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

1. To have establish Tuberculosis surveillance system in the country.

2. To extend mechanisms of TB treatment adherence and contact tracing to pts treated at Pvt. Sector.

3. To ensure proper TB diagnosis and case management and further accelerate reduction of TB transmission.

4. 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:1. Hard copy to the nodal officer for TB notification. a)

by post b) by courier c) by hand.2. Soft copy by authorized Email.3. By authorized mobile: phone call/IVRS/SMS *4. 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 1 Nil (1)

2 Imphal East 2 1 (3)

3 Imphal West 5 4 (9)

4 Tamenglong Nil 1 (1)

5 Thoubal 1 1 (2)

6 Ukhrul 3 Nil (3)

7 Chandel Nil Nil Nil

8 Senapati Nil Nil Nil

9 Bishnupur Nil Nil Nil

State 12 7 19

State District TBUnit HFIDNO Health Facility

Address Pinno Type No. of Notified Patients

Manipur CCP DTC 67113 MSF CCP 795158 Clinic 86

Imphal West

DTC-TU 75211 IMPHAL HOSPITAL

Imphal West

795001 DTC 14

75214 Shija Hospital

Imphal West

795001 Hospital 4

75208 ADARSH Lab 17

75054 Omega Uripok 795001 Lab 3

TML TML 75145 DTC TML 795141 Lab 20Thoubal Kak_TU 75204 Jivan

HospitalKAKCHING 795103 Hospital 4

Ukhrul Ukhrul 2247 Leishiphu Christ.

Hospital

UKL 795142 Hospital 29

Total notified patients as on 25th August 2014 177

No. of Notified Patients 2Q14

Health Facility Who Have Not Initiated Patient Data Entry Report

SL No Name Type Sector

IMPHAL EASTJNIMS Hospital/Clinic/Nursing Home Public

Babina Diagnostics Laboratory Private

Public Hospital and Research Institute

Hospital/Clinic/Nursing Home Private

THOUBAL SUPRIYA DIAGNOSTIC CENTRE THOUBAL

Private

UKHRUL Comprehensive Health Services and Research Centre

Private

Health Facility Who Have Not Initiated Patient Data Entry Report

SL No Name Type Sector

IMPHAL WESTMona Laboratory X-ray Laboratory Private

Sky Hospital Hospital/Clinic/Nursing Home Private

Padma Diagnostic Centre Laboratory Private

Raj Medicity Hospital/Clinic/Nursing Home Private

Districts which do not have private health facilities1. Senapati2. Tamenglong3. Bishnupur4. 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 counselinge) 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.