Dr. Kanthi Ariyarathne, Director/NPTCCD, Sri Lanka.

1. National Programme for
Tuberculosis Control and Chest
Diseases-NPTCCD
Dr. Kanthi Ariyarathne, Director/NPTCCD, Sri Lanka.
Vision: Sri Lanka free of
Tuberculosis and other
respiratory diseases

2. NTRL
NPTCCD Central
Unit
NHRD
DCCs
Gene xpert Machines for the
provinces……
• NHSL
• DCC Kandy
• TH Galle Karapitiya
• TH Anuradhapura
• TH Baticaloa
• PGH Rathnapura
• PGH Badulla
• PGH Kurunegala

3. 9695
8946
9155
9614 9788
10095
10329
9343 9496 9473 9575
8886
8983
8283
8497
8996 9118
9328 9508
8507
8767 8692
8990
8332
7066
6347 6513
6829 6760 6780 6896
6158 6304 6124 6291
5807
4868
4442 4528 4683 4764 4635 4490
4269 4423 4293 4299
4093
2198
1905 1985
2146 1996 2145
2406
1889 1881 1831 1992
1714
1917 1936 1984
2167 2358
2548 2612
2349 2463 2568 2699 2525
510 435 438 394 409 380 395 433 410 456 573 550
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
11000
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
numberofcases
Case Detection of Tuberculosis - 2005 - 2016
All Cases
All New
PTB
PTB +ve
PTB -ve
EXTRA
PTB
Retreatme
nt
Cases

5. 120
437
648
839
1167 1194
1068
143
421 432 409
457
505 492
263
858
1080
1248
1624
1699
1560
0
200
400
600
800
1000
1200
1400
1600
1800
0 - 14 15 - 24 25 - 34 35 - 44 45 - 54 55 - 64 65 +
NumberofCases Distribution of new cases (PTB and EPTB) by age and sex categories in SL 2016
Male Female All New Cases

7. Treatment Outcome
86.8
87.1
82.9
83.2 83.2
84.1
6.2
5.1
5.5
5.7
6.9 6.8
1.0
0.8 0.7
0.9 1.1 1.1
3.5
3.9
4.6
4.8
4.5
4.2
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
80.0
81.0
82.0
83.0
84.0
85.0
86.0
87.0
88.0
2010 2011 2012 2013 2014 2015
Death,LosstofollowupandFailurerate
TreatmentSuccessRate
Treatment Outcome of All Forms of TB 2010 - 2015
Treatment success Died Failure Loss to follow up

8. TB and HIV Screening 2016

9. TB and HIV Screening
2017 Q2
1015
1832
3379
4646
7409
7827 7952
3912
10.1
17.7
36.2
48.9
78.2
81.7
89.5
94.4
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
2010 2011 2012 2013 2014 2015 2016 2017 up to
Q2
Percentage
NumberScreened
Number Screened Percentage

10. TB HIV Co-Infection 2013 - 2017
up to Q2
9
25
20
7 7
6
12
17
5 5
15
37 37
12 12
0
5
10
15
20
25
30
35
40
2013 2014 2015 2016 2017 up to Q2
TB HIV HIV TB TB HIV Cor-Infection

11. Burden in summary…..
 13,500 expected cases per year, but only about 9,000
notified: 4-5,000 missing
 TB cases getting older: 39% of cases notified in 2014 were
45+, 43% in 2016
 Few children diagnosed
 High burden in prisoners (1.68%)
 >90% testing for HIV, but PLHIV few
 Uncertain burden in diabetics, smokers, malnourished
 Treatment success <85%

12. Challenges
 No acceleration of TB control
 M&E inconsistent, so results are uncertain
 Screening of out-patients is not done as expected
 Microscopy facilities lacking in big hospitals
 Contact screening is not happening as expected
 Haphazard active case finding
 Low paeditric patients detection
 NSP not on target
 Multiple plans
 Strengthening of NPTCCD required
 Replace Category II treatment with DST and appropriate regimen
 Infection control in the clinics required

13. Opportunities…..
 Low burden of TB
 Universal health coverage
 Well-equipped hospitals
 Well-trained respiratory physicians
 Strong DTCOs and district teams
 Strong Primary Care network
 General Prctioner network
 Availability of Private hospitals
 Possible collaboration with NCDs/Diabetes/CKDU prevention
programmes
 Social support improvement

14. Business as usual is not an option.
 Consequence is delay, late diagnosis, extensive
disease, and higher risk of death
 Unless case finding and programme performance
can be substantially improved, Sri Lanka will miss
the WHO End TB Strategy targets for 2030.
 Unless radical steps are taken to address these
challenges, no substantial progress will be made.

15. TB control priorities for Sri
Lanka
 A Strategic Health Communication Campaign
 Strengthen the screening of contacts and high risk groups
like Prisoners and HIV positives /AIDS patients
 Involvement of private health sector
 Involvement of Non Governmental Organizations
&Business community
 Involvement of other Ministries like Education ,Social
Welfare and Media
 Operational Research for greater understanding of
patients’ pathways to TB care

16. To improve case finding…..
 Pilot Districts-NTP Central Unit will set up 2-3 pilot
districts, in collaboration with provincial and regional
health directors to prove that addressing the challenges
above can significantly increase case finding within one
year, and improve treatment outcome
 Patient Centered services-NTP will ensure patient-
centered services are provided. All hospitals without
microscopy facilities in OPD should set them up, diagnose
TB cases, register them and initiate treatment on
bacteriologically confirmed cases.

17. To improve case finding…..
 Strengthen monitoring and supervision –NTP Central Unit and
DTCOs should provide constant supportive supervision.
 Strengthen contact tracing activities-By setting targets for the
PHIs and DTCO to find all contacts and increase the sensitivity
of contact screening by performing chest X-rays.
 Active case finding in high risk populations- By strengthening
activities for prison inmates , household contacts and PLHIV.
 Introduction of web based record systems -A laboratory
information system and an electronic case-based patient
record system for TB patients.

18. Treatment Regimen & Operational
Research
 Treatment Regimen - Urgently phase out Category II
treatment in favour of drug susceptibility testing for all
patients requiring re-treatment, with provision of a
regimen that is appropriate for the resistance pattern
found.
 Operational Research-The operational research for greater
understanding of patient’s pathways to TB care ,
performance of TB diagnostic and treatment practices of
the private sector

19. Programme Management
 Policy-There should be one policy, one plan and one
surveillance system.
 Leadership- Advocate the leadership (political and
administrative )for strengthening the support
 Central Unit-Strengthen the NPTCCD Central Unit with
appropriately trained and committed staff
 DTCO -Strengthen the District Chest Clinics with required
human resources in order to improve control activities

20. Join together to End TB in Sri Lanka
Thank You