1. DTOs Quarterly Review Meeting, Ahmedabad 25th Oct 2013
Status of RNTCP in Gujarat
DTOs Quarterly Review Meeting, Ahmedabad
25th Oct 2013
Dr. PV Dave
State TB Officer
Gujarat
3rd Quarter 2013

2. What is Tuberculosis ?
Tuberculosis (TB) is a highly infectious bacterial disease caused by Mycobacterium tuberculosis. TB can affect any part of the body. When it affects the lungs it is called pulmonary TB. The commonest form of TB is pulmonary TB. TB in any other part of the body (i.e. other than lungs) is called extra pulmonary TB.

3. India is the highest TB burden country accounting for an estimated one quarter of all TB cases worldwide
Global annual incidence = 8.8 million
India annual incidence = 2.3 million
India is 16th among 22 High Burden Countries (in terms of TB incidence rate)
Source: WHO Geneva; WHO Report 2011 Global Tuberculosis Control

4. RNTCP Vision and Goal Vision Goal
The vision of the Government of India is a “TB-free India - through achieving Universal Access by provision of quality diagnosis and treatment for all TB patients in the community”
Goal
The goal of TB Control Programme is to decrease the morbidity and mortality by early diagnosis and early treatment to all TB cases thereby cutting the chain of transmission

5. RNTCP Objectives as per 12th FYP
Early detection and treatment of at least 90% of estimated all type of TB cases in the community, including Drug resistant and HIV associated TB.
Successful treatment of at least 90% of new TB patients, and at least 85% of previously-treated TB patients
Reduction in default rate of new TB cases to less than 5% and re-treatment TB cases to less than 10%
Initial screening of all re-treatment smear-positive till 2015 and all Smear positive TB patients by year 2017 for drug-resistant TB and provision of treatment services for MDR-TB patients;
Offer of HIV Counselling and testing for all TB patients and linking HIV- infected TB patients to HIV care and support;
Extend RNTCP services to patients diagnosed and treated in the private sector.

6. HEALTH IN THE MILLENNIUM DEVELOPMENT GOALS
Goal 6: Combat HIV/AIDS, malaria and other diseases
Target 6c: Halt and begin to reverse the incidence of malaria and other major diseases including TB.
Indicator 6.9: Incidence, prevalence and death rates associated with TB
Indicator 6.10: Proportion of TB cases detected and cured under DOTS
Stop TB Partnership targets
By 2005: At least 70% of people with sputum smear-positive TB will be diagnosed (i.e. under the DOTS strategy), and at least 85% successfully treated. The targets of a case detection rate of at least 70% and a treatment success rate of at least 85% were first set by the World Health Assembly of WHO in 1991.
By 2015: The global burden of TB (per capita prevalence and death rates) will be reduced by 50% relative to 1990 levels.
By 2050: The global incidence of active TB will be less than 1 case per million population per year.

7. RNTCP – Goal and Objectives
The goal of TB control Programme is to decrease mortality and morbidity due to TB and cut transmission of infection until TB ceases to be a major public health problem in India.
Objectives:
To achieve and maintain a case detection of at least 70% of new sputum positive TB patients
To achieve and maintain a cure rate of at least 85% in such patients 7

8. Directly Observed Treatment, Short-course
(DOTS) – a five point strategy
Political and Administrative commitment
Good Quality Diagnosis by Sputum smear microscopy
Uninterrupted supply of good quality drugs
Directly observed treatment (DOT)
TB Register
Systematic monitoring and accountability
Note: Directly Observed Treatment (DOT) is only one of the five components of DOTS strategy 8

9. Annual Risk of TB Infection (ARTI) - 1
One of the key epidemiological indicators of the tuberculosis situation in a community
It represents the proportion of population that gets newly infected (or re-infected) with tubercle bacilli over the course of one year.
Currently the average ARTI in the country as a whole is estimated to be 1.5%.

10. Annual Risk of TB Infection (ARTI) - 2
It has been estimated that for every one percent annual risk of tuberculosis infection, there are about
50 new pulmonary sputum smear positive (NSP) cases
50 new pulmonary sputum smear negative (NSN) cases
25 re-treatment pulmonary cases
10 extra-pulmonary cases
Totaling to 135 cases …………..per 100,000 population per year.
This means that, with an ARTI of 1.6% for West Zone (including Gujarat), there will be
80 new smear positive cases,
80 new smear-negative cases,
40 re-treatment cases, and
16 extra-pulmonary cases,
totaling to 216 cases ……………per 100,000 population per year.

11. Estimated. Incidence of TB in India (No
Estimated* Incidence of TB in India (No. of NSP Cases per 100,000 population, per year)
* Estimated from ARTI survey
North
National 75
North Zone 95
East Zone
65**
West Zone 80
South Zone
50**
East
West
South
** For programme monitoring purpose estimated cases in East & South zones have been kept at the national level of 75

12. Structure of RNTCP District TB Centre Tuberculosis Unit TBHV
Central TB Division,
DGHS, New Delhi
DDG-TB, CMO-TB
STO, Deputy STO,
MO, Accountant, IEC Officer,
TB-HIV Coordinator, SA, DEO
Designated IRL and
DOTS-Plus site
State TB Cell
DTO, MO-DTC,
LT, DEO, Driver
Nodal point for TB control
District TB Centre
Urban TB Coordinators, Communication Facilitator
One/ 5 lakh (2.5 lakh in hilly/ difficult/ tribal area)
Tuberculosis
Unit
MO-TC
STS, STLS
One/ lakh (0.5 lakh in hilly/ difficult/ tribal area)
Designated Microscopy Centre
MO, LT
DOT Provider – MPW, NGO, PP, Community Volunteer
TBHV
DOT Centre

13. RNTCP Infrastructure in Gujarat
State TB Cell, Gandhinagar 1
State TB Training & Demonstration Centre / Intermediate Reference Laboratory - Ahmedabad
District TB Centers (reporting units) 30
TB Units
144
Designated Microscopy Centers
754
Peripheral Health Institutes (PHIs)
1942
DOTS providers
43417

14. Human Resource – State level, 3rd Quarter 2013
Name of the post
Number sanctioned
Number in Place
Percentage in Place & trained
STO 1
100%
Medical Officer STC
1(regular)
STDC Director
Assistant Program Officer/Epidemiologist NA
TB –HIV coordinator
IEC officer
State Accountant 2
State DEO
IRL Microbiologist
Urban TB –Coordinators
DEO (IRL)
Sr LT - IRL
Statistician *
Statistical Assistant * 3
Highlight vacancies with Bold & red colour
Data source: 3q11 State PMR
* STC+STDC 14

15. Other Human Resource in the state under TB cadre
Name of the post
Level *
Number sanctioned
Number (%) in Place
Percentage in place & trained
TB Supervisor
State TB Cell 3
100.00
Research Officer
STDC 1 NA
Research Assistant
Statistical Assistant
Computer 2
Treatment Organizer
District TB Centre/ADTC 9 66 57 23 14
Health Visitor 28 15
Level: STC/ STDC/DTC/ADTC/periphery
This will include regular posts under state govt. including the staff sanctioned for clinical activities e.g. ward in STDC may have posts of nursing staff,
Statisticians, statistical assistants, social workers, field workers, BCG technicians, BCG leaders, treatment Organizers, Computer,
* Level: STC/ STDC/DTC/ADTC/periphery 15

16. Human Resource – District Level, 3rd Quarter 2013
Name of the post
Number sanctioned
Number in Place
Percentage in place & trained
DTO 30 21
100
Senior DOTS Plus TB-HIV Supervisor 29
District DEO 28 96
Part time Accountant
MOTC
144
137
STS
141 87
STLS
143 95
TBHV
218
192 92 LT
754
701 98
Highlight vacancies with Bold & red colour
Data source: 3q11 State PMR & district PMRs 16

17. Achievements at a Glance
3rd Quarter 2013
Gujarat state has been in the target zone, consecutively since last more than Seven Years
28 / 30 (93%) reporting units are in the target zone
119/144 (83%) TUs in target zone
TB Suspects Examined – 3Q13 : 1,23,055
New Smear Positive Case Detection Rate – 3Q13 : 74%
New Smear Positive Cure Rate – 3Q12 : 87%
Total TB patients put on treatment : 18,444
New Smear Positive Cases put on treatment : 9283
Since the inception of RNTCP up to
Total TB suspect Examined : 46,79,151
Total TB Patients put on DOTS treatment, : 9,97,884
New Smear Positive patients put on treatment : 4,25,278
Additional lives saved : 1,79,619
Identification of MDR TB Suspects : 45,538
Diagnosis of MDR TB Cases : 5,802
MDR TB Cases Put on CAT – IV : 4,592
XDR TB Cases Put on CAT – V : 72 17 17

18. Annualized New Smear Positive Case Detection Rate and Treatment Success Rate in DOTS areas of Gujarat,
2000-3Q13 18 18

19. Success Rate Vs Case Detection Rate (3Q12/3Q13)

20. TB Suspects Examined per lac per quarter 3rd Quarter 2013
Expected : 150 / Lac / Qtr
Gujarat: 190
3rd Quarter 2012
Gujarat: 175
Gujarat: 197 20

21. TB Suspects Examined per lakh per Quarter Gujarat: 197
Expected : 150 / Lac / Qtr
TB Units – Gujarat
3rd Quarter 2013
Gujarat: 197

22. NSP Case Detection Rate
3Q 2011
NSP Case Detection Rate
3Q 2013
Expected : 70%
Gujarat State: 76%
3Q 2012
Gujarat: 74%
Gujarat State: 72% 22

23. NSP Case Detection Rate
TB Units – Gujarat
3rd Quarter 2013
Expected : 70%
Gujarat: 74%

24. NSP Conversion Rate 4Q 2012 2Q 2013 1Q 2013 Gujarat State: 92%
Expected : 90%
Gujarat State: 92%
1Q 2013
Gujarat: 92%
Gujarat: 91% 24

25. NSP Conversion Rate TB Units – Gujarat Gujarat: 92% 2nd Quarter 2013
Expected : 90%
Gujarat: 92%

26. NSP Success Rate 1Q 2012 3Q 2012 2Q 2012 Gujarat State: 87%
Expected : 85%
3Q 2012
Gujarat State: 87%
2Q 2012
Gujarat: 87%
Gujarat State: 86% 26

27. NSP Success Rate TB Units – Gujarat Gujarat: 87% 3rd Quarter 2012
Expected : 85%
Gujarat: 87%

28. Rate of change in suspects examined per lakh population (compared to same quarter in previous year) 3Q13 Vs 3Q12
Gujarat State : 12.6% 28

29. Rate of change in suspects examined per s+ case diagnosed (compared to same quarter in previous year) 3Q13 Vs 3Q12
Gujarat State : 6.7% 29

30. RNTCP case finding at State level: Gujarat

31. Total Case Notification Rate V/S NSP Case Notification Rate: Gujarat

32. NSP Case Notification Rate V/S NSN Case Notification Rate

33. Positive Notification Rate from PMR V/S
Positive Notification Rate from CFR

34. NSP Notification Rate V/S RT Positive Case Notification Rate

35. Re-Treatment typewise Notification rate trend Gujarat

36. Sputum conversion of NSP patients registered in 2nd quarter 2013

37. Sputum conversion of RT Sm +ve patients registered in 2nd quarter 2013

38. % of PHIs referring 2-3% of new adult OPD Gujarat 3rd Quarter 201338

39. Trend of treatment outcomes in Re-treatment +ve Cases Gujarat39

40. Major indicators – Internal Evaluations- 3Q13
District
Surendranagar
Chhotaudepur
Aug-13
Sept-13
Difference in NSP Cure rate b/w TB register and Quarterly Reports
4.8%
2.0%
Difference in SP-RT Cure rate b/w TB register and Quarterly Reports
2.4%
DOT Rate in NSP interviewed
70%
74%
Place & Timing of DOT Convenient
100%
Proportion of patients aware of their illness
95%
Wrong Categorization
10%
Aware about duration of Treatment
Attended a PP interaction meeting or community meeting 0%
15%
Initial home visit has done
80%
60%
Eligible children received chemoprophylaxis
50%
27%
Practicing proper cough etiquettes
61%
72%
Know their HIV status (Sr. No. 29)
16%
22%% 40

41. Other Health Sector - 3Q13

42. Chest Symptomatic Referrals Civil / Gen. Hospitals (last 4 quarters)
Ahmedabad Zone
Norms 2-3% of new adult OPD for sputum microscopy

43. Chest Symptomatic Referrals Civil / Gen. Hospitals (last 4 quarters)
Gandhinagar Zone
Norms 2-3% of new adult OPD for sputum microscopy

44. Chest Symptomatic Referrals Civil / Gen. Hospitals (last 4 quarters)
Surat Zone
Norms 2-3% of new adult OPD for sputum microscopy

45. Chest Symptomatic Referrals Civil / Gen. Hospitals (last 4 quarters)
Vadodara Zone
Norms 2-3% of new adult OPD for sputum microscopy

46. Chest Symptomatic Referrals Civil / Gen. Hospitals (last 4 quarters)
Bhavnagar Zone
Norms 2-3% of new adult OPD for sputum microscopy

47. Chest Symptomatic Referrals Civil / Gen. Hospitals (last 4 quarters)
Rajkot Zone
Norms 2-3% of new adult OPD for sputum microscopy

48. Chest Symptomatic Referral Rate of Medical Colleges (1)

49. Chest Symptomatic Referral Rate of Medical Colleges (2)

50. PP Involvement – Gujarat - since 2006 Contribution of PPs in RNTCP
3rd Q 13
Patients (no)
% of total of state
PPs involved
4812
Referral of suspects
2572
2.1%
NSP patients put on DOTS
653
7.0%
Total TB patients put on DOTS
1337
7.2% 50

51. Referral of TB Suspects from Health Facilities Gujarat 3rd Quarter 2013

52. ESIS Referral of TB Suspects Gujarat 3rd Quarter 2013

53. NGOs Involvement – Gujarat
Reporting format changed

54. Involvement - as a DOT Provider in RNTCP 3Q13

55. Status of Staffing No. of MOTCs vacant (7 / 144)
AMC (2), Jamnagar (2), Kheda (1), Narmada (1), Navsari (1)
No. of Contractual STSs vacant (3 / 144)
Kheda (1), Narmada (1), Valsad (1)
No. of Contractual STLSs vacant (1 / 144)
Banaskantha (1)
No. of Contractual TBHVs vacant (26/218)
AMC (17), Anand (1), Bharuch (1), Dahod (1), Junagadh (1), Patan (1), Rajkot (2), Surendranagar (2)

56. Status of Training
Untrained MO-TCs (4)
Junagadh (1), Porbandar (1), The Dangs (1), VMC (1)
Untrained STS (12)
AMC (1), Anand (1), Bharuch (1), Chhotaudepur (1), Dahod (3), Kheda (1), Patan (1), Surat-R (1), Vadodara-R (1), VMC (1)
Untrained STLS (7)
Anand (1), Bhavnagar (1), Dahod (1), Narmada (1), Panchmahals (2),
Surat-R (1)
Number of DMC LTs untrained (11)
Banaskantha (2), Chhotaudepur (1), Navsari (4), The Dangs (1), VMC (3)

57. Status Report of MOTCs Monthly Worksheet in 3rd Q 13 (From July to September-13)
No.
Name Of DTC
Total
No. of
TUs
Report received
Reports
to be
received
% of
July
August
September
TOTAL 1
Ahmedabad (R) 3 2 7 9
77.8%
AMC 10 4 6 30
33.3%
Amreli 12
100.0%
Anand
50.0% 5
Banaskantha 18
66.7%
Bharuch 15
Bhavnagar
0.0% 8
Chhotaudepur
Dahod 24
29.2%
Gandhinagar 11
Jamnagar
25.0%
Junagadh 13
Kachchh 21 14
Kheda
73.3%
Mahesana

58. Total Reports to be received
Status Report of MOTCs Monthly Worksheet in 3rd Q 13 (From July to September-13)
Sr. No.
Name Of DTC
Total No.of T.Us.
Report received
Total Reports to be received
% of reports received
July
August
September
TOTAL 16
Navsari 4 12
100.0% 17
Narmada 3 9 18
Panchmahal 7 21 19
Patan 1 2
44.4% 20
Porbandar
Rajkot 22
Sabarkantha 6 23
Surat-R 5 15
80.0% 24
SMC 27 25
Surendranagar 8
66.7% 26
The Dangs
Vadodara (R) 28
VMC
0.0% 29
Valsad 30
Vyara
Gujarat state
144
101 99 87
287
432
66.4%

59. Thank You