1. Impact of in-house RNTCP DMC in
NGO Hospital –a case study
Dr Neerja Arora Dr K N Gupta Dr Reuben Swamickan
Regional TB Project State TB Officer, National TB Project
Coordinator, Rajasthan Coordinator,
CBCI-CARD GFATM RCC CBCI-CARD GFATM RCC
RNTCP Project RNTCP Project

2. Setting
St.Francis hospital, a 240 bedded, multi-
disciplinary NGO health facility in Ajmer in
Rajasthan, where RNTCP-DMC was started in
2009 as part of PPM DOTS initiatives,
spearheaded by the Global Fund-supported
CBCI-CARD RNTCP project
CBCI-CARD GFATM RCC RNTCP PROJECT

3. CBCI-CARD GFATM RCC RNTCP project
The objective of this project is to
facilitate the involvement of
the Catholic Church network in
RNTCP across 19 states of
India
There are more than 5000
Catholic Health facilities
(CHFs), including large number
of Hospitals and Dispensaries
in the country, 85 % of which
are in rural, tribal and hard to
reach areas
Under this project, by 3Q11, CHFs
have signed more than 200
RNTCP schemes for NGOs of
which 86 are DMCs
CBCI-CARD GFATM RCC RNTCP PROJECT

4. St Francis Hospital, Ajmer
CBCI-CARD GFATM RCC RNTCP PROJECT

5. St Francis Hospital DOT Centre
120 108
99
100 91 90
84
80 64
61
60 52
45 41 120
40
100 98
20 5 93 90
85 87 84 87
80 82 83
0
percentage
60
40
Cat I Cat II Cat III Total 20
14 11
10 7
Patients put on DOTS at St Francis Hospital 5 5 4 5 6 6
3 3
0 0 0 2
0 0 2 1 1
0 1 2
DOT Centre Yr 2000-2010 Yr 2001 Yr 2002 Yr 2003 Yr 2004 Yr 2005 Yr 2006 Yr 2007 Yr 2008 Yr 2009
Success Rate Default Rate Death Rate
Failure Rate TO Rate
Trends in Treatment outcomes of ALL Categories of patients
put on DOTS at St Francis Hospital DOT Centre
( Yr 2000 to Yr 2009 )
CBCI-CARD GFATM RCC RNTCP PROJECT

6. St Francis Hospital DMC
Trends in Sputum Examinations for
St Francis Hospital Annexure M for 2010 Diagnoses & Follow-up in Yr 2010
60 53
TB 51
TB
Suspect 50 43
Suspect
s Follow- Patients 39
Month/
TB TB
undergo
s found
up positive
Total
Total Total 40 34 36
suspects Suspect positive Slides 29
Year ing patients in positive negative 26 26
examine s found on examine 30 23 24
2010
d positive
repeat
repeat
examine follow
d
slides slides 22 22
sputum d up 19 1817 18 17
examin 20 1614 14 15
examin 11 13
ation
ations 10
Jan 11 1 0 0 19 0 60 2 58
0
Feb 16 0 0 0 14 2 60 4 56 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Mar 18 4 0 0 17 2 70 10 60 TB suspects examined Follow-up patients examined
Apr 14 3 0 0 18 2 64 8 56 Trends in Slide positivity Rates, positivity among
May 13 5 0 0 22 1 70 11 59
50
Diagnoses Follow-ups in Year 2010
Jun 22 7 0 0 15 3 74 17 57
40 38.
Jul 17 6 1 0 26 3 88 17 71
35.
Aug 23 6 0 0 51 6 148 24 124 30 32
26. 24
Sep 29 7 0 0 43 1 144 15 129 22 21 22.
20 20 19 20
Oct 34 4 0 0 53 4 174 12 162 14. 14 16 16. 15 15
14
12 12.5
11 12 12 12.5 12
Nov 24 3 0 0 39 6 126 18 108 10 9. 10 9 9
7 8 8.
3 5
Dec 26 4 0 0 36 3 124 11 113 2.
0 0 0
TOTAL 247 50 1 0 353 33 1202 149 1053 Jan Mar May Jul Sep Nov TOTAL
Sputum positivity for diagnosis sputum positvity for follow ups
Slide positivity rate
CBCI-CARD GFATM RCC RNTCP PROJECT 6

7. Objectives of the study
To evaluate the impact of in-house RNTCP-DMC
services on
1. Referral of TB suspects
2. Referred patients receiving sputum test
3. TB case notification.
CBCI-CARD GFATM RCC RNTCP PROJECT

8. Methodology
Review of referral register, RNTCP laboratory
register and other relevant records. The
average values of the historical data for 6
years period (2004-2009), when patients were
referred to nearby DMCs, was compared with
the results in the year 2010, i.e. after the
introduction of in-house microscopy services
CBCI-CARD GFATM RCC RNTCP PROJECT

9. Trends in percentage of referred chest symptomatics
undergoing sputum microscopy
Yr 2004-Yr 2010
Trends in Percentage of Suspected Chest Symptomatics
referred at St Francis Hospital, Ajmer, undergoing sputum
Proportion microscopy
Total Not of Referred Yr 2004-Yr 2010
Diagnosed
Referred Positive Negative reached suspects
Year at DMC
cases (D) (E) DMC undergoing
(A) ( C) 100%
(B) (F) sputum
microscopy 90%
80%
70%
Yr 2004 140 77 14 63 63 55% 60%
50%
Yr 2005 137 84 22 62 53 61%
40%
30%
Yr 2006 118 73 19 54 45 62%
20%
Yr 2007 107 55 14 41 52 51% 10%
0%
Yr 2008 87 38 11 27 49 44% Yr 2004 Yr 2005 Yr 2006 Yr 2007 Yr 2008 Yr 2009 Yr 2010
Yr 2009 99 58 10 48 41 59%
Diagnosed Not reached
Yr 2010 271 263 47 216 8 97%
CBCI-CARD GFATM RCC RNTCP PROJECT

10. Results
With the RNTCP-DMC within the hospital
complex, annually,
• The referrals for microscopy have more than doubled
(115 to 271).
• There is significant reduction in the percentage of
referred patients failing to reach the laboratory (44% to
3%).
• The number of suspected TB cases that received
sputum examination recorded more than four-fold
increase (64 to 263).
• The number of smear positive TB cases diagnosed
among the referred patients tripled (15 to 47).
CBCI-CARD GFATM RCC RNTCP PROJECT

11. 300
Trends in Referral & Diagnosis of Chest Symptomatics at
St Francis Hospital, Ajmer 271
263
Yr 2004 to Yr 2010
250
Start of DMC
200 at Hospital premises
Number
150 140 137
118
107
99
100 84 87
77 73
55 58
47
50 38
22 19
14 14 11 10
0
Yr 2004 Yr 2005 Yr 2006 Yr 2007 Yr 2008 Yr 2009 Yr 2010
Total Referred cases Diagnosed Positive
CBCI-CARD GFATM RCC RNTCP PROJECT

12. Conclusions
• Designating the laboratory of NGO hospitals, as
RNTCP-DMC can significantly increase TB
notification
• This would also reduce delay in diagnosis and
ensure standardized treatment.
• Presence of well functioning DMCs at
government or medical college facilities in the
vicinity should not be a deterrent to establish
DMCs in such NGO or PP hospital which are
willing and which have the capacity to attain &
sustain quality microscopy activities
CBCI-CARD GFATM RCC RNTCP PROJECT

13. Conclusions
• This is an example of RNTCP Partnerships
promoting “Universal Access”
• There is scope for replicating and scaling up
similar models across the country in other
private & NGO hospitals having self-
sustainability
CBCI-CARD GFATM RCC RNTCP PROJECT

14. THANK YOU
CBCI-CARD GFATM RCC RNTCP PROJECT 14