IT IS about the recent updates in tuberculosis.

1. TB Burden Updates:
Global and Indian Scenario

2. Countries in the three TB high burden
country list
Global TB Report WHO 2016

3. TB Burden in India
• Incidence: 217(112-355) cases per 100,000 population
• Deaths: 32 (29-35) deaths per 100,000 population
• MDR-TB (Multidrug resistant-TB) in India
–MDR TB among new cases <3% and in Retreatment
cases is 13-17%
–Incidence of MDR/RR TB cases per 100,000: 9.9
• HIV among estimated incident TB patients- 4%
• Affects predominantly economically productive age
group leading to huge socio-economic impact
Global TB Report WHO 2016

4. MDG6 TB target achieved
TB
REVERSED
Rateper100,000population
50%
But huge burden of deaths and suffering remains in India.
Estimated 28 lakh incident TB cases in 2016, with 4.2 lakh
deaths
>3.5 million
additional
lives saved
since
inception
50%

5. WHO’s previous estimations of TB burden in India
MDG Target Achievement
TB Prevalence
To reduce prevalence by half
(>50% reduction)
465  195 per lakh pop
(58% reduction)
TB Mortality
To reduce mortality by half
(>50% reduction)
38  17 per lakh pop
(55% reduction)
TB incidence
To halt increase and reverse trend
(>0% reduction)
216  167 per lakh pop
(23% reduction)
2011 workshop, based on information available from
• 7 district level prevalence surveys,
• prevalence of infection based on ARTI survey
• programme notification information
• Expert opinion
• 4 mortality surveys
Global TB Report WHO 2016

6. WHO’s proposed interim estimates includes, backward
estimation of incidence and mortality from 1990 to 2015
compared with current estimates as below:
Previous estimates Interim estimates
TB Mortality
38  17 per lakh pop
(55% reduction)
76  32 per lakh pop
(4.2 Lakhs)
(58% reduction)
TB incidence
216  167 per lakh pop
(23% reduction)
300  217 per lakh pop
(28 Lakhs)
(28% reduction)
Footnote: These are interim estimates, based on newer evidences &
information available, pending the results of planned National TB
prevalence survey
India Population: 1311 million
Global TB Report WHO 2016

7. TB Burden
Global
2015
India
2015
Global
2016
India
2016
Incidence
TB
96 lakh 22lakh 104 lakhs 28 Lakhs
Mortality
of TB *
11 lakh 2.2lakh 14 lakhs 4.2 Lakhs
Incidence
HIV TB
12lakh 1.1lakh 11.7
lakhs
1.1 lakhs
Mortality
of HIV-
TB *
3.9 lakh 31,000 3.9 lakhs 37,000
MDR-TB 4. 8 lakh 71,000 5.8 lakhs 130,000

8. Is TB burden increasing???….
Answer… NO
• WHO estimates TB burden from time to time based on
the best available information from time to time
• WHO’s re-estimation is based on newer evidences &
information available since the previous estimation
since 2011, pending the results of planned National TB
prevalence survey
• TB burden is not increasing & the re-estimation still
suggests declining trend of incidence and mortality.

9. Rate of TB suspect examined and Total
TB case notification rate
0
100
200
300
400
500
600
700
800
0
20
40
60
80
100
120
140 2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
Perlakhpopulation
perlakhpopulation
Total TB case Notification rate Suspect examined per lakh population
Globally, there was a 4.3 million gap
between incident and notified TB cases
in 2015. India, Indonesia and Nigeria
account for almost half of the missing TB
cases.
TB India Annual Report, GoI 2016

10. Strategic vision of GoI for TB
Vision: “TB-free India” with zero deaths,
disease and poverty due to TB
Goal : Universal Access to quality TB
diagnosis & treatment for all
pulmonary & extra pulmonary TB
patients including drug resistant and
HIV associated TB
‘To achieve a rapid decline in burden of
TB, morbidity and mortality while
working towards elimination of TB in
India by 2025’.
National Strategic Plan for TB Elimination, GoI 2017-2025

13. A New Era of Global TB
Monitoring

14. A New Era of Global TB Monitoring
• The Sustainable Development Goals (SDGs) for 2030 were adopted by the UN in
2015. One of the targets is to end the Global TB epidemic.
• End TB Strategy approved by WHA 2014, has three high level indicators :
– The TB Incidence Rates
– The absolute number of TB deaths
– The percentage of TB patients and their households that experience
catastrophic cost as a result pf TB disease.
• Targets have been defined for these indicators for 2030 and2035, with
accompanying milestones for 2020 and 2025
• The 2020 milestones of the End TB Strategy are a 35% reduction in the absolute
number of TB deaths and a 20% reduction in TB incidence rates, compared with
2015 levels; and that no TB affected household face catastrophic cost
• The strategy calls for 90% reduction in TB deaths and 80% reduction in TB
incidence rates by 2030 compared to 2015 levels

16. Vision:
A world free of TB
Zero TB deaths,
Zero TB disease, and
Zero TB suffering
Goal:
End the Global TB
epidemic
Vision, goal, targets, milestones
(2,2 million)
(2.2 lakh)

17. The End TB Strategy:
3 pillars and 4 principles

22. Global commitment
to End Poverty and to End TB by
2030
Goal 1: End poverty in all its forms everywhere
1.3: Implement nationally appropriate social protection systems
and measures for all, including floors, and by 2030 achieve
substantial coverage of the poor and vulnerable

29. NSP Planning
Vision Documents for seven year
( 2017 /18 to 2013-24 )
Goal : End the TB epidemic in India by 2030
• Planning preparation will be initiated for
NSP in consultation with all stake holders
• Incorporating newer policy and guidelines
• Experience from implementation of NSP
• Alignment with END-TB strategy
• Resource mapping and mobilization
Available from: http://tbcindia.gov.in/WriteReadData/NSP%20Draft%2020.02.2017%201.pdf.

30. Paradigm shift in approach
Medical
Colleges
NGOs
Private
Practitio
ners
Standard
Diagnosis
Standard
Treatmen
t
Public
Health
Responsi
bility
Social
Inclusion
Government is the enabler of the TB
service, not the sole provider
Care of All TB patients as per
Programme guideline

31. TB Surveillance System,NIKSHAY
(Case Based Web Based TB Notification System)
Public TB
notification
system
DR-TB
lab & RX
centres
Private TB
notification
system
External
projects

32. Electronic Patient Treatment adherence
support
- 99DOTS low-cost monitoring and improving
medication adherence
99 DOTS Expansion for all PLHIV patients
- Evaluation of other ICT based mechanism for
expansion

33. Private Sector notification

34. PPM Intervention- Evaluation
TB notification increased with use of free
drugs and ICT facilitation
Microbiological confirmation can be
increased by providing access to CBNAAT
Engage first and then work to improve
quality
Scalability may require additional resources
Can we afford to lose patients from private
sector?

35. Public health action
On receipt of information on TB notifications following
actions are to be taken by local public health staff:
• Patient home visit as per convenience of patient,
• Counselling of TB patient and family members,
• Treatment adherence and follow up support ensure
treatment completion,
• Contact tracing, symptoms screening, evaluation of
TB symptomatic and offering INH chemoprophylaxis
to eligible contacts,
• Offering HIV testing, Drug Susceptibility Testing
(DST), if eligible.

36. Active Case finding
• Identification of high risk and
vulnerable groups
• IEC and Media Campaign for
ACF
• Utilization of more sensitive
tools for diagnosis
• Appropriate linkages for
treatment support

37. RNTCP culture and DST labs network
( July 2016)
By technology
- Solid culture: 46
- LPA: 52
-Liquid culture: 31
- CB-NAAT: 628
C-DST labs:
65
SL-DST: 25

38. Strengthening Laboratory services
• Evaluation of laboratory
network
• In-country Second Line
LPA validation study
• Laboratory scale-up
incorporating newer
technologies and
Programme policy

39. Initial 5 States:
• Himachal
Pradesh
• Sikkim
• Bihar
• Maharashtra
• Kerala
Rollout of Daily Regimen
in 104 districts
Rajas than
Gujarat
Maharas htra
Oriss a
Karnataka
Madhya Prades h
Bihar
Uttar
Pradesh
Jam m u &
Kas hm ir
Tam il Nadu
Assam
Telangana
Chhattis garh
Andhra Pradesh
Jhark hand
Punjab
W est B engal
Kerala
Haryana
Himac hal
Pradesh
Manipur
Mizoram
Andam an & N icobar
Dam an & Diu
Uttarakhand
Sikkim
Arunachal
Pradesh
N aga lan d
Tripura
Whole Country coverage by
end of 2017

40. BDQ Launch – 21 Mar
16
First patient put on BDQ at DR-TB Center
Guwahati, Assam on 6 June 16
Roll out of BDQ-CAP in 5
states

41. TB-Diabetes
• National Framework
• Phase wise implementation
in all states
• Supervision and monitoring
Available from:
http://tbcindia.nic.in/WriteReadData/National%20framework%20for%20joint%20TB%20diabe
tes.pdf.

42. PRAGATI Review
• Consultative meeting
held with states on 22nd
June 2016
• Districts identified
based on agreed criteria
(High TB, TB-HIV,
MDR-TB and low case
finding )
• Development of action
plan for the same in
progress

43. High Priority Districts
Average
High TB
High TB-HIV
High DR-TB
Very low case finding efforts
High case finding but low TCNR
Metro + Sikkim

44. INDEX TB Guidelines 2016
• New guidelines developed for
management of Extra pulmonary TB
by Central TB Division , AIIMS, New
Delhi , WHO and GHA (Global
Health Advocates)
• Dissemination Workshop held on
09th July 2016 at AIIMS New Delhi
• Dissemination and further develop
a training module
Available from:
http://www.icmr.nic.in/guidelines/TB/Index-
TB%20Guidelines%20-20green%20colour%202594164.pdf.

45. Intensified TB case finding and treatment at high burden
Anti-Retroviral Therapy (ART) centres
 Single window service delivery
for TB & HIV
 Intensified case finding
 TB diagnosis through CBNAAT
 Daily Regimen
 Better management of side
effects- Pharmacovigilance
 Use of newer technology for
treatment monitoring
 Isoniazid Preventive Therapy
 Air Borne Infection control
Progress so far
 45419 PLHIV tested for TB
 6389 diagnosed as TB
 185 diagnosed as Rif Resistance
 6073 put on Daily Anti TB
treatment
 149 Rif /R put on CAT IV
Country-wide expansion by 2nd October 2016

46. Accelerating access to quality TB
diagnosis for paediatric cases
• Daily regimen for pediatric TB
• Collaboration with IAP and TB
Alliance for Pediatric module
Dissemination
• UNITAID Project for Augmenting
TB service for pediatric TB

47. Other initiatives
• National Drug Resistance NDRS results for policy
formulation
• Approval of Nutritional support guidelines
• Roll-out of shorter regimen for MDR-TB and 2nd line
LPA
• National Prevalence Survey
• Research Consortium

48. Global TB projections to 2035 compared with current trends

49. World TB Day , 24th March 2017
• It commemorates the day in 1882 when Dr Robert Koch astounded
the scientific community by announcing his discovery: the cause of
tuberculosis, the TB bacillus
• Koch's discovery opened the way towards diagnosing and curing TB.
• Celebrated each year: Build Public Awareness and Design efforts to
Eliminate the disease.
• On 22 March 2017, WHO issues ethics guidance to protect rights of
TB patients: Patients, Communities, Health workers, policy makers,
other stakeholders
LIVES SAVED
49 MILLION
MDR TB CASES
480000
FUNDING
2BILLION US$ PER YR NEEDED TO FILL THE
RESOURCE GAP
GLOBAL

50. Thank You
WORLD TB DAY 24TH MARCH 2017