India's commitment to End TB
ContentThe Government of India has committed to achieving the Sustainable Development Goals(SDG) targets related to ending TB by 2025 (5 years ahead of the global target). This would mean that in 2025, the 2030 target of achieving 80% reduction in incidence, 90% reduction in deaths due to TB compared to that of 2015, is to be achieved.
Parameter 2015 Value SDG 2030 Target Commitment for 2025 Estimated annual Incidence 217 cases/Lakh 80% reduction 44 cases/lakh Estimated annual Mortality 4.5 lakh 90% reduction 45,000 Table: India's commitment to End TB by 2025.
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National Strategic Plan [NSP] for TB Elimination 2017-25
ContentThe National Strategic Plan (NSP) for TB elimination 2017–25 is a bold strategic framework to drive the acceleration of progress toward TB Elimination, and achieving the Sustainable Development Goal (SDG) and End TB targets for India. It expects to guide the activities of all stakeholders including the national and state governments, development partners, civil society organizations, international agencies, research institutions, private sector, and many others whose work is relevant to TB elimination in India. It is adopts strategies under four groups DETECT, TREAT, PREVENT, BUILD.
VISION: TB-Free India with zero deaths, disease and poverty due to tuberculosis
GOAL: To achieve a rapid decline in burden of TB, morbidity and mortality while working towards elimination of TB in India by 2025.The results framework of the NSP outlines the various targets (impact and outcomes) to be achieved.
IMPACT INDICATORS 2015
(Baseline)2020 2023 2025 1. To reduce estimated TB Incidence rate (per 100,000) 217
(112-355)142
(76-255)77
(49-185)44
(36-158)2. To reduce estimated TB prevalence rate (per 100,000)
320
(280-380)170
(159-217)90
(81-125)65
(56-93)3. To reduce estimated mortality due to TB (per 100,000)
32 (29-35) 15 (13-16) 6 (5-7) 3 (3-4) 4. To achieve zero catastrophic cost for affected families due to TB 35% 0% 0% 0% Resources
Assessment Questions
Question Answer 1 Answer 2 Answer 3 Answer 4 Correct Answer Explanation Part of pre-test Part of post-test Which are the groups under which strategies for National Strategic Plan (NSP) for TB elimination 2017–25 were developed? DETECT, TREAT, PREVENT DETECT, TREAT, PREVENT, BUILD DETECT, TREAT, PREVENT, REHABILITATE DETECT, TREAT, REHABILITATE DETECT, TREAT, PREVENT, BUILD The National Strategic Plan (NSP) for TB elimination 2017–25 adopts strategies under four groups: DETECT, TREAT, PREVENT, BUILD. Yes Yes Which of the following does the National Strategic Plan (NSP) for TB elimination 2017–25 aim to bring down to 0% by 2025? Incidence rate Prevalence rate Mortality rate Catastrophic cost for affected families Catastrophic cost for affected families The target of the National Strategic Plan (NSP) for TB elimination 2017–25 is to achieve zero catastrophic cost for affected families due to TB Yes Yes Evolution of TB Elimination Programme in India
ContentThe National Tuberculosis Control Program (NTP) of India was launched in 1962. It relied on BCG, X-ray based diagnosis and Streptomycin and INH based treatment centralized at district level.
Based on a review of the NTP, and WHO recommendations of the DOTS Strategy, Government of India then revised the NTP and launched new program with the title Revised National Tuberculosis Control Program (RNTCP) in 1997. It used Sputum microscopy at DMC(Designated Microscopy Centres) for diagnosis, and multi-drug Short Course Anti-TB Therapy, decentralized to the TU (TB Unit) level.
In recognition of the rising drug resistance problem the DOTS Plus/ PMDT (Programmatic Management of Drug Resistant TB) was launched in 2006 and scaled up to the entire country by 2012.
Further to strengthen the monitoring and supervision system - a case based notification system - Nikshay was introduced in 2012. The same year Tuberculosis was added as a notifiable disease at the point of diagnosis by all health care providers.
Other key milestones from 2012 to 2020 were the availability of the Standards of TB Care in India (STCI) in 2014, introduction of the Daily weight band wise Fixed Dose combination (FDC) in 2016 and new drugs like Bedaquilline and Delaminid were started in 2017 and 2018 respectively.
To emphasise the commitment of the Government of India and to accelerate the efforts towards TB elimination, RNTCP was renamed as "National Tuberculosis Elimination Programme (NTEP)" in 2020.
Figure: Key milestones under NTEP
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Organizational Structure of NTEP
ContentNational Tuberculosis Elimination Programme (NTEP) is a centrally sponsored programme being implemented under the aegis of National Health Mission.
National Level: Managed by Central TB Division (CTD), the technical arm of the Ministry of Health and Family Welfare (MOHFW)
State Level: State TB Cell coordinates the overall TB elimination programme in state under the guidance of State Health Society. The training ,supervision, monitoring and evaluation NTEP at state level are looked after by STDC (State TB Training and Demonstration Centre).
District TB Centre (DTC) is the nodal point for all TB elimination activities in the district under the guidance of the District Health Society.
Tuberculosis Unit (TU) Level: NTEP activities at block/sub-district level are implemented through TU which comprises Designated Medical Officer (MO) supported by two full-time NTEP staff - STS (Senior Treatment Supervisor) & STLS (Senior TB Lab Supervisor).
PHI (Peripheral Health Institute): PHI is a health facility manned by a Medical Officer (MO). Some of the PHIs are also the Tuberculosis Diagnostic Centres, which are the most peripheral level laboratories in the NTEP structure. All the Private Health Facilities like Private Practitioners / Private Hospitals / Clinics / Nursing Homes are also PHI.
Figure: Organisational structure of NTEP
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