TB notification

Background - I TB is a major health public health problem accounting for substantial morbidity and mortality in the country. I n order to ensure TB diagnosis and case management, reduce TB transmission and address the problems of emergence and spread of drugs resistance TB. It is essential to have complete information of all TB cases. Therefore, the health care providers shall notify every TB cases to local authority.

Background - II Large nos. of TB pts availing services from private sectors are not reported to the program me. A large nos. of pts are not benefitted with program me services which leads to non adherence, incomplete, inadequate treatment leading to M/XDR TB. If TB pts diagnosed and treated in Pvt. Sectors are reported to public Health authority, the mechanism available in this system can be extended to these pts ensuring treatment adherence and completion. To prevent the impending epidemic of M/XDR TB and to curve the situation Govt. of India declared Tuberculosis a notifiable disease on 7th May 2012.

Objectives To have establish Tuberculosis surveillance system in the country. To extend mechanisms of TB treatment adherence and contact tracing to pts treated at Pvt. Sector. To ensure proper TB diagnosis and case management and further accelerate reduction of TB transmission. To mitigate the impeding drug resistant TB epidemic in the country

Minimum information requirement for TB notification TB pts name Age/gender GoI-issued personal unique identification nos. Detailed address of TB case with pin code. Phone Number Basis of diagnosis: Microbiologically confirmed TB case/Clinical TB case. Patient category: New/Recurrent TB case/ treatment Change. Site of disease: pulmonary/EP only. Rifampicin resistance: Resistance/Sensitive/not available (& other drug resistance pattern by laboratories)

Definition of TB cases for purpose of Notification Microbiologically confirmed TB Cases: pts diagnosed with at least one sputum positive or a culture positive or RNTCP approved rapid diagnostic molecular test for MTB. Clinical TB case: pts clinically diagnosed TB without Microbiologic confirmation & initiated on anti-TB drugs.

RNTCP endorsed TB diagnostics Smear Microscopy (for AFB). FM with Fluorescence stains. SOLID CULTURE: Solid media (L J media) Liquid media ( Middle Brook) using manual, semiautomatic or automatic machines e.g. Bactec, MGIT etc. RAPID MOLECULAR TEST: Conventional PCR based Line Probe Assay for MTB complex or Real Time PCR based NNAT e.g. GeneXpert.

Health care providers for TB notification clinical establishments run or managed by the Government (including local authorities) private or NGO sectors and/or individual practitioners. The healthcare providers shall notify every TB case to local authorities i.e. District Health officer/CMO of a district/ Municipal Corporation/Municipality in every month in given format.

Registration of Health establishments for TB notification Health establishment is divided into three categories : 1.Laboratories 2.Private practitioner/Clinic (single) 3.Hospital/Clinic /Nursing Home (multi) Each of the Health Establishment will be registered for TB notification by submitting a simple registration form mentioning the details of the establishment. The registration form can be availed from the nodal officers for TB notification can be down loaded from tbcindia.nic.in. Each health establishment will receive the unique number.

Mechanism of TB notification Route for information transmission: Submission by: Hard copy to the nodal officer for TB notification. a) by post b) by courier c) by hand. Soft copy by authorized Email. By authorized mobile: phone call/IVRS/SMS * Uploading of information directly to Nikshay portal under construction. In future direct online TB information transmission from CBNAAT or MGIT etc may include.

TB Notification using Nikshay

TB Notification using mobile app

HEALTH FACILITY REGISTRATION SL No District Type Registered Hospital/Clinic/Nursing Home Laboratory 1 CCP Nil (1) 2 Imphal East (3) 3 Imphal West 5 4 (9) Tamenglong Thoubal (2) 6 Ukhrul 7 Chandel 8 Senapati 9 Bishnupur State 12 19

No. of Notified Patients 2Q14 No. of Notified Patients State District TBUnit HFIDNO Health Facility Address Pinno Type No. of Notified Patients Manipur CCP DTC 67113 MSF 795158 Clinic 86 Imphal West DTC-TU 75211 IMPHAL HOSPITAL 795001 14 75214 Shija Hospital Hospital 4 75208 ADARSH Lab 17 75054 Omega Uripok 3 TML 75145 795141 20 Thoubal Kak_TU 75204 Jivan Hospital KAKCHING 795103 Ukhrul 2247 Leishiphu Christ. Hospital UKL 795142 29 Total notified patients as on 25th August 2014 177

IMPHAL EAST THOUBAL UKHRUL Health Facility Who Have Not Initiated Patient Data Entry Report SL No Name Type Sector IMPHAL EAST JNIMS Hospital/Clinic/Nursing Home Public Babina Diagnostics Laboratory Private Public Hospital and Research Institute THOUBAL SUPRIYA DIAGNOSTIC CENTRE THOUBAL UKHRUL Comprehensive Health Services and Research Centre

Health Facility Who Have Not Initiated Patient Data Entry Report SL No Name Type Sector IMPHAL WEST Mona Laboratory X-ray Laboratory Private Sky Hospital Hospital/Clinic/Nursing Home Padma Diagnostic Centre Raj Medicity Districts which do not have private health facilities Senapati Tamenglong Bishnupur Chandel

TB notification status

TB notification status

Responsibility of the district level nodal officer/Local public health authority Disseminate information Provide formats Ensure registration of all HE by Dec 2012 and given the unique ID Maintain a list of HE with details & IDs Capacity building of MOs and health staff Ensure all notified cases are entered in the NIKSHAY portal within two weeks from submission of reports Routinely review the progress

Responsibility of the health worker -I Regular visit all HE & promote understanding and requirement about TB notification Provide formats of TB notification & registration forms to all HE Collect, collate and upward submit the TB notification reports submitted by the HEs Ensure that all TB cases notified by the HEs are entered in NIKSHAY portal

Responsibility of the health worker -II Visit the TB patients notified by HEs in consultation with them for timely & public health action: a) COUNCELING of TB pts for treatment adherence & Follow up to ensure treatment completion b) TB contract tracing ,screening for symptoms referral for evaluation for TB c) Offering INH chemoprophylaxis d) Family members counseling e) Offering TB treatment under RNTCP if desired by the pts d) Advising on ICTC services, further testing of C&DST, if desirable

Challenges Sensitization of huge no. of private health care providers with inadequate HR is a big challenge. Following up notified cases as a public health responsibility in manner acceptable to pts and community. Managing huge information at different level and creating a national TB register.