

Slide 8

Annual Risk of TB Infection (ARTI) - 2 It has been estimated that for every one percent annual risk of tuberculosis infection, there are about 50 new pulmonary sputum smear positive (NSP) cases 50 new pulmonary sputum smear negative (NSN) cases 25 re-treatment pulmonary cases 10 extra-pulmonary cases Totaling to 135 cases..per 100,000 population per year. This means that, with an ARTI of 1.6% for West Zone (including Gujarat), there will be 80 new smear positive cases, 80 new smear-negative cases, 40 re-treatment cases, and 16 extra-pulmonary cases, totaling to 216 cases per 100,000 population per year.

Slide 9

Estimated* Incidence of TB in India (No. of NSP Cases per 100,000 population, per year) National75 North Zone95 East Zone65** West Zone80 South Zone50** North West East South * Estimated from ARTI survey ** For programme monitoring purpose estimated cases in East & South zones have been kept at the national level of 75

Slide 10

State TB Cell District TB Centre Tuberculosis Unit Tuberculosis Unit Designated Microscopy Centre DOT Centre Structure of RNTCP Designated IRL and DOTS-Plus site Designated IRL and DOTS-Plus site Urban TB Coordinators, Communication Facilitator TBHV Central TB Division, DGHS, New Delhi Central TB Division, DGHS, New Delhi STO, Deputy STO, MO, Accountant,,IEC Officer, TB-HIV Coordinator, SA, DEO STO, Deputy STO, MO, Accountant,,IEC Officer, TB-HIV Coordinator, SA, DEO DTO, MO-DTC, LT, DEO, Driver DTO, MO-DTC, LT, DEO, Driver Nodal point for TB control One/ 5 lakh (2.5 lakh in hilly/ difficult/ tribal area) MO-TC STS, STLS MO-TC STS, STLS MO, LT One/ lakh (0.5 lakh in hilly/ difficult/ tribal area) DOT Provider MPW, NGO, PP, Community Volunteer DOT Provider MPW, NGO, PP, Community Volunteer DDG-TB, CMO-TB

Slide 11

State TB Cell, Gandhinagar1 State TB Training & Demonstration Centre / Intermediate Reference Laboratory - Ahmedabad 1 District TB Centers (reporting units)30 TB Units144 Designated Microscopy Centers749 Peripheral Health Institutes (PHIs)1940 DOTS providers43618 RNTCP Infrastructure in Gujarat

Slide 12

Human Resource State level, 2 nd Quarter 2013 Name of the postNumber sanctioned Number in Place Percentage in Place & trained STO11100% Medical Officer STC1(regular)1100% STDC Director11100% Assistant Program Officer/Epidemiologist 10NA TB HIV coordinator11100% IEC officer11100% State Accountant22100% State DEO22100% IRL Microbiologist11100% Urban TB Coordinators 11100% DEO (IRL)11100% Sr LT - IRL11100% Statistician *11100% Statistical Assistant *33100% * STC+STDC

Slide 13

Other Human Resource in the state under TB cadre Name of the postLevel *Number sanctioned Number (%) in Place Percentage in place & trained TB SupervisorState TB Cell33 100.00 Research OfficerSTDC10 NA Research Assistant STDC10 NA Statistical Assistant STDC10 NA Computer STDC21 100.00 TB Supervisor STDC31 100.00 Treatment Organizer District TB Centre/ADTC 99 100.00 TB Supervisor District TB Centre/ADTC 6657 100.00 Statistical Assistant District TB Centre/ADTC 2314 100.00 Health Visitor District TB Centre/ADTC 2815 100.00 * Level: STC/ STDC/DTC/ADTC/periphery

Slide 14

Human Resource District Level, 1 st Quarter 2013 Name of the post Number sanctioned Number in Place % vacantPercentage in place & trained DTO301743%100 Senior DOTS Plus TB-HIV Supervisor 30293%90 District DEO 30 0%100 Part time Accountant 30 0%100 MOTC 1441430.6%97 STS 1441347%88 STLS 1441403%96 TBHV 2031854%98 LT 7487085.3%100

Slide 15

Composite Score 1 Q 2013 State - Gujarat S.No.Thematic AreaScoresRemarks 1 Human resource management 41/45 (91%) 2 Financial management20/20 (100%) 3 Case finding efforts28/40 (70%) 4 Quality of services85/145 (58%) Total174/250 (70%)

Slide 16

District wise Composite Score 1Q 2013

Slide 17

Slide 18

Gujarat state has been in the target zone, consecutively since last more than Seven Years 26 / 30 (87%) reporting units are in the target zone 113/143 (79%) TUs in target zone TB Suspects Examined 2Q13: 1,06,668 New Smear Positive Case Detection Rate 2Q13 : 75% New Smear Positive Cure Rate 2Q12: 86% Total TB patients put on treatment: 18,864 New Smear Positive Cases put on treatment: 9334 Since the inception of RNTCP up to 30-6-13 Total TB suspect Examined: 45,56,096 Total TB Patients put on DOTS treatment, : 9,69,093 New Smear Positive patients put on treatment : 4,15,995 Additional lives saved : 1,74,437 Identification of MDR TB Suspects: 38,421 Diagnosis of MDR TB Cases: 5,301 MDR TB Cases Put on CAT IV : 4,173 XDR TB Cases Put on CAT V : 56 Achievements at a Glance 2 nd Quarter 2013

Slide 19

Annualized New Smear Positive Case Detection Rate and Treatment Success Rate in DOTS areas of Gujarat, 2000-2Q13

Slide 20

Success Rate Vs Case Detection Rate (2Q12/2Q13)

Slide 21

TB Suspects Examined per lac per quarter 2 nd Quarter 2013 Gujarat: 159 2 nd Quarter 2012 Gujarat: 171 2 nd Quarter 2011 Gujarat: 162 Expected : 150 / Lac / Qtr

Slide 22

TB Suspects Examined per lakh per quarter TB Units Gujarat 2 nd Quarter 2013 Gujarat: 171 Expected : 150 / Lac / Qtr

Slide 23

NSP Case Detection Rate 2Q 2013 2Q 2012 Gujarat State: 75% Gujarat: 75% 2Q 2011 Gujarat State: 77% Expected : 70%

Slide 24

NSP Case Detection Rate TB Units Gujarat 2 nd Quarter 2013 Expected : 70% Gujarat: 75%

Slide 25

NSP Conversion Rate 1Q 2013 Gujarat: 91% 3Q 2012 Gujarat State: 92% 4Q 2012 Gujarat: 92% Expected : 90%

Slide 26

NSP Conversion Rate TB Units Gujarat 1 st Quarter 2013 Gujarat: 91% Expected : 90%

Slide 27

NSP Success Rate 4Q 2011 Gujarat State: 88% Gujarat: 86% 2Q 2012 Gujarat State: 87% 1Q 2012 Expected : 85%

Slide 28

NSP Success Rate TB Units Gujarat 2 nd Quarter 2012 Expected : 85% Gujarat: 86%

Slide 29

Rate of change in suspects examined per lakh population (compared to same quarter in previous year) 2Q13 Vs 2Q12 Gujarat State : 7.2%

Slide 30

Rate of change in suspects examined per s+ case diagnosed (compared to same quarter in previous year) 2Q13 Vs 2Q12 Gujarat State : 8.1%

Slide 31

Sputum conversion of NSP patients registered in 4 th quarter 2012

Slide 32

% of PHIs referring 2-3% of new adult OPD Gujarat 2 nd Quarter 2013

Slide 33

Slide 34

Major indicators Internal Evaluations-2Q13 DistrictDahodJunagadhBharuchNavsari Apr-13May-13 June-13 Difference in NSP Cure rate b/w TB register and Quarterly Reports 0.9%2.1%0.3%0% Difference in SP-RT Cure rate b/w TB register and Quarterly Reports 1.1%0.1%0% DOT Rate in NSP interviewed100%90%85%95% Place & Timing of DOT Convenient90%100% Proportion of patients aware of their illness100% Wrong Categorization0%10%0%5% Aware about duration of Treatment89% 95% Attended a PP interaction meeting or community meeting 11% 10%30% Initial home visit has done80%90%63%90% Eligible children received chemoprophylaxis100%90%56% 100% Practicing proper cough etiquettes37%72%71%95% Know their HIV status21%35%32%30%

Slide 35

Slide 36

Slide 37

Contribution of PPs in RNTCP 1 st Q 13 Patients (no) % of total of state PPs involved4858 Referral of suspects30182.1% NSP patients put on DOTS7267.1% Total TB patients put on DOTS14557.1% PP Involvement Gujarat - since 2006

Slide 38

Referral of TB Suspects from Health Facilities Gujarat 1 st Quarter 2013

Slide 39

ESIS Referral of TB Suspects Gujarat 1 st Quarter 2013

Slide 40

NGOs Involvement Gujarat Reporting format changed

Slide 41

Involvement - as a DOT Provider in RNTCP 2Q13

Slide 42

No. of MOTCs vacant (5 / 144) Jamnagar (2), Kheda (1), Narmada (1), VMC (1) No. of Contractual STSs vacant (5 / 144) Kheda (2), Surendranagar (2), VMC (1) No. of Contractual STLSs vacant (4 / 144) Bharuch (2), Panchmahals (1), Valsad (1) No. of Contractual TBHVs vacant (17/203) AMC (9), Banaskantha (1), Bharuch (1), Dahod (1), Panchmahals (1), Porbandar (1), Rajkot (1), VMC (2) Status of Staffing

Slide 43

Status of Training Untrained MO-TCs (6) Bhavnagar (1), Junagadh (1), Porbandar (1), The Dangs (1), VMC (2) Untrained STS (5) AMC (1), Anand (1), Chhotaudepur (1), Surat-R (1), Vadodara-R (1) Untrained STLS (7) Anand (1), Bhavnagar (1), Dahod (1), Narmada (1), Navsari (1), Panchmahals (1), Surat-R (1) Number of DMC LTs untrained (14) Banaskantha (2), Navsari (5), Sabarkantha (4), The Dangs (1), VMC (2)

Slide 44

Thank You