Sputum microscopic examination

Bringing back smiles with DOTS

Patient-wise boxes of drugs

A DOT provider

Central TB Divison Directorate General of Health Services Ministry of Health and Family Welfare Nirman Bhawan, New Delhi - 110011 http://www.tbcindia.org

TB India 2007 RNTCP Status Report

TB Anywhere is TB Everywhere - Stop TB Now

Central TB Division Directorate General of Health Service Ministry of Health and Family Welfare Nirman Bhavan, New Delhi - 110 011 http://www.tbcindia.org This publication can be obtained from

Central TB Division Directorate General of Health Services Ministry of Health and Family Welfare Nirman Bhavan, New Delhi 110011 http://www.tbcindia.org

ISBN 81-902652-2-9 March 2007 © Central TB Division, Directorate General of Health Services LokLF; ,oa ifjokj dY;k.k ea=h Minister of Health & Family Welfare Hkkjr ljdkj] Government of India fuekZ.k Hkou] ubZ fnYyh&110 011 Nirman Bhavan, New Delhi - 110 011

MkW vUcqe.kh jkenkl Dr. Anbumani Ramadoss FOREWORD

I am extremely pleased to know that the Revised National TB Control Programme (RNTCP) has achieved 100% geographical coverage of the country under DOTS in March 2006 and has also consistently achieved the global target of treatment success rate of over 85% and that the case detection rate has been close to the global target of 70%. RNTCP has been recognised internationally for the fastest expansion in the history of DOTS implementation.

I am happy that the achievements of RNTCP have been lauded on the international stage forum.

India has the distinction of implementing the largest TB control programme in the world, which detects and put on DOTS more than 100,000 patients every month. Since the inception of the programme, about 6.7 million patients have been initiated on treatment, thereby saving more than 1.2 million additional lives. In 2004, 22% of the new infectious cases notifi ed globally were from India.

In October 2006, the Government of India invited a panel of international experts from the fi elds of public health, TB research and treatment, and other related fi elds to review the performance of the programme. Th is is the third such Joint Monitoring Mission (JMM) to review the RNTCP. Th e mission observed that “Programme service delivery is well integrated into the health system; tuberculosis care is provided by general health staff . Th e programme organisation has been established at all levels. External quality assessment has been implemented in the microscopy network. Th ere is an excellent system of recording and reporting, with indicators for monitoring and evaluation...” Th e Mission was impressed with the Government of India’s eff orts and has made several recommendations to further improve the programme, such as strengthening human resources at the central unit, promote eff ective service delivery and integration with NRHM, including prioritising the starting of management of MDR-TB at the earliest. RNTCP is currently taking steps to address these recommendations.

Combating TB is a long-term but a winnable battle. Th is year’s theme for World TB Day that “TB anywhere is TB everywhere” also points towards directing eff ort towards a TB-free India. Let us pledge to continue our eff orts to fi ght against tuberculosis. We need to strengthen the core capacity of all those involved in programme implementation. Th ere is also an urgent need to improve standardised treatment practices based on international guidelines for TB treatment both in the public sector and more so in the private sector. Th is can be achieved by linking all such health care providers to RNTCP and proactively building a working relationship with the other sectors. Th e programme has also put mechanisms in place to make services accessible, acceptable and aff ordable through partnership with the community based organisations and greater community participation and empowerment.

Th is is the seventh annual report of RNTCP being published, at a juncture when the programme has made considerable achievements, established TB/HIV collaborative activities for cross referral linkages between the two programmes, and identifi ed thrust areas in the second phase of RNTCP, backed by the critical observations of the JMM to improve programme eff ectiveness. Concerted eff orts are needed from the Government and all partners to sustain the achievements and eff ectively implement the additional planned activities.

Myself and my Ministry are fully committed to continue and intensify the eff orts to combat TB in India. I hope that all individuals and agencies involved in TB control in India will continue to work with high levels of dedication and commitment to achieve the ultimate goal of a TB-free India.

March 2, 2007 (Dr. Anbumani Ramadoss)

TB India 2007 3 Abbreviations

ACSM Advocacy, Communication and Social Mobilisation ADGHS Assistant Director General of Health Services AIDS Acquired Immune Defi ciency Syndrome AIIMS All India Institute of Medical Sciences ARTI Annual Risk of Tuberculosis Infection ASHA Accredited Social Health Activist BCG Bacillus Calmette-Guerin (antituberculosis vaccine) BPHC Block Primary Health Centre C&S Care and Support CDC Centres for Disease Control and Prevention CGHS Central Government Health Scheme CHAI Christian Health Association of India CHC Community Health Centre CII Confederation of Indian Industries CMAI Christian Medical Association of India CSC Central Steering Committee CTD Central Tuberculosis Division DANIDA Danish International Development Assistance DDG Deputy Director General DFID Department for International Development DGHS Directorate General of Health Services DMC Designated Microscopy Centre DOTS Directly Observed Treatment Short-course DRS Drug Resistance Surveillance DST Drug Sensitivity Testing DTC District Tuberculosis Centre

4 TB India 2007 DTCS District TB Control Society DTO District Tuberculosis Officer E Ethambutol EQA External Quality Assessment GMSD Government Medical Stores Depot GoI Government of India H Isoniazid HIV Human Immunodeficiency Virus HRD Human Resource Development ICMR Indian Council of Medical Research IEC Information, Education and Communication IMA Indian Medical Association IRL Intermediate Reference Laboratories ISM&H Indigenous System of Medicine and Homeopathy IUATLD International Union Against Tuberculosis and Lung Disease JMM Joint Monitoring Mission KAP Knowledge, Attitude and Practices LT Laboratory Technician MDG Millennium Development Goals MDR-TB Multi Drug-resistant TB (resistance to at least rifampicin and isoniazid) MIS Management Information System MO Medical Officer MoHFW Ministry of Health and Family Welfare MOTC Medical Officer-Tuberculosis Control MoU Memorandum of Understanding NACO National AIDS Control Organisation NACP National AIDS Control Programme NGO Non Governmental Organisation NRHM National Rural Health Mission NRL National Reference Laboratories NTF National Task Force NTI National Tuberculosis Institute NTP National Tuberculosis Programme OR Operational Research OSE On-site Evaluation

TB India 2007 5 PHC Primary Health Centre PL Peripheral Laboratory PP Private Practitioner PPM Public-Private Mix PSU Public Sector Units PTB Pulmonary Tuberculosis PWB Patient-wise Boxes QA Quality Assurance R Rifampicin RBRC Random Blinded Re-Checking RNTCP Revised National Tuberculosis Control Programme SDS State Drug Stores SMC Screening and Monitoring Committee STC State TB Cell STDC State Tuberculosis Training & Demonstration Centre STF State Task Force STLS Senior Tuberculosis Laboratory Supervisor STO State Tuberculosis Officer STS Senior Treatment Supervisor TB Tuberculosis TPIS Tuberculosis Programme Information System TRC Tuberculosis Research Centre TU Tuberculosis Unit USAID United States Agency for International Development VCTC Voluntary Testing and Counselling Centres WHO World Health Organization Z Pyrazinamide ZTF Zonal Task Force

6 TB India 2007 Contents

Foreword 3

Abbreviations 4

RNTCP Overview 2006 8

Chapter 1 TB: Burden of the Disease in India 10

Chapter 2 Stop TB Strategy 14

Chapter 3 Activities in 2006 21

Chapter 4 Joint Monitoring Mission 53

Chapter 5 Success Stories 57

Chapter 6 Research Activities 63

Chapter 7 Performance of RNTCP 71

TB India 2007 7 RNTCP OVERVIEW 2006

ndia is a large country with a vast and divergent PUBLIC PRIVATE MIX public sector complemented by an equally large  Over 2,200 Non Governmental Organisations private sector. There are states with good socio- (NGOs), 14,500 private practitioners, and 120 Idemographic and health indicators on the one hand, corporate houses are involved in the provision as well as states with poor economic conditions on the of RNTCP services. other. Delivering equitable health care in such diverse  Presently, 234 medical colleges (including conditions is a challenge which the government faces private colleges) are involved in RNTCP and in every health programme. contributing nearly 10–15% of case detection in their respective districts. The Revised National Tuberculosis Control Programme  Health facilities in government sectors outside (RNTCP) has been implemented in the country for the Health Ministry have been involved, namely close to a decade now, and more than 6.7 million Employees State Insurance (ESI), Railways, Ports patients have been put on Directly Observed Treatment and the Ministries of Mines, Steel, Coal, etc. – Short Course (DOTS). It has geographically  Collaboration for increased participation of expanded to achieve nation-wide coverage in March all sectors in RNTCP is being strengthened 2006, while maintaining a success rate higher than the through constant interaction with all stake- global target of 85%, and New Smear Positive case holders, including professional bodies like the detection rate close to the global benchmark of 70%. Indian Medical Association and the Indian Academy of Paediatricians. RNTCP Achievements till Date Achievements During 2006 PROGRAMME PERFORMANCE  All government health facilities, sub-centres,  Since inception of the programme, nearly and increasing number of community 6.7 million patients have been initiated on volunteers including anganwadi workers, treatment, with nearly 1.4 million in 2006 private practitioners and NGOs, have been alone, resulting in the saving of over 1.2 million involved in the provision of DOTS. Accredited additional lives till date. Social Health Activist (ASHA) workers under  To date, more than 500,000 individuals involved the National Rural Health Mission (NRHM) in RNTCP activities have been trained. are also being trained to participate as DOT  The new smear positive pulmonary TB (NSP) providers in rural areas. case detection rate was 72% in 2004, 66% in  The RNTCP National DOTS-Plus committee 2005 and 66% in 2006, which is close to the for formulating treatment and management global target of 70%. guidelines for MDR-TB cases under the RNTCP  Treatment success rate has been maintained was constituted in February 2005. The RNTCP consistently over the 85% global target. DOTS-Plus Guidelines were published in  Deaths due to TB have been reduced from March 2006. over 500,000 annually at the beginning of the  TB/HIV coordination activities have been programme to currently fewer than 370,000. strengthened. As of December 2006, cross-referral mechanisms have been established between guidelines for implementation of quality health facilities providing RNTCP services and improvement processes in the RNTCP the National AIDS Control Programme (NACP) Laboratory Network were held in 2006. Voluntary Counselling and Testing Centres in  Increasingly the programme is moving toward 14 states. Compared to 2005, the cross-referrals using electronic submission of reports through reported in 2006 have more than doubled. the Tuberculosis Programme Information  More that 13 lakh VCTC clients were reported System (TPIS) initiative. In the quarter ending to have been provided counselling on TB in the December 2006, almost all of the districts have first six months of 2006. As a recent initiative, submitted the quarterly report electronically. a “10-point counselling tool on TB” has been The programme is also pilot testing a Windows developed by RNTCP for use by the counsellors based version of Epi-Centre, and if successful it in the VCTCs. is expected to be rolled out across the programme  To build the national Operational Research in 2007. (OR) capacity and push OR in priority areas, a  A training for Master trainers from Gujarat and series of workshops was planned to develop OR Maharashtra States on DOTS-Plus was held in proposals with medical colleges. The first such January 2007. OR workshop was organised by the TB Research  The second national level training of State IEC Centre in Chennai in September 2006. officers was held in June 2006 to build capacity in  Preliminary findings of the Gujarat Drug planning and implementing ACSM activities. Resistance Surveillance (DRS) survey are  A meeting of the national task force and five zonal available. Interim results show that MDR-TB task force meetings were held to further involve was found in 2.4% of new cases and in 16.9% medical colleges in RNTCP activities. of re-treatment cases.  State specific Annual Risk of TB Infection (ARTI)  Four national level orientation workshops on surveys have been completed in Andhra Pradesh revised External Quality Assessment (EQA) and Kerala. Chapter 1 cases in the country. the in cases were positive about 3.8 TB million bacteriologically there that 2000, year the for estimated been has It world. the in country burden TB highest the India and 2/3rd of the cases in South-East Asia. Th is makes India accounts for a fi fth of the world’s new TB cases annually, country. occurring cases With 1.8 million in our of millions health the Tuberculosis threatens countries. developing and poor in prevalent especially is and eliminated been yet not has TB successors, his Dr of and Koch easily curable disease. Despite the courageous eff orts fibe would world the an TB, control to hard ghting 125 years, even after that expected have least would statement above the making while Koch, Robert Surveillance, Planning and Financing Source: WHO Geneva; WHO Report2006:GlobalTuberculosis Control; “I havenobusinesstolivethislifeifIcannoteradicatehorriblescourgefromthemankind,” = 8.9 million 8.9 = Incidence Annual Global burden countrygloballyaccounting for one-fi� h oftheglobalincidence Phillippines Phillippines Fig. 1:IndiaisthehighestTB Chapter 1 Ethiopia Ethiopia 3 % Other 13 Other Pakista Robert Koch, delivering alecture atBerlinUniversity onhisdiscoveryof tuberculosis bacilli,1882 3 % 3 18 % Non % 20 HBCs HBCs n HBCs HBCs % Bangladesh 4% 10 South Africa South

4% Nigeria 4% Nigeria India 20% India TB India 2007 Indonesia 6% Indonesia China 15% TB: BURDENOFTHE country. Th e bacillus Th bacillus the e of country. economy the as well as health the aff ects that diseases serious most the of one remains TB Magnitude oftheDisease of infection and disease, tuberculin surveys, duration information available on case notifications, prevalence and all account into takes that process consultative and incidence analytical an on based are country the in prevalence, mortality TB of Estimates eff to challenges control. TB ective additional pose MDR-TB of emergence the and decades two last TB the Th during disease. HIV of (MDR-TB) spread e Latent – TB resistant Multi-drug forms and TB Active infection, various in itself presents Source: RNTCP Dat Fig. 2:TBaffects mostlyyoungadults DISEASE ININDIA No. of new smear +ve cases 1 1 0 2 2 4 6 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 a, 200 1 0 0 5 - 1 2 4 6 6 1 1 1 5 6 - 0 2 4 4 9 1 2 2 6 5 - 4 Mycobacterium tuberculosis tuberculosis Mycobacterium Age Groups 3 5 4 6 1 1 3 4 5 - 0 4 6 4 0 9 4 0 5 4 - 5 8 4 7 6 5 1 5 0 - 6 7 4 0 4 5 6 1 5 3 + 0

Chapter 1 1 11 contributionsTB to control from the threat of multi-drug resistant TB. TB (MDR-TB) and HIV-related The burden of TB inIndia is indeed staggeringby TB was any declared measure. emergency” a “global by WHO over a decade ago because of its toll on the health of individualscountry. a andof its development wider overall social on andimpact economic positive pulmonary TB. One sputum positive patient patient positive sputum One TB. pulmonary positive caninfect 10–15 persons in a year if left untreated. Poorly treated patients can develop drug-resistant and potentially incurable formsTB. of Burden Economic TheWorld TB Day theme includes aof numbersupporting messages which are emphasisedesigned the importance of: to 1. Improved endemic country2. financial Community involvement 3. Scale-up of donor investmentcommunities protect to 4. decision-makers for Need TB India 2007 STOP TB Strategy for World TB Day World TB Strategy for STOP World TB World MarchDay, 24th, 2007 will mark the 125th anniversary of Robert discoveryKoch’s of tuberculosis. This year the theme ofis the“TB eventanywhere is TB everywhere”, reflectinga message of urgency and shared responsibility. Unified action on all levels is required to towardswork a world free of tuberculosis. The theme reflects the chronically inadequate investment in development and research surveillance, control, TB as deadlywellTB’s as synergy with HIV. http://www.stoptb.org/events/world_tb_day/2007/ of illness, proportion of smear positive cases, number cases, positive smear of proportion illness, of of cases treated and remaining prevalence,untreated, mortality and demography. HIV tuberculosis estimates disease prevalenceof first The figure the and 1950s, the in available became India in of 4/1000 for the nation as a whole was accepted two then.of Today, every five Indians are infected with theTB bacillus. There is a strong chance that duringdisease TB develop will 10% least at them, of their lifetime. Of the 1.8 millionsputum have million 0.8 around annually, newoccurring TB cases 1 TB affects the most productive age group (15–54 years) group age productive most TB affects the Chapter 1 household and neighbourhood. neighbourhood. and household in the are in ostracised and community, the women men have to deal with the stigma at their workplaces for both men and women. Studies indicate that while burden the to adds disease the of stigma social The because theirparents have TB. 300,000 children are forced to leave school every year, major deterrent to women’s empowerment. More thana it year,making every families their by abandoned are TB with women 100,000 than More rejection. and stigma fearing symptoms TB suppress to try Womenwelfare. family and productivity economic survival, child for implications major have women among deaths infected. TB be to found were of TB died mothers whose children cases, many In duties. is close to her children and has to perform household mother can pose a threat to the entire household as she A TB-affected responsibilities. household neglect to ignore medical help largely in the initial stages, not wanting They disadvantaged. doubly are Women community intoacircle ofdiseaseandpoverty. entire the lock can It common. are crowding over and housing shanty malnutrition, where appears tribal and pockets. Known as the disease of the poor, TB often areas backward of residents dwellers, The usual victims of TB are migrant labourers, slum SocialTB andPoverty Burden – US$ 3billion(more thanRs13,000crore). cost of tuberculosis to the Indian economy is at least workdays lost due to the disease. The annualcrore economic17 about with loss economic huge causes TB 2000. It is not just the death figures that are startling. which was estimated at over 500,000 annually prior to tuberculosis (mortality rate 30 per 100,000 persons), WHO per of Indiadied in persons 370,000 2004, in estimates As death. causing diseases infectious leading the of one is and years) (15–54 group age productive economically the in occur cases the of (DALYs)years life adjusted InIndia,overlost. 70% prematuredisability- measuredof as terms death, in More than 80% of the burden of tuberculosis is due to 12

TB India 2007 poor management of TB cases. It is mainly caused mainly is It cases. TB of management poor of reflection a is rifampicin, and isoniazid least at to resistance as defined MDR-TB, problem. wide world- a is agents antimicrobial to resistant are that The emergence of strains of Resistance inIndia Anti-Tuberculosis Drug HIV prevalence in the country. country. the in prevalence HIV of level any at occurring cases TB new of number the change markedly to the expected is over years few next states the in services DOTS quality of implementation Effective pool. infected non-HIV the by TB-infected driven primarily being however is India in epidemiology TB India. in patients adult TB in HIV of has 5.2% of WHO prevalence a estimated modeling, mathematical on Based HIV negative person, who has a 10% lifetime risk. disease once infected with TB bacilli, as compared totimes an (50–60% lifetime risk) more likely to develop TBinfection to TB disease. An HIV positive person is six TBprogression from of risk theincreasing and TB to vulnerability the increasing system, immune the amongstpersonsinfected withHIV. debilitatesHIV develop opportunistictoearliestdiseases the of one of the adult population of the country. Tuberculosis is be 5.22 million, which equates to approximately 0.9% The burden of HIV infection in India is estimated to Tuberculosis andHIV * Purified Protein Derivative Protein Purified * Fig. 3:LifetimeRiskof

Per cent 10 20 30 40 50 60 70 0 *PPD+/HI TB Disease negativ e V Mycobacterium tuberculosis - PPD+/HIV+ D eveloping

Chapter 1 13 TB control is a long-term battle and will require extended political support. The detectiontargets of andcase treatment successreached and then mustmaintained forfirst several decades.be It has been documented in several countries, that initial success in the control of TB complacencymay and leada subsequent resurgenceto of cases and the emergence and spread of drug resistance. The success of the RNTCP acknowledgedin India worldwide. has However,been it will 10–15take years before the success makes a significant epidemiological impact on the problem of TB in Consideringcountry.the existingthe caseload, and the continuous addition to this pool of patients, TB control services would be required for at least another 40–50 years in India. Though efforts have been made for decentralisation of the programme, it may not be possiblethe logisticsfor theand technicalstates supportto implementingrequiredfund it forat this stage. It is essentialCentralassistance tothethat states for implementation of RNTCP should continue for at least 5–10years.TB-HIVBesides,anotherco- emergence the of infection and MDR-TB has increased the severity and magnitude TBof epidemic globally and poses an important challenge to the TB control efforts in India. Unless the national programme, partners and all healthcare providers proactivelythese challenges,address the goal of TB control may not be realised in this generation’s lifetime. TB India 2007 by failure to ensure that medications rather arethan failure of taken,the medicines to cure a large proportion of patients. Drug resistance develops a as or strain, resistant a with infection to due either patient a when as such treatment inadequate of result is exposed to a single drug, or because of selective drug intake, use of inappropriate non-standardised drug poor supply, drug irregular regimens, treatment erratic absorption of medications. or rarely quality, tuberculosis to threat potential a posing is MDR-TB control in the country. Continuous monitoring of drugresistanceprevalent TB trendssettingshighin is essential in order to assess current interventions and their impact on the TB epidemic.drug resistanceThough against isoniazid and hasbeen rifampicinfrequently reported in India, the available information is hospital-based, anecdotal, and may not have used quality controlled laboratories fordrug susceptibility testing. Presently representativea seriesdrug resistanceof surveillance studies is being conducted in selected states in accordance resistance drug of surveillance global WHO the with project. Data from these surveys will provide more valid estimates of the occurrence of MDR-TB and resistancedrug in trends the monitoringof for allow levels. Available data from the early surveys show 1–3% MDR-TB among new cases and 13–17% among cases with a previous history treatment.of anti-TB Chapter 2   Th 2015. by MDGs are: ey TB-related global has identified six principal components to realise the Th 2006 in StopTB WHO Strategy, released new e rights. human advance and poverty alleviate systems, health strengthen to efforts underpins and challenges, and constraints remaining the addresses effectively sustained, be to achievements enables existing that strategy coherent a requires targets these Meeting control. TB for targets Partnership TB Stop related and (MDG) Goals Development task for the next decade is to major achieve the Millennium the achievements, current the on Building countries. 180 over in implemented being is and basis a on mass TB controlling in tool effective course (DOTS) strategy. DOTS has proved to be an recommended Directly Observed Treatment, Short- internationally the of implementation widespread and development of because mainly – control TB global in progress major seen has Thdecade past e New TB Strategy WHO Stop Addressing TB/HIV, MDR-TB and other other and MDR-TB TB/HIV, Addressing and expansion DOTS quality high Pursuing challenges; enhancement; “WHO hasbeeninthevanguardstrengtheninghealthsectorresponse Chapter 2 HIV-associated anddrug-resistantTB. IthoststheStopTBPartnership, whichhas the dramaticscale-upof TBcontrol,andnewresponsestothehugethreatsof become amodelof consensus-building,innovationandcollaboration.” 14

TB India 2007 control control TB, with the to object ive of strategy curing at least the 85% DOTS of recommended India in internationally application an is RNTCP The     STOP TBSTRATEGY Empowering patients and communities; and communities; and patients Empowering providers; care all Engaging Enabling and promoting research. promoting and Enabling Contributing to health system strengthening; system health to Contributing Former UNSecretary-General Kofi Annan . Ithasled Chapter 2 15 Good quality diagnosis through quality diagnosis through Good sputum microscopy Sputum microscopy continuestool for todetection of beinfectious TB, theas it bestprovides information on the infectiousness of the patient, helps in categorisation of the patient for treatment andobjectiveanis method monitorto the patient’s progress. Other advantages of this method are that it is relatively easy to perform and less expensive than an X-ray. The result is available within two days and correct treatment can be started without Microscopic Microscopic examination of Orissa Centre, Microscopy Designated sputum sample at Nidan Private TB India 2007 Union Union Health Minister Dr Anbumani Ramadoss along with Ms. Lakshmi, P. Minister of State for Health & Family Government Welfare, of India in India support to TB Control political lending The Government of topmostIndia priority to hasTB control accordedprogramme. The government’s thecommitment is measured in terms of continued financialresources and commitment,administrative support. The success human of the programme to date bears testimony to the commitment of the government. Political and administrative commitment administrative and Political of new sputum positive TB patients and detecting at least 70% of such patients. Large-scale expansion of DOTS services in India began in 1997 after a successful pilot from 1993, which established the RNTCP years, technical 8 past the In andstrategy. the of operational feasibility has been expanding rapidly covering 50% of the population in 2002, and full nation wide coverage was achieved by March 2006. to was I Phase in RNTCP of element core essential The country, the in expansion DOTS quality high ensure DOTS the of components primary five the addressing strategy. Chapter 2 Patient-wise boxes entire course of treatment for an individual patient. patient. for of an course entire treatment individual the contains RNTCP, which the of innovation cases), an paediatric and adult (for boxes drug wise patient- of use the are RNTCP of feature unique A provide DOTS services through the private sector. private the through services DOTS provide to initiatives taken has government the physicians, private from As treatment seek also patients. may patients to TB services DOT provide facilities centres, community health centres, and other health health primary RNTCP, the Under sub-centres, all management. stock drug and supply drug and adherence, care, patient improve to helped have (PWBs) Boxes drug Patient-Wise treatment, due to the lack of drugs. of lack the to due treatment, interrupt or treatment, their of initiation delay to District/State/National) to ensure that no patient has Institution/ Health (Peripheral levels appropriate the all at available drugs anti-TB assured quality vision The of the RNTCP 1). is to have Table at all (Refer times, sufficient observation direct facilitate to and reduce the duration Organization, treatment Health World the by recommended as regimens, RNTCP uses intermittent short-course chemotherapy drugs Uninterrupted supplyofgoodquality diagnostic standardised algorithms. using TB treats of and forms all diagnoses RNTCP tool, diagnostic primary the is microscopy sputum delay.Although 16

TB India 2007

and development of new cases of tuberculosis. tuberculosis. of cases new of development and in the community and thereby the burden of disease of infection the spread reduces further to treatment adherence Confirmed organisms. drug-resistant of and adherence reduces the of probability emergence of drug resistance, because direct observation ensures development in reduction the is important Equally rates associated with assured completion of treatment. Themost immediate benefit of DOT is the high cure intherightdoses andattherightintervals. drugs, ensures treatment for the observation entire course with the right Direct drugs. their taking in patient the supports and watches member) family a not is (health worker or trained community volunteer who elements of the DOTS strategy. In DOT, an observer Directly observed treatment (DOT) is one of the key TreatmentDirectly Observed in Hospital Shah-e-Miran at Ahmedabad centre DOT the of occasion inauguration the on of patient a to DOT gives Hamidan A.I. Advocate, has achieved is regular monitoring, supervision and evaluation and supervision monitoring, regular programme is the achieved has that standards high the maintaining to key The Chapter 2 3 E 3 R 3 + 5H 3 E 3 Z 3 R 3 3 R 3 3 R 3 + 1H 3 17 + 4H S 3 3 + 4H E E 3 3 3 Z Z Z 3 3 3 R R R 3 3 3 H 2 Regimen* 2H 2H providing additional contractual staff,continues to RNTCPstrengthen the general health system involvementcareallof area of the In country. thein been has RNTCP private, as well as public providers, a global leader. An effective advocacy, social communicationmobilisation strategy andis in amongst place, RNTCP and TB of visibility inhigh maintain order to and community, andleadersopinionmakers, policy administrativeandpolitical long-term sustain hence commitment and greater community involvement in RNTCP. The programme withResearch Centre, Chennai,active NationalTB Institute, support BangaloreandLalaof Ram Sarup Institute andTB of TB RespiratoryacademiciansotherandDiseases,Delhi in Medical Colleges and research institutes,been undertaking has operational research to generate theassess to anddecisions policyinform toevidence RNTCP of impact and burden disease of magnitude DOTS programme. TB India 2007 New Sputum smear-negative, not seriously ill seriously not smear-negative, Sputum New ill seriously not Extra-pulmonary, New New sputum smear-positive New sputum smear-negative ill** new Seriously extra-pulmonary ill** new Seriously Relapse Sputum smear-positive Failure Sputum smear-positive After Default Treatment Sputum smear-positive Others*** Type of patient of Type Table 1 : Categorisation and Treatment Regimens under RNTCP Regimens and Treatment 1 : Categorisation Table Category III Category Category I Category II Category Category of of Category treatment dosage The week. per doses of number the to refers letters the after subscript The treatment. of months of number the to refers letters the before number *The strengths are as follows: H: Isoniazid (600 mg), R: Rifampicin (450 mg), Z: Pyrazinamide (1500 mg), E: Ethambutol (1200 than who are mg), more 50 150 years who who weigh 60 Rifampicin mg. Patients old S: 500 kg or receive receive additional Streptomycin mg. Patients Patients more Streptomycin (750 mg). weigh less than 30 kg receive drugs as per in I body Categories Patients weight. and II who have a positive sputum smear at the end of the initial intensive phase treatment. intensive of month an additional phase receive medical treating categorising/ to the his sero-status declares HIV-positive and is who or extra-pulmonary pulmonary patient, any ill also includes ** Seriously be done not should HIV testing categorisation, purpose of For the (MO). officer *** In cases, rare and patients who exceptional are sputum smear-negative or who have disease extra-pulmonary can have Relapse or This Failure. diagnosis the cases, In these active TB. current, of evidence be or supported histo-pathological by should culture and by an MO always be cases made in should all such II treatment. given Category and as ‘Others’ be categorised should patient The Revised National Tuberculosis Programme(RNTCP) Phase II is in line with the new WHO TBStop Strategy forTB control and covers all the activities proposed RNTCPThe under strategy. the is already collaborating withof challenges theaddress to National(NACP) Programme AIDSControl TB-HIVco-infection developedhasand guidelines for management of MDR-TB and is in the process strengtheningservices. By Plus DOTS out rolling of laboratories and drug delivery systems, and by Addressing Stop Stop under TB Strategy Addressing RNTCP Systematic monitoring and monitoring Systematic accountability TheProgramme is accountable for theof outcomeevery patient put on treatment. RNTCP uses a standardised recording and reporting system. The curerate and other key indicators are monitored at every level of the health system, and if any area is expectations,meetingintensified.supervisionnot is RNTCP shifts the responsibility for cure from the patient to the health system. INTERNATIONAL STANDARDS FOR TB CARE

The International Standards for Tuberculosis Care (ISTC) Standard 5. The diagnosis of sputum smear-negative pulmonary describes a widely accepted level of care that all practitioners, tuberculosis should be based on the following criteria: at least public and private, should follow in dealing with people who three negative sputum smears (including at least one early have, or are suspected of having, tuberculosis.The Standards morning specimen); chest radiography findings consistent are intended to facilitate the effective engagement of all with tuberculosis; and lack of response to a trial of broad care providers in delivering high-quality care for patients spectrum antimicrobial agents. Because the fluoroquinolones of all ages, including those with sputum smear-positive, are active against M. tuberculosis and, thus, may cause transient sputum smear-negative, and extrapulmonary tuberculosis, improvement in persons with tuberculosis, they should be tuberculosis caused by drug-resistant organisms, and avoided. In persons with known or suspected HIV infection, tuberculosis combined with human immunodeficiency virus the diagnostic evaluation should be expedited. (HIV) infection. Standard 6. The diagnosis of intrathoracic (i.e. pulmonary, The Standards have been developed by the Tuberculosis pleural, and mediastinal or hilar lymph node) tuberculosis in Coalition for Technical Assistance (TBCTA) with funding symptomatic children with negative sputum smears should support from the US Agency for International Development. be based on the finding of chest radiographic abnormalities ISTC emerged after a year-long inclusive process guided by consistent with tuberculosis and either a history of exposure a 28-member steering committee that included individuals to an infectious case or evidence of tuberculosis infection representing a wide variety of relevant perspectives on (positive tuberculin skin test or interferon gamma release tuberculosis care and control. In addition, the document assay). For such patients, if facilities for culture are available, was presented at various public forums with an open sputum specimens should be obtained (by expectoration, invitation for comments. India was intimately involved in gastric washings, or induced sputum) for culture. the development of the ISTC and a representative of the Indian Medical Association (IMA) was a member of the Standards for Treatment Chapter 2 steering committee that supervised the development of the Standard 7: Any practitioner treating a patient for ISTC document. The RNTCP of the Government of India tuberculosis is assuming an important public health conforms to the standards prescribed in the ISTC. responsibility. To fulfill this responsibility the practitioner must not only prescribe an appropriate regimen but also Standards for Diagnosis be capable of assessing the adherence of the patient to the Standard 1. All persons with otherwise unexplained regimen and addressing poor adherence when it occurs. By productive cough lasting two–three weeks or more should doing so, the provider will be able to ensure adherence to be evaluated for tuberculosis. the regimen until treatment is completed.

Standard 2. All patients (adults, adolescents, and children Standard 8. All patients (including those with HIV infection) who are capable of producing sputum) suspected of having who have not been treated previously should receive an pulmonary tuberculosis should have at least two, and internationally accepted first-line treatment regimen using preferably three, sputum specimens obtained for microscopic drugs of known bioavailability. The initial phase should consist examination. When possible, at least one early morning of two months of isoniazid, rifampicin, pyrazinamide, and specimen should be obtained. ethambutol. The preferred continuation phase consists of isoniazid and rifampicin given for four months. Isoniazid and Standard 3. For all patients (adults, adolescents, and ethambutol given for six months is an alternative continuation children) suspected of having extrapulmonary tuberculosis, phase regimen that may be used when adherence cannot be appropriate specimens from the suspected sites of involvement assessed, but it is associated with a higher rate of failure and should be obtained for microscopy and, where facilities and relapse, especially in patients with HIV infection. The doses of resources are available, for culture and histopathological antituberculosis drugs used should conform to international examination. recommendations. Fixed-dose combinations of two (isoniazid and rifampicin), three (isoniazid, rifampicin, and Standard 4. All persons with chest radiographic findings pyrazinamide), and four (isoniazid, rifampicin, pyrazinamide, suggestive of tuberculosis should have sputum specimens and ethambutol) drugs are highly recommended, especially submitted for microbiological examination. when medication ingestion is not observed.

18 TB India 2007 Standard 9. To foster and assess adherence, a patient-centred for treatment. Given the complexity of co-administration approach to administration of drug treatment, based on the of antituberculosis treatment and antiretroviral therapy, patient’s needs and mutual respect between the patient and consultation with a physician who is expert in this area is the provider, should be developed for all patients. Supervision recommended before initiation of concurrent treatment and support should be gender-sensitive and age-specific and for tuberculosis and HIV infection, regardless of which should draw on the full range of recommended interventions disease appeared first. However, initiation of treatment for and available support services, including patient counseling tuberculosis should not be delayed. Patients with tuberculosis and education. A central element of the patient-centred and HIV infection should also receive cotrimoxazole as strategy is the use of measures to assess and promote adherence prophylaxis for other infections. to the treatment regimen and to address poor adherence when it occurs. These measures should be tailored to the Standard 14. An assessment of the likelihood of drug individual patient’s circumstances and be mutually acceptable resistance, based on history of prior treatment, exposure to a to the patient and the provider. Such measures may include possible source case having drug-resistant organisms, and the direct observation of medication ingestion (directly observed community prevalence of drug resistance, should be obtained therapy—DOT) by a treatment supporter who is acceptable for all patients. Patients who fail treatment and chronic cases and accountable to the patient and to the health system. should always be assessed for possible drug resistance. For patients in whom drug resistance is considered to be likely, Standard 10. All patients should be monitored for response to culture and drug susceptibility testing for isoniazid, rifampicin, therapy, best judged in patients with pulmonary tuberculosis and ethambutol should be performed promptly. by follow-up sputum microscopy (two specimens) at least at the time of completion of the initial phase of treatment (two Standard 15. Patients with tuberculosis caused by drug- Chapter 2 months), at five months, and at the end of treatment. Patients resistant (especially multi drug resistant [MDR]) organisms who have positive smears during the fifth month of treatment should be treated with specialized regimens containing should be considered as treatment failures and have therapy second-line antituberculosis drugs. At least four drugs modified appropriately. (See Standards 14 and 15) In patients to which the organisms are known or presumed to be with extrapulmonary tuberculosis and in children, the response susceptible should be used, and treatment should be to treatment is best assessed clinically. Follow-up radiographic given for at least 18 months. Patient-centred measures examinations are usually unnecessary and may be misleading. are required to ensure adherence. Consultation with a provider experienced in treatment of patients with MDR Standard 11. A written record of all medications given, tuberculosis should be obtained. bacteriologic response, and adverse reactions should be maintained for all patients. Standards for Public Health Responsibilities Standard 12. In areas with a high prevalence of HIV Standard 16. All providers of care for patients with tuberculosis infection in the general population and where tuberculosis should ensure that persons (especially children under 5 years of and HIV infection are likely to co-exist, HIV counseling age and persons with HIV infection) who are in close contact and testing is indicated for all tuberculosis patients as part with patients who have infectious tuberculosis are evaluated of their routine management. In areas with lower prevalence and managed in line with international recommendations. rates of HIV, HIV counseling and testing is indicated for Children under 5 years of age and persons with HIV infection tuberculosis patients with symptoms and/or signs of HIV- who have been in contact with an infectious case should be related conditions and in tuberculosis patients having a evaluated for both latent infection with M. tuberculosis and history suggestive of high risk of HIV exposure. for active tuberculosis.

Standard 13. All patients with tuberculosis and HIV infection Standard 17. All providers must report both new and should be evaluated to determine if antiretroviral therapy is retreatment tuberculosis cases and their treatment outcomes indicated during the course of treatment for tuberculosis. to local public health authorities, in conformance with Appropriate arrangements for access to antiretroviral applicable legal requirements and policies. drugs should be made for patients who meet indications

TB India 2007 19 Chapter 2 the International Standards for TB Care, and also and Care, TB for endorsed Standards International and the adopted has 2006, held November in meeting its in (NTF) RNTCP in Colleges The National Task involvementForce on of Medical standards. international the per as patients TB their to care give shall providers care health all that commit and ISTC the endorse bodies of professional that imperative is It management cases. TB the for observed are international standards the is that ensure entirety to means its only in the RNTCP practising India, In The Road Ahead Health Minister of Kerala, Ms. P.K. Sreemathy handing overThe TBPatients’ ChartertoaTBpatient 20

TB India 2007 International Standards for TB Care TB for Standards International with international guidelines and standards. and guidelines international with in accordance tuberculosis, with patients managing in care possible best the provide to commitment its demonstrate to has community medical Indian RNTCP. the of The principles the to commitment their also is which standards, international these to all to them commitment their seek and through practitioners, medical and all bodies, to standards these professional take to is country the in The important next step ahead for health professionals advocacy for RNTCP with other professional bodies. undertake shall members NTF the that committed Chapter 3 18 450 530 778 947 130 287 1080 (millions) Population Covered Covered Population 1114 (100%) 21 Coverage, 1998 through 2006 Table 1: Rapid Scale-up of RNTCP Table March 2006 March 2001 2002 2003 2004 2005 Year 1998 1999 2000 ACTIVITIES IN 2006 ACTIVITIES recommended recommended Directly Short Observed Treatment, control. TB for strategy (DOTS) course expandedhas RNTCP the years, eight past the Over rapidlyfromcovering million18 people 1998into the entire population of 1,114 million by March 2006. The Indian TB Control Programmesuccessfully completed thehas largest and most rapid expansion of DOTS in history to cover the entire country.Phase II (2006-2011) of RNTCP is a step towards achieving the TB-related UN millennium edevelopment programme goals. has developedTh a ‘Strategic Vision for TB Control for the country up to 2015’, under which it aims to achieve and TB India 2007 PM Manmohan Singh during the convocation address at the the at address convocation the during Singh PM Manmohan All-India Institute for Medical Sciences in New Delhi, October 2005 in New Sciences Medical for Institute All-India in our moral obligation to all citizens.” in our moral obligation to all citizens.” Chapter 3 Chapter “We recognise health as an inalienable human right that every individual can justly inalienable human right that every recognise health as an “We claim. So long as wide health inequalities exist in our country and access to essential in our country wide health inequalities exist claim. So long as health care is not universally assured, we would fall short in both economic planning and short in universally assured, we would fall health care is not Health Minister Dr. Anbumani Ramadoss addressing the RNTCP Joint RNTCP the addressingAnbumaniRamadoss MinisterHealthDr. Monitoring Mission, October 2006 National health is important for the overall health of the the of health overall the for important is health National rightly Singh Manmohan Minister Prime As citizens. With lives. healthy demand to right a have people said, Control Tuberculosis National this goal, the Revised Programme was set infection up of to transmission decreasecut and mortalityTB to and due morbidity in problem health public major a be to ceases a TB of until recommendations and ndings fi the on Based India. (GoI), India of Government by conducted review joint Development WHO International and the Swedish built is It 1992. in launched was RNTCP the Agency, upon the infrastructure already established by the previous National Tuberculosis Programme, while incorporating the elements of the internationally Chapter 3 Mix (PPM) activities to increase the reach of DOT of reach the increase to activities (PPM) Mix Public-Private pro-active services; DOT friendly patient and accessible decentralised microscopy; sputum for protocol assurance quality RNTCP the of implementation through DOTS of quality the strengthen to efforts making is II Phase RNTCP problem. health public a be to ceases tuberculosis until decades few next the for least at programme, quality high a as RNTCP the of implementation of sustained the towards Government committed fully stands India The cases. such of 70% least at of detection and patients, TB pulmonary positive sputum new in 85% least at of rate a cure maintain Indicators for Target 8tobeusedevaluate the implementation and impactof TBcontrol: prevalence and death rates associated with To havehaltedby2015and beguntoreverse the incidence of malaria and other major Population covered (millions) Figure 1:PopulationcoveredunderDOTSandtotalTBpatients Between 1990and 2015,to halvethe 1000 1200 1000 1200 20 40 60 80 20 40 60 80 0 0 0 0 0 0 0 0 0 0

Qtr1-94

Qtr3-94 TB-related Millennium Development Goals tuberculosis; and Indicator 23 Total patients treated Qtr1-95 Populatio 22 Qtr3-95

To combatHIV/AIDS,malaria and other diseases >100,000 patients put on on put patients >100,000 Qtr1-96 put patients million 1.4 ≈ treatment every month every treatment on treatment in 2006 in treatment on put ontreatmentineachquarter TB India 2007 Qtr3-96 n

Qtr1-97 coverage(i

Qtr3-97 diseases, including tuberculosis. Qtr1-98 Qtr3-98 m n

Quarter/Year Qtr1-99 illions Qtr3-99 Target 8 Goal 6 Qtr1-00

Qtr3-00 ) positive TBcasesarising annually, and to Qtr1-01 guidelines. per as patients MDR-TB of management case the for sites, DOTS-Plus have to and RNTCP for services Testing(DST) Sensitivity Drug and culture providing state, large each in one (IRLs), Laboratories Reference Intermediate level network of RNTCP accredited quality assured state- “new” a cases MDR-TB year. isThe vision to havea 5,000 to up for management RNTCP and care in provide to proposed been have activities New services. quality for demand and awareness advocacy, based to generate and mobilisation social need communication and drugs; anti-TB line services; rational use of standardised first and second By 2005,todetect 70%of new smear Qtr3-01 successfully treat 85%of these cases Qtr1-02 Qtr3-02 Qtr1-03

Qtr3-03 Indicator 2 Qtr1-04 Qtr3-04 Qtr1-05 Qtr3-05 4 Qtr1-06 Qtr3-06 337275 0 50000 100000 150000 200000 250000 300000 350000

Total Patients treated Chapter 3 23 delivery of services through all the existing health provider sectors, e.g. ministries, other under medical facilities health sector, private colleges, NGOs, etc.,andalso through strengthening ofprogramme management capacity at central, state and district levels by strengthening manpower and training. RNTCPalsoisworking mainstreamto services for marginalised groups such as urban slum dwellers and tribals in terms of improved access to health facilities. Need-based, focused and people-centric Information, Education and(IEC) Communicationactivities have been especiallyregularly for such people organisedliving in hard-to-reach areas. RNTCP trains interpersonalcounsellinganditsskillscommunication programme staff to inbridge the gap between patients and providers so that they complete treatment and continue to be advocates of DOTS. Enhancing communityparticipation in DOTS is also paramount to the success of the programme. RNTCP carries out supervisionan of intensiveactivities regularly to systematicincrease efficiencythe of health workers by developingknowledge, perfectingtheir their skills, improving their attitudes towards their work and increasing their motivation, and hence ensuring that the services provided are of the highest quality. TB India 2007 DDG (TB) addressing the Joint Monitoring Mission meeting, October 2006 RNTCP Activities 2006 Activities RNTCP The entire country is now covered by theRevised makingProgramme,Control Tuberculosis National it the second largestworld. suchSince the programmeprogramme began, the RNTCP in hasthe trained over half a million staff in the healthwithmillionpeople 24 thansystem,evaluated more suspected TB, examined more than 100 millionsputum slides and treated more than 6.7 million patients, and thereby prevented almost 1.2 million TB deaths. Alongside this rapid expansion, quality of services has been maintained. The results meet the internationally set a benchmark of a treatment success rate of >85% among new sputum positive pulmonaryTB cases. Case detection rates are close to the global target of 70%. The second phase (2006–2011) of theaims to consolidate, RNTCP maintain and further improve theachievements ofthe first phase. The main focus is on maintenance and improvement in the quality of RNTCP services by widening providingstandardised, qualitygoodtreatmentand the scope for diagnostic services to all TB patients. An enabling patient-friendly environment is to be provided in whichever health care facility they seek treatment from. This is envisaged to beinter-sectoralscalingof up achieved collaboration, including through Chapter 3 laboratory related activitiesoftheprogramme. laboratory quarter and works as a task force to guide and oversee WHO India as members. This committee meets every Nationaland ReferenceCTD (NRLs), Laboratories constituted with representatives of the three RNTCP A Central RNTCP Laboratory Committee has been network for RNTCPlaboratory at the higher levels. national and level) (state intermediate the by and locally (STLS) Supervisor Laboratory TB Senior monitoring of the diagnostic systems by the RNTCP and supervision for and (EQA) assessment quality external microscopy sputum for system designed been has routine in-built An network. laboratory the to equipments the and reagents provides quality of supply programme the TB, for practices the meet Tostandards of internationally cases. recommended and diagnostic suspects TB for services diagnostic assured quality accessible and affordable available, appropriate, provides which envisaged, is laboratories microscopy smear sputum designated assured quality RNTCP of network nation-wide A Services Quality Assured Diagnostic Centre (TRC), Chennai; National Tuberculosis Tuberculosis National Chennai; (TRC), Centre designated NRLs, namely the Tuberculosis Research three of consists network laboratory RNTCP The network Laboratory has overseen the speedy expansion of RNTCP RNTCP of expansion speedy the overseen has the Union Ministry of Health and Family Welfare, Dr Chauhan, the Deputy Director General (TB) with India. in activities control of TB Dr. L.S. Chauhan, DDG, as a mark of appreciation million people. million 1,114 of population entire country’s the cover to has been awarded by the Stop TB Partnership to to Partnership Stop TB the by awarded been has on the international forum and the first Kochon ThePrize achievements of RNTCP have been recognised RNTCP getsinternational recognition –Kochon Prize 24

TB India 2007

DDG (TB) receiving the prestigious Kochon prize at Paris; Paris; at prize Kochon prestigious the receiving (TB) DDG Inset - Kochon Medal Kochon - Inset in the country by the end of RNTCP Phase II (2010- It is planned that 24 state level IRLs will be established services. diagnostic RNTCP the offering laboratories peripheral most the are district each in DMCs RNTCP. under covered also are (DMCs) centres microscopy designated 12,000 about and (IRLs), Laboratories Reference Intermediate level the for DRS the state The Pradesh. Uttar of state the of half western undertake also will JALMA Chennai). (TRC, laboratory supra-national the by Agra as Institute, the NRL fourth has been initiated JALMA accrediting for process The Delhi. (LRS), Diseases Respiratory and Tuberculosis of Institute Sarup Ram Lala and Bangalore; (NTI), Institute    The programme isabouttoroll outDOTS-Plus RNTCP isinthe process of building upthe Diagnostic facilities innearly 12,000 Gujarat and Maharashtra byearly2007. management for MDR-TB inthe statesof facilities. level IRLswouldbeupgraded toprovide C/S tests (C/S). By the end of 2007, 12 new state of undertaking culture and drug sensitivity intermediate reference laboratories capable quality assurance havebeen putinplace. at these facilities in2006. Systems for 6.2 million TBsuspectshavebeenexamined been upgraded and established. More than laboratories throughout the country have Achievements

Chapter 3 136 277 209 Nos. of of Nos. the states districts in districts in 11 11 13 assigned states/UTs states/UTs Total nos. of of nos. Total State level Staff concerned with with Staff concerned EQA: sputum microscopy Laboratory STLS and DTO, Technicians District level 25 National level 7 10 10 TU of IRLs of assigned Total nos. nos. Total DMC 3 Lab TU Pradesh, Pradesh, Karnataka, Madhya Pradesh, Punjab and Uttar Pradesh has already been initiated and these civil needed any complete to expected are states ve fi the reaches equipment the before IRL the for works laboratory sites. Members of the 2006 Joint Monitoring Mission conducted eld fi visits to 20 randomlydistrictsstates(Gujarat,sixin Haryana, Karnataka, selected Madhya Pradesh, Punjab and Bengal)West in the month of October 2006. e Th programmeextensively was reviewed in terms of the diagnostic National Reference Reference National District TB Centre TB District DMC 2 TB India 2007 TU Intermediate Reference Lab Reference Intermediate DMC 1 Lab Committee Fig. 2 : Structure of RNTCP Laboratory Network The different levels of laboratories under RNTCP are as follows: are RNTCP under laboratories levels of different The feedback State TB Cell Andhra Pradesh, Chandigarh, Chhattisgarh, Goa, Chhattisgarh, Chandigarh, Pradesh, Andhra & Diu), Daman Haveli, Nagar (& Dadra Gujarat Nadu Sikkim, Tamil Punjab, (& Lakshadweep), Kerala (2) Pradesh Uttar and Arunachal Pradesh, Assam, Delhi, Haryana, Delhi, Haryana, Assam, Pradesh, Arunachal Mizoram, Meghalaya, Manipur, Pradesh, Himachal Uttaranchal and Tripura Nagaland, Karnataka, Jharkhand, Kashmir, and Jammu Bihar, Orissa, Puducherry, Pradesh, Madhya Maharashtra, & Nicobar Andaman and Bengal Rajasthan, West States and Union Territories (UTs) assigned assigned (UTs) Union Territories States and EQA for direction of supervision of direction of direction Central TB Division Central Table 2: States Assigned to NRLs for Monitoring of Laboratory Activities of Laboratory Monitoring to NRLs for 2: States Assigned Table TRC LRS NTI NRL 11) for undertaking Culture and Drug Sensitivity Testing (DST), and conducting Drug Resistance Surveillance in selected states. A one-time supply of the equipment required for Culture and DST shall be made by RNTCP to the 24 states e equipment where IRLs proposed to are be established. Th has already been supplied and installed in Gujarat and Maharashtra during Phase I. e supplyTh and Delhi, Chhattisgarh, Pradesh, Andhra in installation Tamil Rajasthan, Orissa, Kerala, Jharkhand, Haryana, Nadu, Uttaranchal and West Bengal is currently e procurementunderway. Th process forHimachal Chapter 3 conducted in 2006. Th e orientation training was was training Th orientation 2006. e in conducted in directors) EQA, four of batches level were national workshops STDC/IRL and (STOs managers programme level state the of building For capacity protocol. assurance quality the and currently 70% of the districts are have implementing EQA, in country trainers level the state of in training completed states the (EQA) All Assessment guidelines. Quality the External utilising RNTCP performance laboratory the assess to RNTCP under established been has process A External qualityassessmentservices action. for data use and analyse plan, to State (STDCs) the of capacity Centres Tuberculosis Training Demonstration and the improve further to mission the by recommended was It health programmes. other for model a is which diagnosis, for services microscopy the including eff ective, very is programme the that Th stated aspects. mission e Figure 3:ReportingSystemforQualityAssuranceSputumMicroscopy RBRC reports Panel testingreports Quarterly Programme Management report b. Summary report ii. a.Detailcheck-list (NRL,IRL,TU) i. On-site evaluation reports DMCs withHigh Falseerrors) Management report (%of Quarterly Programme During on-siteevaluation CTD Quarterly &yearlyreports Quarterly 26

TB India 2007 OSE-Yearly OSE-Yearly EQA Periodic Reporting NRL DTC IRL report Management Programme Quarterly and DSTare intheprocess ofbeingfinalised. laboratories in medical colleges of for performingaccreditation the culture have for those IRLs and developed of been accreditation for documents The results. of reporting and STLS, all of testing operationalisation of the RBRC procedures, panel facilities centres, diagnostic staffeff districts/ to conducting in visits OSE ective and laboratories the of strengthening in problems the by states the on NRLs, have focused operational Recommendations of the annual supervising visits to wastes. infected of disinfection/disposal on and safe reagents, staining microscopy the for specifications quality issues, operational/technical on level, staffDMC IRL to eff conducting by (OSE) Evaluations On-Site ective resources, human up of IRLs, as setting such issues level state to regard with responsibilities and roles held at NTI, to Bangalore make them aware of their Qu Quarterly &yearlyreports Monthly &Quarterly reports arterly &yearlyr Monthly EQA-OSE & RBRC TU eports (50,000 - 100,000) DMC DMC DMC DMC DMC Chapter 3 - Y Y Y Y Y Y Y Y Y Y Y N N N N N N N N N N N N N N Panel Panel Testing EQA EQA - Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y P P P P P P P N N RBRC Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y P N N N OSE 27 The key to maintaining the high standards that the programme has achieved is regular supervision is crucial that monitoring,and It proper evaluations. systems are not only put into place at the but outsetalso that these systems ensure that good quality services continue to be provided on a sustainable basis in the coming years. At the same time, it is important to monitor the districts which have been implementing for a few years, so as to ensure that practices and laxity do not set in. wrong TB India 2007 Name of institution where IRL established where institution Name of Guwahati Medical College Guwahati Medical STDC, Naharlagun TB Sanatorium Itki STDC, Thiruvananthapuram STDC, Bhopal STDC, Nagpur STDC, Puducherry Chennai Medicine, Thoracic of Institute Lucknow KGMU, and STDC, Agra STDC, Dehradun STDC, Kolkata STDC, Ahmedabad PHL, Karnal Dharampur TB Hospital, STDC, Srinagar STDC, Srinagar STDC, Bangalore STDC, Patiala Government Medical College Medical Government STDC, Patiala STDC, Ajmer STDC, Gangtok STDC, Hyderabad STDC, Patna Raipur Institute, Research and Training Leprosy Regional Delhi TB Centre New STDC, Cuttack GMC, Bambolim Table 3: List of Designated IRLs and Status of EQA Activities Status of EQA IRLs and 3: List of Designated Table State Arunachal Pradesh Arunachal Jharkhand Kerala Pradesh Madhya Assam Maharashtra Puducherry Nadu Tamil Pradesh Uttar Uttaranchal Bengal West Gujarat Haryana Pradesh Himachal Jammu Kashmir Karnataka Orissa Punjab Rajasthan Sikkim Bihar Chhattisgarh Delhi Goa Andhra Pradesh Andhra RNTCP is a complex programme to implement andimplement to programmecomplex a is RNTCP manage, both in the technical and programmatic relativelyhas It India.countrylike large a aspects,in complicated diagnostic, treatment and follow-up protocols, especially when all these activities to be supervisedare and monitored, and the staff held accountable for their provision. Y – Activity performed in all districts as per guidelines P – Activity performed in some of the districts as per guidelines N – Activity not being performed as yet and Monitoring Supervision Chapter 3 to review the quality of performance are laid out in out laid are performance of quality the review to interviews. Besides supervisory visits, the clear monitoring conduct indicators to developed been have patients are also interviewed at their homes. Checklists visit, each During level. field the at programme the of visits each level of staff is expected to make to review review. The supervisory protocol provides the number objectivefor tools and visits supervisory conducting all levels. The strategy lists the detailed procedure for at programme the of review objective for used be to ‘RNTCP an developed Supervision and Monitoring Strategy’ has as a document programme The Supervision andmonitoring strategy defines the supervisory activities to be by done activities each clearly the supervisory defines strategy monitoring and supervision The the strategydocument. DTO of West Garo Hills, Meghalaya, on a visit to a patient’s home patient’s a to visit a on Meghalaya, Hills, DTOGaro West of RNTCP review meeting for North-eastern states, November 2006 November states, North-eastern for meeting review RNTCP 28

TB India 2007 their respective states. Over ten states have been evaluated been by the Central Unit have in the states last 12 months. ten Over by states. respective evaluated their were districts 125 about 2006, In international standards of TB control. expected maintaining and personnel empowering RNTCP. It plays a vital role in ensuringof transparency,strategy monitoring and supervision the of part integral an become have Evaluations centre. the by double-checked is it subsequently and state the by done is evaluation of level first The adopted. been have checks quality for measures stringent which for challenge, a is implementation of quality the of maintaining world, the in phase programme expanding initial an from implementation. Since it has been hailed as the fastest maintenance and RNTCP has now moved into a phase of consolidation Evaluation programme manager at different levels (Table 4). 4). (Table levels different at manager programme reviewed eachmonth. Central DivisionTB being districts two to one with from team the by conducted are evaluations level quarter.Central each in districts two of evaluations by the programme staff, each state conducts internal In addition to the routine supervision and monitoring are document. strategy the in stated activities clearly supervising of level each for Tools

Chapter 3

Tools 29 RNTCP TB register RNTCP register Laboratory RNTCP register Supervision reports PHI monthly STLS of reports OSE QA Supervisory checklist Programme reviews Programme report programme Annual Laboratory Register Laboratory OSE Checklist TB register register Laboratory cards Treatment register treatment for Referral Supervisory checklist Annual district report district Annual TU reports Quarterly review programme Monthly PHI reports Monthly report assurance Quality checklist DTO/supervision of diary Tour and STSs MOTCs, of activity reports Monthly Annual programme report (State and (State and report programme Annual districts) TB with District review programme Quarterly Officers (DTOs) reports District/TU Quarterly reports evaluation District DTOs of diaries activity reports/tour Monthly checklist STO/supervision of diary Tour STF College Medical Report from STLSs TB register RNTCP register Supervision register treatment for Referral Supervisory checklist (National) (National) with State TB review programme 6-monthly Officers (STOs) State Reports annual and Quarterly reports evaluation District STOs of activity reports Monthly Consultants RNTCP-WHO of reports Monthly ZTFs College Medical Report from as with a year least randomly randomly TB India 2007 S & M Activities ndertake programme reviews with State TB reviews programme ndertake for Each Level of Programme Implementation Level of Programme for Each STS/STLS once every month. every once well as public Peripheral Health Institutions Institutions Health Peripheral well as public quarter. every (PHIs) every year U a year level twice at national officers selected NSP patients and their DOT DOT their and selected NSP patients on every field visit day. providers randomly at least 3 randomly of homes Visit the DOT with their along selected NSP patients day. on every field visit providers meeting review fortnightly Conduct at Centres Microscopy Visit all the DMC OSE at the Conduct visit should STS The month. every once within one positive patients smear all the treatment. starting of month Visit to Medical College if any, every month if any, College Visit to Medical every quarter meetings review DTCS Conduct by DM – to be chaired DTC at the meeting review monthly Conduct by DM/CMO – to be chaired field for in a month Reserve at least 7 days visits. every month. Centres Visit all Microscopy private participating the of Visit most IRL team to visit DTC at least once at least once IRL team to visit DTC with the meetings review quarterly Conduct at state level. Meeting TB officers district Director Secretary/ by Health to be chaired (DGHS) Services Health of General field visits in a week for Reserve 3–5 days MO) 2nd and (between DTO every month. Visit all TB Units every quarter Centres Visit all Microscopy at least 3 of homes Visit the Conduct periodic review of RNTCP in the the in RNTCP of review periodic Conduct state level during DTOs states with the meetings review of evaluations level internal Central Conduct every month at least 2 districts On-site to visit IRL (for NRL Team at least once testing) Panel and evaluation state at least once in the Visit all districts every 6 months of evaluations state level internal Undertake every quarter atleast 2 districts at least PHIs visit all DMCs and should STS

                       Table 4: Supervision and Monitoring Activities and Tools under RNTCP RNTCP under Tools and Activities Monitoring and 4: Supervision Table STLS State TB Cell (STO/MO/STDC IRL Director/ Microbiologists/ RNTCP-WHO Consultants) Central Unit Central [Deputy Director (DDG)/ General Medical Chief Officers (CMOs)/ team/ India WHO NRL/CTD RNTCP- WHO Consultants] Unit responsible Unit responsible (persons) STS District TB Centre TB Centre District TB (District Officer/ 2nd DTC) MO Medical Officers Medical (TB Control) Chapter 3 the quarterly reporting formats include: formats reporting quarterly the to changes important the of Some programme. the the of assess implementation the to monitor and levels performance national and state district, helps Th information is time. of period specifi ed a over specifi area a ed were in who treatment for patients registered of group a is context this in cohort A patients. of cohorts of analyses enables RNTCP in used system reporting Th quarterly e ‘Epi-Info’ transmission. and analysis entry, data for the software, on based ‘Epi-Centre’, software, individual and Th addresses. email made operator custom uses e programme entry data a facilities, Offi internet with computer a with supplied are ces TB District RNTCP, all the Under electronically. OffiTB (CTD) Division TB Central the to and cer level quarterly reports are then submitted to the ThState district reports. e level TU respective the from reports quarterly level district the of preparation the for DTO responsible is the level, district the At districts. the to reports which in activities, initiation turn submits quarterly treatment and microscopy logistics, to relation in (TU) Unit Tuberculosis the to basis monthly a on report (DMC) centres microscopy designated and ‘international standards for care’. for TB standards ‘international the by envisaged as treatment receive patients that defi the ensure from to learn ciencies and data own their evaluate to them enable to built is districts of to adjustments suit the local Capacity requirements. the of needs and comprehend the make programme to steps active taken have administrators the and evaluations these benefi from have ted districts All health institution (PHI) institution health peripheral the from generated is reporting Routine Recording andreporting 1 For the purpose of RNTCP, a PHI is a health facility which is manned by at least a medical offi cer (even if the post is currently vacant). At At vacant). currently offi is medical a post the least if at (even by manned cer is which facility health a is RNTCP,PHI of a purpose the For DMCs should submit a monthly PHI level report to the respective TUs and the district. the and TUs respective the to report level PHI monthly a submit should DMCs in RNTCP are considered as also PHIs under participating the programme. sector Some of be All PHIs also DMCs. PHIs these with/without will in the private/NGO facilities All health the district. within colleges hospitals/medical facilities)/TB health other (including clinics/hospitals this level are the dispensaries, Primary Health Centres (PHCs), Community Health Centres (CHCs), referral hospitals, major hospitals, speciality 1 level upwards. Th upwards. PHIs level e 30

TB India 2007  the important issues and areas for improvement improvement for areas and issues highlights important and the state the to feedback additional provides only level central the exercise, capacity building the of part As district. respective the of performance quarterly the on districts their of each Every quarter, the states provide routine feedback to Electronic transferofdata   Obtaining disaggregated data on paediatric paediatric on data disaggregated Obtaining Modifications in programme management management programme in Modifications re- all and new for rates conversion Sputum Note: 100%of reports from the districts received electronically in2006 boxes; drug patient-wise paediatric for requirements cases paediatric under DOTS and in calculating of cases) – to have estimates on the proportion of types all (for RNTCP under registered patients status at the end of every quarter. every of end the at status IEC fund and fi management and activities, nancial activities supervisory and conducted re-training and training – issues HRD-related (on of quality DOTS involved), colleges indicators, data EQA medical and NGOs/PPs of (no. revised PPM RBRC), include to report and TAD,failure); (relapse, cases treatment Programme surveillancesystem Central TBDivision Feedback Peripheral Health Institute Electronic Transmission District TBCentre Tuberculosis Unit Quarterly Report Figure 4: Quarterly Report Monthly Report State TBCell Feedback Chapter 3 dia.org in www.tbc 31 2006, when the country has been underfully moreRNTCP, coveredthan 80% of the personnel manning key posts like Medical OfficerSenior (MO),Treatment Supervisor (STS), SeniorLaboratory TB Supervisor (STLS) Technicianand Laboratory(LT) have been trained inNewer RNTCP. categories of human resourcesin the includedtraining programme are staffColleges, of NGOs, MedicalPrivate Practitioners (PPs) and community DOT providers. statesIn addition,conduct thecontinuous programmesinduction for new and turnover staff. training There are three types of training for the personnel providing RNTCP services: training RNTCP Initial This includes all induction trainings in RNTCP of newly placed staff or replacement staff following staff turnover. It consists of modular training for Medical Officers, STS, STLS, purpose LTs Workers and(MPWs), and Multi-initial training of NGO and private practitioners in RNTCP. Training and retraining Training RNTCP has conducted training 500,000health personnelof of various cadres to date. more than longandarduousais task, significantIt butis itsin contribution to the efficient functioning of such a large public health programme. A series of modular training courses with printed material has been developed community for the to all Officers TB levels State of the from staff ranging DOT providers. Over the lastRNTCP training modules threehave been updated and years, allprogrammes training and modules guidelines, newer have been added to the existing training packages. The training material for key TB personnel has a CommunicationInterpersonal Improved on section (IPC) skills. availableguidelinesare andmodules training the All on RNTCP website

TB India 2007 Human resource developmentRNTCP goes beyond(HRD) ‘training specific underpersonnel for specific tasks’. It includespersonnel, in managementaddition to maintainingof targetthe training.Hence, ofconstant,standardsquality high istoachieve sustained professional competency in TB control activities that will benefit not just the states, but also the country at large. Since March Human Resource Development Resource Human Epi-Centre software which has several advantages previoustheover DOS-based version. softwareThe hasbeenpilot-tested Bengal andRajasthan West in with encouraging results and will be introduced in the remaining states during 2007. and action – technical and administrativethe quarterly performance– to on the respective states. Further, many states hold quarterlyofficials health high-level by chaired programmemeetings review such as the Principal Secretary, Health Secretary and/or Joint Secretary of Health. In an increasing numberdistricts,of analysis theofquarterly datais being performed not only for the district and TU levels, but also for the microscopy centre level. The quarterly performance report is a publisheddocument, both in printed and electronic form on the RNTCP website (www.tbcindia.org), which ensures wide dissemination of the report, not only to the programme officers but also in the publicdomain. Annual results of publishedtheinthe yearly “TB India RNTCP-Status programme are Report”.This document is also available in printed and electronic form via the programme website.RNTCP annual data is also reported on an annual basis to WHO Geneva for inclusion in the WHO Annual Global TB Report. Some ofnamelyAndhraGujarat, Pradesh,Pradesh,Madhya the states, Bengal,publishrespectivetheir West Rajasthanand TB detailed with reports performance quarterly state Unit-wise analyses. The programme has developed a windows-based Chapter 3 the modules, as found appropriate. appropriate. found as modules, the of sections relevant on conducted is training based need- and identified are areas requiring specific in re-training persons etc. DTO, personnel, STDC STO, the by visits supervisory during addition, In sections related to specific activities. the complete set of initial training modules, or only on and hence the concerned staff may need re-training on training. For these individuals, training is need-based during supervision, have been identified to require re-who but training, RNTCP initial received already These trainings individualsmainly are for havewho, Re-training RNTCP. in involvement effective their for formed been have A national task force and five zonal task forces (ZTF) physicians. practising other for models as role of all teaching and practising DOTS, and most important by programme the sustaining in trendsetters, leaders and opinion as control TB in role important an have professors college the Medical priority. a high is staff, RNTCP in colleges service medical of health involvement general from Apart activities. related TB and/or activities HIV/AIDS in involved are NGOs who to given being also is Training activities. collaborative TB/HIV implementing states 14 the of TB/HIV. in ongoing are Such currently trainings issues the address which packages training of range a developed has (NACO), Organization Control AIDS National with collaboration in CTD, The RNTCP workshop on PPM-DOTS held at Muradabad, January 2006 January Muradabad, at held PPM-DOTS on workshop RNTCP 32

TB India 2007 to further reducing the information gap. contributewilllevels all available committedatstaff and competent Having and decision-making. effective appropriate timely, enable will programme the under activities for guidelines clear with along authority of levels and responsibilities delineated cultivated at the state level be to ensure this aspect. will Well commitment administrative and political levelsallatnecessary. is Itenvisagedis thatsufficient empowerment of staff and ownership of results,thedeliver todevelopment resourceprogrammehuman For over oneortwodaysaspertheirconvenience. hours six for trained are etc. ports, mines, railways, practitioners medical of the NGOs, The PPs and PPs. other sectors like for material training RNTCP the in included been have themselves standards the and ISTCs the of summary a (ISTC), Care TB for With the recent launch of the International Standards doctors. of group this of needs the meet specifically to developed been has module training RNTCP an training, quality impart To institutions/clinics. their at or (IMA) Association Medical Indian the practitioners (PPs) is being sensitised either through A large number of medical staff of NGOs and private meetings. review programme regular the as such activities routine during mainly planned are updates These are areas. these on staff updated field the and that important is activities it new initiatives, introduces RNTCP the As Updates on new activities and initiatives collaborations collaborations with all up the major health set care facilities to trying been has RNTCP adopted The RNTCP. yet not have sectors health these under facilities health the of proportion considerable a patients, TB manage sectors health governmental facilities under various government, private and non- where care health thediverse Though treatment. seek they from sector healthcare the of irrespective assured free to treatment TB in patients the country quality providing to committed is government The Public Private Mix inRNTCP Chapter 3 33 care and multi-specialityprivateof variety large a haveallopathic alsosystems hospitals. The non- practitioners ranging from untrained traditionalhealers to qualified indigenous practitioners. There complemented level national the at efforts been have by the local programmethe managersprivate sectorto involvein RNTCP. than Currently14,500 private practitionersmore are involved in RNTCP. The IndianMedical Association (IMA), a majorpartner of RNTCP, has formed a “National Cell for the RNTCP” and identified coordinatorsnational at and state levels. A fornational theworkshop state presidents/secretariesRNTCP coordinators, supported by the Central TB Divisionand and thethe WHO India, Surajkund,was heldHaryana at in August 2006. formulatednationalworkshop.thisTheactionain plan IMA A proposal from the IMA for involving medicalpractitioners fivestatesin namely Andhra Pradesh, Haryana, Maharashtra, Punjab and Uttar Pradesh and the union territory of Chandigarh, has been approved by the GFATM for Roundinclusion 6 of ingrants. theAndhra Pradesh, Karnataka,Kerala, Maharashtra, Orissa, Rajasthan and Uttar Pradesh have conducted state level sensitisationworkshops for IMA leaders. TB India 2007 Private sector Private The private sector has widea spectrum of providers ranging from individual practitioners to tertiary PPM tools available PPM tools available disseminatedguidelinesdevelopedand has RNTCP non-governmentalinvolvementoffororganisations (NGO)privateandpractitioners (PP),advocacyan kit containing materialssensitising andmedical documentspractitioners trainingsix-hourmoduleatraining forRNTCP. on andfor a concise All these documents are available on the RNTCP website. sinceits implementation. The programme employs Public-Private Mix (PPM), which is a strategy to diagnose and treat TBof mix a patientsthough RNTCP under care health reportingof sectors to all the However, providers. care health of types different effortsprogrammetheby servicesmake RNTCPto available through all sectors of healthrapid the and care diversity the by are challenged extent to some growth of the non-public health sectors especially theprivate Severalsector. competing forces like the rapidly growing drug market and its influence on the prescription practices of medical practitioners havealso been identified as factors working against the PPM initiatives of RNTCP. National workshop for state leaders and RNTCP coordinators of the Indian Medical Association, August 2006 Chapter 3 Physicians’ Association, etc. Resource persons from persons Resource etc. Association, Physicians’ Family Association, Health Public Indian Society, Medicine, Chest Indian Physicians, Chest of NationalCollege Social and Preventive of Association workshops organised by bodies like the IMA, Indian pro-activelyconferencesalso the in and participated RNTCP Paediatrics. of Academy Indian the with RNTCP on consensus professional strengthening for strive to continued RNTCP TB, Paediatric of Building upon the joint consensus statement on management organisations. professional other important with collaborating been also has RNTCP the national secretary of IMA of secretary national the Aggarwal, Dr. Vinay by owned Delhi in hospital private a in centre microscopy designated a inaugurating (TB) DDG Chauhan, L.S. Dr. N GO guidelines guidelines GO 34 PP training module training PP

TB India 2007 Figure 5:PPMTools Available RNTCP advocacy kit advocacy RNTCP (NGOs) Non-governmental organisations for RNTCP intheseevents. participated Centres Nodal College Medical the from members faculty also and WHO LRS, TRC, NTI, CTD, Medical Colleges, the programme functions through in programme the of implementation effective For institutions andapublichealthprogramme. betweenteaching partnership successful and unique this by made been have achievements important several and further, strengthened has RNTCP and Colleges Medical between partnership the 2006, In programme. the of success long-term the ensure to involvement their sought actively thus has and practitioners, medical of generations future to skills trendsetters, and as teachers imparting knowledge and Medical colleges in TB control of as opinion role leaders and critical the recognised always has RNTCP Medical colleges Bengal in the difficult riverine belt of Sunderbans. ‘SHISH’ is managing seven TUs in two districts withRNTCPnational at instate andlevels. NGO, An West collaborating are etc. Mission, R.K. (CHAI), India of Association Health Christian (CMAI), India of hospital associations like Christian Medical Association the RNTCP. Bigger NGOs like World Vision, mission total2200AofNGOs have formal agreements with PP guidelines PP Chapter 3 35 2006, at Indira Gandhi Medical College (Shimla), Gandhi Medical College (Hyderabad), Rajendra InstituteMedicalofSciences (Ranchi),Medical J B Institute Manipal Sikkim and (Ahmedabad) College of Medical Sciences (Gangtok), respectively. Each ZTF workshop included an open scientific update faculty college medical all to open was which session, and residents of the host college and other practitioners,local in addition to the ZTF participants from all medical colleges in the zone.workshops includedThe group work ZTFsessions to evolve various policy and implementationMedical College involvement in and aspectsRNTCP, the of evolution of State-specific action plans with time- lines. Representatives of all Medical Collegesthe zone, in the STF Chairpersons, STOs and other programme officials actively participated in these zonal workshops. As of December 2006, more than Colleges230 acrossMedical the country were involved in theand theRNTCP, vast majority of medical colleges inthe country have already established an RNTCP respective their in centre microscopy-cum-treatment an played Colleges Medical 2006, During institutions. implementationplanning,programme in role active and evaluation, including operational(formulation researchof generic protocols, participatingin the state OR committees, and by undertaking contribution to RNTCP Ms. Adriana Ferranti, who runs the NGO MAITRI in Bodhgaya, Bihar ant TB India 2007 NGO’s signific MAITRI NGO’s Set up by an Italian lady named Adriana Ferranti in Ferranti Adriana named lady Set up by an Italian is Bodhgaya, Bihar in 1987, MAITRI Charitable Trust 4 2 and Scheme through with RNTCP associated now of has a network It MAITRI covers 7 blocks. NGOs. for having over an area spread providers DOT 276 trained Designated The 2,50,000 population. approximately to more MAITRI is contributing of Centre Microscopy in the detected positive patients smear than 50% of 2 sputum MAITRI has also opened Unit. Tuberculosis and areas to reach in difficult centres collection MAITRI conducts DMCs. to Government them linked through TB patients the contacts and IEC activities MAITRI has also meetings. interaction provider patient leaders. opinion of numbers large sensitised a Task Force mechanism at the National, Zonal and Zonal mechanism at the National, Force Task a were Forces Task State 2006, February By levels. State formed in with all Medical Colleges. 27 States/UTs zones five in constituted been have forces task Zonal located colleges medical the to catering country, the of zones East North and West East, South, North, the in of the country. RNTCP has established 7 nodal centres for Medical College involvement across the (Chandigarh), PGI Delhi), (New AIIMS at country, College Medical LTM (Jaipur), College Medical SMS (Mumbai), Guwahati Medical College (Guwahati), CMC (Vellore) and R G Kar (Kolkata), which are Medical actively involved in the Zonal College Force. Task and in the National Forces Task All the five zones have had highly successful and well-attended zonal task force (ZTF) workshops during 2006, held between August and October Private doctors in a DMC during RNTCP training Chapter 3 conducted in the National Task Force workshop, workshop, Force Task National the in conducted Based on officers. other Programme the group work and STFs, and ZTF of Chairpersons the and Force task National the of members the to addition country, in the of parts various in located Colleges Thiswas attended byfaculty members from Medical 2006. November, 11th to 9th during programme and a national level CME and Research Operational workshop Force Task National fifth the organised (AIIMS), Sciences Medical of Institute India All of leadership the under Force, Task National The year. the throughout evaluations internal various in and 2006, Mission Monitoring Joint the including evaluations, and reviews programme in participation their by also and coordination TB/HIV RNTCP, in of system Assessment Quality External the in MDR-TB, of national guidelines for DOTS-Plus for management of development the in surveys, prevalence disease of implementation and planning the in studies), Meeting of National Task Force, November 2006 November TaskForce, National of Meeting The National Task Force Workshop and CME/OR Programme, AIIMS, New Delhi, November, 2006 November, Delhi, New AIIMS, Programme, CME/OR and Workshop TaskForce National The 36

TB India 2007 ru wr drn te Z the during work Group Hyderabad, Sept.2006 their sensitisation. The standardised Sensitisation Sensitisation standardised The sensitisation. their in and members faculty other training in involved themselves are Trainers, persons resource Master trained as these and institutes level national at for training nominated been have Colleges Medical of number large a from members faculty 120 Over NTF. the by issued and discussed health also public the were with co-ordination, on and TB/HIV functionaries, and colleges medical within co-ordination improving system, reporting quarterly mechanism, and treatment on the referral Recommendations Tuberculosis. XDR and MDR of prevention the and drugs anti-TB line second of use rational promoting statement a issued and Care, TB for Standards International the also endorsed NTF The practitioners. other and residents faculty, of sensitisation for faculty College by Medical used be then other could which and material, RNTCP reference on presentations standard comprising CD’ ‘Sensitisation a issued NTF the onal Task Force Force Task onal M eeting, eeting, South Zone, Zone, South Chapter 3

37 Shri Ashok Bhatt, Health minister of Gujarat inaugurating West Zone Zone West inaugurating Gujarat of minister Health Bhatt, Ashok Shri ForceTask meeting of Medical Colleges including the paediatric cases are treated as per RNTCP RNTCP per as treated are cases paediatric the including referred are TUs other from patients The guidelines. their and diagnosis after TUs respective their to back phone through up followed is RNTCP the into entry calls. The space for the DMC and DOT centre are provided by the railways. The laboratory technician are reagents laboratory The NGO. an by provided is an is This society. control TB district the by supplied health different between partnership good of example sectors. RNTCP also supervises the activities. The Railway Hospital in Chennai Perambur, which is a involved in RNTCP. In 2006, 151 cases were registered 505-beddedregistered were hospital cases with151 2062006, In medical officers RNTCP. is in involved for treatment. referred and 145 cases were Dr. Sujata Basu, medical officer in charge of the DMC cum DOT centre centre DOT cum DMC the of charge in officer medical Basu, Sujata Dr. (Eastern Railway), Kolkata Hospital in BR Singh TB India 2007 Other central government central government Other departments/PSUs There have been workshops at national and state levels to review and improve the involvement ofdifferent central government departments and the public sector undertakings. A national CME cum was which Delhi in ESI for conducted was workshop owned centrally 22 from representatives by attended ESI hospitals from different parts of the country. All the doctors of CGHS in Delhi were in In RNTCP. trainedChennai, all the 18 CGHS clinics including the polyclinics are involved as referral or the atinaugurated was centre DOT A centres. DOT Military Hospital, Namkom, Jharkhand which is a chest diseases centre with 525 beds exclusively for indoor treatment of respiratory diseases. BR Singh Hospital of Eastern Railway in Kolkata, which is a designated microscopy centre, puts on treatment an average 50 TB cases under RNTCP TB patients attending this hospital All each quarter. CD now available, is expected to further boost the process of sensitisation of Medical College faculty, residents and staff. Operational Research (OR) has been an and priority area Medical under Colleges RNTCP, have of been encouraged to participate in OR projects and to submit OR proposals for RNTCP funding. In projects OR for guidelines detailed 2005, December submission, approval and increasing fundingan and were issuedNTF, the by in recommended as CTD, evident. now is proposals OR of submission in interest college medical for workshop research operational An September in Chennai, TRC, by organised was faculty 2006, which led to the development of three draft generic OR protocols. As part of the aNTF half-dayalso, OR programme was organised on 9th November 2006. TheState OR committees have states, of number increasing an in formed been now which are vetting and encouraging OR proposals, and the formation of Zonal OR Committees is also underway. Chapter 3 Chikitsalay, Jayant, a multi speciality hospital of of hospital speciality multi a Jayant, Chikitsalay, centres in the estate health facilities. DOT and Microscopy have Assam Dibrugarh, and centres. centres. Jute mills, mines and sugar mills have DOT Bharat Heavy Electricals Limited (BHEL) have Microscopy Industries, Petrochemicals Corporation, Power Thermal National Factories, Cement Plants, Steel/Aluminium The RNTCP. facilities in health involved are corporate 120 over Currently Haryana have become involved in RNTCP activities. Bawal, at BD like companies which following CII the of headquarters the at Delhi in held was etc. BD, Organosys, Jubilant NTPC, like companies corporate with workshop interactive An unions. trade the and (FICCI) Industry and Commerce of like Chamber Indian of Federation Forum, houses Economic World (CII), Industries corporate Indian of the Confederation of major the with organisations interactions had has RNTCP Corporate sector Medical College Contribution to Pvt. Practitioners 6% Other Govt. Corp. Sector0 Medical College 22 State Govt. Contribution toreferral of TBsuspects Pvt. Practitioners 4% The tea gardens in Jalpaiguri, West Bengal Bengal West Jalpaiguri, in gardens tea The Other Govt. Corp. Sector0 State Govt. Figure 6:SummaryofContributionbyDifferentHealthSectorsin 17

3 % % 6 NGOs % 7 new smear positive case noti %

4 % 7% % 6 % 4 % NGO 6 % 38 14 IntensifiedUrbanPPMSites;2006

TB India 2007 Nehru Shatabdi N=362330 N= 25105 fication Medical College of Madhya Pradesh is a DMC. a is Pradesh Madhya of district Sidhi in Limited Coalfields Northern the been an important finding which has highlighted and has This cases. of proportionsizeable a contributed have number, in fewer though Colleges, Medical has remained the largest contributor to case detection. the public health department of the State government number of cases notified under RNTCP. In all the siteshave shownsites, steadya andgradual increase thein PPM intensified the from reports the of Analyses facilities are involved in the programme. NGOs,medical75 colleges, corporate33and sector practitioners,520private 6,200 sites, pilot these In data from the different health care provider categories. PPM DOTS districts continue to capture disaggregatedsystem implemented in the surveillance original supplementary 14 intensified The 2006. pilot in districts 70 expanded to activities were intensified PPM The Intensified PPM Medical College Pvt. Practitioners 7% Other Govt. Contribution toallsmearpositive diagnosis Other Govt. State Govt. Pvt. Practitioners 1% State Govt. Corp. Sector0 Corp. Sector0

4 Contribution toDOT provision

2 3 % 76 19 %

% 70 % % % % % NGO NGO 11 7 % % N= N=48056

73202 Chapter 3

practitioners Private hospitals Private practitioners facilities NGO health industries Corporate Non-allopathic etc. healers, Traditional Non-public       Non-Government 39 and IEC. 2 in Hyderabad, Indore, Mumbai, and Varanasi which have large numbers of slum dwellersmigrant and populations. The “Urban Projects”TB have Controlbeen established in these sites improvingfor the quality and reach of specialRNTCP to groups such treatment friendly” as“patient more through migrants, the slum sectors dwellers NGO and private of involvement and observation, The team which led the economic evaluation of PPM at Bangalore during a data analysis workshop at NTI, Bangalore TB India 2007 Welfare (MoHFW) Welfare Ministry) Natural gas) Natural (CGHS) Defence) & Petroleum (Ministry of Refineries Power) (Ministry of plants Thermal Colleges Medical Services Health Central Services Health Government Central (Railway Ministry) Railway hospitals (Labour Employees’ State Insurance Mines) (Ministry of Coal department Shipping) (Ministry of hospitals Port Steel) (Ministry of Steel plants (Ministry of hospitals forces Armed 1 Under Ministry of Health and Family Family and Health Ministry of 1 Under           Healthcare providers in India Public in India providers Healthcare 2 Ministries besides MoHFW besides 2 Ministries Departments under Central under Departments Government Table 5: Healthcare Providers in India 5: Healthcare Providers Table of medicine (Ayurveda, (Ayurveda, medicine of etc.) Homeopathy, department (health care care (health department local under facilities governments) (primary health centres, centres, health (primary hospitals) dispensaries, college (medical department hospitals) systems Non-allopathic administration Municipal department health Public education Medical     Departments under State under Departments Governments Urban DOTS projects DOTS Urban The Central TBDivision has undertaken 4Urban DOT projects funded through GFATM round reinforced the importance of initially prioritising and and prioritising initially of importance the reinforced on facilities those activities of PPM DOTS targeting by which are of utilised the number largest patients, rather than attempting at the start to involve facilities irrespective of all their caseloads. Thisis even more important where resources for such activities are limited as in India. TheNGO sector has been to shown be for an source especially care, important However, areas. select in treatment, of delivery the in in involved of providers number of large the because the yield of cases from the sector, the private private to the has not proportionate been to RNTCP sector numerous are there because is This involved. number private clinics and hospitals in the urban areas and loads patient large have not do facilities individual the and TB suspects visiting them. Another important finding has been that the intensified PPM-DOTS activities have the strengthened health Government to in leading an the programme, involvement sector sector. the from detection case increased Chapter 3 IMA leaders of western Uttar Pradesh on a field visit during RNTCP sensitisation workshop at Moradabad at workshop sensitisation RNTCP during visit field a on Pradesh Uttar western of leaders IMA training module for medical practitioners (PPM (PPM practitioners medical for module training RNTCP existing the into incorporated been has document, including the ISTC actual standards the themselves, of summary A document. ISTC the of steering committee, which supervised the development ofa professional association from India on the global was nominated by the RNTCP to be the representative IndianMedicalAssociationthe ofmembersenior A activities. RNTCP in providers care health TB in additional involve and care of recruit to and India, health of sectors standards all the across management improve to (ISTC) Care” document TB for Standards “International published recently the adopted has RNTCP The Tuberculosis Care (ISTC) International Standards for done. being is analysis data in as Geneva well as The WHO India. headquarters The WHO the from support surveyed. technical received been study have receiving treatment patients RNTCP 1000 than More study. the conducted which agency nodal the was Bangalore, (NTI) Institute TB National The completed. was city Bangalore in DOTS PPM intensified the of The operational research on the economic evaluation Operational Research onPPM 40

TB India 2007 are observed in the management of TB cases. is the means to ensure that the international standards care for TB. In India, practising RNTCP in its entirety adherence to the internationally recognised standard of ensureRNTCPtoadopt to care healthproviders of all expectsprogramme the ISTC, the in down laid standardsRNTCPtheconformsthemodule). to As not treated properly. Childhood TB is a reflection of common in children and they are more likely to die if highly susceptible. The serious forms of TB are more children less than five in years low of age, which usually makes them is infection TB resist to immunity not accorded high priority as it is less infectious. The Paediatric TB is generally less infectious. It is generally is under. as RNTCP given under children in TB pulmonary of management The TB. of forms serious from suffer to prone also are Children disease. to infection of progression prevent to resistance low their to due years 1-4 the in seen are cases the of majority the children can Although present with group. TB at any stage, age paediatric the in are cases TB new all of 6-8% about that estimated is It mortality. and Tuberculosis is a major cause of childhood morbidity PaediatricTB Chapter 3 Sputum Positive 2 or 3 Positives 3 Negatives Paediatrician If no, refer to refer If no, TB (Anti TB Treatment) TB TB (Anti Cough Persists 41 Antibiotics 10-14 days Antibiotics Suggestive of TB of Suggestive (Anti-TB Treatment) (Anti-TB Sputum-Negative TB Sputum-Negative Repeat 3 Sputum Examinations Negative X-Ray + Mantoux boxes (PWBs), wherein (6-8months) of medicine theis earmarked the day the complete coursepatient is registered for treatment. e drugsTh are given under direct observation of a DOT provider, who is accessible and acceptable to the patient and accountable to the system. All government health facilities, sub-centres, and community volunteers includinganganwadi workers, private practitioners and NGOs have been involved in the provision TB India 2007 Negative for TB for Negative Negative for TB for Negative Refer to Paediatrician X-Ray 1 Positive Or diagnosed case of active TB case of Or diagnosed Is expectoration present? expectoration Is with suspected contact History of / or cough 3 weeks Fever and wt gain wt/No Loss of If yes, examine 3 sputum smears examine If yes,  Pulmonary TB Suspect   Figure 7: Diagnostic Algorithm for Paediatric Pulmonary TB Algorithm for Paediatric Figure 7: Diagnostic Suggestive of TB of Suggestive Sputum-Positive TB Sputum-Positive (Anti-TB Treatment) (Anti-TB 2 or 3 Positives Paediatric patient-wise boxes patient-wise Paediatric To ensure uninterrupted supplyprogramme of drugs,had introducedthe patient-wise drug the prevalence of sputum smear-positive pulmonary smear-positive sputum of prevalence the tuberculosis in the community and the extent of transmission of infection in the e community. RNTCP the Th per as is TB pulmonary of management 7 ). TB (Figure for Paediatric diagnostic algorithm Chapter 3 use of these boxes. these of use RNTCP staff in all the states has been in trained the key All Table 6. in given as bands weight different the for used dosages the to according designed are boxes These PWBs. paediatric the using treatment on initiated be would RNTCP, under treatment for registered and diagnosed patients paediatric all PWBs, paediatric of RNTCP.availability the With under patients (PWBs) adult for boxes supplied those to similar patient-wise in available drugs paediatric make to steps taken has Paediatrics, of Academy Indian the with RNTCP,consultation in villages. the in providers DOT as participate to trained being also are (NRHM) Mission Health Rural National under workers ASHA DOTS. of boxes patient-wise Paediatric 0.9 % of the adult population of the country. The The country. the of population adult the of % 0.9 to approximately equates which million, to be 5.21 estimated is India in infection HIV of burden The TB/HIV Coordination Ethambutol Isoniazid Drugs Streptomycin Pyrazinamide Rifampicin (mg/kg) 30-35 10-15 Table 6:PaediatricDosagesandWeight Bands Dosage 42 15 30 10

TB India 2007 6-10 kg 200 250 75 75 - Dosage inmgfor weight bandsinkg of these boxes in all the states the all in boxes these of use the in trained been has staff RNTCP key The Chennai. Health, Child of Institute at DOTS administered being patient Paediatric     through: of coordination to the TB/HIV importance address makers policy key of sensitisation on focuses plan action The programmes. two the between synergy optimum ensure to (NACP) Programme Control formulated in coordination with the National AIDS been has Plan Action TB/HIV Joint the epidemic, Keeping in mind the urgent infection. need to address the TB dual latent with people in re-activation disease of risk the the increases HIV as worsen situation to TB potential the has epidemic HIV

cross and delivery service of Coordination 11-17 kg sensitisation and involvement of NGOs, NGOs, of involvement and the through sensitisation programmes both of outreach Optimal and comprehensive use of the community Voluntary Counselling and Testing Centre coordination; Centre (VCTC)-RNTCP Testing and Counselling Voluntary NACP; and RNTCP in involved A joint training programme for service providers HIV services; TB counselling and and testing to services access treatment and optimal diagnostic ensure to referrals 400 500 150 150 - 18-25 kg 600 750 225 225 - 26-30 kg 1000 1250 300 300 - Chapter 3 43 The crossreferral mechanism betweenVCTC and RNTCP diagnostic and treatment pilot servicestested first in was Maharashtra and is now being implementedCommon the on in 14 linkages states. cross-referral All the 14 on states reporting are now List-server ([email protected])reporting simultaneous and whichregular facilitate has to beencreated feedback regular of system A programmes. the both to been has districts to state from and state to centre from established. Coordination Committees have been meet which level, and at district the state established of the implementation to review basis on a quarterly activities. collaborative TB/HIV Results of Results TB-HIV collaboration for cross-referral From January to November 57,0002006, VCTC moreclients, than suspected of disease,having TB were referred microscopyto RNTCP centresdesignated for Duringthe furthersame period, over 50,000 TBpatients, investigation. registered under RNTCP, who wereof havingsuspected HIV infection, were referred for counsellingHIV and testing (Table 7). Compared to 2005, the cross-referrals reported up alreadyexceededentirehave2006theNovember to number referred in 2005. In 2005, 23,950 VCTC 30,389servicesand RNTCP to referred were clients TB patients were selectively referred Thefor VCT. TB India 2007 Joint IEC efforts at the national level, monitoring monitoring level, national the at efforts IEC Joint national and state district, at system evaluation and levels to assess the coordination and treatment HIV/AIDS. with living people for services community-based organisations and private in both programmes; practitioners involved Use of universal precautions to prevent the spread spread the prevent to precautions universal of Use persons, HIV-infected for caring facilities in TB of and to prevent the spread of HIV through safe and injection practices in the RNTCP;

Phase I of the coordination activities was initiated to initiated was activities coordination the of I Phase Andhra namely states, prevalence high HIV the cover Nagaland Manipur, Maharashtra, Karnataka, Pradesh, coordination the of II Phase 2004, In Nadu. Tamil and saw activities extended to eight additional states, namely Delhi, Gujarat, Himachal Pradesh, Kerala, Orissa, Punjab, Rajasthan and West Bengal. As of December 2006, cross-referral mechanisms have been established between health facilities providing RNTCP services and functional NACP VCTCs in 14 states, including all states classified by NACO as states, these In prevalence. HIV mid or high a having the for counsellors by questioned are clients VCTC all of Regardless disease. TB of symptoms the of presence or symptoms have who clients those results, test HIV facility nearest the to referred are disease TB of signs services. treatment and diagnostic RNTCP providing This is frequentlylocated within the same facility as VCTC. the   TB/HIV Coordination review meeting at Chennai, July 2006 Chapter 3 VCT needs to be systematically implemented and and implemented systematically be to needs VCT for clients of referral selective of policy the Second, cross-referrals. in them involve optimally and units these of staff the of capacity build to need a is there all, of First programmes. both by addressed be to need that Thereare in challenges the mechanism cross-referral Mechanism Challenges intheCross-Referral 8. Figure in shown is 2006 and 2005 in from VCTC in to referrals RNTCP for increase TB Source: Monthly Cross-referral Report from SACS from Report Cross-referral Monthly Source: Tuberculosis patients identified asHIV-infected Tuberculosis patients referred toVCTC Referral of DiagnosedTBPatients from RNTCP To VCTC Referral of SuspectedTuberculosis Casesfrom VCTC toRNTCP Diagnosed asTuberculosis Case Treated byRNTCP (percent of totaldiagnosed) Figure 8:Progressincross-referral(1) Table 7:VCTC-RNTCP Cross-referrals from14states,January–November2006 Number ofclientsreferredfrom VCTC clients referred for TBevaluation ICTCs toRNTCPservices (ii) SputumNegative TB (iii) Extra-Pulmonary TB 23950 (i) SputumPositive TB 2005 2005 vs.2006 Total 44 2006 (11months)

51183 TB India 2007 114% increase in ICTC clients referred to RNTCP

HIV positive 2,932 (70%) 27,525 4,213 1,475 2,227 461 from ICTCs that needs to be addressed. be to needs that ICTCs from Third,there is lossa of in clients significant referrals centres. (C&S) Support and Care and centres ART like settings other in finding case intensified on focus more provide to a is need there initiation. ART eligible, if and, assessment to for centres directly ART patients TB HIV-positive identified all refer to mechanism a develop to NACO with collaboration prioritised has RNTCP ART centres. given. being is to point referral Currently, primary VCTCs the are therapy anti-TB concomitant when nevirapine for efavirenz of substitution the for made are provisions are although provided, being nevirapine), + lamivudine + (stavudine and nevirapine) + lamivudine + (zidovudine regimens, the of growing number ART two Currently centres. to significantly country, in contributing the centres facilitate this process. NACO provides free ART at 85 to RNTCP in trained being are ART centres the at posted officers medical the All individuals. HIV infected to services treatment and diagnostic TB to access optimal ensure to NACP the of ART centres ART-DOTS at all the are established being linkages patients Provision ofART toHIV-positiveTB HIV Negative 5,602 (78%) 29,682 7,214 1,927 4,953 334 7,590 (15%) 51,183 8,534 (75%) 11,427 57,207 3,402 7,230 Total 795 Chapter 3 7 – (existing 3) x 7 – (existing 45 Drug Requirements (Quarterly consumption/ (Quarterly 3) x 10 – (existing consumption/ (Quarterly districts stocks in the stock in SDS including quarter) the of at end stores drug x 4 – (existing x 4 – (existing consumption/3) (Quarterly at end stores PHI drug stock in TU including quarter) the of (Monthly consumption x 2) - (existing stock in x 2) - (existing consumption (Monthly month) of end PHI at the stock in district including TU & PHI including stock in district quarter) the of at end stores drug Drug logistics management logistics Drug Thirty threeState DrugStores (SDSs) have been established in 26 states. Drugs for the respective districts, based on their Quarterlyissued thesetoSDSsonwardfor distribution Reports,theto are districts. This has been an important step towards decentralisationresponsibilitiesof logisticsdrug for to the states. Manuals for state and district levels encompassing the Standard Operating Procedures for drug management havethe Centralbeen TB Divisionprepared for the states,by based on GlobalTB Drug Facility (GDF) utilising financial support of the DFID. UK’s Drugs for Haryana are utilising USAID throughWHOprocuredGDF, by support. The procurement of drugs for rest of the population,isbeing made asper recommendations Bank.ofWorld Thefirst of procurement second line anti-TB drugs 100 for level central the by made being is RNTCP for treatment on initiated be will who patients, MDR-TB in the states of and from Gujarat early Maharashtra 2007. With the expansion of DOTS-Plus services, areas Bank-funded the for drug World procurement will be made as per World Bank procedures. For the Global Fund to Fight AIDS Tuberculosis and the of procurement states, (GFATM)-funded Malaria drugs will line be the anti-TB second made through Green Light Committee mechanism as required by GFATM. TB India 2007 1 month 3 months 3 months 2 months Reserve Stock 1 month 0 months 0 months 0 months Stock for Utilisation Stock for Table 8: Reserve Drug Stocking Norms and Calculation of Drug Requirement Table State Drug Store District drug District Store Level PHI TU Drug Store Drug Procurement and Logistics Procurement Drug Management Since 2005 the supplies of first line drugs for 500 million population are being acquired through the RNTCP, in RNTCP, collaboration with NACO conducted a periodic HIV survey in TB patients in four HIV high prevalent states in the year 2005-06, which is being scaled up in 2006-07 to 15 districts with low to high prevalence of HIV. Theresult of this activity is expected to provide valuable information on and prevalence trend TB of disease HIV co- and morbidity, and would inform the development of national and state policies. IEC materials regarding facilities. at NACP being made available TB are support has technical Additional also been provided to TB/HIV in states for the the implementing form HIV the in WHO by funded consultants TB/HIV of funded coordinators TB/HIV and states burden high Joint states. burden low HIV in RNTCP the through for formulated been have TB/HIV on modules training NACP. and RNTCP of staff of categories various Standardised IEC material on HIV, prepared by is displayedNACP, in facilities providing RNTCP coordination in RNTCP, initiative, new a As services. has developed a“10-point withNACP, counselling tool” for the VCTC counsellingcounsellorsTB. on to facilitate Chapter 3 ensure quality. to quality. ensure tested and Inspectors Drug Central and by state taken also are samples addition, In GMSDs. by sampling random through drugs of assurance quality the for place in also is system A GMSDs. and SDSs DTCs, from basis random a on taken samples, quality tests drug regularly which laboratory, control independent an hired has CTD patients. the by consumption to up shelf-life their throughout quality the of of testing monitoring and drugs pre-dispatch defect also is product There and reporting. methods dispensing and storage proper inspection, post-dispatch and pre- certification, batch practices, manufacturing good of certification selection, supplier careful include have been adopted by RNTCP for quality assurance Thethat measures various requirement. programme critical a is drugs the of quality the Maintaining Quality assurance patient. the to instructions proper with dispensed safely are and ensured, is diagnosis after patients to availability custody, in are safe kept they timely to districts, the issued are drugs the once that important equally is It level. months seven to up stocks their replenish to districts the to issued are drugs yet, as SDS an established not have (Tablewhich For states 8). the states to replenish their stocks up to 10 months level submitted by the districts. The drugs are issued to the reports quarterly the through Division TB Central – levels and to district continue be at monitored the state at both – positions stock and requirements, consumption Drug country. the across located (GMSDs) Depots Store Medical Government the six at stored be to continue procured drugs The level. state the at management drug strengthening in way long a go to expected is This soon. re-trained be will country and drug logistics it is that all envisaged states of the on re-trained been already have states Eight SDS. the managing functionaries with along imparted being is pharmacists and DTOs to training which 46

TB India 2007 Phase I of RNTCP: RNTCP: of I Phase such asurbanslumdwellers, tribalgroups, etc. providing improved access to the marginalised groups seek treatment from. The RNTCP II also envisaged they facility care health whichever in environment, diagnostic services to TB patients in a patient-friendly and treatment quality good standardised,providing for scope the widen to aims RNTCP of II Phase    during taken were initiatives following The the programme as it is a familiar word in the field. Mobilisation. The term ‘IEC’ is continued toSocial beandAdvocacy, Communication includeused that in is used in RNTCP to indicate communicationan importantinitiatives component of the RNTCP.Information, TheEducation term and Communication ‘IEC’ (IEC) is Social Mobilisation Advocacy, Communicationand        National and regional workshops were held on held were workshops regional and National developed. was strategy communication A and Attitude Knowledge, country-wide A Two national level trainings of IEC Officers have few a in organised were workshops Media Radio and TV spots were developed, and shared developed. centre resource IEC Web-based flip leaflets), and (posters materials Printed Standardisedmessages and prototypes developed Prototype print material developed in the form in form the developed material print Prototype and communication strategy. communication and mobilisation social advocacy, the for basis the and also formed data and information, baseline provided that conducted was study Practice been organised. organised. been programme. the in involvement active their for and advocacy media for states big selected states. the with produced. were caps and badges, shirts, T- as such materials promotional and charts for use at the state, district and sub-district level. RNTCP. in sector private the of involvement for kit a of planning andimplementationofIECactivities.

Chapter 3 47 on IEC activitiesIECon undertaken districttheat and state level against the plannedindicated in the annual action activitiesplans. as level has been enhanced. The Centremultidisciplinary has communicationa team – the ‘Advocacy and IEC Unit’ supported‘IEC Advisoryby Group’.an The IECUnit at the nationalsupportexpertisedrawslevelandfrom Centresexcellenceof communication,in social research, interpersonal communication social mobilisation.and district level in the form of ‘Communication facilitators’. A communication facilitator could would who individual an or NGO agency, an be implementing and planning in districts the help has IEC been activities. made Provision for one per 5–6 districts. Communication Facilitator 4. A reporting format has been introduced to report report 4. to introduced been has format reporting A 5. Staffing at the national and sub-district Additional support has been provided at the TB India 2007 IEC Activities in States / Districts in States IEC Activities Systematic planning andis implementationenvisaged in IEC strategyknowledge andbased understanding on ofthe the issues,target audiences, communication tools, and mechanism for monitoring of activities channels and monitoring is decentralised toensure contextual relevance and wide reach of information. groups specific target communicationall reach to plans, and innovation useand local adaptation tools. communication appropriate most the with 2. Detailed planning, choice of communication district- and state develop to 3. districts and states The IEC strategy in audiences target identifies clearly Strategy IEC The interventionsimplementdifferentand plan to order modifiedbe to needsbehaviourthat the focusingon to achieve the objectives of the programme. 1. IEC is a long-term commitment for RNTCP. Chapter 3 a quizmaster for the show in which patients, patients, which in show the for quizmaster a plays patient cured A audience. live a of front in organised being are TB on shows similar television, on shows quiz of popularity the Seeing hosts. show game into turned have officers TB district RNTCP. of message The the spread to identified been has approach unique a districts, Nakashipara and Nabadwip Krishnanagar, Bengal’s West In awareness among villagers, mostly fishermen and was used by a team of motivated staff to create 2006. This innovative method of IEC activities coastal areas of Kasaragode district, Kerala in April by the RNTCP staff and other health staff in the Kerala: changes and updating knowledge inthe RNTCP. programme washeld tohighlight the recent extend their fullcooperation inRNTCP. ACME encouraged about1,200Anganwadi workers to was held for Anganwadi workers. The programme the message of DOTS. Asensitisation programme various IECactivities were carried outtospread Chennai: Onthe occasion of World TBDay, A ‘Padayatra’ (journey by foot) was organised 48

TB India 2007 IEC ActivitiesinVarious States Quiz forTBAwareness treatment being doubled. being treatment for hospitals to reporting patients of number the with response, overwhelming an received has show The TB. with associated myths and medicines symptoms, effects, side its treatment, don’ts, and dos TB’s on questions answer to able being for prize as distributed is Crockery audience. the in sit villagers and new, and participate old both providers and patients. and providers DOT between meetings of series a for West Imphal in held was documentation photo visit, field the During clubs. youth and helpers workers, Anganwadi Meirapaibis, as such organisations social and voluntary leaders, village between interaction in participated and visits field Manipur: attract the attention of curious villagers. treatment available with the beating of drums to shouted slogans about symptoms of TB and the free of padayatra held placards in their hands and to the patients by the government. The participants farmers, about TB and free treatment made available The Manipur State TB Officer conducted conducted Officer TB State Manipur The Chapter 3 49 RNTCP DOTS-Plus RNTCP The emergence of multi-drug resistant TB (MDR- TB), which is defined as isoniazidresistance and rifampicin, has become toa significant at least public health problem in a number of countriesand an obstacle to effective TB control. In India, the exact prevalence of MDR-TB is not known at present. However, available information suggests that the prevalence of MDR-TB is relatively low in India. Nonetheless, this translates into a large absolute number of cases and the country is as yet not fully equipped to manage MDR-TB patients. Specific measures are now thebeing RNTCPtaken towithin address andpatients, thisMDR-TB ofmanagement appropriate problem through the prevent to strategies existing the of enhancement propagation and dissemination of MDR-TB. reaffirmsRNTCPthatpreventionthe MDR-TB of is the priority task and that this can be achievedonlythroughimplementationthe goodqualitya of community over a period of time. RNTCP has taken has RNTCP time. of period a over community measurestepsimportantthisto indicator acrossthe determiningprevalence anti-TBFor theofcountry. drug resistance among new and previously treated patients, state-wide Drug Resistance Surveillance (DRS) surveys are being conducted in the states of AndhraGujarat,Pradesh,Maharashtra, Orissa,and Pradesh.secondUttarA roundDRSsurveysof will be carried out in the same states, using the same methodology, after a period of five years. The DRS surveys ofGujarat andMaharashtra have beencompleted in2006, and the survey inAndhra Pradesh is ongoing. TheMDR- of interim percentage the that showed report Gujarat survey, of DRS TB cases amongst new cases is 2.4% and amongst undercases intake of The 17%.re-treatmentis cases DRS in Maharashtra was completed in the month of November and the results are being analysed.The DRS surveys of Orissa andUttar Pradesh will be starting in 2007-08. TB India 2007 to address the needs of the special groups and ‘hard to reach populations’, urbanpopulations,marginalised populationsin such as tribal slums, and other marginalised and vulnerable sections of the community. of community-based organisations, AWWs, practitioners, private healers, NGOs,traditional CHWs, cured patients, tribal youth and other community-based volunteers in IEC activities and provision of DOT. relevant IEC messages and patient education material using local vocabulary. social mobilisation campaigns conducted by other disease control programmes is another important aspect ofinitiatives envisaged in RNTCP theII. communication New Areas New surveillance resistance Drugs The prevalence of anti-TBthe drugcommunity canresistance be taken inas an the indicatoreffectiveness of of TB control activities in the States and districts develop IEC and develop States action plans districts as part state The plans. action district and state annual in the of keeping states the by developed are Plans Action IEC reproduction advocacy, for required activities the mind of material for use by the districts, of organisationinteraction communication meetings based with need the other professional and and groups legislative Theactivities. state ActionPlans are atreviewed the sent are observations and feedback and level national their implement districts and states The states. the to report a quarter, Every plan. action the per as activities state the to districts the by sent is activities IEC the on format reporting the in centre the to state the by and purpose. the for developed State and district action plans and district State 6. envisaged arecommunication initiatives Special 7. IEC strategy also envisages active involvement 8. The strategy encourages development locallyof 9. Linking RNTCP-IEC activities with the Chapter 3 strengthened to prevent the emergence of more more cases. MDR-TB of emergence the prevent to strengthened be must activities RNTCP existing the addition, In drugs. anti-TB second-line quality-assured of implementation, and facilitation of the procurement DOTS-Plus rational enabling policies cooperation, control TB inter-agency resources, human of includes and development retention infrastructure, adequate environment DOTS-Plus An appropriate activities. RNTCP basic the into MDR-TB of management the integrating for environment long-term both investment and requires leadership in ensuring It an appropriate other components. the four maintain and establish to essential is commitment and administrative political Sustained commitment Sustained politicalandadministrative      are: and included, are strategy DOTS-Plus the of elements essential all that ensuring comprehensive, are components core The same. the are principles underlying the as strategy, DOTS the of components five same the around organised is framework DOTS-Plus The managed. properly and identified correctly both are the MDR-TB with under patients that RNTCP, so activities DOTS-Plus and DOTS of integration full promotes strategy DOTS-Plus The treatment. and management diagnosis, MDR-TB for components add that programmes DOTS to DOTS programme. Traditionally, DOTS-Plus refers Accurate, timely diagnosis through quality quality through diagnosis timely Accurate, Standardised recording and reporting system. system. reporting and recording Standardised Uninterrupted supply of quality assured anti-TB second-line utilising treatment Appropriate commitment; government Sustained (DST); testing susceptibility drug and culture assured drugs; and drugs; supervision; strict under drugs 50

TB India 2007 Reference laboratories. laboratories. National Reference RNTCP the of one as reference such laboratory recognised a with testing proficiency quality for link a including external place, in be and should assurance control quality internal Therefore, whole. a as programme control TB the major consequences for have both individual patients and results DST unreliable and contamination, culture cultures, Non-viable is DST indispensable. and thus culture of assured Quality commencement treatment. before correctly diagnosed be must MDR-TB activities. backbone DOTS-Plus the the of is diagnosis timely and Accurate sensitivity testing quality assured, timelyculture anddrug TB through Diagnosis ofdrug-resistant the severity of the disease. Such factors include: the the include: Such factors disease. of the severity the to addition in factors several on ambulatory depends treatment and hospitalisation between The cases. choice MDR-TB treating for regimen drug second-line standardised a using be will RNTCP conditions under appropriate management utilising second-lineanti-TBdrugs Appropriate treatment strategies important points of RNTCP of points important the on Gujarat Commissioner, Health the briefing Officer TB State Chapter 3 51 laboratory based. RNTCP therefore aims to establish to aims therefore RNTCP based. laboratory Intermediate assured quality accredited, of network a ReferenceLaboratoriesprovidingculture (IRLs)for and anti-tubercular DST services. It to is have atplanned least one accredited IRL in each of the large states by 2009-10. The strengthening of the state level IRLs is underway and the laboratories at Andhra Pradesh, Gujarat, and Maharashtra are in the process of being accredited. Category II patients, who remain sputum positive even after 4 months of supervised treatment will be identified as MDR-TB suspects and referred for diagnosis by culture and DST done at an RNTCP accredited IRL. On being diagnosed as an MDR- case,TB thepatient willreferredbe designated ato state level DOTS-Plus site. These sites will be in a least atspecialised centres,highly of numberlimited eachstate,inwhichonereadywillaccess havean to The laboratory. DST and culture accredited RNTCP DOTS-Plussitewill supportedbe qualifiedby staff availabletomanage patients using thestandardised second-lineCategory IVdrug regimen given under daily DOT and standardised follow-up protocols. There will be mechanisms to deliver ambulatory DOT after an initial short period monthof of in-patient careup to stabilise theto patient on one the second-line drug regimen, and a logistics and standardised information system will be in place. phased established a be in will sites DOTS-Plus The manner similar to that for the establishment of the cultureand DSTlaboratory network, and sites will linkedgeographicallybe establishedtheto RNTCP accredited IRLs. The DOTS-Plus sites have been established in Gujarat and Maharashtra and registrationthe of MDR-TB cases at these sites commencewill in the first quarter of 2007. RNTCP will be using a standardised Kanamycin, – Category drugs IV six comprising regimen treatment Ofloxacin, Cycloserine, Ethionamide, Ethambutol TB India 2007 Based on the above components, RNTCP to aims address the issue of diagnosisof andMDR-TB patients.treatment It needs to be recognised that the diagnosis of MDR-TB is not clinical but Management of MDR-TB under Management RNTCP A recording and reporting system and reporting A recording designed for DOTS-Plus The specific characteristicsprogrammerequirerecording a system, culture and of a DOTS-PlusDST results, and monitoring treatment delivery and treatment response for 24 months.analysis in DOTS-Plus Cohortincludes interim indicators and treatment outcomes after 2 Theor developedmore recordingyears. and reporting system is essential for evaluating programme performance and treatment effectiveness. Uninterrupted supply of quality- Uninterrupted drugs second-line assured Management of treatment with second-line anti- TB drugs is complex. Most second-line drugs have a short shelf life, global productionassured drugs is limited, and drugof registration may quality- be a lengthy and costly process that is not always manufacturers.drugaddition,attractivedrugsto In mayneedchangedbeto sideduetoeffects, delayed DST results, and poor response to treatment. To ensure uninterrupted drug supply, procurementmustbegin advancewellin theanticipated of need, and projected drug needs must be accurately estimatedas possible. as availability of hospital beds; the availability of trained trained of availability the beds; hospital of availability personnel at hospitals and clinics totreatment and administermanage adverse drug reactions; the availability of a DOT and social support network andambulatorytreatment; to adherencefacilitate to the presence of other clinical or social conditions in patients. Chapter 3 a trained DOT provider. During treatment, there there treatment, During provider. DOT trained a to be administered daily under direct observation by the continuation phase for 18 months. All aredrugs Cycloserine, Ethionamide and Ethambutol – during Ofloxacin, – drugs four byfollowed months, 9 to 6 of phase intensive the during – Pyrazinamide and 52

TB India 2007 to theDOTS-Plus siteforfollow-up. visits their for enablers provide will programme the treatment, arduous and long the completes patient the that Toensure guidelines. international the on based protocol the per as examination smear culture by and progress of follow-up regular a be will Chapter 4 MISSION 53 Dr Fabio Luelmo, Senior Mission Member Mission Senior Luelmo, Dr Fabio additional lives. Life-saving TB services are nowreaching millions of patients in India, free of cost. As part of the country’s commitment to maintain high standards of diagnosis and of Government India invited an international panel treatment, the of experts from the fieldsother and education medical treatment, ofand research public health, TB related sectors, to visit the country and participate e in the 2006 Monitoring Joint Mission (JMM). Th international experts were from the World Health World Partnership, (WHO),Stop-TB Organization JOINT MONITORING MONITORING JOINT TB India 2007 the suffering of future generations.” the suffering of Chapter 4 Chapter If RNTCP is maintained, it will reduce tuberculosis in India, saving millions of lives and saving millions of will reduce tuberculosis in India, is maintained, it If RNTCP “They said it could not be done; it is now the largest achievement in the world in TB control. achievement in the world in not be done; it is now the largest “They said it could India has the distinction of implementing the largest the implementing of distinction the has India provides which world, the in programme control TB patients registered newly 100,000 over for treatment every month, with a treatment success rate of over 85%.e RNTCP, basedTh on the internationallyin expanded been has strategy, DOTS recommended aphased manner from 1997. Since the programme began, the RNTCP has trained over half a million in the staff health system, evaluated more than 24 million people with suspectedTB, examined more that 100 million sputum slides and treated nearly 6.7 million patients, saving almost 1.2 million Dr. Fabio Luelmo, WHO TB expert, addressing the Joint Monitoring Mission, October 2006 Chapter 4 Dr. L.S.Chauhan, DDG(TB),briefingtheJMMteam,October 2006 The JMM was conducted with the following following the with objectives: conducted was JMM The such review beingconductedin2003. the third such mission to review the RNTCP, the last   organised from the 3 from states. The GoI/WHO RNTCP JMM 2006 was experts and TB NGOs Association, MedicalIndian National experts were mainly from medical colleges, experts. TB leading other (IUATLD),and Diseases Union Against TubeInternational Centres for Disease Control and Prevention (KNCV), (CDC), Association Tuberculosis Netherlands Royal (USAID), Agency Development States International for United (DFID), Development International for UK’s Department (GFATM), the fight Fundto Global Bank, 

achieve TB control in India. in control TB achieve eventually and 2015 by MDGs related TB the achieving towards move to as so objectives two above the on recommendations formulate To etc). DOTS-Plus, surveillance, resistance sputum drug surveys, microscopy, prevalence of EQA (e.g. RNTCP the of phase second the in activities, newer or recent more the of especially policies, technical review To 2003. in out carried review JMM the base a as taking RNTCP of performance the Toreview rd Oct to 17 54 AIDS, TB and Malaria Malaria and TB AIDS,

th Oct 2006. This is rculosis and Lung TB India 2007 and recommendations: and observations key following the made mission The patient records, programme staff. andinterviewed state and district level authorities, extensively reviewed national, with interacted also teams The DOTS. of selected patients were interviewed and to assess the quality diagnostic the treatment services in the field. Nearly 100 randomly review to scrutinised were Centres Microscopy Designated 80 and Units TB Madhya Pradesh, Punjab and West Bengal. Over 40 districts in six states — Gujarat, Haryana, Karnataka, selected randomly 20 visited JMM the of Members   

the entire country. country. entire the cover to history in DOTS of expansion most rapid and has largest the programme completed successfully Control TB Indian The control. for TB impact epidemiological desired the achieve to order activities in RNTCP under the of sustainability the assess To through treatment. treatment. through patients to support the programme joined have volunteers community and workers health of established thousands of hundreds and country, been the across have centres microscopy 12,000 About patients. to cost of free provided Quality-assured microscopy and drugs have been Chapter 4 55 Improve Improve programme effectiveness by concerted efforts to wider case provide improve detection, decentralised DOT provision, further decrease default rates of and simplification the recording and reporting systems. Suggestions made to increase case detection included the improvingtraining ofinterventions generalimplementing and medical staff, officersparamedical and such as screening for systematic cough by non- medical and paramedical staff, retrieving initial to more workers community using and defaulters of Use awareness. community and referral increase in communication effective improve to strategies awareness expand to particular in community, the of the location of free recommended. also microscopywere care tuberculosis and free To address MDR-TB, the Mission recommended recommended Mission the MDR-TB, address To expediting the of establishment laboratories for quality-assured culture and drug-susceptibility testing, and implementation of the national plan for and TheMDR-TB. guidelines Mission in those including providers, all that recommended adhere should hospitals, TB and colleges medical MDR-TB. for guidelines national the to For scaling up collaborative theactivities national with HIV programme, the recommended the setting up of a Missionnational level coordination greater and group working technical the on focus a with patients of referrals ensure to TB/HIV burden. with the highest areas

JMM team in village Sausera, district Vidisha, Madhya Pradesh JMM team in village Sausera,    TB India 2007 s National Rural ’ The Government of India TheMission stated that the programme is very effective, including the microscopy for servicesdiagnosis, reliable supplies of good quality reportingpowerful and transparent a and drugs, system, which isand services aof expansion modelrapid The programmes. for other health the scale of activities have, however, stretched the capacity of the health system. TheMission thereforerecommended stepsstrengthento the core capacity for programme implementation at central and state levels. Health Mission (NRHM), which launchedhas been to strengthen thesystem, generaloffers an healthopportunity provided controlelementskeytheTBthat programme theof are protected and sustained.urged the national The government to ensureMission that anti-tuberculosisdrug procurement, core full- time RNTCP staff,TB specific reporting and financing are continued under the NRHM,and ensure maximum use of available.the It new also staff stated that the shouldprogramme support the National MissionRural to identify andHealth address weaknesses in thehealth system, including lacklaboratoryof techniciansand vacancy or frequent transfers. The NRHM, through its cadresimprove could access and convenience also of services at community level.

JMM team reviewing records at a health centre JMM team reviewing records   Chapter 4  Press conferencefollowingJMMde-briefing

long-term sustainabilityoftheprogramme. external technical and financial partners to ensure TB and TB control activities and to partner with of India continues to give the highest priority to Government the that urged Mission the battle, long-term a is TB combating that Recognising 56

TB India 2007 Development Goals. Development achieve should the TB targets India set under the UN Millennium interventions, additional necessary the undertakes effectively and impetus current its Thethat if observed Mission the RNTCP continues SUCCESS STORIES Chapter 5

The successful performance of RNTCP throughout the country is a remarkable example of administrative and political commitment towards TB control. The RNTCP strategy to engage all frontline TB care providers like medical practitioners, laboratory technicians and STLS/STS has ensured the decentralisation of the Programme. Empowering people with TB is another step towards community participation in TB care.

The Programme is proud of its large contingent of NGO workers, members of self-help groups and cured patients, who work with extraordinary commitment and dedication to make DOTS services available and accessible even in the most remote corners of India. These are ordinary people who are in a position to take charge of their own lives, communities and resources. Their remarkable effort to take such initiatives at the grassroots level has been the backbone of the success of the Programme. Each state and district has such success stories to share. Some of the stories are presented below.

Laundry turns to make-shift DOT centre Shambhu Yadav, a resident of a backward settlement, Nandai Mohalla of Rajnandgaon had tested sputum positive for TB. He was undergoing DOTS treatment, but was unable to visit the District TB Centre regularly to take his medicine. This initially resulted in missing doses. The health worker motivated him to visit the DOT centre regularly. Shambhu explained to the health worker about his problem and enquired about making provision of DOT nearby his residence.

The doctors decided to search for a more suitable DOT provider in the local vicinity. Shyam Lal Rajak, a laundryman (dhobi) living in that poor and backward settlement, happily agreed to become DOT provider for Shambhu Yadav. Shyam Lal was trained on TB symptoms, its treatment and DOTS. After completing the training, he started the DOTS regimen RAJNANDGAON for Yadav with a keen sense of dedication. CHHATTISGARH Shambhu Yadav has now recovered considerably, though his treatment is still going on. On the other hand, Shyam Lal Rajak has gained confi dence and has expressed desire to provide DOTS treatment to other patients in his locality.

TB India 2007 57 DOTS relief to couple Sitabai Nada of Jodhpur Ward (Dhamtari District) had become very weak with prolonged fever and cough. Her body weight dropped to a sickly 30 kg. She was unable to afford proper treatment due to financial problems.

On visiting the district TB centre in Dhamtari, she was found to be suffering from TB after a sputum test. The doctor advised that her husband should also get his sputum test done. After three samples of sputum test, it was found that both husband and wife had TB.

“I was told that I will have to take the medicines through DOTS method and I will be cured,” says Sitabai. The couple completed six months course of medicines and have fully recovered to lead again a DHAMTARI healthy life. Sitabai has since become an activist and has already sent nine TB suspects to the DTC. Three of these were found positive and are availing DOTS treatment. CHHATTISGARH

According to Sitabai, “My weight has increased from 30 kg to 42 kg. Now I have recovered my strength and I am able to do household work. It is due to DOTS that I can now get back to my incense sticks (agarbatti) work to get some extra income. I feel that it is my duty to inform other suspect TB patients about DOTS.”

Mega conference held at IMA to promote DOTS It was a great opportunity for the team of RNTCP to simultaneously inter- act with about 2000 private practitioners at the 58th Gujarat State Annual Conference GIMACON 2006 held by the Surat chapter of the IMA. The conference promoted modern medical services, which includes DOTS. Lectures were given on DOTS and TB-HIV coordination among others. The attractive IEC stall of RNTCP displayed the key message given by SURAT CTO, “together we can make a difference, and there is nothing that looks

impossible”. GUJARAT

At the outset the NSP case detection rate of 70% has been achieved. Total case detection rates have also improved. Quality of the RNTCP services in the area has enhanced since the TU started functioning in 2005. Most of that credit goes to Dr Das.

DOTS transforms family Thirteen-year-old Tirsi studies in Class six at Kharswan district in Jharkhand. A bright stu- dent, Tirsi is loved and cared for by her teachers and classmates. But a sudden drastic change appeared in their attitude since she started coughing non-stop. Her friends who earlier played together with her, got annoyed with her wheezing and started avoiding her. Her father Boka – a low-wage worker – was unable to afford her treatment and sought help. Friends informed him about the DMC at Seraikella, where the sputum examination and full course of drugs is provided free of cost. After a thorough examination, Tirsi tested sputum positive for TB and was immediately put on DOTS. Boka was given details of the DOTS centres where treatment is provided free of cost and is given under the observation of DOT KHARSWAN provider. Gradually after taking her drugs thrice a week for two months, her cough and other JHARKHAND symptoms subsided and her body weight improved. After six months of treatment, Tirsi has been declared free of TB. She has since rejoined her class and is welcomed by her teachers and classmates. Boka feels obliged to the DOTS services and goes around town spreading the message of DOTS. He has become an IEC member of Jharkhand’s RNTCP and refers lots of patients for sputum examination

58 TB India 2007 DOT centre opened at Military Hospital The Military Hospital at Namkum, Jharkhand, has 525 beds exclusively for in-patient treat- ment of tubercular and non-tubercular respiratory diseases. As per the existing policy, all of- ficers and other ranks suffering from pulmonary tuberculosis, are given supervisory treatment as in-patients. This ensures good drug compliance and regular monitoring, resulting in a cure rate of more than 95%. On the other hand, families of officers and other ranks, and ex-ser- vicemen were being treated as outdoor patients. Their treatment was unsupervised and led to poor drug compliance, decreased cure rate and increased likelihood of relapse and resultant multi drug resistant patients.

The hospital soon adopted the RNTCP guidelines and opened a

DOTS Centre in January 2007. Commenting at the inauguration, Brig NAMKOM P. Krishnamurthi, Commandant Military Hospital Namkum, said that this being the first hospital in the armed forces to start DOTS, could JHARKHAND serve as a role model for other service hospitals too. Col MS Barthwal, Chest Physician and officer incharge DOTS programme said that with this introduction of the DOTS programme, the cure rate of tuberculo- sis in families and ex-servicemen is likely to improve appreciably.

Doctor-speak on DOTS Dr C. Ravindran is a professor at the Department of TB and Chest Diseases Medical College, Calicut. Here is his personal account of his perception of RNTCP.

“Initially, I had reservations about the programme, especially after the dismal outcome of the NTP (the earlier TB control programme in India). But watching the programme closely, I felt that the organisational structure is strong and the programme managers are committed. Moreover, the flexibility to adapt when faced with challenges was amazing and it really prompted me to work for the programme. I thought that the best way to criticise is not from outside but when within it.

CALICUT During my tenure as the Head of department from 2002 to 2006, I had the good opportunity KERALA to work in tandem with DTC of Kozhikode and establish a well-functioning RNTCP unit in Calicut Medical College. I understand that this is the best performing Medical College Unit in the state. We could sensitise almost all faculties and most of the residents and students of this college. We are also working with organisations like IMA, Calicut Forum for Internal Medicine, and Calicut Chest Club for promoting RNTCP. One interesting observation is that in 2006 we had only one admission with MDR-TB, truly reflecting the effort to improve treatment compliance.”

Persistent Collector fights TB Indore, the commercial capital of Madhya Pradesh, with big and diverse health care facilities, had a low new smear positive case detection rate until 4th quarter 2005. The credit for the remarkable improvement in programme performance after second quarter of 2006 onwards, goes to the district collector for giving special attention to the TB cases.

The district collector, Shri Vivek Aggarwal, identified poor supervision as the most impor-

tant factor for the low case detection. Following this, the collector started reviewing the INDORE programme regularly. He regularly chaired the quarterly RNTCP district review meetings. The additional collector, Ms. Renu Pant, who was given charge of RNTCP, conducted field visits along with the DTO, especially to areas with suboptimal performance. These efforts by the district collector showed results from the first quarter 2006 itself and the case detec- MADHYA PRADESH tion started increasing, which is evident in the programme performance reports.

TB India 2007 59 Doctors trained in PPM Module Nehru Shatabdi Chikitsalay, Jayant is a multi-specialty hospital of Northern Coalfields Ltd., in Sidhi district of Madhya Pradesh. Last year, about 43 doctors were trained with the RN- TCP PPM module under the guidance of the State TB Officer. In addition, four doctors of Nehru Shatabdi Chikitsalay were given a five-day modular training workshop at the Regional Health and Family Welfare Training Centre, Jabalpur. SIDHI The Nehru Shatabdi Chikitsalay has examined about 577 TB suspects since it was designated as microscopy centre, of which 57 have been found positive for AFB. The hospital has put 94 TB patients on DOTS in about 10 months. This is a big achievement for a district with only 57 doctors. MADHYA PRADESH

DOTS quiz for doctors It has been often felt that many general practitioners, who get first hand contact of tuberculosis cases, are not aware of RNTCP and DOTS due to which they are not able to provide quality care to the patients. To com- bat this complacency, the Pimpri Chinchwad Municipal Corporation (PCMC) came up with the idea of hosting a quiz show for doctors. The aim of this DOTS quiz was to sensitise all the general practitioners of Pimpri Chinchwad on the RNTCP.

The quiz questions ranged from epidemiology of tuberculosis to aspects of RNTCP. The PCMC area was divided into six different zones. The winning team from each zone was selected to compete at the zonal level. A certificate, PIMPRI CHINCHWAD memento and a grand prize of Rs. 2500/- was given to the winner. PUNE, MAHARASHTRA

One man’s mission to control TB This is a story of a watchman who really ‘watches’ over his TB patients. With his supported supervision and the bond he develops with patients, there have been no default cases so far. Watchman Bahdeng Sunn of Mawngap, East Khasi Hills doubles as a committed and sincere DOT provider. He maintains high quality DOTS service and promptly retrieves their treat- ment. He visits the patients door to door and also counsels the alcoholics.

The state/district supervisors were pleased to hear Bahdeng Sunn proudly declare the steadily rising number of his cured patients. He often insisted that the DTO personally visit the patients for verification. He also remains in close contact with the MO in charge and reports the matter

KHASI HILLS to him when there are any complications with the patients under him. MEGHALAYA Bahdeng Sunn is one of the community volunteers who is passionate about seeing the entire Meghalaya one day free of TB. The RNTCP staff hopes that the district will have more like him in order to attain the goal and objective of the programme.

60 TB India 2007 Lions in DOTS treatment Ten Lions Club International of Moga, Punjab have taken the lead in participating in RNTCP. More than 110 Lions’ members were sensitised in a workshop held in No- vember 2006. Presentations were given on RNTCP and TB-HIV coordination. The workshop successfully created awareness among members about the current status of the

scourge of TB worldwide and the role that NGOs can play in RNTCP. The members MOGA

reported that after the workshop they have started advocating RNTCP in their areas and PUNJAB have volunteered to become DOT providers. They are making sincere efforts to establish flexi-DOT centres in their areas.

Community Empowerment - Story of a woman from an NGO-’SWACCH’ Chander Meghwal is a 21-year old Dalit woman living in Danteradi village of Salumbar block in Udaipur District, Rajasthan. Almost all inhabitants of this village belong to Scheduled tribes. She has taken the initiative of changing her own life and those of others for the better. She is going to appear for BA final exam even after getting married and having a baby.

UDAIPUR She has recently joined SWACCH, an NGO working in 6 tribal TUs of Udaipur as one of its over 300 volunteers. Now her home RAJASTHAN is the DOT Centre for her village. Her accessibility and bonding with the TB patients coming to the DOT Centre supports them during their treatment, and the honorarium she will receive will give her financial freedom.

RNTCP DOT PROVIDERS

DOTS in Railway health facility Unani healer as DOT provider in Jaipur

A prisoner, also a DOT provider for TB patients within A patient receiving DOTS at Hirabaug Health Centre, Central Jail, Rewa district, Bhopal Surat, Gujarat

TB India 2007 61 DOT provider wins election Rafatullah Khan started a DOT centre at his residence in the criss-crossing by-lanes of Kashmiri Bazaar, Agra. “Khan Sahib”, as he is popularly known, got involved with full dedication in the programme. Patients who could not afford the full course of the expensive medication turned to him. Soon, patients started pouring in by the dozen at his DOT centre and he had to request the CMO and Agra DM to use the Municipality primary school in the area as a makeshift DOT centre in the evenings to keep up with the inflow of patients.

Since the implementation of RNTCP in Agra districts in the second quarter of 2003, he has provided DOTS to 142 patients and presently 43 patients are on DOTS at his centre. His commitment knows no bounds and one can see him regularly at the district TB Centre, which he frequents to keep himself

updated on the Programme. Leadership comes naturally to Rafatullah. He AGRA gathers all the patients who complain of complications and personally takes them to the district TB Centre for an expert medical opinion.

It was not surprising that the local public encouraged him to contest UTTAR PRADESH the election for Municipality ward member. With the support of his patients and the community, he won the election convincingly in November 2006. “DOTS service provided by me has been the reason for my success in the elections. I would remain ever committed to providing DOTS services to the community,” remarked an elated Rafatullah. The District TB Control Society, which has chosen him as the best DOT provider twice, seems to agree.

Hospital leads fight against TB K.B. Patel Charitable Trust Hospital gives subsidised services to patients including clinical, pathological and radiological investigations. It has joined hands with the government after seeing the achievements of RNTCP. After being convinced about the policies, objectives and operational modalities of RNTCP, the hospital adminis- tration started providing services to TB patients at a no profit-no loss basis.

The doctors and paramedical staff of K.B. Patel Charita- ble Trust Hospital were trained in RNTCP after the im- plementation of the programme in district Agra in June DAYALBAGH, AGRA

UTTAR PRADESH 2003. The NGO hospital now works as a Designated Microscopy cum Treatment Centre (NGO Scheme-4) in the TB Unit of Agra North with full dedication to the TB services it provides. Its trustees, administration, doctors and technicians have been very considerate and caring to the patients, and their performance is on a steady rise.

62 TB India 2007 Chapter 6

1 The Stop TB strategy, WHO 2006 WHO Stop TB strategy, The 63 ANNUAL RISK OFINFECTION IN INDIA TUBERCULOUS DISEASE PREVALENCE SURVEY Th eTuberculous AnnualInfection Risk (ARTI) of Th was selected as the epidemiological parameter to obtain the most reliable index of TB fi rst nation-wide survey ARTI was situation e in Th the country. ed stratifi was country e Th 2000-03. during conducted into 4 zones and the study was designed to estimate average annual risk of tuberculosis infection in each of the ezones. zonalTh estimates were pooled to estimate the national level ARTI, which was 1.5%. every ARTI National repeat to plans programme e Th 2007-09. for planned round next the with years, 5-6 undertaken been also have studies ARTI c State-specifi and Orissa. Kerala in Andhra Pradesh, A large-scale national disease prevalence survey is ideal to get a direct estimate of theTB prevalence. However, in a vast country like India this is feasiblenot due toestimate representative more thea obtain To constraints.operational and technicaland study the trend in prevalence, the programme plans to undertake TB disease prevalence surveys in 6 select sentinel sites/districts erent zones in diff RESEARCH ACTIVITIES ACTIVITIES RESEARCH TB India 2007 Chapter 6 Chapter A survey on prevalence and patterns of anti TB TB of anti and patterns A on survey prevalence Agra) (JALMA, district Banda in resistance drug Utility of generic and disease c specifi health related quality of life instruments as outcome RNTCP under treated patients TB for measures at Chandigarh (PGIMER, Chandigarh) Evaluation of the efficacy ofDOTS regimenthrice in TB weekly usionpleural at eff six months (AIIMS, New Delhi) A study on the assessment of RNTCP strategy of FNAC diagnosis at monthstwo duration weeksof treatment andfor peripheralsix TB Lymphadenitis (PGIMER, Chandigarh) TB Prevalence survey (MGIMS,Wardha) in Wardha district TB prevalence survey in Neelmangla Taluk, Rural Bangalore district (NTI, Bangalore) and workable solutions, testing them in the fi eld and planning for the scaling up of activities.” scaling up of the for eld and planning in the fi testing them solutions, and workable

“Designing and conducting locally relevant operational research can help in identifying problems research can help in identifying locally relevant operational “Designing and conducting ARTI indicates the probability of a person acquiring new infection or re-infection with tubercle bacilli during the course of one Th e RNTCPTh vision is to widely communicate its researchagenda andapplication process, encourage more people to undertake research andon streamline the researchRNTCP proposal, approval and funding process. Studies approved by the Research (OR) Centralcommittee in May 2006: Operational       1 year. It refl ectsthe overall uencingimpact transmission of various factorsrefl It of year. the tubercleinfl bacilli such as the load of infectious cases ciency of public healthin measures the community to controlTB. and the effi Chapter 6 analysis showed that prevalence of culture-positive culture-positive of prevalence that showed analysis Multivariate years. 33 over tuberculosis positive culture- of prevalence in decline the of one-fourth for accounted implementation DOTS of period year 2.5 The implementation. and DOTS after 11.9 5.6% with compared annum per 2.5% 2.3 and by declined tuberculosis smear-positive and RESULT: the at years. 2.5 after and of DOTS implementation start conducted were screening symptom and radiography using surveys Prevalence area. the in implemented was DOTS 1999, In examination. sputum for tool screening a as radiography using India 1986, to 1968 from South years 2.5 every in approximately population cluster rural a random of using sampling conducted was surveys earlier with DOTS programmes. of impact the compare to surveillance community We active used published. DOTS been not have prevalence tuberculosis on WHO-recommended strategy the of impact epidemiological documenting surveys community BACKGROUND: R P Narayanan and K, Sadacharam N, Selvakumar G, P Gopi S, R, Subramani Santha T, Frieden T R, Radhakrishna 2006 22, September Epidemiology, of 1968–2001. India, South different tuberculosis control Tiruvallur,measures, of impact the of surveillance community Active Select Abstracts Millennium Goals. Development TB-related the towards progress evaluate to years five every repeated be would and 2007-10 in undertaken be will surveys The survey. the undertaking be will (Jabalpur) RMRCT and (Agra) JALMA (Chandigarh), PGIMER Delhi), MGIMS NTI (Wardha), (Bangalore), AIIMS (New include which repute of Institutes country. the of From 1968 to 1999, culture-positive culture-positive 1999, to 1968 From METHODS: METHODS: Advance Access published published Access Advance Tuberculosis is curable, but but curable, is Tuberculosis 64 International Journal Journal International Tuberculosis disease disease Tuberculosis

TB India 2007 national data. data. national the in described also as default, was amongst interviewees seen outcome most treatment The unfavourable treatment. DOTS II Category from the private sector. Only 6.1% (n _ 10) had defaulted in treatment from (n previous _ had 140) defaulted and relapses 2.1% (n _ 4) failure 26) cases. Of the TAD _ cases, 84.8% (n 13.3% with interviewees, of (TAD) after default 84.6% (165/195) comprised (97.5%) of retreatment cases interviewed. Treatment RESULTS: questionnaire. a semi-structured using interviewed and register tuberculosis cases the from identified were retreatment sputum-positive II Category METHODS: AND Rajasthan. of districts five in 2003 to March January from registered cases retreatment in outcomes II treatment Category sputum-positive and categorization of accuracy source, determine Rajasthan. of state Indian north the in high remained cases retreatment sputum-positive global of proportion of the cure, and detection for achievement targets and coverage DOTS BACKGROUND: M Zignol and S, L Chauhan S, F,Sahu Wares S, R Sisodia 2006 1373–1379, the majority of interviewed retreatment cases cases retreatment interviewed of majority the India, 2003. 2003. India, Rajasthan, in Programme Control TB National Revised the under cases re-treatment of Source prevalence. tuberculosis of reduction rapid DOTS with was resistance, associated of rifampicin levels low relatively with and epidemic HIV a large of absence the In years. 30 previous the for decline gradual a following rapidly decreased tuberculosis culture-positive of prevalence implementation, temporal to related trends. declines slight only DOTS to after owing 2.8–16.6%) CI: 95% per annum, (10.0% substantially decreased tuberculosis CONCLUSIONS: CONCLUSIONS: Categorisation was correct in 195 195 in correct was Categorisation CONCLUSION: CONCLUSION: I t Tbr Ln Dis Lung Tuberc J nt Three years after state-wide state-wide after years Three Two hundred consecutive consecutive hundred Two Following DOTS DOTS Following TADs constituted TADs constituted MATERIAL MATERIAL 10(12) : : 10(12) AIM: AIM: To Chapter 6

RESULTS: RESULTS: Int J Tuberc Tuberc J Int Involvement of private Public-private mix activities 65 2006; 6: 710–25

To To test the feasibility of involving PPs in Ballabgarh Block, Haryana, 2006, 10(3):264–269 CONCLUSION: practitioners in TB control is possible and results in benefits for all stakeholders. International Standards for Tuberculosis Care. Hopewell Pai P, M, Maher D, Uplekar M, andRaviglione M. Whilehealthcarenationalpartofproviders arewho tuberculosis programmes have been trained areand expected to have adopted proper diagnosis, Lancet Infect Dis success for new patients positive for acid fast bacilli.patientsfastnewsuccessacidpositiveforfor CONCLUSIONS: were associated with increased case notification,whilemaintaining acceptable treatment outcomes. Collaborations betweenprovidershealthholdconsiderableofcare potential public and to improve tuberculosisprivate control in India. tuberculosis in practitioners private of Involvement India.Ballabgarh,Northern in control Lung Dis, Krishnan A, Kapoor S K OBJECTIVE: private practitioners (PPs) identificationin and themanagement ofTB cases.RNTCP for DESIGN: were identified andRNTCP guidelines. They referredinvited TB suspects for for facility. publicnearby a diagnosistoconfirmation of training in Patients could subsequently choose to return theirreferring doctortothegovernment toor facility. Patientsanddoctors wereinterviewed theendofat the project to assess their perceptions. guidelines RNTCP in trained were 72% PPs, 146 Of and 14 agreed to treatment provide(DOT). During the study period (Maydirectly 2001–observed December 2003) 113 patientstreatment,incrementalleadingan11.5% toofgain initiated sputum 113 the among rate cure The finding. case in positivepatients was73%, and thedefault ratewas 11.5%. TB India 2007 DATA DATA DATA DATA Literature review. DATA DATA EXTRACTION: Of 24 identified public-private To To review the characteristics of DESIGN: Review of surveillance records from 2006;332;574-578; originally published

(84.6%), and were overwhelminglyweregeneratedbeing (84.6%),and irregularby treatment privatetheinFurther sector. involvement of the private sector in programmethe DOTS in Rajasthan is neededcreation of furtherto retreatmentstop cases. the Improving tuberculosis control through review public-private collaboration in India: literature, BMJ public-privateprojectsmixIndiatheirand ineffect on case notification and treatment outcomes fortuberculosis. online 8 Feb 2006 Dewan P K, Lal S S, Knut Lonnroth,Uplekar M, Wares Sahu S, GranichF, R, and Chauhan L S OBJECTIVE: SOURCES: Indiantuberculosis programme project, evaluation reports, and medical literature for public-private mix projects in India. SYNTHESIS: Project characteristics,Projectnotification tuberculosiscase ofnew patients with sputum smear results positive foracidfastbacilli, andtreatment outcome. mix projects, data were available from 14 (58%), involving private practitioners, corporations, and non-governmental organisations. In all reviewed projects,the public sector tuberculosis programme provided training and providers.supervision Among the five projects withof available privatedata on historical controls, case notification rates were higher after implementationinvolvingprojectsseven Amongproject. mix private of a public- private practitioners, 2796 of 12 147 (23%) new patientspositive acidforfastbacilli attributedwere to private providers. Corporate based governmentaland non- organisations served assource the formain tuberculosis programmeseven project servicesareas, detecting in9967 new patientspositive for acid fast bacilli. In nine of 12 projects treatmentwithdataon outcomes, privateproviders exceeded the programme target of 85% treatment Chapter 6 rural India. India. rural from study population-based a tuberculosis: and cough with individuals among seeking Healthcare HIV infection. with combined tuberculosis and tuberculosis complex, Mycobacterium drug-resistant by caused tuberculosis and tuberculosis, extra-pulmonary smear-negative, including smear-positive, ages, with all of those patients high for care delivering in quality providers care all engage to intended is document The tuberculosis. having, of suspected are in or have, who achieve to individuals managing seek should practitioners care all of that level endorsed widely a describe (ISTC) Care for Tuberculosis Standards International The function. public-health an also assuming important are they but individual, an to care delivering they are only not that recognise must patients tuberculosis with of treatment and evaluation undertake who providers All control. tuberculosis and care patient good for essential are treatment effective and diagnosis, accurate and be Prompt must out. carried responsibilities public-health essential and monitored; be should treatment to response with appropriate used treatment support and promptly; be supervision; should regimens established treatment be standardised should diagnosis worldwide: a same the are tuberculosis suspected having, or of with, people for care of principles care that is poor Thequality suggest basic common. world the of parts different several in sector conducted private the of performance the of Studies providers. programme non for true be to likely not is same the practices, public-health and treatment, of private and public health care. care. health public and private of utilisation the on focus special with weeks, >3 of cough with women and men among seeking care OBJECTIVE: SETTING: al. et Deshpande, K, G Fochsen 995-1000. Ujjain district, Madhya Ujjain district, Pradesh, India. Int J Tuberc Lung Dis, Lung Tuberc J Int To describe and compare health health compare and describe To 66

TB India 2007 2006 2006 DESIGN: DESIGN: 10(9): 10(9): A A provider. provider. public a visiting and haemoptysis TB, of history were examination sputum with associated Factors sputum smear examination since the a onset of cough. had having reported care seeking those of 13% care seeking were found between men health and women. Only in differences significant No survey. our in (TB) tuberculosis with diagnosed patients for found was pattern seeking care health A similar illness. their during point some at provider public a visited 23% only but 71%), vs. (69% symptoms their for care health seeking reported women and 1.2% among men and women. Themajority of men and 2.8% wasofrespectively cough Theprevalence 45 719 aged individuals > or = 15 years. including survey cross-sectional population-based tuberculosis control. control. in tuberculosis steps northern next the in & challenges centre successes, care India: tertiary a at DOTS activities. control TB in providers private of involvement as well as the need illustrate for practices improved diagnostic setting Indian rural this in reported examinations sputum few the and services care health public of carrying detailed information of all patients seen at seen of all patients information register detailed carrying A cases. TB suspected of treatment evaluation and the for guidelines RNTCP followed (2001-2005). years four almost for India northern in centre care the of status a DOTS on centre being run at a large tertiary report brief a present We successes. their and challenges, their experiences, individual centres’ DOTS detailing exist reports few extensive, and rapid been has expansion While (RNTCP). the of guidance the National Revised Tuberculosis Programme Control under India, throughout directly of centres (DOTS) short-course treatment, expansion observed rapid a seen has decade OBJECTIVES: & BACKGROUND al. et K, S Sharma TahirM, 702-6. 123(5): CONCLUSION: CONCLUSION: METHODS: METHODS: nin Md Res Med J Indian The low utilisation utilisation low The The DOTS centre centre DOTS The RESULTS: The past past The , 2006, 2006, Chapter 6

Int J Int J Tuberc Lung Indian J Med Res. Indian J Med Res. . 2006;103:2869– Int J Tuberc Lung Dis. 2006;53:7–11. 2006;10:115–117. 67 IndianTuber. J 2006;10:346–348. 2006;124(1):71–76. tuberculosis pulmonary of Yield PR. Narayanan cases by employing two screening methods in a community survey. 2006;10(3):343–345. RelationshipNarayanan PR.Kumaraswami V, of ARTI to incidencetuberculosis in a anddistrict of south prevalenceIndia. LungTuberc ofDis. Rajeswari ChandrasekaranRadhakrishnanV, S, R,Balasubramanian R, Thomas Muniyandi A, M, Narayanan PR. Performance of a DOTS programme: administrative challengesand —technical a field report from a district S, Kremer K, Gutierrez MC, Hilty M, Hopewell M, Hilty MC, Gutierrez K, Kremer S, PC, Small PM. Variablecompatibility in Mycobacterium tuberculosis.host–pathogen Proc Natl Acad Sci. USA 2873. Narayanan N, Selvakumar A, Thomas T, Santha PR. Association of conversion & cure positivesmearnewgradingamong initialsmear with pulmonary tuberculosiswith Category patientsI regimen. treated2006;123(6):807–814. VV, Narayanan PR. Estimation riskof of annualtuberculosis infection among children irrespective of BCG scar in the south zone of India. Trend in the prevalenceand ARTI ofafter implementationTB infectionof a DOTS programme in south India. Dis. PR. ImpactvaccinationBCGof PR. tuberculinon tuberculosis of risk annual the estimate to surveys infection in south India. 9. Gopi PG, Subramani R, Sadacharam K, PP, Kumaran T, Santha10. R, Subramani PG, Gopi 11. Gopi PG, Subramani R, Santha T, 5. Gopi PG, Chandrasekaran V, Subramani R, 6. Gopi PG, Subramani R, Kolappan C, Prasad 7. Gopi PG, Subramani R, Narayanan PR. 8. GopiPG, Subramani Narayanan R,Nataraj T,

TB India 2007 Treatment A total of 1490 of total A Int JTuberc Lung Dis Int J Tuberc Lung Dis. RESULTS: RESULTS: CONCLUSION: 2006;332;574–578;originally BMJ deJong BC, Narayanan S, Nicol M, Niemann 10(9): 995–1000. Jaggarajamma K, Gopi PG, Chandrasekaran V, Narayanan PR. A ruralpartnership public-private model in tuberculosisin South control India. Chauhan, and R., Granich S., Sahu M., Uplekar, “Improvingtuberculosis S.,controlthrough L. review public-private collaboration in India: literature”, 2006;10(12):1380–1385. published online 8 Feb 2006 ”Healthcare seeking among individuals with cough and tuberculosis: a population-basedstudy from rural India.” Papers Published in 2006 Published Papers 1. VB, Rao R, Ramachandran R, Balasubramanian 2. F., Lonnroth,KnutWares SS,Lal, Dewan, PK, the DOTS centre was kept by the senior clinician. Datafromthisregister extractedwere analysedand measures.descriptive for patients were evaluated. Of the 768 patients with cough,27per cent (211) were found tobesputum positiveacid-fastfor bacilli (AFB).Among patients medications,anti-tuberculosis on initiated were who cure was achieved in 92 per centnew (71 sputumof 77)smear of positive patients;completion100)of cent(91achievedper was91 in treatment extrapulmonaryof (EPTB)TBcentper(4675and 61)ofsputum-negativeof pulmonary patients.TB Overall treatment success was achieved in 86 per cent (229 of 266). results were in keeping with the RNTCP guidelines.RNTCP the withkeeping in were results Tertiary care centres appear to be excellent place for education of medical students and operational research. The latter is much needed, as HIV-TBco-infection, multi-drug resistant TB, and EPTB continue to be major public health threats even in the era of DOTS. 4. Gagneux S, Deriemer K, Van T, Kato-Maeda M, Kato-Maeda 4. T, Van K, Deriemer S, Gagneux 3. Fochsen, G, K. Deshpande, et al. (2006). Chapter 6 19. Mahadev B, Kumar P,.Sharada MA “How “How MA P,.Sharada Kumar B, Mahadev 19. Kumar V, NS, P, Venkatesan S, Gomathi 18. Balaji 14. Jaggarajamma 14. K, Muniyandi M, Chandrasekaran Gutierrez MC, 13. Ahmed N, Willery E, Narayanan Gupta D. 12. and Chauhan LS, “Case detection rate 20. Muniyandi M, Rajeswari R, Balasubramanian Balasubramanian R, Rajeswari M, Muniyandi 20. 17. Krishnan, A., Kapoor, S K, “Involvement of of “Involvement K, S Kapoor, A., Krishnan, 17. 15. Joseph P, Chandrasekaran V, Thomas A, Gopi Gopi A, V,Thomas P, Joseph Chandrasekaran 15. 16. Kolappan C, Subramani R, Karunakaran Karunakaran R, Subramani C, Kolappan 16. aie Kraaa. Karnataka”. Palike, study under RNTCP in Mahanagara Bangalore are as shop effective keepers DOT providers? A diagnosis. TB rapid for medium liquid in overnight grown specimens sputum processed in flora normal of growth exponential the control to cocktail Phage PR. Narayanan K, Jayasankar G, Sekar n ot Ida India. south in migration a factor leading to default under under RNTCP? default to leading factor a migration V,PG,Santha A, Gopi G, Thomas Sudha T. Is 1367–1374. India. in ancestral lineages of Mycobacterium tuberculosis VM, Vincent V, Katoch Locht C, DS, Supply P. Predominance Chauhan of SE, Hasnain S, 2006. 6, No. of India, Journal Medical The National Experience”, Indian The DOTS: under targets 123–134. R, R, Narayanan PR. dimensions Socio-economic (1):18–26. 53 Dis Dis India.” Northern Ballabgarh, in control tuberculosis in practitioners private regimen. regimen. and II outcome category to ‘failures’ of profile susceptibility treatment on susceptibility drug T. Santha of N, Influence Selvakumar R, PG, Rajeswari R, Balasubramanian R, Subramani Organ. Organ. India. Chennai, in patients tuberculosis of Mortality PR. Narayanan K, 10(3):264–269, 2006. 10(3):264–269, 2006;84(7):555–560. 2006;84(7):555–560. Indian J J Tuberc.Indian Indian J J Tuber.Indian mr Ifc Dis. Infect Emerg J Microbiol Methods. Methods. Microbiol J Indian J Tuberc. Tuberc. J Indian Indian J Tuberc Tuberc J Indian 68 2006;53:141–148. 2006;53:141–148.

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25. Radhakrishna S, Frieden TR, Subramani R, R, Subramani TR, Frieden S, Radhakrishna 25. the in methods Molecular CN. Paramasivan 24. G, Dakshayani P. Narang CN, Paramasivan 23. MS, Jawahar P, Selvaraj D, Rajeswari Nisha 22. 28. Ramachandran G, Hemanthkumar AK, AK, Hemanthkumar G, Ramachandran 28. Humoral SD. P, Das J, Rajavelu Madhumathi 27. B. Ramalingam UD, Ranganathan A, Raja 26. 21. Muniyandi M, Rajeswari R, Balasubramanian Balasubramanian R, Rajeswari M, Muniyandi 21. (Edinb). (Edinb). for testing infection. tuberculous dual identifying of Value PR. Narayanan 2006;53:61–63. tuberculosis. of diagnosis 2006;53:196–200. India. in DOTS implementation of context the in districts three in programme conditions under tuberculosis pulmonary positive smear of diagnosis bacteriological of Chandrasekaran V, Venkataraman P. Evaluation Res. tuberculosis. pulmonary active in cells positive of perforin percentage Elevated AR, M, PR. Vidyarani Narayanan Adhilakshmi Rajasekaran S, Padmapriyadarsini C, C, S. Swaminathan V, Kumaraswami K, Raja S, Sathishnarayan B, Sukumar G, Padmapriyadarsini Narendran S, Rajasekaran 2006;91(7):918–922. India. South from IS6110 of copy antigens single harbouring of tuberculosis Mycobacterium strains prevalent sonicate most the from prepared multiple to patients and tuberculosis of normals responses immune 2006;56:281–287. pulmonary in tuberculosis. antibodies complex-bound immune of detection specific of value Clinical Indian J J Tuber. Indian (RNTCP). national programme control revised tuberculosis under tuberculosis with R. Estimating provider cost for treating patients Centre. Research Tuberculosis studies from of decades two over Review : control tuberculosis of 2006;123(5):687–690. 2006;123(5):687–690. J Comm Dis. Comm J 2006;86:47–53. 2006;86:47–53. 2006;53:12–17. 2006;53:12–17. Diagn Microbiol Infect Dis. Dis. Infect Microbiol Diagn 2006;38(3): 204–215. 2006;38(3): Indian J Tuber. Tuber. J Indian Indian J Med Med J Indian Indian J Indian Tub. Tuberculosis Tuberculosis Curr Sci. Sci. Curr Chapter 6

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2006;11(10):

PERFORMANCE OF RNTCP Chapter 7

New Smear Positive TB Case Detection Rate of India, 2006

< 30% 30% – 49.9% 50% – 69.9% > 70%

TB India 2007 71 Cure rate by district, India 2005

< 85% 90% – 84.9% 80% Cure rate not expected as districts began RNTCP in 2006

72 TB India 2007 - & % aland; 00 g SK AN AR DL % 1 90 PD CH HP a; MZ-Mizoram, NG-Na RJ y a 80% MZ hal GU WB g DN AP 2004 70% 2005 TN DD MG 2003 MH 2006 AS JH KA OR NG 0% HR MN 2001 CG 2002 2000 UP ana; HP-Himachal Pradesh; JK- Jammu & Kashmir; JH-Jharkhand; KA PN GA y r MP % 6 TR 50 UR KE a Pradesh; MH-Maharashtra; MN-Manipur; MG-Me y 40% Annual New Smear Positive Case Detection Rate JK 0% BI Case Detection Rate and Treatment Success Rates in India for 2006/2005 Case Detection Rate and Treatment er Haveli; GA-Goa; GU-Gujarat; HR-Ha g ; PN-Punjab; RJ-Rajasthan; SK-Sikkim; TN-Tamil Nadu; TR-Tripura; UP-Uttar Pradesh; UR-Uttaranchal; WB-West y % 3 r 20 LK 10%

95% 90% 85% 80% 75% 70% 65%

100% New Smear Positive Treatment Success Rate Success Treatment Positive Smear New AP- Andhra Pradesh; AN- Andaman & Nicobar; AR-Arunachal AS-Assam; BI-Bihar; CH-Chandigarh; CG-Chhatisgarh; DD- Daman Diu;DL-Delhi; DN-Dadra & Na Karnataka; KE-Kerala; LK- Lakshadweep; MP-Madh Bengal OR-Orissa, PD-Puducher

TB India 2007 73 - 3 72 40 235 296 675 466 871 815 591 461 9394 2925 3020 2887 9236 4961 2778 2574 1990 6014 7192 ment 13711 11420 20658 EP cases for treat for (Contd.) No of new new No of registered registered - 6 94 70 299 765 441 552 846 449 642 9853 9444 7388 2414 2617 5447 1584 ment cases smear 34995 26361 11620 12746 12265 15318 23467 39547 negative negative for treat for No of new new No of registered registered - 48% 56% 55% 59% 43% 64% 48% 61% 58% 59% 54% 72% 64% 67% 58% 53% 62% 66% 54% 55% 58% 42% 59% 55% 60% out of out of % new % new pulmo sputum positive positive total new total new nary cases

93% 74% 64% 27% 82% 59% 75% 67% 90% 52% 77% 60% 81% 33% 64% 60% 43% 14% 54% 65% 59% 66% 77% 60% 105% positive case positive 70 56 79 48 20 77 47 60 53 85 41 61 57 77 31 48 45 32 11 43 52 45 49 57 45 Annual new smear Annual new detection rate (%) detection rate - 7 95 274 922 785 148 637 548 959 4965 3635 1141 1220 New New ment smear 44907 14012 19615 10737 13717 33601 13155 14024 25363 10707 28884 54093 positive positive patients for treat for registered registered 64 88 75 24 234 133 223 111 229 123 158 157 296 132 146 151 207 113 116 111 133 180 159 200 126 rate rate Annual detection total case - 3 16 920 391 280 2607 2322 2036 4603 3929 1912 2695 32311 61151 28209 47606 79821 34693 13303 10268 33035 64842 25248 74435 Total Total ment 107131 138837 patients for treat for registered registered 9% 7% 7% 6% 3% 8% 15% 12% 16% 13% 12% 12% 12% 16% 11% 17% 14% 14% 16% 12% 17% 13% 16% 10% 14% cases among suspects % of S+ve S+ve % of 2 - 6 379 187 198 776 1352 1662 1091 8354 5229 1478 1832 1279 diag No of No of smear 66924 18573 29289 13273 25427 60231 22893 18289 40886 13866 45923 76759 nosed positive positive patients - 99 61 96 72 256 139 231 347 120 163 424 244 168 159 173 238 156 154 171 100 140 187 117 205 111 quarter popula tion per per lakh Suspects examined examined 189 4040 1613 3020 7835 9470 Annual Performance of RNTCP Case Detection (2006), Smear Conversion 10824 14048 10356 61070 72411 19159 11582 447523 114640 222802 109289 156732 348473 159318 112432 344976 229692 267667 583510 No. of No. of (4th quarter, 2005 and 1st to 3rd quarter, 2006) and Treatment Outcomes (2005) 2006) and Treatment 2005 and 1st to 3rd quarter, (4th quarter, suspects examined

1 - 4 2 2 1 12 10 15 64 26 25 10 21 804 290 908 229 161 548 230 116 292 561 336 668 1041 lakh) Popula covered covered tion (in by RNTCP by State Andhra Pradesh Andhra Pradesh Arunachal Assam Chandigarh D & N Haveli & Diu Daman Gujarat Haryana Pradesh Himachal & Kashmir Jammu Jharkhand Karnataka Kerala Lakshadweep Pradesh Madhya Maharashtra Manipur Meghalaya Mizoram Nagaland Andaman & Nicobar Andaman Bihar Chhattisgarh Delhi Goa

74 TB India 2007 - 286 366 232 6864 6424 1465 12092 17441 20190 14535 ment 183180 EP cases for treat for No of new new No of registered registered - 311 273 478 7918 3416 12346 31649 24711 74719 25445 ment cases smear 400496 negative negative for treat for No of new new No of registered registered - 61% 68% 63% 56% 65% 57% 72% 55% 56% 66% 58% out of out of % new % new pulmo sputum positive positive total new total new nary cases

59% 85% 55% 80% 68% 49% 52% 49% 78% 66% 116% positive case positive 50 64 52 64 87 51 37 50 46 59 50 Annual new smear Annual new detection rate (%) detection rate - 666 505 1255 4279 New New ment smear 19663 13630 40152 33314 91610 50435 positive positive patients 553660 for treat for registered registered 68 115 145 133 173 252 133 122 126 127 125 rate rate Annual detection total case - 3 1513 1458 2314 44790 34537 87065 11653 Total Total ment 107783 224465 109319 patients 1397498 for treat for registered registered 9% 8% 14% 13% 19% 11% 13% 14% 13% 12% 13% cases among suspects % of S+ve S+ve % of Annual Performance (Contd.) 2 - 787 1481 1611 7685 25741 20592 70912 49317 66873 diag No of No of smear nosed 133715 834870 positive positive patients - 91 117 395 149 146 321 237 125 162 163 140 quarter popula tion per per lakh Suspects examined examined 7432 16477 12401 59751 183290 154763 365455 619549 922839 560008 No. of No. of 6224636 suspects examined

1 - 6 10 34 92 391 260 624 653 858 1839 lakh) 11142 Popula covered covered tion (in by RNTCP by State Orissa Punjab Rajasthan Sikkim Puducherry Nadu Tamil Tripura Pradesh Uttar Uttarakhand Bengal West Total Grand Projected population based on census population of 2001 is used for calculation of case-detection rate. 1 lakh = 100,000 population rate. case-detection of calculation 2001 is used for of population based on census population Projected cases positive retreatment smear positive cases and smear new include diagnosed positive patients Smear ‘Others’ cases and positive retreatment smear cases, extra-pulmonary new cases, negative smear new positive cases, sputum smear new includes treatment for registered patients Total Estimated New Smear Positive cases/lakh population based on ARTI data for North Zone (Chandigarh, Delhi, Haryana, Himachal Pradesh, Jammu & Kashmir, Punjab, Uttar Pradesh, Uttarakhand) Uttarakhand) Pradesh, Uttar Punjab, & Kashmir, Jammu Pradesh, Himachal Delhi, Haryana, (Chandigarh, Zone North for based on ARTI data cases/lakh population Positive Smear New Estimated Pradesh, (Andhra is 75; South Zone Bengal) West Sikkim, Tripura, Nagaland, Mizoram, Meghalaya, Manipur, Jharkhand, Bihar, Assam, Pradesh, Arunachal & Nicobar, (Andaman is 95; East Zone Rajasthan) is 80; Maharashtra, Pradesh, Madhya & Diu, Goa, Gujarat, Daman Haveli, & Nagar (Chhattisgarh, Dadra Zone West is 75 and Nadu) Tamil Puducherry, Lakshadweep, Kerala, Karnataka, Orissa is 85 1 2 3

TB India 2007 75 83% 74% 84% 83% 70% 94% 80% 91% 97% 77% 83% 88% 84% 87% 63% 77% 76% 73% 82% 86% 100% 100% 1 15 62 60 669 603 323 962 827 7904 4263 6438 9034 3493 5267 7021 done within 7 27616 11057 21702 15617 16159 38763 No (%) of cured cured No (%) of days of last dose of days end of treatment treatment end of NSP cases having follow- up sputum follow- 97% 96% 99% 96% 91% 98% 99% 98% 98% 95% 90% 99% 96% 92% 92% 26% 95% 95% 92% 100% 100% 100% 7 95 271 924 771 148 627 4092 2295 9888 1061

No (%) of NSP No (%) of DOTS treatment DOTS 43188 13303 17424 10607 13377 32971 12308 13067 23435 26824 50583 cases registered cases registered of starting RNTCP starting RNTCP of within one month 99% 84% 94% 85% 78% 87% 86% 98% 91% 79% 86% 87% 90% 98% 77% 84% 88% 82% 85% 98% 100% 100% 7 95 diagnosis 276 878 686 145 506 RNTCP DOTS DOTS RNTCP cases started 9262 3955 2605 9475 1132 No (%) of NSP No (%) of 37382 11591 14928 12384 28893 11031 10306 21041 22550 44512 within 7 days of of within 7 days 82% 87% 90% 82% 83% 86% 86% 78% 93% 87% 70% 87% 83% 89% 83% 87% 79% 84% 83% 87% 85% 100% rate of of rate success positive positive patients* Treatment Treatment new smear new 78% 84% 87% 79% 74% 86% 83% 78% 86% 87% 70% 86% 82% 87% 81% 82% 77% 82% 79% 86% 84% smear 100% of new new of positive positive Cure rate rate Cure patients* 91% 90% 90% 87% 80% 91% 89% 84% 89% 89% 84% 91% 88% 92% 86% 88% 84% 85% 20% 87% 91% 88% rate of of rate positive positive patients 3 month new smear new conversion conversion 3% 3% 3% 4% 5% 5% 0% 5% 5% 2% 2% 4% 6% 9% 0% 4% 6% 8% 17% 12% 14% 10% 1 0 56 15 135 888 225 161 229 219 276 paediatric No (%) of No (%) of 2539 2174 1309 5223 2690 1395 1175 3078 1930 2298 6825 cases out of cases out of all new cases all new 0% 22% 24% 30% 20% 26% 26% 15% 24% 30% 33% 27% 35% 36% 35% 23% 17% 27% 18% 29% 22% 24% cases out of out of positive positive all smear ment cases % of retreat- % of 0 76 48 40 403 272 236 355 Annual Performance of RNTCP Case Detection (2006), Smear Conversion 3409 6979 1847 6702 7246 2639 1081 2857 9412 2353 cases 14434 17701 11580 15356 positive positive (4th quarter, 2005 and 1st to 3rd quarter, 2006) and Treatment Outcomes (2005) 2006) and Treatment 2005 and 1st to 3rd quarter, (4th quarter, treatment retreatment retreatment No of smear No of registered for for registered 6% 7% 29% 11% 15% 11% 36% 11% 23% 20% 37% 28% 17% 19% 27% 29% 22% 27% 19% 12% 18% 24% % of % of cases cases out of out of new EP new all new all new State Andaman & Nicobar Andaman Bihar Chhattisgarh Delhi Goa Andhra Pradesh Andhra Pradesh Arunachal Assam Chandigarh D & N Haveli & Diu Daman Gujarat Haryana Pradesh Himachal & Kashmir Jammu Jharkhand Karnataka Kerala Lakshadweep Pradesh Madhya Maharashtra Manipur

76 TB India 2007 80% 66% 69% 68% 72% 91% 81% 95% 78% 69% 89% 93% 84% 81% 769 377 490 446 269 1205 9973 8869 3574 done within 7 26905 23928 52188 35242 No (%) of cured cured No (%) of 342091 days of last dose of days end of treatment treatment end of NSP cases having follow- up sputum follow- 96% 58% 98% 95% 89% 98% 93% 99% 97% 81% 99% 98% 88% 95% 546 645 638 502 650 1165 4198 15441 13323 37365 32347 88383 47691 No (%) of NSP No (%) of DOTS treatment DOTS cases registered cases registered 520160 of starting RNTCP starting RNTCP of within one month 87% 58% 93% 80% 69% 91% 78% 96% 80% 81% 89% 91% 79% 84% diagnosis 544 630 491 486 670 RNTCP DOTS DOTS RNTCP 1008 3909 cases started No (%) of NSP No (%) of 12848 12418 31511 26550 77193 39738 within 7 days of of within 7 days 451636 81% 91% 87% 85% 78% 84% 88% 88% 84% 87% 87% 87% 87% 86% rate of of rate success positive positive patients* Treatment Treatment new smear new 78% 91% 86% 79% 73% 81% 86% 88% 82% 82% 84% 86% 86% 83% smear of new new of positive positive Cure rate rate Cure patients* 84% 93% 91% 86% 85% 87% 91% 87% 88% 85% 89% 93% 90% 89% rate of of rate positive positive patients 3 month new smear new conversion conversion 9% 5% 9% 4% 2% 6% 5% 1% 5% 6% 5% 6% 16% 11% Annual Performance (Contd.) 82 21 21 246 189 183 523 paediatric No (%) of No (%) of 1486 1680 4142 8255 4910 cases out of cases out of all new cases all new 10118 64697 32% 26% 28% 16% 25% 28% 34% 30% 22% 19% 26% 33% 19% 26% cases out of out of positive positive all smear ment cases % of retreat- % of 567 193 372 222 214 289 3666 5177 9229 2112 20491 31785 11621 cases 190964 positive positive treatment retreatment retreatment No of smear No of registered for for registered 28% 37% 22% 18% 23% 23% 14% 32% 23% 12% 11% 16% 16% 16% % of % of cases cases out of out of new EP new all new all new State Meghalaya Orissa Punjab Rajasthan Sikkim 2005 after 4th quarter RNTCP states that began implementing for expected not are rate success and rate * Cure Mizoram Nagaland Puducherry Nadu Tamil Tripura Pradesh Uttar Uttarakhand Bengal West Total Grand

TB India 2007 77 out Trans Trans 2.6% 0.4% 1.1% 0.9% 0.3% 2.9% 0.4% 4.5% 0.0% 0.5% 1.8% 0.6% 0.3% 0.4% 2.1% 0.7% 2.6% 0.7% 0.4% 0.6% 0.1% 0.5% 0.0% 0.7% 0.5% 0.0% 1.1% De- 7.0% 7.7% 8.7% 7.9% 2.2% 4.7% 9.1% 7.7% 2.7% 8.0% 5.8% 4.5% 4.9% 5.8% 5.2% 5.4% 6.0% 7.1% 3.0% 2.2% 6.3% 8.4% 4.4% 10.8% 13.8% 10.0% 12.8% faulted 2 0.0% 0.2% 0.4% 0.2% 0.3% 0.3% 0.0% 0.0% 0.0% 0.2% 1.4% 0.1% 0.2% 0.2% 0.2% 0.3% 0.2% 0.1% 0.2% 0.3% 0.0% 0.1% 0.2% 0.2% 0.1% 0.0% 0.1% Failure 7.0% 2.7% 8.3% 2.7% 1.2% 1.2% 2.3% 0.0% 7.7% 0.9% 2.5% 2.1% 1.9% 2.4% 5.0% 1.8% 3.7% 2.8% 1.6% 2.7% 1.7% 2.1% 2.6% 2.1% 2.8% 2.9% 2.5% Died New Extra Pulmonary Extra New leted Comp- 83.5% 89.0% 79.4% 87.4% 90.3% 93.5% 92.6% 86.4% 84.6% 95.7% 80.5% 89.1% 91.9% 92.5% 87.9% 91.5% 88.2% 91.3% 91.8% 89.4% 88.2% 94.2% 95.1% 84.1% 90.3% 88.7% 92.0% 0 22 13 115 277 691 282 968 755 506 561 274 8861 2566 1499 2208 9210 5205 3140 1213 1482 5940 6587 6765 5521 ered 13342 11187 21632 Regist- out 1.2% 0.5% 1.5% 1.0% 0.3% 0.7% 0.3% 0.0% 0.0% 0.6% 1.5% 0.8% 0.3% 0.3% 0.7% 0.1% 2.0% 0.6% 0.0% 0.3% 0.6% 0.2% 0.2% 0.0% 0.1% 0.9% 0.0% 1.1% Trans Trans De- 7.3% 2.1% 9.8% 4.5% 4.6% 6.3% 8.1% 9.0% 7.1% 0.0% 8.4% 8.4% 7.2% 6.4% 7.4% 10.5% 10.0% 13.9% 10.5% 18.2% 17.2% 10.2% 10.4% 12.4% 10.7% 11.9% 16.5% 10.7% faulted 2 0.0% 0.7% 1.0% 0.7% 0.7% 1.4% 0.4% 0.0% 0.0% 1.3% 1.3% 1.1% 2.1% 1.3% 0.4% 0.6% 0.9% 0.6% 0.0% 0.9% 0.9% 0.3% 1.4% 1.6% 0.6% 0.3% 0.3% 1.0% Failure 3.5% 4.6% 9.8% 4.1% 2.5% 1.7% 3.6% 9.1% 0.0% 1.9% 3.7% 4.0% 4.2% 4.8% 4.1% 2.4% 6.1% 4.8% 0.0% 2.7% 3.8% 2.7% 5.6% 5.8% 4.3% 4.6% 6.5% 4.2% Died New Smear Negative New leted 84.9% 87.1% 77.7% 80.3% 85.9% 94.1% 85.9% 72.7% 95.5% 91.7% 76.4% 83.9% 83.1% 87.3% 82.4% 88.7% 82.0% 86.9% 85.3% 86.3% 84.9% 84.4% 94.4% 78.5% 87.7% 82.5% 86.3% Comp- 100.0% 3 86 22 22 737 574 542 956 515 789 291 9199 9298 7923 2763 1231 5204 1654 7708 ered 39826 10083 13652 15398 11318 18777 23588 44647 12404 Regist- out 3.1% 0.8% 0.4% 0.8% 0.3% 3.2% 0.3% 3.8% 0.0% 1.4% 1.8% 0.9% 0.5% 0.2% 1.3% 0.2% 2.3% 0.7% 0.0% 0.4% 0.7% 0.5% 0.5% 0.2% 0.7% 0.5% 0.0% 1.1% Trans Trans De- 7.7% 4.6% 4.1% 9.9% 9.5% 3.2% 7.5% 7.0% 5.5% 5.4% 8.0% 4.1% 8.5% 6.5% 8.7% 6.1% 0.0% 9.1% 5.2% 9.3% 7.1% 3.3% 7.2% 7.6% 7.0% 11.3% 20.4% 15.8% faulted Treatment Outcome of New Cases for 2005 Treatment 1 0.8% 2.6% 3.7% 2.3% 2.3% 3.9% 1.2% 3.8% 0.0% 3.9% 4.0% 2.8% 4.2% 2.9% 2.3% 1.6% 3.4% 4.2% 0.0% 2.6% 2.3% 2.2% 7.4% 2.7% 3.0% 1.2% 1.6% 2.6% Failure 6.2% 4.9% 2.1% 4.8% 4.7% 3.8% 5.2% 3.8% 0.0% 2.4% 3.3% 4.2% 4.0% 4.0% 5.1% 5.0% 6.5% 4.9% 0.0% 4.8% 5.0% 2.8% 4.0% 2.5% 2.0% 5.4% 4.4% 5.0% Died New Smear Positive New 3.8% 2.9% 2.3% 3.7% 9.1% 0.0% 2.5% 0.0% 7.0% 0.2% 0.7% 0.5% 1.4% 1.7% 2.2% 5.0% 1.7% 2.3% 0.0% 3.6% 1.0% 1.0% 2.7% 0.4% 0.7% 6.5% 5.4% 3.1% leted Comp- Cure 78.5% 84.3% 87.5% 78.5% 74.0% 85.9% 83.2% 77.5% 85.9% 86.6% 69.5% 86.2% 81.9% 87.1% 80.5% 81.6% 77.3% 81.8% 79.5% 85.8% 84.3% 78.3% 90.9% 85.8% 78.8% 72.8% 81.2% 100.0% 1 80 71 130 813 745 604 551 957 614 8464 9702 4833 1643 9949 1045 1167 ered 44061 11886 12733 30289 12630 26724 11174 27699 54995 20019 11926 Regist- Madhya Pradesh Madhya Implementing states & Nicobar Andaman Bihar Chhattisgarh Delhi Goa Orissa Punjab Andhra Pradesh Andhra Pradesh Arunachal Assam Chandigarh D & N Haveli & Diu Daman Gujarat Haryana Pradesh Himachal & Kashmir Jammu Jharkhand Karnataka Kerala Lakshadweep Maharashtra Manipur Meghalaya Mizoram Nagaland Puducherry

78 TB India 2007 out Trans Trans 0.7% 1.0% 0.4% 0.0% 0.1% 0.6% 0.2% 0.6% De- 6.8% 2.4% 3.8% 3.9% 4.8% 5.9% 4.8% 5.6% faulted 2 0.2% 0.7% 0.1% 0.6% 0.1% 0.1% 0.2% 0.2% Failure 1.7% 2.4% 2.9% 3.4% 0.9% 1.1% 2.9% 2.3% Died New Extra Pulmonary Extra New leted 90.6% 93.4% 92.8% 92.1% 94.1% 92.3% 91.9% 91.3% Comp- 412 178 1237 ered 11812 17055 16068 13675 Regist- 171259 out 0.2% 1.9% 0.3% 0.0% 0.1% 0.7% 0.2% 0.5% Trans Trans De- 8.2% 2.9% 6.1% 7.1% 8.9% 5.2% 7.8% 8.5% faulted 2 0.9% 1.3% 0.3% 1.5% 0.6% 1.3% 0.7% 0.8% Failure 2.8% 4.1% 4.3% 5.6% 2.1% 2.6% 4.5% 3.6% Died New Smear Negative New leted 87.9% 89.8% 89.0% 85.8% 88.3% 90.1% 86.8% 86.7% Comp- 314 337 2994 ered 31801 28601 61873 26874 Regist- 392004 out 0.3% 0.9% 0.5% 0.1% 0.1% 0.5% 0.3% 0.6% Trans Trans Treatment Outcome (Contd.) Treatment De- 6.6% 1.9% 7.7% 4.9% 7.9% 7.0% 6.2% 6.9% faulted 1 1.9% 6.5% 2.3% 2.6% 1.2% 2.2% 2.5% 2.4% Failure 3.1% 2.8% 5.5% 5.7% 3.9% 3.3% 4.0% 4.5% Died New Smear Positive New 1.5% 0.0% 1.6% 4.4% 3.0% 0.9% 1.0% 2.3% leted Comp- Cure 86.4% 87.9% 82.4% 82.2% 83.8% 86.1% 86.1% 83.3% 536 768 4419 ered 38407 37428 71171 48779 Regist- 507013 Treatment success for New Smear Positive is cured and treatment completed. and treatment is cured Smear Positive New success for Treatment completed. treatment Pulmonary are Extra and New Smear Negative New success for Treatment Implementing states Rajasthan Sikkim 1 2 Tamil Nadu Tamil Tripura Pradesh Uttar Uttarakhand Bengal West Total Grand not expected are shaded areas for Values

TB India 2007 79 Outcome of Smear Positive Retreatment cases for India, 2005 (excluding “Others”)

Type of retreatment Cured Success Died Failure Defaulted Transferred out No. registered case Relapse 66.6% 72.7% 7.2% 5.2% 13.9% 0.8% 75232 Failure 51.5% 58.9% 8.2% 14.1% 17.9% 0.9% 17771 Treatment after default 59.2% 66.9% 7.6% 4.3% 19.5% 1.8% 72280 Total 61.7% 68.7% 7.5% 5.7% 16.8% 1.2% 165283 State-wise outcome of Smear Positive Retreatment cases for 2005 (excluding “Others”)

Implementing states Cured Success Died Failure Defaulted Transferred out No. registered Andaman & Nicobar 76.9% 92.3% 0.0% 2.6% 2.6% 2.6% 39 Andhra Pradesh 59.1% 69.0% 8.2% 6.8% 15.0% 0.9% 12980 Arunachal Pradesh 68.9% 71.2% 6.3% 15.0% 6.9% 0.6% 347 Assam 52.5% 63.3% 7.2% 7.0% 19.2% 3.2% 3033 Bihar 57.7% 72.3% 8.4% 4.4% 14.6% 0.5% 2775 Chandigarh 71.1% 72.2% 4.8% 5.5% 11.0% 6.5% 291 Chhattisgarh 63.0% 69.3% 7.9% 4.3% 17.8% 0.7% 1631 D & N Haveli 68.8% 68.8% 12.5% 0.0% 18.8% 0.0% 16 Daman & Diu 74.1% 74.1% 7.4% 11.1% 7.4% 0.0% 27 Delhi 69.6% 70.4% 6.1% 7.2% 14.3% 2.0% 6029 Goa 49.7% 50.3% 4.5% 7.9% 33.3% 4.0% 177 Gujarat 54.9% 60.1% 8.7% 6.5% 22.3% 2.4% 15986 Haryana 63.5% 70.1% 7.0% 6.1% 16.2% 0.7% 6813 Himachal Pradesh 69.6% 75.9% 6.9% 7.4% 9.4% 0.5% 2210 Jammu & Kashmir 70.9% 73.5% 7.5% 7.2% 9.4% 2.4% 374 Jharkhand 63.6% 77.3% 6.3% 4.2% 12.0% 0.6% 2305 Karnataka 49.3% 56.6% 9.5% 7.8% 21.3% 4.7% 8924 Kerala 62.9% 69.0% 7.2% 7.3% 16.3% 1.2% 2100 Lakshadweep 0 Madhya Pradesh 55.6% 65.9% 7.7% 6.8% 18.9% 0.6% 10998 Maharashtra 58.3% 63.8% 9.0% 6.2% 19.9% 1.1% 14973 Manipur 68.2% 69.7% 4.3% 5.2% 20.8% 0.0% 327 Meghalaya 48.7% 58.1% 6.2% 17.1% 16.5% 2.1% 485 Mizoram 79.1% 80.2% 4.3% 5.3% 9.6% 0.5% 187 Nagaland 78.7% 79.9% 4.0% 3.8% 12.0% 0.3% 399 Orissa 52.1% 66.5% 7.9% 4.0% 20.5% 0.8% 3256 Puducherry 46.6% 53.4% 9.1% 3.6% 34.0% 0.0% 253 Punjab 64.4% 71.0% 8.1% 5.8% 13.2% 1.9% 4406 Rajasthan 69.3% 76.9% 5.7% 3.7% 12.8% 1.0% 19397 Sikkim 72.1% 72.1% 6.7% 15.4% 4.2% 1.7% 240 Tamil Nadu 56.2% 61.4% 8.8% 6.4% 22.4% 0.9% 7656 Tripura 63.6% 75.9% 6.4% 5.9% 11.8% 0.0% 187 Uttar Pradesh 69.0% 76.1% 6.2% 3.2% 13.4% 0.3% 23709 Uttarakhand 75.3% 76.9% 5.9% 3.6% 12.9% 0.7% 1939 West Bengal 64.3% 67.8% 7.6% 7.1% 16.9% 0.6% 10814 Grand Total 61.7% 68.7% 7.5% 5.7% 16.8% 1.2% 165283 Values for shaded areas are not expected

80 TB India 2007 5 82% 87% 86% 92% 84% 89% 86% 88% 88% 89% 90% 87% 86% 85% 88% 87% 91% 89% 84% new new (17) pati- ents ment Treat- Treat- smear rate of of rate success positive positive (Contd.) 5 78% 85% 86% 87% 79% 86% 84% 86% 88% 86% 85% 86% 85% 85% 73% 82% 88% 87% 71% (16) smear of new new of positive positive Cure rate rate Cure patients 4 new new 91% 92% 91% 91% 85% 91% 92% 92% 91% 91% 91% 91% 91% 90% 91% 90% 92% 92% 76% (15) conv- smear ersion ersion rate of of rate positive positive 3 month patients 2% 2% 0% 3% 1% 7% 2% 6% 1% 1% 3% 3% 2% 5% 1% 2% 3% 1% 17% (14) 7 45 40 16 35 53 40 45 68 38 pediatric 135 106 109 385 103 337 124 152 117 No (%) of No (%) of cases out of cases out of all New cases all New 76 367 819 224 586 406 620 933 758 564 443 836 674 590 468 859 720 186 493 (13) ment ment cases No of No of smear retreat- positive positive for treat- for registered registered 58 235 124 564 519 283 933 373 159 201 280 247 138 382 271 294 104 167 for for 1478 (12) ment tered tered cases No of No of treat- regis- new EP new 299 776 608 615 1691 1262 1652 2338 2670 1499 1225 1071 2090 2656 1371 1189 1083 1127 1669 new new (11) ment cases No of No of treat- regis- smear negative negative tered for for tered 48% 65% 60% 59% 56% 47% 53% 56% 62% 55% 55% 52% 44% 59% 66% 61% 58% 47% 49% (10) cases onary pulm- out of out of % new % new sputum positive positive total new total new

93% 73% 88% 55% 70% 68% 96% 82% 53% 92% 67% 75% 71% 55% 73% 70% 53% 67% 140% (9) rate (%) rate detection new smear new Annualized 70 55 66 41 53 51 72 61 40 69 50 56 53 41 55 53 40 50 positive case positive 105 274 869 991 1438 2543 1628 1439 2649 3377 2405 1479 1314 2253 2105 1982 1168 1895 1488 1631 (8) New New ment smear positive positive patients for treat- for registered registered 93 95 97 (7) rate rate 234 103 149 215 103 145 132 163 162 160 130 160 110 124 136 126 detection total case Annualized 3 920 (6) Total Total 2714 5777 1776 4077 3963 6835 7640 6356 3452 3041 5846 5963 4113 2680 4259 3834 2419 4088 ment patients for treat- for registered registered

2 9% (5) % of % of 17% 13% 14% 11% 15% 13% 14% 15% 15% 20% 16% 15% 15% 14% 22% 15% 13% 11% smear among positive positive suspects TB cases (4) 4040 8258 9256 9462 10512 27878 21846 12857 28269 41142 39025 13872 22202 18745 16476 10740 13315 14511 16325 suspects No. of TB No. of examined 1 4 8 (4th Quarter, 2005 and 1st to 3rd Quarter 2006) and Treatment Outcomes 2005 and 1st to 3rd Quarter 2006) Treatment (4th Quarter, 26 39 40 27 52 47 39 37 19 45 37 37 28 34 28 25 32 by by (in (3) Annual Performance of RNTCP Case Detection (2006), Smear Conversion lakh) Popu- Popu- lation RNTCP covered covered Adilabad * Adilabad Anantapur Bhadrachalam Cuddapah East Godavari Guntur Hyderabad Karimnagar Khammam Krishna Kurnool Mahbubnagar Medak Nalgonda Nellore Nizamabad Prakasam (2) Chittoor Andaman & Nicobar & Nicobar Andaman * Islands District (1) Andaman & Nicobar & Nicobar Andaman Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra State

TB India 2007 81 5 new new (17) 77% 91% 89% 91% 80% 93% 92% 85% 87% 93% 94% pati- ents ment Treat- Treat- smear rate of of rate success positive positive 5 76% 86% 88% 88% 77% 93% 92% 75% 82% 93% 94% (16) smear of new new of positive positive Cure rate rate Cure patients 4 new new 79% 92% 92% 92% 87% 96% 86% 97% 78% 90% 96% 86% 92% 94% 87% 97% 78% 93% (15) conv- smear ersion ersion rate of of rate positive positive 3 month patients 2% 4% 2% 5% 2% 4% 0% 2% 2% 2% 4% 2% 3% 0% 7% 2% 4% 0% (14) 0 2 3 4 8 4 0 1 4 0 pediatric No (%) of No (%) of 64 17 12 cases out of cases out of 103 139 100 131 182 all New cases all New 19 31 46 33 48 33 82 10 31 13 22 20 765 374 582 540 837 790 (13) ment ment cases No of No of smear retreat- positive positive for treat- for registered registered 3 4 21 17 12 28 90 11 61 11 10 18 for for 642 395 751 436 185 410 (12) ment tered tered cases No of No of treat- regis- new EP new 32 18 40 90 61 87 26 50 17 28 19 new new 791 271 (11) ment cases No of No of treat- regis- smear 1082 1624 1616 1291 1999 negative negative tered for for tered 69% 50% 58% 67% 61% 54% 64% 79% 60% 51% 67% 37% 41% 61% 57% 66% 67% 69% (10) cases onary pulm- out of out of % new % new sputum positive positive total new total new

86% 81% 75% 89% 77% 79% 58% 65% 81% 72% 147% 133% 131% 106% 190% 147% 124% 131% (9) rate (%) rate detection 65 61 56 67 58 59 43 98 79 49 60 93 98 54 new smear new Annualized 110 100 142 110 positive case positive 58 68 61 92 51 41 65 33 58 43 122 186 (8) New New 2408 1629 2250 1590 1986 2390 ment smear positive positive patients for treat- for registered registered 94 134 151 134 145 128 150 196 311 250 175 192 538 245 213 211 215 130 (7) rate rate detection total case Annualized 3 91 75 126 121 190 234 270 201 702 229 127 104 (6) Total Total 4989 4066 5377 3447 4378 6041 ment patients for treat- for registered registered

2 Annual Performance of Districts (Contd...) 8% 8% (5) % of % of 18% 13% 14% 13% 21% 17% 11% 12% 15% 12% 12% 14% 13% 12% 18% 14% smear among positive positive suspects TB cases 578 584 795 938 904 364 802 390 461 475 (4) 1277 2775 21382 15624 23125 17381 15082 20238 suspects No. of TB No. of examined 1 1 1 1 1 2 1 1 1 1 1 37 27 40 24 34 40 by by (in 0.4 0.4 (3) lakh) Popu- Popu- lation RNTCP covered covered District Deomali DTC Deomali * East Kameng * East Siang * Lower Subansiri * Pare Papum DTC Pasighat DTC Tezu * Upper Siang * Upper Subansiri * Kameng West (2) Lohit ** Srikakulam Visakhapatnam Vizianagaram Warangal Godavari West DTC Along DTC Bomdila ** Changlang Valley Dibang * Tawang † Tirap Rangareddi State Arunachal Pradesh Arunachal Pradesh Arunachal Pradesh Arunachal Pradesh Arunachal Pradesh Arunachal Pradesh Arunachal Pradesh Arunachal Pradesh Arunachal Pradesh Arunachal Pradesh Arunachal Pradesh Arunachal Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Arunachal Pradesh Pradesh Arunachal Pradesh Arunachal Pradesh Arunachal Pradesh Arunachal Pradesh Arunachal Pradesh Arunachal (1) Pradesh Andhra Value for blank cells are not expected as these districts/reporting units have been newly created or have stopped reporting in 2006 due to merger with other reporting units. Treatment outcome, for the cohort registered in 2005 these the cohort registered for outcome, Treatment units. with other reporting in 2006 due to merger stopped reporting or have created been newly units have as these districts/reporting not expected blank cells are for Value units is given.

82 TB India 2007 NE 89% 81% 84% 78% 83% 77% 84% 87% 83% 75% 71% 79% 82% 71% 78% 81% 80% 87% 90% 89% 89% 79% 83% 85% 79% 83% 79% 78% 81% (17) (Contd.) NE 89% 73% 81% 75% 80% 71% 74% 86% 81% 73% 68% 76% 80% 53% 73% 79% 77% 87% 88% 86% 82% 77% 80% 82% 71% 71% 79% 61% 65% (16) 96% 85% 90% 90% 85% 82% 83% 90% 91% 86% 86% 89% 85% 73% 90% 91% 90% 92% 92% 89% 89% 86% 85% 91% 82% 87% 86% 82% 80% 84% (15) 1% 2% 1% 2% 2% 3% 1% 6% 3% 4% 2% 6% 3% 3% 1% 2% 3% 3% 3% 5% 1% 7% 3% 8% 2% 4% 8% 1% 6% 9% (14) 1 9 5 2 5 24 11 25 32 17 14 19 35 59 61 34 28 31 19 60 49 67 55 27 14 115 117 106 134 193 15 95 59 78 62 37 58 93 89 95 32 54 59 170 126 162 210 212 170 477 109 129 191 191 298 266 190 178 179 254 (13) 8 10 48 77 83 23 78 46 94 35 73 65 20 89 27 18 52 12 70 86 108 492 166 396 152 138 223 211 263 123 (12) 26 73 275 264 591 705 163 815 470 254 321 155 329 642 484 312 569 379 288 932 419 250 848 315 523 203 661 359 (11) 1593 1308 63% 71% 63% 45% 50% 65% 50% 65% 60% 62% 62% 62% 66% 52% 56% 54% 55% 61% 56% 54% 61% 66% 57% 72% 50% 35% 43% 37% 22% 35% (10) 51% 60% 41% 57% 66% 60% 92% 57% 69% 56% 66% 61% 79% 48% 89% 63% 70% 62% 54% 74% 57% 83% 88% 29% 22% 30% 53% 12% 23% 35% (9) 9 40 38 45 31 43 50 45 69 43 52 42 49 46 60 36 67 47 52 47 40 55 43 62 66 22 17 22 17 27 44 688 446 483 706 308 802 876 381 532 248 540 527 390 677 459 442 500 112 494 823 515 111 489 212 448 707 (8) 1263 1180 1135 74 85 90 94 85 85 99 57 59 70 28 95 98 123 100 109 116 169 100 111 114 148 142 111 117 100 125 106 144 142 (7) 137 990 560 841 504 933 992 254 395 663 (6) 1322 1336 1778 2066 2159 1032 1219 3132 1308 1441 1077 2514 1225 1218 2631 1779 1335 1529 2437 2610 9% 8% (5) 11% 17% 16% 12% 13% 19% 19% 19% 15% 20% 10% 15% 16% 20% 12% 19% 14% 18% 15% 15% 13% 20% 19% 17% 13% 10% 16% 10% 481 (4) 4964 3753 5975 7077 2013 5670 6955 3156 3083 3195 4586 3396 4133 3596 3924 3477 9239 3573 1169 3309 8226 7232 6024 1588 4151 3057 7486 12939 10952 1 6 9 6 9 8 2 7 18 10 16 16 18 13 10 11 27 11 10 10 25 12 11 18 13 23 22 18 26 27 (3) Ziro DTC Ziro Bongaigaon Darrang Dhemaji Dhubri Goalpara Hailakandi Jorhat Kamrup * Anglong Karbi Karimganj Kokrajhar Marigaon Nagaon Nalbari Cachar Hills * North Tinsukia (2) Barpeta Cachar Dibrugarh Golaghat Lakhimpur Sibsagar Sonitpur Arwal Bhagalpur ** West Siang * Siang West ** Araria ** Aurangabad-BI ** Banka ** Begusarai Arunachal Pradesh Arunachal (1) Pradesh Arunachal Bihar Bihar Bihar Bihar Bihar Bihar Bihar Assam Assam Assam Assam Assam Assam Assam Assam Assam Assam Assam Assam Assam Assam Assam Assam Assam Assam Assam Assam Assam Assam Assam Assam

TB India 2007 83 5 NE NE NE NE NE NE NE NE new new (17) 73% 82% 68% 76% 83% 82% 80% 81% 87% 67% 80% 89% 74% 87% pati- ents ment Treat- Treat- smear rate of of rate 100% success positive positive 5 NE NE NE NE NE NE NE NE 73% 82% 68% 59% 75% 81% 80% 76% 80% 63% 80% 83% 57% 87% (16) smear 100% of new new of positive positive Cure rate rate Cure patients 4 new new 80% 91% 86% 82% 78% 81% 73% 69% 81% 75% 60% 70% 86% 76% 90% 81% 60% 83% 69% 86% 80% 91% 83% (15) conv- smear ersion ersion rate of of rate positive positive 3 month patients 2% 2% 5% 1% 2% 4% 7% 1% 4% 3% 3% 1% 0% 2% 4% 4% 1% 3% 1% 2% 3% 1% 10% (14) 6 7 9 3 1 pediatric 15 11 93 30 11 26 34 64 24 30 13 21 12 22 41 10 No (%) of No (%) of 166 596 cases out of cases out of all New cases all New 95 63 47 14 92 472 256 284 118 110 189 239 133 140 311 282 104 120 247 480 259 240 173 (13) ment ment cases No of No of smear retreat- positive positive for treat- for registered registered 37 32 61 31 26 43 10 67 37 17 27 11 49 96 48 37 76 30 48 29 for for 209 224 594 (12) ment tered tered cases No of No of treat- regis- new EP new 94 529 376 818 221 341 247 144 634 135 133 373 590 368 753 331 274 820 902 473 1169 2230 3194 new new (11) ment cases No of No of treat- regis- smear negative negative tered for for tered 44% 43% 55% 44% 58% 40% 46% 67% 59% 63% 58% 30% 48% 55% 51% 43% 26% 53% 67% 39% 43% 43% 52% (10) cases onary pulm- out of out of % new % new sputum positive positive total new total new

6% 22% 25% 37% 32% 18% 15% 29% 26% 47% 12% 13% 21% 25% 42% 54% 14% 26% 17% 52% 19% 32% 19% (9) 9 5 rate (%) rate detection new smear new Annualized 17 18 28 24 13 11 22 19 35 10 16 19 31 40 10 19 13 39 14 24 14 positive case positive 56 411 284 913 311 232 214 296 920 162 188 351 727 388 269 380 556 607 673 504 (8) New New 1007 1654 2012 ment smear positive positive patients for treat- for registered registered 48 52 74 69 51 37 67 46 76 23 22 24 40 48 80 49 45 29 46 76 34 (7) rate rate 111 131 detection total case Annualized 3 803 762 658 704 437 424 277 893 894 (6) Total Total 1172 2679 2625 1193 1995 1872 1001 4560 1280 1295 6754 1980 2128 1230 ment patients for treat- for registered registered

2 Annual Performance of Districts (Contd...) 9% 8% (5) % of % of 13% 17% 13% 16% 17% 17% 15% 20% 16% 10% 17% 12% 11% 12% 17% 14% 13% 14% 15% 12% 10% smear among positive positive suspects TB cases 821 4377 2132 8563 3504 2094 2379 2686 8409 3166 1547 4620 9872 4225 4575 3923 6610 6704 9039 7067 (4) 11153 11883 21989 suspects No. of TB No. of examined 1 9 24 15 36 38 24 15 10 14 26 14 14 17 39 12 41 26 20 33 52 43 28 27 by by (in (3) lakh) Popu- Popu- lation RNTCP covered covered District (2) Gaya ** Gopalganj ** ** Bhojpur ** Bhojpur Buxar ** Darbhanga ** Jamui ** Jehanabad ** Kaimur ** Katihar ** Khagaria ** Kishanganj ** Lakhisarai ** Madhepura ** Madhubani ** Munger ** Muzaffarpur ** Nalanda ** Nawada Champaran Pashchim Patna ** Purba Champaran ** Purnia Rohtas State (1) Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar

84 TB India 2007 NE NE NE NE NE NE NE 75% 90% 86% 79% 88% 74% 91% 89% 82% 78% 91% 88% 83% 78% 85% 91% 87% 86% 89% 78% (17) (Contd.) NE NE NE NE NE NE NE 78% 62% 67% 86% 73% 87% 67% 90% 89% 71% 73% 88% 87% 82% 75% 84% 88% 86% 85% 88% (16) 78% 71% 72% 77% 87% 66% 77% 77% 78% 91% 89% 92% 57% 90% 92% 90% 87% 91% 95% 93% 85% 91% 91% 91% 88% 92% 84% (15) 2% 4% 4% 0% 1% 2% 1% 4% 7% 1% 6% 1% 2% 6% 2% 2% 3% 9% 6% 5% 4% 1% 5% 8% 5% 12% 12% (14) 1 2 6 22 47 33 11 18 23 16 32 14 24 55 53 27 45 16 15 121 195 225 117 225 213 137 306 92 52 22 69 66 49 30 56 78 68 48 48 285 298 248 146 153 301 272 111 214 162 115 124 294 153 210 (13) 5 20 12 33 22 45 42 85 57 82 62 87 42 72 205 141 163 229 675 160 338 101 771 116 445 253 201 (12) 94 647 385 159 111 949 543 204 441 920 803 194 256 817 309 332 217 323 301 488 931 625 1700 1867 1836 1701 1567 (11) 61% 44% 33% 58% 33% 42% 39% 38% 50% 31% 64% 42% 54% 72% 59% 42% 40% 51% 57% 60% 62% 40% 49% 42% 51% 55% 36% (10) 37% 29% 15% 14% 14% 24% 11% 11% 38% 82% 59% 53% 77% 59% 55% 47% 50% 76% 64% 59% 39% 61% 62% 67% 68% 50% 75% (9) 9 8 60 28 22 11 10 11 18 28 77 47 43 62 47 44 37 40 61 52 47 31 49 49 54 55 40 79 80 504 820 528 619 337 207 844 785 679 937 489 365 540 323 437 331 523 199 461 687 768 863 148 (8) 1355 1780 158 71 88 31 47 36 64 32 29 91 96 (7) 122 229 140 107 102 104 136 109 134 113 109 118 133 130 136 143 358 270 752 808 802 741 957 725 704 391 (6) 1284 3280 1469 2245 1278 3630 2322 2002 2339 4201 1584 1071 1111 1850 4297 1914 3103 9% 15% 12% 13% 12% 13% 15% 15% 11% 11% 12% 14% 12% 20% 12% 10% 12% 11% 11% 13% 10% 12% 17% 13% 14% 10% (5) 12% 1613 895 5067 9418 6472 1097 6375 3576 4322 6879 9833 3206 4033 4970 4291 4553 3866 5112 2738 4397 5248 6297 (4) 10984 14048 16388 17126 10352 2 6 6 8 8 8 7 6 6 9 17 37 36 29 30 19 30 10 14 22 31 14 11 14 33 14 22 (3) Dadra & Nagar & Nagar Dadra † Haveli (2) Saharsa ** Siwan Supaul ** Bastar * Bilaspur-CG Dhamtari Raipur Samastipur ** Samastipur ** Saran Sheikpura Sheohar ** Sitamarhi ** Vaishali Chandigarh * Dantewada Durg Janjgir * Jashpur * Kanker ** Kawardha Korba ** Koriya Mahasamund ** Raigarh-CG Rajnandgaon † Surguja (1) Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Chandigarh Chandigarh Chhattisgarh Chhattisgarh Chhattisgarh Chhattisgarh Chhattisgarh Chhattisgarh Chhattisgarh Chhattisgarh Chhattisgarh Chhattisgarh Chhattisgarh Chhattisgarh Chhattisgarh Chhattisgarh Chhattisgarh Chhattisgarh Chhattisgarh D & N Haveli D & N Haveli

TB India 2007 85 5 new new (17) 91% 91% 86% 89% 88% 84% 85% 86% 87% 88% 90% 87% 86% 92% 88% 85% 82% 91% 87% 88% 85% pati- ents ment Treat- Treat- smear rate of of rate 100% success positive positive 5 82% 91% 86% 88% 87% 83% 85% 86% 86% 88% 90% 87% 86% 92% 88% 85% 82% 91% 87% 87% 84% (16) smear 100% of new new of positive positive Cure rate rate Cure patients 4 new new 91% 79% 92% 88% 87% 88% 86% 87% 87% 92% 89% 91% 92% 86% 91% 88% 89% 92% 88% 91% 86% (15) conv- smear ersion ersion rate of of rate positive positive 3 month patients 0% 3% 9% 15% 13% 17% 17% 10% 16% 12% 12% 16% 17% 15% 11% 14% 15% 16% 12% 13% 16% (14) 0 1 pediatric 90 66 No (%) of No (%) of 130 521 211 137 293 100 432 191 550 218 164 483 306 220 138 582 291 cases out of cases out of all New cases all New 27 13 189 568 254 274 296 257 452 287 138 713 161 292 126 584 378 260 262 662 330 (13) ment ment cases No of No of smear retreat- positive positive for treat- for registered registered 9 31 for for 256 437 564 760 327 506 287 567 320 222 750 478 387 722 (12) ment tered tered cases No of No of 1579 1012 1226 1298 1682 treat- regis- new EP new 8 62 new new 246 232 372 306 239 660 504 127 940 371 263 138 877 458 396 295 426 (11) ment cases No of No of treat- regis- smear 1101 1272 negative negative tered for for tered 55% 70% 60% 53% 70% 62% 67% 62% 62% 53% 71% 58% 50% 65% 61% 57% 65% 57% 63% 55% 60% (10) cases onary pulm- out of out of % new % new sputum positive positive total new total new

74% 48% 89% 86% 53% 75% 60% 90% 73% 78% 43% 82% 93% 48% 105% 150% 176% 109% 127% 115% 114% (9) rate (%) rate detection 59 38 85 82 51 71 57 86 69 74 41 78 89 45 new smear new Annualized 109 108 100 142 168 104 121 positive case positive 76 19 369 542 603 617 387 564 307 375 485 220 847 534 492 641 (8) New New 1240 1091 1301 1183 1536 ment smear positive positive patients for treat- for registered registered (7) rate rate 179 101 272 330 301 161 510 252 537 354 189 302 301 216 142 280 373 292 145 401 386 detection total case Annualized 3 50 230 769 (6) Total Total 1183 5012 1632 1921 2213 1367 3497 1921 1026 4593 1635 1410 4255 2614 1757 1574 5662 2283 ment patients for treat- for registered registered

2 Annual Performance of Districts (Contd...) 6% 8% (5) % of % of 14% 16% 17% 13% 18% 15% 22% 15% 14% 26% 12% 13% 16% 16% 18% 16% 14% 15% 18% smear among positive positive suspects TB cases 811 (4) 2209 4404 8531 7639 5284 4716 6032 7290 6449 9127 7729 7261 7078 8632 6229 6575 9217 11791 12368 16702 suspects No. of TB No. of examined 1 1 4 5 4 5 7 5 5 5 7 5 7 6 6 15 12 15 15 11 14 by by (in 0.5 (3) lakh) Popu- Popu- lation RNTCP covered covered District (2) Diu Gulabi Bagh LRS NDMC Daman Clinic BJRM Chest Clinic DDU Chest Clinic Chest GTB C Clinic Hedgewar Jhandewalan Nagar Karawal Kingsway Clinic LN Chest Nagar Moti Narela NDTC Nagar Nehru Patparganj RK Mission Clinic RTRM Chest Clinic SGM Chest Shahdara State Daman & Diu Daman (1) Daman & Diu & Diu Daman Delhi Delhi Delhi Delhi Delhi Delhi Delhi Delhi Delhi Delhi Delhi Delhi Delhi Delhi Delhi Delhi Delhi Delhi Delhi Delhi Delhi

86 TB India 2007 (17) 87% 70% 71% 84% 86% 87% 89% 81% 88% 87% 89% 87% 88% 90% 87% 81% 86% 88% 88% 85% 87% 86% 89% 87% 88% 96% 86% 86% (Contd.) 87% 69% 71% 84% 86% 86% 89% 79% 88% 87% 87% 86% 88% 88% 86% 81% 86% 88% 88% 85% 87% 86% 88% 87% 87% 93% 85% 86% (16) 87% 85% 83% 91% 89% 91% 92% 90% 92% 90% 90% 94% 91% 92% 91% 87% 91% 92% 93% 89% 91% 92% 92% 89% 90% 94% 92% 89% (15) 7% 6% 8% 4% 3% 6% 4% 8% 3% 6% 5% 6% 3% 2% 3% 2% 4% 3% 3% 5% 4% 4% 5% 3% 9% 1% 3% 11% 14% 11% (14) 7 70 91 52 52 86 24 61 89 25 56 47 13 88 41 74 39 14 17 42 100 136 420 172 187 125 101 107 107 338 95 81 21 17 219 141 617 408 810 493 950 338 975 436 477 667 519 792 468 427 732 858 374 737 400 502 400 (13) 1988 1138 1299 8 61 62 12 331 301 165 443 191 283 316 207 518 188 205 384 317 150 204 216 187 121 600 288 376 196 144 299 1771 1072 (12) 49 47 35 221 340 212 660 207 490 384 503 139 409 252 193 663 204 500 520 738 327 401 880 299 624 379 360 365 (11) 1216 1018 63% 52% 55% 65% 68% 80% 73% 60% 79% 75% 83% 79% 77% 86% 71% 76% 74% 70% 78% 76% 69% 64% 83% 62% 76% 70% 70% 77% 72% 70% (10) 82% 54% 49% 63% 83% 68% 81% 70% 87% 69% 85% 73% 70% 78% 50% 79% 76% 17% 73% 18% 73% 78% 72% 69% 66% 72% 76% 75% 107% 134% (9) 78 43 39 50 67 54 65 56 70 55 68 86 58 56 62 40 63 60 13 58 14 58 62 58 55 53 58 61 60 107 84 383 374 263 819 667 844 661 178 743 949 865 117 940 852 (8) 1250 2541 1298 1525 1422 1470 1517 1155 1655 1391 1204 2344 1986 1410 1449 30 32 97 260 142 120 131 226 111 154 165 129 138 128 189 131 115 135 102 142 128 225 136 114 169 134 167 121 138 150 (7) 802 397 189 196 (6) 1282 1234 3263 8614 1675 3093 4474 2643 3681 1258 3349 1892 2376 3592 1689 3105 2546 4930 1743 3912 3807 2203 4392 1979 2126 2127 (5) 17% 10% 12% 19% 17% 13% 19% 19% 19% 20% 22% 16% 17% 13% 13% 16% 25% 14% 16% 25% 17% 18% 14% 17% 17% 13% 18% 11% 17% 22% 625 (4) 3678 7029 3327 9138 4570 9006 8379 1841 8904 9920 1314 9256 9497 13314 32071 12478 16347 12561 15253 16004 13698 16690 10187 13510 15427 22310 15917 10411 20440 5 9 7 6 2 25 38 15 20 27 20 27 10 18 14 21 27 17 22 20 13 22 13 34 23 16 26 16 15 14 (3) (2) South Goa AMC Ahmedabad Amreli Anand Kantha Banas Bharuch Bhavnagar Udepur Chhota * Dahod Gandhinagar Jamnagar Junagadh Kachchh Kheda Mahesana Navsari Patan Porbandar Sabar Kantha Surat Corp Municipal Surat Surendranagar * Dangs The Vadodara Corp Vadodara SPM Marg Goa North Panch Mahals Panch Rajkot Gujarat Gujarat Gujarat Gujarat Gujarat Gujarat Gujarat Gujarat Gujarat Gujarat Gujarat Gujarat Gujarat Gujarat Gujarat Gujarat Gujarat Gujarat Gujarat Gujarat Gujarat Gujarat Gujarat Gujarat Gujarat Gujarat (1) Delhi Goa Goa Goa Gujarat Gujarat

TB India 2007 87 5 new new (17) 86% 86% 83% 85% 85% 81% 79% 80% 85% 85% 80% 87% 80% 83% 88% 83% 79% 88% 82% 85% 83% pati- ents ment Treat- Treat- smear rate of of rate success positive positive 5 86% 85% 82% 83% 83% 80% 76% 79% 83% 85% 78% 86% 80% 82% 88% 82% 77% 88% 81% 83% 82% (16) smear of new new of positive positive Cure rate rate Cure patients 4 new new 90% 89% 90% 89% 88% 87% 87% 85% 89% 90% 85% 92% 90% 89% 89% 89% 87% 87% 91% 86% 87% 91% (15) conv- smear ersion ersion rate of of rate positive positive 3 month patients 6% 3% 4% 4% 5% 3% 8% 4% 6% 3% 5% 7% 7% 8% 4% 6% 8% 5% 4% 1% 10% 10% (14) pediatric 39 40 77 23 48 81 29 69 58 74 51 48 62 40 57 78 14 No (%) of No (%) of 131 147 133 149 117 cases out of cases out of all New cases all New 466 311 230 650 621 256 572 569 313 536 359 375 176 277 213 123 333 236 393 452 346 216 (13) ment ment cases No of No of smear retreat- positive positive for treat- for registered registered 89 76 for for 328 248 212 703 102 416 203 276 270 175 220 204 204 203 208 143 426 189 314 169 (12) ment tered tered cases No of No of treat- regis- new EP new 547 337 230 578 241 339 355 301 292 285 426 242 312 126 156 577 195 308 187 837 282 new new (11) ment 1119 cases No of No of treat- regis- smear negative negative tered for for tered 72% 72% 69% 65% 53% 68% 73% 73% 65% 73% 68% 67% 62% 61% 70% 63% 51% 66% 68% 80% 46% 68% (10) cases onary pulm- out of out of % new % new sputum positive positive total new total new

96% 48% 72% 60% 61% 88% 61% 60% 64% 61% 65% 47% 57% 33% 56% 59% 48% 68% 66% 54% 58% 114% (9) rate (%) rate detection 51 55 new smear new Annualized 91 77 45 69 57 58 83 58 57 61 58 62 44 54 31 53 56 45 65 63 positive case positive 876 501 514 902 975 554 795 595 865 401 481 294 271 597 378 663 761 711 589 (8) New New 1389 1070 1238 ment smear positive positive patients for treat- for registered registered 77 189 148 117 171 179 132 217 129 155 155 146 140 121 151 161 186 122 182 139 168 123 (7) rate rate detection total case Annualized 3 736 825 (6) 2892 1678 1298 2656 3882 1163 2355 2163 1499 2009 1510 1949 1097 1339 1967 1022 1867 1692 2344 1320 Total Total ment patients for treat- for registered registered

2 Annual Performance of Districts (Contd...) 8% (5) % of % of 15% 21% 20% 14% 17% 15% 21% 14% 15% 16% 14% 10% 13% 21% 12% 15% 16% 10% 19% 14% 13% smear among positive positive suspects TB cases 5646 9210 5492 9855 4544 9324 5553 7200 6022 2410 4108 6156 3872 7048 6822 6769 (4) 13759 12174 12842 11548 10556 17813 suspects No. of TB No. of examined 1 9 9 9 5 8 15 11 11 16 22 11 17 10 13 10 14 10 11 10 12 14 11 by by (in (3) lakh) Popu- Popu- lation RNTCP covered covered District Panchkula (2) Ambala Bhiwani Fatehabad Hisar Jhajjar Rewari Sirsa Sonipat Vyara(Surat) Faridabad Gurgaon Jind ** Kaithal Karnal Kurukshetra Mahendragarh Mewat** Panipat Rohtak Yamunanagar Valsad * Valsad State Haryana Gujarat Haryana Haryana Haryana Haryana Haryana Haryana Haryana Haryana Haryana Haryana Haryana Haryana Haryana Haryana Haryana Haryana Haryana Haryana Haryana Haryana (1) Gujarat

88 TB India 2007 (17) 90% 87% 89% 90% 91% 87% 88% 91% 89% 88% 89% 86% 83% 95% 90% 77% 78% 67% 76% 85% 57% 83% 88% 76% 90% 82% 87% 68% 91% (Contd.) 88% 83% 88% 88% 81% 87% 84% 89% 88% 84% 88% 86% 81% 95% 90% 74% 73% 67% 74% 85% 57% 83% 88% 76% 90% 81% 86% 68% 88% (16) 91% 89% 94% 91% 84% 91% 84% 92% 94% 92% 91% 92% 87% 93% 92% 79% 76% 80% 85% 93% 82% 89% 94% 83% 92% 92% 91% 64% 92% (15) 0% 4% 0% 2% 2% 1% 2% 4% 6% 1% 3% 4% 5% 1% 2% 3% 2% 4% 1% 2% 2% 3% 1% 6% 4% 2% 2% 2% 3% (14) 0 3 7 5 2 2 9 0 20 12 13 50 19 37 27 36 10 10 18 38 19 19 18 23 18 15 18 62 40 9 33 35 21 81 14 13 14 26 26 62 65 67 163 286 115 421 307 460 291 216 188 150 126 293 142 163 188 137 (13) 64 36 40 91 37 76 11 54 268 169 543 316 401 463 188 199 186 110 241 258 380 141 188 116 113 182 317 229 173 (12) 43 53 66 69 72 25 92 155 208 120 490 309 351 273 131 148 133 160 224 748 389 133 145 107 154 233 975 338 347 (11) 68% 66% 71% 66% 58% 61% 27% 69% 68% 72% 74% 66% 80% 75% 72% 62% 44% 37% 44% 64% 64% 52% 65% 73% 63% 58% 51% 50% 62% (10) 97% 88% 72% 72% 71% 60% 87% 81% 74% 85% 58% 20% 31% 32% 49% 35% 33% 51% 33% 35% 38% 28% 47% 19% 40% 69% 53% 60% 128% (9) 92 84 68 68 68 57 82 77 70 81 55 19 30 30 46 33 32 48 31 33 36 27 44 18 38 52 40 45 122 60 20 42 45 (8) 331 407 298 964 490 783 584 340 428 260 256 203 410 368 594 303 232 155 196 244 263 324 341 566 1000 44 60 69 78 63 58 93 93 (7) 202 246 167 177 210 367 376 216 223 189 192 140 128 114 107 167 119 108 110 116 130 726 729 186 132 917 663 589 409 926 142 578 161 463 460 604 827 986 800 (6) 1197 2505 1475 2058 1700 1015 1016 2059 1048 2508 1172 4% 4% 3% 7% 6% 4% 5% 8% 4% 9% 5% 7% (5) 13% 17% 10% 17% 11% 15% 13% 16% 11% 12% 11% 12% 14% 11% 14% 21% 13% 1986 6341 669 760 908 889 (4) 3741 3687 4402 5231 9029 6911 4881 7899 3790 7661 6951 6991 4243 9841 4310 5305 2257 5007 3614 7829 6605 9210 10070 4 5 4 1 4 8 5 5 5 7 8 1 6 7 1 4 7 6 9 9 14 10 13 13 18 14 19 13 (3) 0.4 (2) Bilaspur-HP Chamba Shimla Solan Leh * Rajouri Udhampur Deoghar ** Hamirpur-HP ** Hamirpur-HP Kangra * Kinnaur Kullu & Spiti * Lahul Mandi Sirmaur Una Anantanag Badgam Baramula Doda Jammu * Kargil Kathua Kupwara Poonch Pulwama Srinagar ** Chatra Bokaro Himachal Pradesh Himachal Pradesh Himachal Pradesh Himachal Pradesh Himachal Pradesh Himachal Pradesh Himachal Pradesh Himachal Pradesh Himachal Pradesh Himachal Pradesh Himachal Pradesh Himachal Jammu & Kashmir & Kashmir Jammu & Kashmir Jammu & Kashmir Jammu & Kashmir Jammu & Kashmir Jammu & Kashmir Jammu & Kashmir Jammu & Kashmir Jammu & Kashmir Jammu & Kashmir Jammu & Kashmir Jammu & Kashmir Jammu & Kashmir Jammu & Kashmir Jammu Jharkhand Jharkhand (1) Himachal Pradesh Pradesh Himachal Jharkhand Jharkhand

TB India 2007 89 5 new new (17) 89% 88% 85% 88% 87% 89% 89% 89% 79% 91% 86% 81% 93% 85% 84% 87% 82% 84% 71% 77% 67% pati- ents ment Treat- Treat- smear rate of of rate success positive positive 5 85% 74% 72% 86% 87% 87% 79% 86% 43% 84% 85% 81% 91% 84% 78% 83% 79% 72% 69% 73% 65% (16) smear of new new of positive positive Cure rate rate Cure patients 4 new new 93% 83% 93% 94% 83% 92% 86% 92% 62% 84% 83% 88% 94% 90% 88% 84% 83% 88% 80% 82% 72% (15) conv- smear ersion ersion rate of of rate positive positive 3 month patients 4% 1% 8% 3% 2% 3% 5% 4% 4% 2% 8% 2% 3% 6% 1% 2% 2% 5% 9% 10% 11% (14) 9 9 pediatric 92 14 92 60 15 23 88 28 72 40 16 31 74 13 13 71 No (%) of No (%) of 185 199 490 cases out of cases out of all New cases all New 57 36 82 56 83 50 96 66 69 64 55 210 171 152 334 148 182 306 248 284 (13) 1014 ment ment cases No of No of smear retreat- positive positive for treat- for registered registered 168 73 14 70 56 11 21 98 19 12 54 49 17 76 44 34 21 for for 2010 274 233 576 (12) ment tered tered cases No of No of treat- regis- new EP new 94 98 new new 943 781 554 838 363 362 778 293 261 263 942 812 833 624 323 173 522 (11) ment cases No of No of treat- regis- smear 1270 1280 negative negative tered for for tered 53% 50% 48% 51% 59% 47% 51% 59% 51% 62% 68% 60% 52% 47% 60% 54% 42% 57% 63% 57% 63% (10) cases onary pulm- out of out of % new % new sputum positive positive total new total new

54% 88% 60% 57% 60% 48% 44% 81% 24% 90% 72% 70% 82% 68% 77% 67% 61% 67% 71% 54% 66% (9) rate (%) rate detection new smear new Annualized 40 66 45 43 45 36 33 61 18 67 54 53 62 51 57 50 46 50 53 40 49 positive case positive 98 787 507 887 515 320 821 430 424 212 402 720 461 424 300 706 (8) New New 1044 1013 1232 1520 2182 ment smear positive positive patients for treat- for registered registered 94 88 93 78 53 99 162 125 105 134 136 110 110 150 122 127 127 129 107 101 159 (7) rate rate detection total case Annualized 3 995 830 949 288 855 433 839 900 568 (6) Total Total 2448 1935 1401 2156 1936 2458 1723 2718 3830 1293 1744 7058 ment patients for treat- for registered registered

2 Annual Performance of Districts (Contd...) 9% (5) % of % of 15% 21% 15% 21% 17% 12% 14% 14% 16% 17% 16% 16% 14% 21% 24% 16% 13% 15% 19% 14% smear among positive positive suspects TB cases (4) 8693 5138 4377 6253 3460 3019 7200 3740 1032 3065 1720 4197 9443 4008 7382 4655 3211 1839 12463 11277 38844 suspects No. of TB No. of examined 1 9 7 5 6 4 8 8 6 26 12 11 21 11 25 16 14 21 30 10 18 44 by by (in (3) lakh) Popu- Popu- lation RNTCP covered covered District (2) Dhanbad Garhwa Gumla † Sahibganj ** Kharsawan** Dumka ** Dumka ** Giridih ** Godda ** Hazaribagh ** Jamtara ** Kodarma ** Lathehar * Lohardaga ** Pakaur ** Palamu Pashchimi Singhbhum* † Purbi Singhbhum † Ranchi Saraikela- ** Simdega Bagalkot City Bangalore State Jharkhand Jharkhand Jharkhand Jharkhand Jharkhand Jharkhand Jharkhand Jharkhand Jharkhand Jharkhand Jharkhand Jharkhand Jharkhand Jharkhand Jharkhand Jharkhand Jharkhand Jharkhand Karnataka Karnataka Karnataka (1) Jharkhand

90 TB India 2007 (17) 84% 87% 81% 77% 73% 69% 82% 86% 80% 80% 81% 80% 68% 70% 83% 81% 87% 82% 80% 85% 82% 83% 84% 82% 82% 74% 84% 83% 80% 84% 83% (Contd.) 83% 85% 76% 77% 72% 66% 81% 86% 80% 79% 80% 79% 67% 68% 83% 76% 87% 80% 77% 85% 80% 83% 84% 82% 82% 61% 81% 80% 80% 82% 81% (16) 91% 88% 84% 79% 83% 75% 86% 89% 87% 82% 88% 86% 75% 81% 90% 83% 91% 87% 87% 89% 89% 86% 91% 84% 85% 79% 87% 85% 85% 83% 84% (15) 5% 7% 9% 8% 1% 6% 8% 5% 4% 3% 4% 5% 6% 5% 3% 3% 4% 5% 6% 5% 6% 6% 6% 6% 9% 3% 4% 3% 4% 21% 10% (14) 96 11 89 89 51 66 53 69 81 45 41 41 15 68 81 80 24 22 47 35 179 340 218 109 143 111 160 118 139 369 211 29 32 286 407 402 455 289 357 263 147 216 364 265 302 239 580 193 258 458 310 388 537 476 158 399 205 131 140 321 175 115 (13) 99 440 829 701 505 216 244 268 245 383 445 636 147 216 337 221 112 532 130 516 649 168 248 597 219 139 353 459 186 541 198 (12) 524 615 797 363 677 290 237 609 357 630 323 198 348 406 100 686 347 459 794 721 714 548 216 359 709 656 112 293 158 (11) 1198 1000 63% 63% 59% 64% 57% 51% 69% 64% 62% 72% 59% 69% 69% 54% 67% 61% 64% 69% 69% 70% 64% 60% 42% 70% 68% 51% 50% 62% 69% 73% 73% (10) 59% 56% 52% 88% 41% 49% 84% 47% 84% 60% 62% 55% 58% 46% 51% 55% 40% 76% 80% 76% 66% 82% 39% 63% 52% 35% 42% 43% 28% 42% 46% (9) 44 42 39 66 31 37 63 35 63 45 47 41 43 35 39 41 30 57 60 57 50 62 29 47 39 26 32 32 21 32 35 882 490 708 643 423 907 890 707 449 707 632 174 759 510 457 376 701 251 810 438 (8) 1058 1739 1430 1009 1151 1527 1072 1390 1082 1303 1057 94 82 93 95 92 76 95 76 87 79 50 74 74 (7) 112 123 150 110 145 132 108 126 122 106 103 122 128 136 126 147 109 101 440 600 938 (6) 2232 3086 4225 3241 1304 2122 1492 1124 2127 2186 2393 2084 1095 3160 1683 1574 3276 1630 2550 3513 2579 1661 2984 1187 1092 1941 2592 1891 7% 7% 9% 6% 9% 8% 9% 5% 7% 4% 6% 8% (5) 10% 11% 10% 17% 13% 15% 11% 13% 12% 16% 13% 17% 13% 12% 16% 11% 16% 13% 11% (4) 9982 8168 5681 8421 7413 8996 9675 9493 5722 8943 4295 7236 9873 8717 4352 7472 6945 24189 15753 12955 11668 14927 12589 18875 17331 23732 10825 15044 16768 20202 17032 6 20 25 45 22 16 19 10 12 16 20 19 17 10 33 18 15 27 13 19 28 18 17 27 12 14 22 33 12 25 13 (3) (2) Belgaum Bellary Bijapur Dharwad Alappuzha Bangalore U Bangalore ** Bidar Chamarajanagar Chikmagalur Chitradurga Kannada Dakshina Davanagere Gadag ** Gulbarga Hassan Haveri Kodagu Kolar Koppal Mandya Mysore Raichur Shimoga Tumkur Udupi Kannada Uttara Ernakulam Idukki Kannur Kasaragod Bangalore Rural Bangalore Karnataka Karnataka Karnataka Karnataka Karnataka Karnataka Karnataka Karnataka Karnataka Karnataka Karnataka Karnataka Karnataka Karnataka Karnataka Karnataka Karnataka Karnataka Karnataka Karnataka Karnataka Karnataka Karnataka Karnataka Karnataka Kerala Kerala Kerala Kerala Kerala Kerala (1) Karnataka

TB India 2007 91 5 new new (17) 86% 81% 83% 87% 83% 87% 84% 85% 84% 89% 82% 73% 70% 89% 76% 83% 83% 90% 86% 89% 72% pati- ents ment Treat- Treat- smear rate of of rate 100% success positive positive 5 85% 79% 81% 85% 81% 85% 82% 83% 81% 83% 77% 63% 67% 89% 69% 81% 78% 82% 86% 84% 69% (16) smear 100% of new new of positive positive Cure rate rate Cure patients 4 new new 87% 84% 85% 87% 83% 90% 86% 78% 84% 20% 90% 88% 85% 89% 89% 76% 87% 82% 83% 89% 90% 83% (15) conv- smear ersion ersion rate of of rate positive positive 3 month patients 8% 5% 2% 7% 2% 7% 0% 3% 3% 0% 4% 5% 0% 5% 2% 8% 6% 1% 2% 10% 13% 26% (14) 0 2 3 7 pediatric 83 32 17 25 20 62 65 24 64 79 22 No (%) of No (%) of 141 230 126 293 162 162 123 cases out of cases out of all New cases all New 0 70 55 63 159 174 213 175 217 238 269 163 160 147 283 342 374 264 275 198 122 266 (13) ment ment cases No of No of smear retreat- positive positive for treat- for registered registered 3 76 97 99 53 82 46 for for 395 403 754 545 542 214 598 677 149 119 341 220 152 179 173 (12) ment tered tered cases No of No of treat- regis- new EP new 6 27 new new 534 281 531 506 291 126 641 411 198 378 193 249 626 803 247 442 304 541 691 (11) ment cases No of No of treat- regis- smear 1246 negative negative tered for for tered 52% 89% 62% 75% 64% 64% 77% 78% 63% 73% 59% 54% 53% 69% 64% 51% 44% 33% 76% 64% 60% 48% (10) cases onary pulm- out of out of % new % new sputum positive positive total new total new

44% 55% 41% 31% 47% 46% 42% 48% 45% 14% 33% 45% 35% 52% 61% 30% 48% 83% 81% 43% 49% 42% (9) rate (%) rate detection new smear new Annualized 33 41 31 23 35 35 31 36 34 11 26 36 28 42 49 24 38 67 65 35 40 34 positive case positive 7 (8) 889 851 930 886 965 448 280 420 428 437 662 991 394 786 799 448 501 761 215 New New ment smear 1074 1127 positive positive patients for treat- for registered registered 75 85 82 57 75 67 78 82 83 24 71 73 61 75 95 56 (7) rate rate 108 155 114 143 153 100 detection total case Annualized 3 16 873 687 878 946 356 (6) Total Total 2031 1746 2503 2163 2056 2668 2559 1128 1702 3141 1854 1543 1711 1063 1375 1932 ment patients for treat- for registered registered

2 Annual Performance of Districts (Contd...) 6% 5% 6% 6% 8% 7% 5% 6% 6% 3% (5) % of % of 17% 13% 13% 21% 18% 12% 18% 21% 21% 13% 13% 15% smear among positive positive suspects TB cases 189 (4) 7592 5741 3414 5634 5153 5272 6725 7559 5280 3425 4733 8060 1745 16506 22972 20933 18110 14404 31746 23269 15689 suspects No. of TB No. of examined 1 8 1 7 6 27 21 30 38 28 13 34 31 16 12 15 16 20 16 20 12 14 19 by by (in (3) lakh) Popu- Popu- lation RNTCP covered covered District (2) Thrissur Balaghat ** Barwani † Betul ** Chhatarpur ** Dewas Dhar † Kottayam Kozhikode Malappuram Palakkad Pathanamthitta Thiruvananthapuram Wayanad * Lakshadweep Bhind Bhopal ** Chhindwara ** Damoh Datia † Dindori Kollam State Kerala Kerala Kerala Kerala Kerala Kerala Kerala Kerala Lakshadweep Lakshadweep Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya (1) Kerala

92 TB India 2007 (17) 85% 79% 75% 93% 83% 74% 89% 85% 89% 84% 84% 89% 70% 71% 88% 81% 86% 85% 80% 79% 86% 88% 85% 75% 85% 93% 71% 84% 84% 79% 87% 82% (Contd.) 81% 79% 75% 92% 82% 66% 83% 76% 88% 84% 72% 84% 63% 68% 87% 76% 85% 84% 75% 78% 82% 87% 83% 74% 84% 93% 60% 83% 82% 77% 84% 79% (16) 87% 90% 77% 94% 88% 81% 90% 85% 93% 90% 84% 86% 80% 77% 90% 90% 90% 90% 86% 87% 84% 91% 89% 75% 88% 96% 75% 90% 87% 86% 91% 79% (15) 1% 5% 3% 5% 6% 8% 2% 5% 4% 5% 4% 1% 4% 3% 5% 3% 2% 2% 2% 7% 6% 1% 3% 3% 1% 2% 2% 1% 3% 2% 4% 7% (14) 17 11 84 22 76 62 83 35 16 51 20 48 18 21 20 23 16 32 17 10 14 21 10 36 18 65 28 105 179 157 148 129 50 82 63 260 670 265 570 534 178 202 178 281 143 366 640 185 172 212 148 235 237 455 371 228 181 143 279 224 189 295 133 358 (13) 38 89 91 45 79 94 68 33 43 76 53 140 263 228 796 350 102 174 267 136 163 101 132 118 174 431 191 272 111 100 183 263 (12) 81 516 600 146 665 704 515 536 640 693 692 211 632 403 216 424 267 669 635 410 936 980 626 433 325 270 661 446 409 552 169 (11) 1003 61% 65% 49% 50% 65% 70% 58% 57% 55% 51% 71% 51% 63% 61% 53% 59% 35% 47% 55% 47% 54% 47% 39% 83% 60% 61% 67% 58% 63% 50% 61% 52% (10) 56% 77% 33% 70% 58% 63% 59% 89% 57% 53% 66% 63% 48% 39% 76% 51% 37% 51% 46% 47% 65% 53% 41% 38% 46% 44% 72% 47% 39% 56% 41% 111% (9) 45 61 26 56 46 51 47 71 46 42 53 51 38 32 60 41 29 41 37 38 52 42 33 31 37 35 89 57 38 31 45 33 824 139 673 731 834 863 712 524 663 674 334 485 387 365 568 494 825 875 395 394 641 500 549 913 760 417 851 186 (8) 1104 1320 1215 1170 97 73 83 59 78 90 86 79 84 (7) 148 157 126 115 102 151 103 118 106 144 115 160 104 113 126 108 126 122 125 106 180 116 109 382 882 980 757 481 (6) 1792 2674 1882 3602 2750 1577 1778 1942 1999 1046 1886 2024 1284 1406 1752 1454 2748 2723 2583 1262 1356 1288 1114 1845 1736 1050 2068 (5) 18% 21% 13% 14% 13% 25% 15% 26% 15% 16% 17% 20% 21% 19% 10% 25% 14% 18% 19% 14% 18% 20% 13% 20% 20% 14% 26% 20% 14% 19% 19% 18% (4) 6692 1472 7530 8670 6028 4388 7586 6404 4369 5506 6528 2709 6565 2508 3757 4761 5045 9374 9080 6289 3668 2981 4364 5678 3093 5905 7091 2957 8040 1431 11218 16833 5 8 9 6 6 18 18 12 29 24 15 12 19 17 10 13 18 11 12 14 13 22 22 21 12 13 17 14 16 20 13 19 (3) (2) Raisen ** Rajgarh Ratlam Rewa Sagar ** Seoni ** Shajapur Shivpuri Ujjain Gwalior ** Harda ** Hoshangabad Indore Jabalpur † Jhabua Katni ** Khandwa ** Khargone † Mandla Mandsaur Morena ** Narsinghpur Neemuch ** Panna Satna ** Sehore Shahdol Sheopur Sidhi ** Tikamgarh Umaria Guna Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya (1) Pradesh Madhya

TB India 2007 93 5 88% 87% 89% 84% 86% 86% 91% 89% 86% 89% 90% 87% 91% 88% 88% 87% 88% 81% 84% 88% 88% 85% new new (17) pati- ents ment Treat- Treat- smear rate of of rate success positive positive 5 84% 87% 85% 82% 84% 86% 89% 88% 86% 87% 88% 86% 84% 88% 82% 87% 83% 81% 83% 77% 87% 85% (16) smear of new new of positive positive Cure rate rate Cure patients 4 new new 89% 91% 92% 86% 89% 88% 93% 92% 92% 92% 92% 91% 91% 90% 86% 92% 87% 91% 89% 83% 91% 90% (15) conv- smear ersion ersion rate of of rate positive positive 3 month patients 5% 4% 5% 2% 6% 3% 8% 5% 4% 4% 5% 3% 6% 5% 5% 2% 2% 5% 5% 3% 10% 10% (14) 57 pediatric No (%) of No (%) of 64 29 36 53 66 90 86 92 96 38 79 54 39 26 23 cases out of cases out of 1999 210 204 102 201 122 all New cases all New 95 68 396 275 264 109 313 145 174 199 160 498 295 198 216 159 393 272 225 216 155 (13) 3400 ment ment cases No of No of smear retreat- positive positive for treat- for registered registered 72 for for 151 522 248 152 316 306 217 247 223 352 304 169 189 120 455 173 334 416 100 190 (12) ment tered tered cases No of No of treat- regis- 4915 new EP new new new 442 173 691 177 694 476 526 932 858 725 340 426 563 784 371 814 162 720 (11) ment cases No of No of treat- regis- smear 1255 1351 1720 6752 negative negative tered for for tered 34% 61% 65% 63% 56% 69% 62% 57% 68% 58% 58% 59% 64% 63% 48% 54% 49% 64% 62% 51% 61% 54% (10) cases onary pulm- out of out of % new % new sputum positive positive total new total new

61% 60% 59% 63% 50% 53% 64% 63% 60% 67% 66% 70% 73% 71% 60% 63% 55% 64% 51% 41% 62% 77% (9) rate (%) rate detection new smear new Annualized 49 48 47 50 40 42 51 51 48 54 53 56 58 56 48 51 44 51 40 33 49 61 positive case positive 657 830 298 891 395 620 608 729 513 765 653 170 (8) New New 2108 1132 1120 1286 1174 1024 2004 1320 1104 7882 ment smear positive positive patients for treat- for registered registered 92 90 99 201 103 105 137 110 117 103 115 126 128 129 120 128 136 117 120 130 103 199 (7) rate rate detection total case Annualized 3 807 538 (6) Total Total 2703 4531 1842 2435 1096 2270 1409 2132 3025 2855 2369 1257 1652 1441 4632 2075 1675 2930 2213 ment 25465 patients for treat- for registered registered

2 Annual Performance of Districts (Contd...) 9% 9% (5) % of % of 14% 11% 14% 11% 10% 13% 15% 11% 11% 16% 12% 12% 13% 11% 15% 11% 18% 11% 11% 18% smear among positive positive suspects TB cases (4) 11023 80706 6458 8392 5342 6592 8705 8656 6199 8613 3634 5417 1885 20501 13196 11461 15760 11950 11949 20781 11636 14002 suspects No. of TB No. of examined 1 6 9 5 13 44 18 22 22 12 23 24 22 18 10 13 11 40 17 13 33 22 by by (in (3) 128 lakh) Popu- Popu- lation RNTCP covered covered District Ahmadnagar Akola Corp Mun Amravati Rural Amravati Muni Aurangabad ** Aurangabad-MH Bhandara ** Bid ** Buldana Chandrapur Dhule ** Gadchiroli Gondiya ** Hingoli Jalgaon ** Jalna Dombivli MC Kalyan Kolhapur Corp Mun Kolhapur Mumbai (2) Corp Latur ** Vidisha ** Vidisha State (1) Pradesh Madhya Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra

94 TB India 2007 85% 91% 90% 84% 87% 90% 84% 82% 88% 86% 85% 86% 88% 85% 85% 84% 86% 85% 82% 87% 83% 89% 81% 79% 88% 86% 86% 86% 89% 82% 79% (17) (Contd.) 85% 90% 88% 84% 82% 90% 84% 82% 88% 86% 85% 86% 88% 85% 84% 83% 86% 80% 79% 86% 83% 89% 81% 79% 86% 86% 86% 84% 88% 82% 79% (16) 91% 93% 91% 90% 90% 95% 91% 91% 92% 91% 90% 91% 94% 91% 90% 87% 89% 88% 86% 91% 88% 92% 90% 89% 91% 87% 92% 88% 92% 82% 89% (15) 4% 1% 4% 1% 1% 7% 6% 4% 6% 4% 2% 3% 2% 5% 9% 4% 4% 2% 3% 7% 2% 6% 2% 4% 3% 7% 3% 16% 19% 11% 22% (14) 6 7 22 12 74 62 61 88 81 78 50 56 41 53 33 12 98 21 113 125 837 226 114 107 148 400 226 125 12 16 151 74 65 33 19 62 48 462 227 325 159 358 135 246 136 220 242 388 581 406 317 195 393 138 217 159 737 442 135 189 147 434 (13) 75 70 36 133 419 129 150 776 275 348 131 176 507 671 433 219 343 196 544 141 228 171 939 685 318 154 435 169 139 (12) 1034 1008 81 519 874 166 638 312 322 383 634 412 796 924 979 889 636 202 456 716 376 562 304 571 370 105 350 315 (11) 1064 1975 1746 1916 1108 71% 62% 56% 61% 52% 56% 62% 62% 61% 51% 62% 63% 67% 57% 51% 65% 51% 42% 46% 68% 58% 60% 59% 49% 57% 57% 54% 49% 44% 31% 37% (10) 71% 82% 64% 69% 61% 75% 54% 86% 47% 51% 78% 63% 60% 67% 65% 63% 56% 53% 52% 58% 70% 74% 75% 71% 71% 56% 61% 61% 64% 84% 58% (9) 57 66 51 55 49 60 43 69 38 41 63 50 48 54 52 50 45 42 41 47 56 59 60 57 57 45 49 46 48 63 44 63 255 689 499 523 601 654 680 943 211 384 523 810 288 755 490 101 155 185 (8) 1254 1418 1348 2511 1370 1889 1272 1164 1270 1500 2870 1296 82 86 156 127 125 144 120 137 110 222 107 186 142 111 142 148 112 166 146 137 145 143 210 175 140 111 128 164 182 402 185 (7) 667 782 889 361 239 985 783 (6) 3440 2731 3280 1686 5753 1277 1684 1299 1721 2010 3891 4377 3368 2707 2588 4391 1268 2752 1366 6942 2850 1858 1222 3389 8% 8% 9% 6% 2% (5) 17% 12% 13% 18% 12% 12% 13% 16% 10% 15% 14% 14% 12% 14% 12% 10% 15% 14% 14% 19% 21% 12% 16% 14% 12% 13% 920 1884 7494 5275 7440 7379 6241 7826 1899 6666 7229 8208 3366 7528 3127 946 (4) 14873 10340 14318 24496 10976 25782 12405 10116 14979 19832 19141 25234 13056 6962 2103 5 8 5 9 9 5 2 1 2 4 22 22 26 14 42 12 16 16 11 27 40 24 18 23 30 32 48 14 13 11 26 (3) Nagpur Rural Nagpur ** Nanded MC Waghela Nanded * Nandurbar Nashik Corp Nashik Mumbai Navi ** Osmanabad ** Parbhani Pimpri Chinchwad Pune Rural Pune Raigarh-MH Ratnagiri Sangli Corp Muni Sangli Satara Sindhudurg Corp Solapur Muni Thane Corp Muni Thane Corp Muni Ulhasnagar Wardha Washim ** Yavatmal * Chandel * Churachandpur (2) Solapur Imphal East Nagpur Muni Corp Muni Nagpur Bishnupur (1) Maharashtra Manipur Manipur Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Manipur Manipur Manipur

TB India 2007 95 5 new new (17) 90% 83% 80% 91% 77% 81% 73% 86% 65% 85% 88% 88% 89% 93% 93% 96% 91% 88% 95% 92% 83% pati- ents ment Treat- Treat- smear rate of of rate success positive positive 5 90% 83% 80% 88% 72% 65% 72% 83% 58% 76% 87% 88% 88% 93% 92% 96% 91% 88% 95% 92% 82% (16) smear of new new of positive positive Cure rate rate Cure patients 4 new new 92% 90% 75% 89% 72% 93% 78% 79% 74% 98% 86% 89% 95% 91% 91% 82% 91% 89% 93% (15) conv- smear ersion ersion 100% 100% rate of of rate positive positive 3 month patients 4% 5% 2% 9% 6% 2% 8% 6% 5% 5% 8% 5% 2% 2% 6% 5% 5% 11% 10% 16% 17% (14) 3 9 8 4 4 8 7 2 5 3 5 pediatric No (%) of No (%) of 31 35 12 16 28 68 41 11 24 cases out of cases out of 118 all New cases all New 6 6 3 65 49 11 36 32 19 50 54 12 78 61 17 17 30 14 96 293 100 (13) ment ment cases No of No of smear retreat- positive positive for treat- for registered registered 81 10 40 20 72 48 12 57 44 25 23 63 11 45 20 29 for for 215 111 472 134 360 (12) ment tered tered cases No of No of treat- regis- new EP new 9 14 38 44 79 49 27 68 27 52 15 29 21 new new 304 115 262 365 168 132 210 229 (11) ment cases No of No of treat- regis- smear negative negative tered for for tered 47% 54% 73% 33% 62% 62% 49% 57% 70% 84% 69% 54% 52% 51% 41% 57% 71% 58% 53% 53% 52% (10) cases onary pulm- out of out of % new % new sputum positive positive total new total new

78% 44% 42% 43% 56% 36% 66% 44% 75% 59% 90% 66% 84% 34% 96% 61% 42% 67% 54% 118% 102% (9) rate (%) rate detection new smear new Annualized 58 33 32 33 42 27 49 33 56 44 68 49 63 26 72 46 88 31 51 40 76 positive case positive 38 63 71 47 28 47 36 21 33 24 (8) 274 134 128 350 105 116 375 156 229 130 252 New New ment smear positive positive patients for treat- for registered registered 66 68 81 79 195 104 156 133 248 106 147 132 169 269 110 251 142 189 213 118 222 (7) rate rate detection total case Annualized 3 79 86 53 70 918 423 614 201 181 335 303 730 534 978 119 164 111 278 139 735 (6) Total Total 1760 ment patients for treat- for registered registered

2 Annual Performance of Districts (Contd...) 9% 4% 6% 7% 7% (5) % of % of 10% 10% 15% 12% 10% 21% 19% 13% 14% 14% 13% 11% 10% 10% 14% 18% smear among positive positive suspects TB cases 465 676 926 939 302 794 799 355 360 522 385 (4) 4716 1293 1078 3189 1170 3520 1536 3422 1198 1618 suspects No. of TB No. of examined 1 5 4 1 4 2 3 7 3 2 1 6 3 4 1 1 1 1 1 1 1 3 by by (in (3) lakh) Popu- Popu- lation RNTCP covered covered District (2) Ukhrul * East Khasi Hills * Aizawl * Champhai * Saiha * Senapati * Senapati * Tamenglong Thoubal Hills * East Garo Hills * Jaintia * Ri Bhoi Hills * South Garo Hills * Garo West Khasi Hills * West * Kolasib * Lawngtlai * Lunglei * Mamit * Serchhip Imphal West * Dimapur State Manipur Manipur Manipur Manipur Meghalaya Meghalaya Meghalaya Meghalaya Meghalaya Meghalaya Meghalaya Meghalaya Mizoram Mizoram Mizoram Mizoram Mizoram Mizoram Mizoram Mizoram Mizoram (1) Manipur Nagaland Nagaland

96 TB India 2007 (17) 87% 80% 93% 89% 87% 88% 94% 90% 91% 84% 86% 89% 87% 83% 77% 91% 89% 76% 77% 92% 92% 90% 82% 86% 93% 89% 87% 78% 78% 91% 87% (Contd.) 83% 80% 93% 88% 87% 88% 94% 89% 82% 81% 79% 86% 82% 81% 61% 91% 84% 72% 68% 92% 88% 89% 71% 64% 92% 88% 84% 63% 74% 89% 84% (16) 91% 90% 88% 78% 93% 98% 97% 93% 88% 89% 86% 86% 87% 82% 81% 90% 92% 83% 79% 91% 93% 92% 76% 73% 96% 93% 90% 78% 81% 93% 90% (15) 8% 5% 0% 0% 5% 4% 2% 2% 6% 2% 2% 5% 2% 4% 9% 5% 1% 3% 4% 4% 6% 2% 3% 4% 3% 4% 2% 2% 13% 16% 15% (14) 7 0 0 5 6 24 41 16 77 48 75 21 22 24 18 11 66 34 70 30 30 75 39 15 62 40 34 34 86 21 189 52 59 60 13 57 15 20 65 38 61 87 11 88 58 40 77 78 88 78 111 101 140 202 533 108 161 161 106 151 117 220 (13) 4 94 23 91 43 22 52 27 70 61 155 179 272 172 251 196 167 468 151 116 787 106 315 153 298 129 150 413 187 193 555 (12) 96 44 49 15 23 20 70 60 72 73 166 236 903 476 378 198 271 335 250 303 265 511 104 189 676 410 180 301 313 (11) 1343 1455 56% 66% 77% 74% 53% 77% 64% 70% 46% 57% 62% 78% 64% 80% 73% 61% 57% 63% 59% 76% 64% 56% 69% 80% 63% 62% 48% 81% 66% 60% 62% (10) 48% 47% 79% 35% 55% 58% 28% 54% 65% 34% 50% 74% 30% 40% 34% 45% 47% 92% 69% 24% 37% 73% 93% 73% 28% 78% 34% 70% 55% 134% 108% (9) 92 47 36 35 59 26 41 43 21 46 55 29 42 63 25 34 29 38 40 78 59 20 31 62 79 62 23 67 29 59 114 86 42 75 35 (8) 121 164 184 558 782 625 606 250 356 233 715 111 453 431 226 541 336 429 325 378 745 583 509 1964 1117 1107 2172 93 76 68 63 93 70 95 60 82 71 79 95 41 76 59 88 93 (7) 117 137 138 149 109 160 149 161 150 110 150 106 215 194 394 227 382 120 614 118 105 433 850 564 230 884 460 874 757 818 (6) 1130 2123 1502 1366 1773 1080 4977 1307 2131 2490 1154 1330 1099 4575 1009 9% 8% 8% 7% 8% 9% (5) 17% 10% 46% 10% 10% 14% 11% 16% 13% 11% 19% 17% 10% 12% 19% 18% 11% 10% 20% 14% 13% 19% 12% 17% 17% 591 505 497 (4) 1506 1055 1470 2228 7420 7247 7727 3902 1863 3899 2884 8676 1213 4594 2796 4043 4965 3997 7268 4300 4611 4588 5754 4730 3627 14800 11105 14953 3 2 3 2 4 2 2 4 7 3 6 5 7 5 12 14 22 14 14 25 11 33 11 17 14 14 17 13 13 24 11 (3) (2) Baleshwar Cuttack Debagarh Gajapati † Ganjam Mokokchung * Mokokchung * Mon * Phek * Tuensang * Wokha * Zunheboto Kohima * Kohima Anugul ** Balangir Bargarh Baudh Bhadrak Corp Bhubaneshwar Dhenkanal Jagatsinghapur Jajapur Jharsuguda ** Kalahandi † Kandhamal Kendrapara Kendujhar Khordha † Koraput * Malkangiri † Mayurbhanj † Nabarangapur Nagaland Nagaland Nagaland Nagaland Nagaland Nagaland (1) Nagaland Orissa Orissa Orissa Orissa Orissa Orissa Orissa Orissa Orissa Orissa Orissa Orissa Orissa Orissa Orissa Orissa Orissa Orissa Orissa Orissa Orissa Orissa Orissa Orissa Orissa

TB India 2007 97 5 new new (17) 76% 91% 87% 86% 87% 85% 88% 78% 82% 88% 85% 80% 77% 86% 86% 78% 83% 89% 84% 81% 83% 89% pati- ents ment Treat- Treat- smear rate of of rate success positive positive 5 73% 64% 73% 82% 85% 73% 81% 73% 77% 88% 84% 80% 72% 84% 85% 69% 81% 87% 84% 81% 81% 81% (16) smear of new new of positive positive Cure rate rate Cure patients 4 new new 66% 76% 89% 89% 87% 89% 92% 85% 85% 90% 84% 85% 84% 88% 92% 80% 89% 91% 92% 84% 87% 93% (15) conv- smear ersion ersion rate of of rate positive positive 3 month patients 8% 2% 5% 6% 8% 5% 3% 2% 7% 4% 5% 7% 5% 4% 4% 7% 3% 7% 4% 7% 4% 4% (14) pediatric 17 48 74 91 24 76 21 59 39 38 72 76 64 22 28 52 36 24 No (%) of No (%) of 101 302 153 286 cases out of cases out of all New cases all New 70 97 95 43 172 131 178 222 650 313 160 101 423 421 332 380 108 423 148 164 275 111 (13) ment ment cases No of No of smear retreat- positive positive for treat- for registered registered 28 62 94 for for 206 262 124 292 422 286 268 176 166 216 365 252 606 148 939 141 130 121 (12) ment tered tered cases No of No of treat- regis- 1287 new EP new 91 563 417 204 323 352 189 926 311 390 193 465 543 503 454 168 205 160 248 140 new new (11) ment 1056 1680 cases No of No of treat- regis- smear negative negative tered for for tered 43% 44% 71% 70% 60% 56% 59% 68% 66% 64% 66% 75% 60% 66% 63% 69% 71% 49% 68% 74% 68% 73% (10) cases onary pulm- out of out of % new % new sputum positive positive total new total new

54% 67% 37% 63% 49% 81% 85% 64% 59% 68% 49% 39% 49% 57% 52% 54% 53% 62% 51% 68% 63% 101% (9) rate (%) rate detection 46 57 31 86 54 42 69 64 61 56 65 46 37 46 54 49 51 50 59 48 64 60 new smear new Annualized positive case positive 423 323 499 754 529 241 666 706 382 268 686 860 414 434 459 533 376 (8) New New 1342 2010 1041 1023 1620 ment smear positive positive patients for treat- for registered registered 79 98 (7) rate rate 170 154 152 132 153 145 157 140 162 113 101 110 127 121 107 150 133 101 140 124 detection total case Annualized 3 871 566 959 650 859 983 961 776 (6) Total Total 1562 1259 1328 1305 2983 1513 5162 1771 1886 2462 2008 2527 4850 1163 ment patients for treat- for registered registered

2 Annual Performance of Districts (Contd...) 9% (5) % of % of 13% 16% 12% 15% 11% 11% 14% 19% 13% 16% 11% 19% 13% 10% 13% 13% 13% 14% 14% 17% 11% smear among positive positive suspects TB cases (4) 5323 2561 5675 6154 6978 2168 8863 3989 3041 6104 4459 4385 4450 4944 4371 13469 16477 15792 11435 12788 11519 18807 suspects No. of TB No. of examined 1 9 6 9 6 6 6 8 7 9 8 6 16 10 19 10 33 13 19 22 16 21 32 by by (in (3) lakh) Popu- Popu- lation RNTCP covered covered District (2) Puri Sambalpur Amritsar Fatehgarh Sahib Nayagarh † Nuapada † Rayagada Sonapur † Sundargarh Puducherry Bathinda Faridkot Firozpur Gurdaspur Hoshiarpur Jalandhar Kapurthala Ludhiana Mansa-PU Moga Muktsar Nawanshahr State (1) Orissa Orissa Orissa Orissa Orissa Orissa Orissa Puducherry Puducherry Punjab Punjab Punjab Punjab Punjab Punjab Punjab Punjab Punjab Punjab Punjab Punjab Punjab Punjab Punjab

98 TB India 2007 (17) 85% 86% 88% 86% 88% 90% 87% 86% 87% 91% 86% 88% 88% 90% 86% 87% 91% 88% 87% 87% 87% 87% 88% 85% 88% 87% 93% 88% 92% 86% 87% (Contd.) 81% 83% 83% 85% 86% 87% 87% 85% 85% 91% 85% 86% 84% 88% 85% 86% 88% 87% 85% 87% 86% 85% 86% 85% 87% 85% 90% 85% 89% 85% 86% (16) 85% 86% 87% 90% 89% 92% 91% 88% 89% 93% 90% 91% 91% 93% 92% 92% 91% 91% 92% 91% 92% 89% 90% 91% 91% 93% 95% 86% 90% 89% 93% (15) 7% 4% 4% 3% 3% 5% 1% 3% 7% 9% 5% 2% 6% 2% 4% 7% 8% 2% 3% 4% 6% 2% 3% 9% 3% 5% 2% 5% 10% 10% 10% (14) 77 84 78 15 81 80 55 49 12 37 61 74 63 23 85 268 180 134 108 302 193 232 114 145 121 155 661 112 233 104 152 544 266 358 773 674 417 440 626 535 346 708 606 441 496 545 459 751 108 322 406 595 693 639 498 645 571 300 534 (13) 1302 1179 2023 79 46 826 334 355 763 611 184 269 135 215 746 522 151 376 465 310 218 139 406 405 133 302 460 226 386 268 303 188 336 (12) 1883 612 257 753 917 681 732 664 630 856 691 525 607 649 178 857 649 770 739 951 416 509 (11) 1470 1705 1184 1396 1383 1112 3108 1415 1324 1331 67% 70% 56% 55% 50% 58% 60% 46% 43% 60% 58% 53% 69% 57% 58% 60% 70% 52% 66% 52% 61% 40% 54% 56% 53% 58% 55% 52% 47% 66% 66% (10) 68% 52% 47% 92% 64% 96% 57% 57% 60% 88% 87% 75% 81% 90% 77% 93% 74% 62% 45% 74% 57% 61% 96% 84% 59% 75% 94% 98% 113% 114% 148% (9) 65 50 45 74 51 77 90 46 46 91 48 70 70 60 64 72 62 74 59 50 36 59 46 49 77 67 48 60 75 79 118 590 959 990 744 938 780 278 577 768 963 821 972 (8) 1269 1779 1680 1272 1019 1067 2032 1004 1390 1121 1447 1219 1246 3426 1565 1023 1167 1457 1201 (7) 174 129 120 229 148 185 217 132 145 250 141 190 159 167 167 191 225 165 187 189 116 116 155 132 132 201 179 124 171 159 194 652 (6) 3417 1530 2573 5514 4883 3063 2453 2868 3358 5554 2945 2014 3167 3140 2435 2073 2752 3258 3144 1865 2021 2782 4219 2678 3105 3794 3446 1735 2393 10960 (5) 14% 10% 10% 24% 17% 24% 19% 11% 16% 19% 17% 17% 22% 26% 17% 18% 33% 18% 20% 16% 11% 18% 19% 18% 17% 21% 20% 17% 19% 24% 18% (4) 9094 7521 8284 6283 8828 6876 8579 7603 6036 9702 3777 5146 6699 9076 8109 9703 4510 9321 17916 12806 15979 14528 14599 11972 18247 12068 10956 50076 17996 10826 11712 6 20 12 21 24 33 17 11 22 23 22 21 11 20 19 15 11 12 20 17 58 16 13 21 32 13 17 31 20 11 12 (3) (2) Alwar Dausa Dhaulpur Jhalawar Patiala Rupnagar Sangrur Ajmer † Banswara Baran Barmer Bharatpur Bhilwara Bikaner Bundi Chittaurgarh Churu † Dungarpur Ganganagar Hanumangarh Jaipur Jaisalmer Jalore Jhunjhunun Jodhpur Karauli Kota Nagaur Pali Rajsamand Sawai Madhopur (1) Punjab Punjab Punjab Rajasthan Rajasthan Rajasthan Rajasthan Rajasthan Rajasthan Rajasthan Rajasthan Rajasthan Rajasthan Rajasthan Rajasthan Rajasthan Rajasthan Rajasthan Rajasthan Rajasthan Rajasthan Rajasthan Rajasthan Rajasthan Rajasthan Rajasthan Rajasthan Rajasthan Rajasthan Rajasthan Rajasthan Rajasthan

TB India 2007 99 5 new new (17) 87% 85% 88% 87% 85% 94% 89% 94% 88% 78% 84% 83% 83% 80% 86% 91% 77% 79% 84% 87% 79% 82% pati- ents ment Treat- Treat- smear rate of of rate success positive positive 5 86% 85% 85% 86% 85% 94% 89% 94% 88% 77% 82% 81% 81% 78% 84% 91% 72% 78% 83% 86% 79% 82% (16) smear of new new of positive positive Cure rate rate Cure patients 4 new new 91% 89% 91% 91% 88% 83% 91% 85% 91% 85% 89% 88% 86% 80% 92% 90% 84% 86% 85% 90% 90% 89% (15) conv- smear ersion ersion rate of of rate positive positive 3 month patients 5% 2% 3% 4% 6% 7% 9% 4% 6% 5% 5% 14% 18% 19% 17% 14% 14% 21% 16% 18% 14% 15% (14) pediatric 24 92 88 19 44 32 92 50 56 No (%) of No (%) of 158 209 355 277 454 161 393 233 334 596 264 222 212 cases out of cases out of all New cases all New 12 43 36 622 285 779 123 856 568 399 226 261 357 595 155 131 140 595 176 204 125 (13) 1173 ment ment cases No of No of smear retreat- positive positive for treat- for registered registered 75 38 77 47 for for 408 279 805 204 945 721 490 737 360 984 282 185 221 168 443 316 (12) ment tered tered cases No of No of 1792 1063 treat- regis- new EP new 42 41 38 new new 565 943 152 463 867 684 572 272 380 634 358 481 (11) ment cases No of No of treat- regis- smear 1266 1426 1484 1028 1303 1257 1181 negative negative tered for for tered 51% 53% 62% 66% 64% 38% 73% 72% 65% 66% 48% 63% 58% 66% 60% 57% 63% 54% 54% 51% 69% 55% (10) cases onary pulm- out of out of % new % new sputum positive positive total new total new

64% 83% 79% 84% 59% 68% 79% 79% 66% 84% 57% 62% 37% 69% 56% 68% 63% 141% 119% 136% 106% 100% (9) rate (%) rate detection 51 67 95 59 80 75 63 44 51 59 59 50 63 43 47 28 52 new smear new Annualized 42 51 48 113 102 positive case positive 26 99 627 268 112 799 748 459 451 653 801 590 (8) New New 1301 1508 2770 2782 1962 1221 1196 1339 1893 1390 ment smear positive positive patients for treat- for registered registered 75 158 170 267 218 306 309 204 176 161 104 163 149 154 104 166 102 111 166 105 116 123 (7) rate rate detection total case Annualized 3 802 136 288 232 (6) Total Total 3995 1598 3572 6347 7151 4618 3905 2007 3106 2809 5014 1791 1090 1218 4465 1637 1821 1521 ment patients for treat- for registered registered

2 Annual Performance of Districts (Contd...) 9% 6% 6% 9% 7% 9% 7% 7% 9% 7% 7% 8% (5) % of % of 17% 20% 24% 31% 10% 10% 13% 12% 10% 10% smear among positive positive suspects TB cases 321 878 (4) 4988 9596 4918 1315 7232 7390 9913 9311 13261 22598 62601 29375 25771 20421 25470 27572 34186 12954 26088 10827 suspects No. of TB No. of examined 1 9 3 1 1 25 13 29 44 44 24 14 20 27 30 18 10 16 27 16 16 12 by by (in 0.4 (3) lakh) Popu- Popu- lation RNTCP covered covered District (2) East South ** Chennai Coimbatore Cuddalore Dharmapuri Dindigul Erode Kancheepuram Kanniyakumari Karur Krishnagiri Madurai Nagapattinam Namakkal Perambalur Sikar Sirohi Tonk Udaipur * North ** West State Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu Tamil (1) Rajasthan Rajasthan Rajasthan Rajasthan Sikkim Sikkim Sikkim Sikkim Sikkim

100 TB India 2007 (17) 81% 83% 79% 84% 88% 80% 80% 84% 83% 85% 85% 87% 85% 87% 87% 85% 80% 95% 82% 88% 88% 88% 90% 88% 83% 81% 90% 90% 78% 83% (Contd.) 79% 83% 67% 83% 86% 77% 79% 83% 83% 82% 83% 86% 85% 87% 87% 84% 80% 74% 81% 83% 85% 87% 78% 88% 82% 81% 89% 89% 76% 83% (16) 88% 86% 82% 86% 91% 82% 84% 89% 88% 87% 88% 92% 89% 92% 92% 90% 87% 78% 87% 86% 87% 92% 87% 89% 91% 91% 92% 91% 92% 89% (15) 4% 1% 6% 9% 5% 1% 0% 0% 2% 7% 7% 1% 2% 3% 5% 5% 4% 4% 12% 18% 10% 13% 21% 19% 26% 12% 16% 11% 17% 10% (14) 2 2 1 74 17 16 16 35 74 68 74 51 163 237 313 164 622 495 148 177 455 432 174 256 388 441 356 300 445 193 35 45 47 54 83 174 166 458 213 287 152 515 136 234 362 222 207 518 515 247 143 573 302 544 308 575 142 127 (13) 1567 1136 6 36 35 83 72 295 272 789 242 713 126 269 888 243 780 628 615 310 727 769 155 621 561 527 139 268 222 540 115 (12) 1068 76 73 459 371 963 515 135 376 929 794 633 838 162 167 566 633 973 344 509 (11) 1074 1059 1043 1683 1710 1165 1383 1589 2623 1513 1176 58% 65% 61% 51% 52% 50% 36% 60% 61% 55% 46% 61% 61% 55% 60% 54% 69% 56% 73% 80% 55% 58% 52% 53% 61% 63% 71% 56% 35% 56% (10) 55% 75% 63% 59% 67% 22% 69% 72% 63% 59% 66% 73% 79% 77% 75% 72% 70% 44% 32% 55% 44% 71% 56% 30% 81% 40% 69% 69% 22% 36% (9) 42 56 47 44 50 17 52 54 48 45 49 55 59 58 56 54 52 33 24 41 41 67 53 28 77 38 66 66 21 34 635 698 538 133 594 583 977 995 173 209 195 678 639 851 630 642 (8) 1477 1162 1560 1120 1449 1259 2118 1732 1659 2221 2895 1000 1666 1952 54 92 75 46 71 67 81 69 74 104 123 119 129 142 189 144 113 123 143 127 130 150 141 157 141 151 138 158 134 154 (7) 435 303 474 374 (6) 1581 1526 3728 1556 3297 2178 4158 1379 3083 4197 2910 2139 5487 4372 2886 1163 5636 4989 7539 1496 2063 3548 1733 4583 2100 1387 7% 7% 7% 7% 6% 6% 7% 7% 8% 8% 9% 8% 7% 9% 8% (5) 11% 10% 16% 13% 15% 17% 14% 13% 12% 15% 18% 18% 14% 13% 14% (4) 9303 3314 9831 1414 1887 3045 6055 6824 8526 6235 6815 5904 13269 31897 12072 34424 13776 19752 22535 22133 20238 12232 46286 23575 15801 22070 22470 35455 13122 20578 8 3 6 8 15 12 31 12 23 12 29 12 25 29 23 16 37 31 18 16 40 33 55 22 13 44 13 30 30 19 (3) (2) Salem Thanjavur Thiruvallur Thiruvarur Dhalai * Allahabad Baghpat Ramanathapuram Sivaganga Nilgiris The Theni Tiruchirappalli Tirunelveli Tiruvanamalai Toothukudi Vellore Viluppuram Virudhunagar Tripura North South Tripura Tripura West Agra Aligarh Nagar Ambedkar Auraiya Azamgarh ** Bahraich Ballia Balrampur Pudukkottai Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu Tamil Tripura Tripura Tripura Tripura Tripura Uttar Pradesh Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar (1) Nadu Tamil

TB India 2007 101 5 new new (17) 76% 87% 85% 86% 86% 91% 92% 67% 33% 81% 90% 88% 88% 84% 92% 56% 90% 90% 82% 85% 72% 88% 87% 79% pati- ents ment Treat- Treat- smear rate of of rate success positive positive 5 60% 84% 82% 84% 84% 83% 91% 67% 33% 78% 86% 86% 85% 84% 82% 56% 89% 90% 78% 83% 72% 85% 86% 77% (16) smear of new new of positive positive Cure rate rate Cure patients 4 new new 87% 88% 90% 91% 89% 92% 95% 88% 71% 83% 92% 89% 89% 91% 88% 72% 92% 93% 88% 87% 77% 88% 91% 91% (15) conv- smear ersion ersion rate of of rate positive positive 3 month patients 7% 5% 5% 7% 8% 5% 6% 3% 5% 4% 8% 4% 6% 6% 4% 8% 9% 3% 4% 5% 8% 4% 7% 13% (14) 25 50 66 57 92 82 52 76 70 pediatric 100 205 292 208 213 211 279 257 116 246 220 664 126 112 183 No (%) of No (%) of cases out of cases out of all New cases all New 406 618 289 536 505 496 341 186 196 620 380 223 354 357 346 250 434 291 147 781 387 (13) 1315 1034 1084 ment ment cases No of No of smear retreat- positive positive for treat- for registered registered 85 58 54 137 422 662 482 380 131 446 152 347 148 206 232 234 370 697 104 153 73 for for 1482 143 291 (12) ment tered tered cases No of No of treat- regis- new EP new 690 605 252 461 752 944 435 467 556 893 427 916 712 753 871 288 1243 2293 1258 1571 2287 2476 1767 1859 new new (11) ment cases No of No of treat- regis- smear negative negative tered for for tered 34% 53% 71% 45% 63% 56% 47% 73% 59% 47% 68% 55% 43% 66% 62% 61% 65% 52% 71% 52% 58% 50% 38% 48% (10) cases onary pulm- out of out of % new % new sputum positive positive total new total new

35% 67% 78% 51% 50% 70% 65% 30% 67% 20% 62% 50% 41% 63% 39% 49% 80% 99% 22% 38% 18% 41% 58% 50% (9) rate (%) rate detection new smear new Annualized 34 63 74 48 47 66 62 29 64 19 59 48 39 60 37 47 76 94 21 36 17 39 55 47 positive case positive 560 524 563 570 710 743 951 713 698 452 701 (8) New New 2148 2951 1100 1638 2254 2010 1808 1042 1063 1003 3424 1091 2072 ment smear positive positive patients for treat- for registered registered 92 68 56 88 98 56 47 (7) rate rate 108 131 198 138 135 165 152 124 118 126 140 232 239 110 147 135 104 detection total case Annualized 3 (6) Total Total 1797 4439 7870 3150 3185 4592 5339 1237 1350 1704 3824 1751 1653 2195 2491 3169 3065 8715 1882 3363 1956 1696 5095 1537 ment patients for treat- for registered registered

2 Annual Performance of Districts (Contd...) (5) % of % of 17% 17% 15% 18% 13% 13% 14% 14% 20% 14% 16% 14% 13% 17% 14% 24% 16% 15% 13% 19% 13% 12% 14% 14% smear among positive positive suspects TB cases (4) 6465 9115 6524 4128 6222 9220 7992 9396 9483 8597 7808 8201 8409 6483 8434 16674 31002 18719 21668 18560 17369 10240 28343 21050 suspects No. of TB No. of examined 1 9 17 34 40 23 35 34 32 18 30 31 15 19 17 26 23 13 36 34 31 42 12 38 15 by by (in (3) lakh) Popu- Popu- lation RNTCP covered covered District (2) Basti ** Etah Etawah Faizabad Farrukhabad Fatehpur ** Ghazipur Barabanki ** Barabanki Bareilly ** Bijnor ** Budaun Bulandshahar Chandauli Chitrakoot Deoria Firozabad Nagar Gautam Budh Ghaziabad Gonda Gorakhpur ** Hamirpur-UP ** Hardoi Hathras Banda ** Banda State Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar (1) Pradesh Uttar

102 TB India 2007 NE (17) 86% 86% 82% 74% 80% 76% 85% 87% 85% 82% 87% 83% 82% 91% 94% 85% 91% 90% 76% 86% 80% 82% 84% 85% 89% 33% 92% 83% 88% 89% 89% 90% 100% (Contd.) NE 84% 84% 81% 72% 80% 67% 77% 84% 83% 82% 87% 83% 82% 86% 92% 80% 90% 89% 71% 82% 79% 73% 73% 85% 87% 33% 87% 80% 86% 86% 89% 84% (16) 100% 89% 91% 84% 85% 87% 82% 87% 56% 87% 91% 86% 89% 91% 90% 88% 93% 88% 92% 93% 81% 87% 89% 88% 84% 88% 90% 82% 96% 87% 83% 90% 89% 93% 84% (15) 5% 4% 5% 3% 5% 4% 7% 2% 5% 4% 6% 7% 3% 4% 4% 4% 4% 4% 3% 5% 4% 6% 4% 4% 5% 9% 2% 6% 4% 2% 3% 4% 3% 4% (14) 9 85 92 51 46 46 19 66 76 41 22 57 73 86 78 20 98 42 19 88 198 296 192 364 118 223 250 146 104 146 149 363 135 196 96 73 490 469 322 272 273 252 995 747 174 217 142 280 203 270 102 619 285 548 745 616 250 379 776 252 343 101 192 781 106 187 (13) 1079 1196 53 79 97 44 49 85 53 65 94 72 51 77 51 135 529 200 680 288 134 995 323 835 124 407 488 141 166 231 343 861 131 227 314 178 (12) 53 687 581 557 251 468 454 731 430 660 622 936 647 994 366 895 219 584 211 888 (11) 2593 1328 1603 1828 1036 1368 1853 2520 1070 1928 1135 1088 1155 2306 58% 44% 62% 63% 67% 61% 61% 44% 58% 51% 63% 60% 45% 89% 60% 57% 24% 60% 61% 49% 67% 59% 46% 51% 58% 66% 52% 42% 59% 60% 51% 53% 69% 56% (10) 29% 68% 30% 33% 62% 50% 51% 59% 35% 44% 49% 26% 64% 25% 71% 71% 24% 56% 56% 62% 23% 87% 65% 62% 59% 54% 30% 66% 76% 71% 27% 59% 49% 35% (9) 59 48 49 57 33 42 46 25 61 23 67 67 23 53 53 59 21 82 62 59 56 51 28 63 72 68 25 56 46 34 27 65 29 32 947 944 938 510 740 356 751 728 543 417 933 439 932 859 398 843 327 617 468 (8) 2069 2118 2171 2742 1356 2739 1452 2465 2181 2007 1543 2129 1302 2593 1124 74 91 67 57 60 75 59 73 66 52 68 (7) 148 133 112 115 117 136 141 169 103 104 131 101 188 119 144 116 137 143 180 176 167 100 156 966 807 927 713 844 (6) 2380 5778 2168 1904 1136 1590 5337 4825 1834 1522 6903 1432 1831 3012 2069 6241 2798 5987 4551 2488 2277 4559 3833 5540 2493 2824 1482 6244 2387 9% (5) 16% 15% 15% 11% 16% 19% 22% 13% 18% 10% 15% 13% 11% 24% 14% 15% 14% 12% 12% 15% 11% 13% 20% 11% 15% 11% 12% 15% 16% 11% 13% 14% 11% 9459 9914 5327 4994 2982 6739 6414 3316 8357 6737 9262 4714 9349 2620 7920 4463 (4) 17748 10980 18345 17309 10223 37523 10691 23913 15058 26160 21845 16534 12775 20135 24117 12499 27144 12739 8 16 43 19 17 15 18 46 14 35 32 11 41 24 18 23 20 33 23 42 39 18 30 32 21 32 16 15 28 10 23 40 16 35 (3) (2) Lalitpur ** Mirzapur Pilibhit ** Rampur Shahjahanpur Sitapur ** Sultanpur Jaunpur ** Jhansi Jyotiba Phule Nagar** Kannauj Dehat ** Kanpur Nagar Kanpur Kaushambi Kheri Kushinagar Lucknow ** Maharajganj ** Mahoba Mainpuri Mathura ** Mau Meerut ** Moradabad Muzaffarnagar ** Pratapgarh ** Rae Bareli Saharanpur ** Nagar Kabir Sant Nagar Ravidas Sant ** Shravasti ** Siddharthnagar Sonbhadra Jalaun ** Jalaun Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar (1) Pradesh Uttar

TB India 2007 103 5 88% 88% 93% 86% 88% 95% 89% 83% 83% 82% 93% 87% 92% 86% 89% 89% 86% 87% 88% 82% 84% 89% new new (17) pati- ents ment Treat- Treat- smear rate of of rate success positive positive 5 88% 86% 93% 85% 87% 93% 89% 82% 83% 81% 86% 87% 92% 86% 87% 88% 84% 86% 88% 79% 83% 88% (16) smear of new new of positive positive Cure rate rate Cure patients 4 new new 91% 91% 98% 93% 87% 98% 96% 92% 92% 90% 96% 89% 93% 94% 94% 92% 89% 91% 89% 87% 87% 90% (15) conv- smear ersion ersion rate of of rate positive positive 3 month patients 4% 7% 4% 5% 4% 3% 2% 3% 6% 2% 6% 7% 3% 6% 2% 7% 2% 4% 4% 12% 10% 10% (14) 6 8 pediatric 22 10 19 12 33 56 14 41 39 23 81 75 76 No (%) of No (%) of 181 329 240 551 268 521 193 cases out of cases out of all New cases all New 51 35 95 56 86 504 516 120 128 308 351 281 107 149 345 363 902 433 234 492 826 664 (13) ment ment cases No of No of smear retreat- positive positive for treat- for registered registered 33 63 11 84 93 53 34 72 for for 316 637 124 450 216 104 128 525 747 262 274 849 903 (12) ment tered tered cases No of No of 1076 treat- regis- new EP new 58 80 84 130 159 913 324 326 228 123 262 613 116 894 470 784 2655 1934 3356 1034 1642 1803 new new (11) ment cases No of No of treat- regis- smear negative negative tered for for tered 39% 54% 65% 62% 58% 54% 44% 50% 65% 67% 67% 61% 50% 53% 61% 71% 55% 69% 73% 59% 59% 60% (10) cases onary pulm- out of out of % new % new sputum positive positive total new total new

61% 68% 38% 36% 58% 40% 54% 45% 40% 60% 52% 57% 42% 54% 60% 87% 73% 94% 87% 69% 68% 105% (9) rate (%) rate detection new smear new Annualized 58 65 36 34 55 38 52 42 38 57 50 54 40 51 57 66 55 71 79 65 52 51 positive case positive 93 93 246 222 719 321 602 470 249 133 264 686 181 (8) New New 1726 2259 2239 4061 2281 1271 1121 2368 2740 ment smear positive positive patients for treat- for registered registered 92 87 91 92 174 156 150 177 111 147 106 127 126 138 147 122 134 131 147 206 143 123 (7) rate rate detection total case Annualized 3 628 235 601 221 840 532 314 829 469 (6) Total Total 5209 5445 2467 1439 1221 1857 4152 9920 4214 2360 3539 6527 6629 ment patients for treat- for registered registered

2 Annual Performance of Districts (Contd...) 7% (5) % of % of 15% 14% 10% 11% 15% 12% 10% 14% 15% 16% 13% 12% 13% 12% 12% 12% 14% 13% 14% 11% 11% smear among positive positive suspects TB cases 4154 1213 2476 1885 4668 8173 7516 2593 1425 3367 9527 2264 (4) 14154 22279 10490 24865 46338 21885 12257 13946 32188 31745 suspects No. of TB No. of examined 1 7 3 4 2 8 8 5 2 7 3 30 35 14 16 13 34 74 32 16 17 46 54 by by (in (3) lakh) Popu- Popu- lation RNTCP covered covered District Varanasi Almora Bageshwar Chamoli Dehradun Hardwar Nainital Pithoragarh Rudraprayag Garhwal Tehri Nagar Udhamsingh Uttarkashi Bankura Barddhaman Birbhum Dakshin Dinajpur ** Darjiling Haora Hugli (2) Champawat Garhwal Unnao ** Unnao State (1) Pradesh Uttar Uttar Pradesh Uttar Uttarakhand Uttarakhand Uttarakhand Uttarakhand Uttarakhand Uttarakhand Uttarakhand Uttarakhand Uttarakhand Uttarakhand Uttarakhand Uttarakhand Uttarakhand Uttarakhand Bengal West Bengal West Bengal West Bengal West Bengal West Bengal West Bengal West Bengal West

104 TB India 2007 87% 87% 83% 83% 85% 87% 89% 89% 89% 89% 89% 87% 86% 86% 85% (17) 87% 86% 83% 82% 85% 84% 88% 89% 89% 88% 89% 86% (16) 83% 81% 81% 89% 90% 84% 88% 89% 90% 91% 90% 90% 91% 92% 89% (15) 89% 88% 87% 8% 3% 9% 7% 4% 3% 5% 4% 6% 3% 5% 4% 6% 5% 4% (14) 73 416 519 315 125 158 326 192 490 114 301 116 2748 9635 64697 840 247 571 369 601 754 534 356 746 290 1141 1258 8244 (13) 31932 190964 480 470 365 748 663 266 418 1045 1637 1025 1780 1002 7941 (12) 21113 183180 932 722 993 436 809 1474 1837 1706 1835 1756 1463 1499 (11) 21009 92138 400496 76% 67% 74% 65% 85% 62% 68% 59% 75% 55% 73% 63% 58% 59% 53% (10) 72% 79% 72% 72% 78% 72% 73% 87% 73% 70% 66% 79% 55% 111% 102% (9) 83 54 59 77 54 54 58 54 55 65 55 53 50 59 41 3018 1435 2899 2696 2541 3023 3663 2662 5213 1766 4066 1372 (8) 29899 553660 105108 82 168 115 144 156 122 119 125 114 155 105 118 125 141 103 (7) 6128 3044 7077 5494 3881 6819 7434 6137 4215 7751 3091 (6) 10907 70924 262138 1397498 8% (5) 15% 10% 14% 14% 12% 14% 11% 12% 12% 11% 10% 13% 15% 14% 26043 18715 36776 24696 27070 29904 43233 40640 52436 18247 41569 17455 (4) 267675 6224636 1028022 36 27 49 35 47 56 63 49 95 27 74 26 503 (3) 2522 11142 Koch Bihar ** Koch Kolkata ** Maldah East Medinipur West Medinipur Murshidabad Nadia 24 Parganas North South 24 Parganas Dinajpur Uttar (2) Puruliya Jalpaiguri ** Jalpaiguri Projected population based on census population of 2001 is used for calculation of case-detection rate. 1 lakh = 100,000 population case-detection rate. calculation of 2001 is used for population based on census of Projected cases retreatment cases and smear positive smear positive patients diagnosed include new Smear positive cases and ‘Others’ retreatment smear positive cases, extra-pulmonary new cases, smear negative new cases, sputum smear positive includes new treatment for patients registered Total during 4th quarter 2006 states that began implementing RNTCP for not expected rate Smear conversion after 4th quarter 2005 states that began implementing RNTCP for not expected are and success rate rate Cure Summary of performance of Tribal Districts Tribal of performance Summary of and Poor of performance Summary of Districts Backward Districts & Poor/Backward Districts † Tribal than 50% tribal population) ** Poor/Backward Districts (more * Tribal with other merged have in 2006 as they stopped reporting or have created been newly units have as these districts/reporting not expected are blank areas for 2007; Values till 25th February not reported NR indicate states have units reporting (Andaman & Nicobar, is 95; East Zone Uttarakhand) Uttar Pradesh, Punjab, Jammu & Kashmir, Himachal Pradesh, (Chandigarh, Delhi, Haryana, North Zone cases / lakh population based on ARTI data for Smear Positive Estimated New Zone Nadu ) is 75 and West Tamil Puducherry, Lakshadweep, Kerala, Karnataka, Pradesh, (Andhra Bengal) is 75; South Zone West Nagaland, Sikkim, Tripura, Mizoram, Meghalaya, Jharkhand, Manipur, Bihar, Assam, Arunachal Pradesh, Rajasthan) is 80; Orissa 85 Maharashtra, Pradesh, Madhya Daman & Diu, Goa, Gujarat, & Nagar Haveli, (Chhattisgarh, Dadra (1) Bengal West 1 2 3 4 5 West Bengal West Bengal West Bengal West Bengal West Bengal West Bengal West Bengal West Bengal West Bengal West Bengal West Bengal West total Grand

TB India 2007 105 263 4118 1382 5763 4716 24561 147 3106 HIV Negative Total 546 2315 1491 4352 2948 HIV 20263 Positive 96 310 HIV 9081 1185 1591 1219 Negative 30 653 Tamil Nadu Tamil 719 639 326 862 HIV 7338 1684 Positive 9 2 71 42 53 22 HIV 8 Negative 21 Nagaland 6 4 60 19 29 23 HIV Positive 6 3 1 8 10 101 HIV 9 Negative 26 Manipur 6 13 25 44 30 177 HIV Positive 33 507 138 678 586 HIV 2802 Negative 48 1041 Maharashtra 58 302 127 487 424 HIV 2851 Positive 69 499 186 754 600 HIV 2842 Negative 28 561 Karnataka 82 320 181 583 459 HIV 2175 Positive 62 703 HIV 9664 1912 2677 2281 Negative 24 (Reported by Phase-I States Implementing Joint TB-HIV Action Plan) 804 Referral of TB Suspects from VCTC to RNTCP diagnostic units, during 2006 Referral of TB Suspects from VCTC 70 Andhra Pradesh Andhra 942 513 HIV 7662 1525 1150 Positive b) Sputum Negative TB b) Sputum Negative TB c) Extra-Pulmonary diagnosed TB patients d) Total from VCTCs to RNTCP facilities* to RNTCP VCTCs from patients (d), number receiving patients (d), number receiving DOTS a) Sputum Positive TB a) Sputum Positive Total Population (In lakhs) Population Total TB suspects referred 1. Number of Total No. of districts No. of Total 3. Out of above total diagnosed TB above 3. Out of 2. Out of the above persons, number diagnosed as having TB: persons, the above 2. Out of * Includes TB suspects referred during 4th quarter 2005 and 3rd quarter 2006 during 4th quarter 2005 and 3rd * Includes TB suspects referred

106 TB India 2007

Sputum microscopic examination

Bringing back smiles with DOTS

Patient-wise boxes of drugs

A DOT provider

Central TB Divison Directorate General of Health Services Ministry of Health and Family Welfare Nirman Bhawan, New Delhi - 110011 http://www.tbcindia.org