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DISTRICT TUBERCULOSIS CENTRE [ DTC]

Place

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Tuberculosis is one of India's biggest health issues.

According to WHO, India has world's largest TB epidemic.

In 2020, India accounted for 26% of the incident TB cases across the globe.

TB causes about 220,000 deaths every year.The cost of this death and disease to the indian economy between 2006 and 2014 was approximately USD 1,000,000,000.

Introduction

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TUBERCULOSIS

Tuberculosis or TB is a potentially serious infectious disease that mainly affects the lungs. The bacteria that causes TB Mycobacterium tuberculosis are spread from person to person through tiny droplets released into the air via cough and sneezes.

The symptoms of active TB include:

Coughing for 3 or more weeks

Coughing of blood or mucus

Chest pain

Unintentional weight loss

Fatigue

Fever

Night sweats

Chills

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DIAGNOSIS

There are four specimen collection methods for pulmonary TB disease

• Coughing

• Induced sputum( early morning and spot)

• Bronchoscopy

• Gastric aspiration

Drug Sensitive TB: Direct sputum smear microscopy by Ziehl-Neelsen acid-fast staining /Fluorescence Microscopy are the primary tools for diagnosis of patients with Pulmonary Tuberculosis presumed to be drug sensitive .

Drug Resistant TB: Patients at risk of Multi Drug Resistant TB (MDR-TB) as defined by

the programme are diagnosed using WHO

endorsed rapid diagnostics (WRD) like

Cartridge Based Nucleic Acid Amplification Test

(CBNAAT) / Line Probe Assay (LPA)/ TrueNAT.

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MULTI DRUG RESISTANCE TUBERCULOSIS (MDR-TB)

MDR-TB is caused by an organism that is resistant to isoniazid and rifampicin, the 2 most potent TB drugs.

The 2 reasons why multidrug resistance continues to emerge and spread are mismanagement of TB treatment and person to person transmission.

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TB HIV COLLABORATIVE ACTIVITIES

TB -HIV co infection results in higher mortality rates and nearly 25% of all deaths among PLHIV are estimated to be due to TB.

The TB-HIV collaborative framework is being successfully implemented since 2001.

India ranks 2nd in the world and 9% of global burden of HIV associated TB

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The District Tuberculosis Centre (DTC) is the nodal point for TB control activities in the district.

A full-time District Tuberculosis Officer (DTO), trained at national level & based at the DTC, is responsible for planning, training, supervising and monitoring the programme in the district.

DTC

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DTC consist of

  • District officer
  • 3 supervisors- a.District programme coordinator, b.NIKSHAY operator c. Drug resistance TB cases Coordinator

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At sub district level - Tuberculosis Unit

  • Consists of a designated medical officer - Tuberculosis Control (MO-TC) ,
  • one full time supervisory staff - Senior Treatment Supervisor (STS) and
  • One senior TB Laboratory Supervisor (STLS) , will continue to be in 5 lakh population
  • and 1 TBHV per one lakh urban population is there to support the urban TB control activities.

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Following independence, the Indian government established various regional and national TB reduction programme.

  • The programme started as National TB

programme(NTP) in 1962.

  • The government introduced RNTCP in 1992.

  • The Indian government revised national TB control programme(RNTCP) started in India during 1997.

  • The programme used WHO recommended Directly

Observed Treatment Short course(DOTS) strategy to develop ideas and data on TB treatment.

  • This group's objective was to achieve and maintain

a TB treatment success rate of atleast 85% in India.

TB PROGRAMMES

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NATIONAL TUBERCULOSIS ELIMINATION PROGRAMME (NTEP)

  • In 2010, the RNTCP made a major policy decision that it would change, focus and adopt the concept of Universal access to quality diagnosis and TB treatment for all TB patients.

  • In 2017 , the Government amended it to National tuberculosis Elimination Programme (NTEP)

  • National TB Elimination Program (NTEP) envisages to reach every TB patient for free provision of diagnosis and evidence-based treatment.

  • National TB Elimination Programme has expanded free access of anti TB drugs to the patient seeking care in private sector through various mechanisms

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PROGRESS OF NTEP

During 2018, 15,66,623 TB patients in Public Sector and 4,82,894 TB patients in Private Sector have been initiated on first line standard treatment, of which, treatment outcome has been reported in NIKSHAY online portal for 96% (Public Sector) and 78% (Private sector) TB patients respectively.

Overall treatment success rate of 81% has been accomplished among the total initiated on treatment, with in public and private sector have reported 84% and 71% respectively.

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CHALLENGES

National TB Elimination Programme

would like to address the following challenges:

  • Increase access to molecular diagnostics upfront for TB detection.
  • Individual Patient tracking post-referral or post-transfer of the patients for TB treatment initiation, both in public

and private sector.

  • To check early identification of side effects of anti-TB drugs
  • Addressing social determinants of TB like poverty, malnutrition, ventilation stigma & belief
  • Effective utilization of patient wise information being capture under Nikshay.

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DOTS is critical for patients with drug resistant TB, HIV infected patients. DOTS means that a trained healthcare worker or other designated individuals provide a prescribed TB drugs and watches the patient swallow every dose.

DOTS

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Treatment of TB

All regimens for the treatment of TB have 2 phases. An intensive phase followed by continuation phase.

  • Intensive phase-The patient recieves intensive treatment with 4-6 drugs daily for a period of 2 months.
  • Continuation phase- The patient recieves 3-4 drugs daily for a period of 4 months.

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Standard treatment regimen for MDR-TB

Intensive phase(6-9 months):Kanamycin, levofloxacin, ethionamide, Cycloserine, Pyrazinamide, Ethambutol+Pyridoxine 100mg/day

Continuation phase(18 months):Levofloxacin, Ethionamide, Ethambutol, Cycloserine+Pyridoxine 100mg/day

All the drugs are administered daily under directly observed treatment(DOT)

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NIKSHAY Portal registration

NIKSHAY communicates with TB patients as well as health workers at different tiers of the healthcare delivery system through an SMS.

NIKSHAY

1. Go to portal

2. Click enrollment on the left side to register

3. Select patient type

4. Fill basic details(Name, age, sex, phone number, spouse name)

5. Press the Click to select option given in red colour

6. Fill state, district, TB unit, PHI and press done

7. Residence details, address, pin code

8. Demographic details

9. Emergency contact person details

10. Click add case and proceed to add test

11. You will obtain the personal NIKSHAY ID

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Functions and Use of Nikshay

It acts as a Surveillance tool under National

TB Elimination Programme:

Staff manages information of each patient

throughout the patient lifecycle related to

a. Testing (Diagnosis & follow up)

b. Treatment initiation

c. Public health action (Contact tracing,

comorbidities)

d. Adherence monitoring

e. Outcomes

f. Transfer and referral for testing

  • It helps in Digital Adherence monitoring.
  • Nikshay performs Direct Benefit Transfers.

  • It helps in the management of staff, health facilities and reporting hierarchy.

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WORLD TB DAY - 24 MARCH This day presents an opportunity to mobilise political , social commitment and build public awareness for the fight against Tuberculosis. The theme for this year is :

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BY :

ABHIRAMI ARAVIND (2)

ABHISHEK DENGI (4)

AKASH SATHYANARAYANA(13)

AKSHAY DV(14)

ANUSREE SREEKUMAR (23)

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