National TB Elimination Programme in India aims to eliminate TB by 2025. TB remains a major public health problem in India, being one of the leading causes of death. In 2019, the estimated TB incidence was 26.4 lakh cases and estimated deaths were 4.45 lakh. There is a large gap between estimated cases and cases notified to the government. Private sector notification is very low. The government's targets are to reduce TB deaths by 90% and cut incidence rate by 80% by 2025 compared to 2015. This will require detecting all TB cases, ensuring treatment completion, preventive measures like contact screening, and building strong public-private partnerships.

1. National TB Elimination Programme

2. Where we stand?

3. TB BURDEN – COMPARISON WITH OTHER
DISEASES
Tuberculosis is (India)-
• Leading cause of death among communicable diseases- as a single
infectious agent
• 5th leading cause of death among all diseases
Diarrheal
diseases
Tuberculosis
Typhoid
and
paratyphoid
Encephalitis
HIV/AIDS
Maternal
disorders
Meningitis
Malaria
0
200
400
600
800
1000
1200
1400
1600
1800
DALY
per
100000
Deaths attributed to disease
Source: IHME, Global disease burden

4. Comparison of annual mortality of Infectious Diseases in India:
1.Malaria (2020), 2. Dengue (2019), 3. HIV (2020) , 4. COVID (2021) & 5.TB (2020)
Data Sources:
1. NVBDCP Report: Countrywide
Epidemiological Situation (1995 –
2020)
2. NVBDCP report: Dengue Cases
and Deaths in the Country since
2015
3. NACO INDIA HIV ESTIMATES
2020
4. India Coronavirus COVID-19
Deaths
(https://tradingeconomics.com/indi
a/coronavirus-deaths)
5. WHO Global TB Report 2021
Malaria, 93
Dengue, 166
HIV,51000
COVID, 332000
TB, 504000

5. TB Epidemiology –India 2019-2021
Source: WHO Global TB Report 2016, 2020, 2021 & 2022
Parameters 2015 2019 2020 2021
Estimated TB incidence 28,40,000 26,40,000
25,90,0
00
29,50,00
0
Incidence per 100 000
population 217 193 188 210
Total TB Deaths 4,19,000 4,45,000
5,04,00
0 5,05,000
TB case fatality ratio
(estimated
mortality/estimated
incidence) 15% 17% 20% 17%
Total cases notified 17,40,000 23,91,022
18,12,6
43
21,16,97
6
11 lakhs

6. GAP BETWEEN ESTIMATES AND NOTIFICATION-
INDIA (NUMBERS IN LAKHS)
28.40 27.90 27.4026.90
26.40 25.9
29.5
16.67 17.64 17.87
19.94
23.90
18.1
21.2
24.3
10.00
15.00
20.00
25.00
30.00
35.00
2015 2016 2017 2018 2019 2020 2021 2022
WHO estimated incident TB cases
GAP
Two significant
causes of the
GAP—
Case presented
with symptom
but remain
undiagnosed
Diagnosed but
NOT notified
Gap has increased in huge proportion due to COVID in 2020

7. PROPORTION OF DRUG SALES IN PRIVATE AND CONSUMPTION IN NTEP-
VS
PROPORTION OF PRIVATE NOTIFICATION
1 1 1 1 1 1
0.8
0.9
0.7
0.5
0.4
0.5
0.02
0.06
0.12
0.18
0.30 0.28
0
0.2
0.4
0.6
0.8
1
1.2
2015 2016 2017 2018 2019 2020
Public Drug Consumption Private Drug Sale Private Notification
IQVIA data- Calculated from Drug sales in private and consumption in NTEP. Notification
We are still missing Notifications from
Private

8. Where to go?

9. Few Public-health targets set by WHO
Eradication (zero transmission at global level)
• Polio
• Dracunculiasis (Guinea worm disease)
• Yaws
Elimination (interruption of active transmission at country level)
• Onchocerciasis
• Human African trypanosomiasis (g)
Elimination as a public-health problem (elimination of morbidity, mortality and/or reduction of transmission)
• Tuberculosis
• Human African trypanosomiasis (r)
• Chagas disease
• Lymphatic filariasis
• Rabies
Control (reduction of morbidity)
• All the others
• Trachoma
• Visceral leishmaniasis
• Schistosomiasis
• Soil-transmitted
helminthiases
• Leprosy
• Malaria

10. Where to go: India’s Commitment to End TB
Vision: India free of TB
TARGETS (for
Reduction)
INDIA (NSP) SDG WHO
End TB
2025 2030 2035
Reduction in number of TB deaths
Compared with 2015 (32 deaths per 1 lakh )
90%
(3 per lakh)
90% 95%
Reduction in TB incidence rate
Compared with 2015 (217 cases per 1 lakh)
80%
(44 per lakh)
80% 90%
Family affected with catastrophic costs
due to TB
100%
(0)
100% 100%

11. THE STATE STRATEGIC PLAN FOR TUBERCULOSIS ELIMINATION
2020 – 2025
Treat
Prevent
Build
Detect
Find all TB cases
through quality
assured Diagnostics
with an emphasis on
reaching every TB
patient in the private
sector
Treat all TB cases with
high quality anti TB
drugs
Prevent the emergence
of TB in susceptible
populations and stop
catastrophic
expenditure due to TB
Build & strengthen
supportive systems
including enabling
policies, empowered
institutions & human
resources

12. 100% Notification from the entire Private
Sector
Registration in TB Surveillance
portal(Nikshay)
Notificationcan be done in 3 ways—
A) Using registered ID inNikshaydirectly
B) Through Patient Provider Support
Agencies
C) Inform District TB officer in
prescribed format
Use Molecular Diagnostic Technology.
Establish Microbiological confirmation
All TB cases has to undergo Drug
Susceptibility testing
Nikshayrecords all events of a TB patient,
hence has to be updated real time
regularly)
Scale up of
Technology
Govt
Sector- WB
2021
Microscopy 1029
Rapid
Molecular Test
276
Culture lab
(for drug resistance
test)
5
GAP--
Quantum of TB
Diagnostic modalities
present in Private is
Unknown. Urgent need
to line list ALL PRIVATE
HEALTH FACILITIES
along with the
D
E
T
E
C
T

13. When we suspect TB?
Presumptive TB : Sign & symptoms of Pulmonary TB in adult
1. Cough for 2 weeks or more
2. Any Chest X-ray abnormality
3. Fever for 2 weeks or more
4. Significant weight loss (>5% wt. loss in last 3 month)
5. Blood in sputum
6. Abnormal night sweat
Any one of the above qualify for TB testing
Presumptive TB : Sign & symptoms of TB in Children (<15
years)
1. H/o Cough or fever for 14 days or abnormal chest X-ray or hemoptysis or weight loss or no
weight gain
2. H/o contact with active TB within two years in case of under six years
• For extra-pulmonary TB- symptoms depend on organ affected
• Socially and clinically vulnerable populations needs to be screened for TB at
regular intervals
• In case of PLHIV , cough for any duration qualify for TB testing
In a Health
Facility
around 3-5%
of total OPD
footfall is
referred for
TB testing

15. ANTIBIOTICS TO AVOID IN PATIENT HAVING ANY
SIGN/SYMPTOM OF TB , TILL TB STATUS IS KNOWN
Fluoroquinolones Macrolides Rifamycins Aminoglycosides
Ciprofloxacin Azithromycin Rifampicin Streptomycin
Ofloxacin Clarithromycin Rifabutin Amikacin
Levofloxacin Erythromycin Kanamycin
Moxifloxacin Roxithromycin

16. 0.5%
5.8%
12.9%
17.0%
19.9%
23.5% 22.9%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
2017 2018 2019 2020 2021 2022 2023
% Private Notification in Paschim
Medinipur

17. PUBLIC VS PRIVATE- KEY INDICATORS: PASCHIM MEDINIPUR (2022)
Indicators
Norms /Target
/National Average Public (%) Private (%)
% Pediatric Cases 6-8% 1.6 3.5
% Female Cases 35-40% 24.6 34.5
Drug Susceptibility testing offered 90% 72.4 37.3
Microbiological confirmation 80% 71.3 36.1
% DRTB detected 6% 2.3 0.3
Proportion of Treatment Days
monitored/reported adherence 50% 33 20
HIV status known 100% 97.9 95.4
Treatment Success Rate (2020) 90% 87.2 86.2
Better surveillance indicator for women & child
Public health action? Status of Treatment Adherence?
Are we missing DRTB Patients from the Private Sector?

18. WHY NOTIFICATION?
PUBLIC HEALTH ACTIONS FOR THE NOTIFIED TB PATIENTS !
Components—
1. Patient home visit as per convenience of patient
2. Counselling of patient and family members
3. Treatment adherence and follow up support to ensure treatment
completion
4. Contact tracing -- Symptoms screening -- Evaluation of TB
symptomatics
5. Offering TB preventive treatment to all contacts after ruling out TB
6. Offering HIV counselling and testing
7. Offering Diabetes testing
8. Offering drug susceptibility testing
9. Linking with available social welfare schemes and Nikshay Poshan
Yojana

19. INCENTIVE TO PRIVATE PROVIDERS & TREATMENT
SUPPORTERS
Health Establishment are expected to utilise these incentives in
recordkeeping, facilitating notification, for storing NTEP drugs,
dispensing them to patients as per norms, counselling, ensuring
adherence, timely follow up, recordkeeping, updating Nikshay
portal and liasoning with Govt
Patients Private Providers
Beneficiary All TB patients (Private, Public,
DS, DR)
All types of Private providers.
Private provider who notifies
the earliest
Benefits
Rs 500/- per treatment month.
Travel allowance for DRTB
patient. Locally managed
additional nutrition, Social
support scheme etc
500 for notifying, 500 for
declaring outcome
Mode Payment is made through direct bank transfer

20. GAZETTE ON TB NOTIFICATION
Mandatory Notification and Public Health Actions of TB patients
Private Clinics---Hospitals---Laboratories--- Chemists
 Latest version of the Gazette dated 19th
March 2018 has the following provision—
Failure to take the mandated steps may attract
the provisions of Sections 269 and 270 of
the Indian Penal Code (IPC)

21. Follow STANDARDISED Treatment
Protocol for Drug Sensitive and
Drug Resistant TB cases
Use 2ndline Anti TB Drugs like
Linezolid, Kanamycin only for
Microbiologically confirmed Drug
Resistant TB cases
Use injection free regimens with
latest Anti TB drugs
Store NTEP drugs in Private
Pharmacies for periodic
dispensation to private TB patients
Use IT based adherence technology
to monitor compliance
Sustain treatment success rate of
95% and more
T
R
E
A
T
STOP
empirical
treatmen
t/ Trial
ATD

22. First-line regimen
Drug Susceptible TB (Both New & Previously treated
TB patient)
IP CP
2
H
4
H
R R
Z E
E

23. Adult weight bands

24. Regimen class Intensive phase
Continuation
phase
H mono/poly DR TB (R resistance not detected and H resistance)
All oral H mono-poly
DR TB regimen
(6) Lfx R E Z
MDR/RR TB
Shorter Oral MDR TB
regimen
(4-6) BDQ(6) Lxf Eto Cfz Z Hh E (5) Lxf Cfz Z E
All oral longer MDR TB
regimen
(18-20) Bdq(6) Lfx Lzd# Cfz Cs
Treatment regimens for DRTB

25. DOSAGE DISPARITY
Daily dosage according to Standards of TB
Care in NTEP are—
FDCs are prepared in such a way that they
can cater to all age groups. Even
paediatric formulations are present.
Weight
band
Number of tablets
Intensive phase Continuation
phase
HRZE HRE
75/150/400/275
mg
75/150/275 mg
25-39
kg
2 2
40-54
kg
3 3
55-69
kg
4 4
≥70 5 5

26. Sustain COVID
appropriate behavior
Contact Tracing
&amp;amp; TB Preventive
Treatment for all contacts
of TB patients–GAME
CHANGER
TB preventive
treatment after testing
for TB infection among
clinically vulnerable
Airborne Infection
Control in Health
Facilities
Contact tracing and
screening of all
household contacts and
TB Preventive Treatment
P
R
E
V
E
N
T
Clinical risk groups-
Patients on anti-TNF treatment
Receiving dialysis
Preparing for organ or hematological
transplantation
Those with silicosis
On immune suppressants
Patients with cancer
Having HIV infection
Cross

27. Display Information material on TB in
Hospital premise
Strengthening workforce in the
hospital for TB awareness and
counselling among staff and patients,
Notification techniques
Formation of Private Hospitals
Consortium for TB
elimination.Member of State TB Forum
Apply for NTEP certification for TB
diagnosis and Drug susceptibility
testing. Join IPAQT labs
Establish dedicated DR-TB, Pediatric
TB wards/ ICU
Avail Partnership Options Or
apply CSR
Mobilize Brand Ambassador for TB,
Organize High Visibility Event,
Support Mass Media Activity, Social
Media Campaign, Community
B
U
I
L
D
Plenty of
Partnership
options available
Invest to Eliminate TB
Make India TB Free by
2025
#TBHaregaDeshJeetega

28. IT’S TIME TO
COME
TOGETHER
TO END TB
Thank You