Status of RNTCP in Gujarat Dr. PV Dave State TB Officer Gujarat 2 nd Quarter 2013
Transcript
Slide 1
Status of RNTCP in Gujarat Dr. PV Dave State TB Officer Gujarat
2 nd Quarter 2013
Slide 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.
Slide 3
Slide 4
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.
Slide 5
RNTCP Goal and Objectives Goal 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
Slide 6
Directly Observed Treatment, Short-course (DOTS) a five point
strategy TB Register l Political and Administrative commitment l
Good Quality Diagnosis by Sputum smear microscopy l Uninterrupted
supply of good quality drugs l Directly observed treatment (DOT) l
Systematic monitoring and accountability Note: Directly Observed
Treatment (DOT) is only one of the five components of DOTS
strategy
Slide 7
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%.
Slide 8
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.
Slide 9
Estimated* Incidence of TB in India (No. of NSP Cases per
100,000 population, per year) National75 North Zone95 East Zone65**
West Zone80 South Zone50** North West East South * Estimated from
ARTI survey ** For programme monitoring purpose estimated cases in
East & South zones have been kept at the national level of
75
Slide 10
State TB Cell District TB Centre Tuberculosis Unit Tuberculosis
Unit Designated Microscopy Centre DOT Centre Structure of RNTCP
Designated IRL and DOTS-Plus site Designated IRL and DOTS-Plus site
Urban TB Coordinators, Communication Facilitator TBHV Central TB
Division, DGHS, New Delhi Central TB Division, DGHS, New Delhi STO,
Deputy STO, MO, Accountant,,IEC Officer, TB-HIV Coordinator, SA,
DEO STO, Deputy STO, MO, Accountant,,IEC Officer, TB-HIV
Coordinator, SA, DEO DTO, MO-DTC, LT, DEO, Driver DTO, MO-DTC, LT,
DEO, Driver Nodal point for TB control One/ 5 lakh (2.5 lakh in
hilly/ difficult/ tribal area) MO-TC STS, STLS MO-TC STS, STLS MO,
LT One/ lakh (0.5 lakh in hilly/ difficult/ tribal area) DOT
Provider MPW, NGO, PP, Community Volunteer DOT Provider MPW, NGO,
PP, Community Volunteer DDG-TB, CMO-TB
Slide 11
State TB Cell, Gandhinagar1 State TB Training &
Demonstration Centre / Intermediate Reference Laboratory -
Ahmedabad 1 District TB Centers (reporting units)30 TB Units144
Designated Microscopy Centers749 Peripheral Health Institutes
(PHIs)1940 DOTS providers43618 RNTCP Infrastructure in Gujarat
Slide 12
Human Resource State level, 2 nd Quarter 2013 Name of the
postNumber sanctioned Number in Place Percentage in Place &
trained STO11100% Medical Officer STC1(regular)1100% STDC
Director11100% Assistant Program Officer/Epidemiologist 10NA TB HIV
coordinator11100% IEC officer11100% State Accountant22100% State
DEO22100% IRL Microbiologist11100% Urban TB Coordinators 11100% DEO
(IRL)11100% Sr LT - IRL11100% Statistician *11100% Statistical
Assistant *33100% * STC+STDC
Slide 13
Other Human Resource in the state under TB cadre Name of the
postLevel *Number sanctioned Number (%) in Place Percentage in
place & trained TB SupervisorState TB Cell33 100.00 Research
OfficerSTDC10 NA Research Assistant STDC10 NA Statistical Assistant
STDC10 NA Computer STDC21 100.00 TB Supervisor STDC31 100.00
Treatment Organizer District TB Centre/ADTC 99 100.00 TB Supervisor
District TB Centre/ADTC 6657 100.00 Statistical Assistant District
TB Centre/ADTC 2314 100.00 Health Visitor District TB Centre/ADTC
2815 100.00 * Level: STC/ STDC/DTC/ADTC/periphery
Slide 14
Human Resource District Level, 1 st Quarter 2013 Name of the
post Number sanctioned Number in Place % vacantPercentage in place
& trained DTO301743%100 Senior DOTS Plus TB-HIV Supervisor
30293%90 District DEO 30 0%100 Part time Accountant 30 0%100 MOTC
1441430.6%97 STS 1441347%88 STLS 1441403%96 TBHV 2031854%98 LT
7487085.3%100
Slide 15
Composite Score 1 Q 2013 State - Gujarat S.No.Thematic
AreaScoresRemarks 1 Human resource management 41/45 (91%) 2
Financial management20/20 (100%) 3 Case finding efforts28/40 (70%)
4 Quality of services85/145 (58%) Total174/250 (70%)
Slide 16
District wise Composite Score 1Q 2013
Slide 17
Slide 18
Gujarat state has been in the target zone, consecutively since
last more than Seven Years 26 / 30 (87%) reporting units are in the
target zone 113/143 (79%) TUs in target zone TB Suspects Examined
2Q13: 1,06,668 New Smear Positive Case Detection Rate 2Q13 : 75%
New Smear Positive Cure Rate 2Q12: 86% Total TB patients put on
treatment: 18,864 New Smear Positive Cases put on treatment: 9334
Since the inception of RNTCP up to 30-6-13 Total TB suspect
Examined: 45,56,096 Total TB Patients put on DOTS treatment, :
9,69,093 New Smear Positive patients put on treatment : 4,15,995
Additional lives saved : 1,74,437 Identification of MDR TB
Suspects: 38,421 Diagnosis of MDR TB Cases: 5,301 MDR TB Cases Put
on CAT IV : 4,173 XDR TB Cases Put on CAT V : 56 Achievements at a
Glance 2 nd Quarter 2013
Slide 19
Annualized New Smear Positive Case Detection Rate and Treatment
Success Rate in DOTS areas of Gujarat, 2000-2Q13
Rate of change in suspects examined per lakh population
(compared to same quarter in previous year) 2Q13 Vs 2Q12 Gujarat
State : 7.2%
Slide 30
Rate of change in suspects examined per s+ case diagnosed
(compared to same quarter in previous year) 2Q13 Vs 2Q12 Gujarat
State : 8.1%
Slide 31
Sputum conversion of NSP patients registered in 4 th quarter
2012
Slide 32
% of PHIs referring 2-3% of new adult OPD Gujarat 2 nd Quarter
2013
Slide 33
Slide 34
Major indicators Internal Evaluations-2Q13
DistrictDahodJunagadhBharuchNavsari Apr-13May-13 June-13 Difference
in NSP Cure rate b/w TB register and Quarterly Reports
0.9%2.1%0.3%0% Difference in SP-RT Cure rate b/w TB register and
Quarterly Reports 1.1%0.1%0% DOT Rate in NSP
interviewed100%90%85%95% Place & Timing of DOT
Convenient90%100% Proportion of patients aware of their illness100%
Wrong Categorization0%10%0%5% Aware about duration of Treatment89%
95% Attended a PP interaction meeting or community meeting 11%
10%30% Initial home visit has done80%90%63%90% Eligible children
received chemoprophylaxis100%90%56% 100% Practicing proper cough
etiquettes37%72%71%95% Know their HIV status21%35%32%30%
Slide 35
Slide 36
Slide 37
Contribution of PPs in RNTCP 1 st Q 13 Patients (no) % of total
of state PPs involved4858 Referral of suspects30182.1% NSP patients
put on DOTS7267.1% Total TB patients put on DOTS14557.1% PP
Involvement Gujarat - since 2006
Slide 38
Referral of TB Suspects from Health Facilities Gujarat 1 st
Quarter 2013
Slide 39
ESIS Referral of TB Suspects Gujarat 1 st Quarter 2013