World TB Day Slogans

World TB Day, falling on 24 March each year, is designed to build public awareness that tuberculosis today remains an epidemic in much of the world, causing deaths of several million people each year, mostly in the third world. 24 March commemorates the day in 1882 when Dr Robert Koch astounded the scientific community by announcing that he had discovered the cause of tuberculosis, the TB bacillus. At the time of Koch’s announcement in Berlin, TB was raging through Europe and the Americas, causing the death of one out of every seven people. Koch’s discovery opened the way towards diagnosing and curing tuberculosis, so this day is celebrated as World TB Day.

World TB Day 2017: Unite to End TB

2016: Unite to End TB

2015: Gear up to end TB

2014: Reach the 3 million

2013: STOP TB: in my lifetime

2012: STOP TB: in my lifetime

2011: ON THE MOVE AGAINST TUBERCULOSIS: Transforming the fight towards elimination

2010: On the move against tuberculosis: Innovate to accelerate action

2009: I am stopping TB: Fighting TB is the responsibility of every citizen

2008: I am stopping TB: Fighting TB is the responsibility of every citizen

2007: TB anywhere is TB everywhere

2006: Actions for life: towards a world free of tuberculosis

2005: Frontline TB Care providers: heroes in the fight against tuberculosis

2004: Every breadth counts – Stop TB now

2003: DOTS cured me – it will cure you too

2002: Stop TB, fight poverty

2001: DOTS: TB Cure for all

2000: Forging new partnerships to Stop TB

1999: DOTS: Key to success

1998: DOTS success stories and also TB disaster stories

1997: Use DOTS more widely

This Publication can be obtained from:

Central TB Division Directorate General of Health Services, Ministry of Health and Family Welfare, Nirman Bhawan, New Delhi 110108 http://www.tbcindia.gov.in March 2017

© Central TB Division, Directorate General of Health Services

Printed By: Shree Ganesh Associates LokLF; ,oa ifjokj dY;k.k ea=h Hkkjr ljdkj Minister of Health & Family Welfare Government of India

txr izdk'k uM~Mk Jagat Prakash Nadda FOREWORD

ABBREVIATIONS

ACSM Advocacy, Communication and EQA External Quality Assessment Social Mobilization GMSD Government Medical Store Depot AIDS Acquired Immune Deficiency GoI Government of India Syndrome GFATM The Global Fund to Fight against AIIMS All India Institute of Medical AIDS, Tuberculosis and Malaria Sciences H Isoniazid ANSV Annual Negative Slide Volume HBCs High Burden Countries ART Anti-Retroviral Therapy HIV Human Immuno Deficiency Virus ARTI Annual Risk of Tuberculosis Infection HRD Human Resource Development ASHA Accredited Social Health Activist IAC IEC Advisory Committee CBCI Catholic Bishop’s Conference of ICB International Competitive Bidding India ICMR Indian Council of Medical Research CGHS Central Government Health ICTC Integrated Counselling and Testing Scheme Centre CHAI Clinton Health Access Initiative IEC Information, Education and CHC Community Health Centre Communication CII Confederation of Indian Industries IMA Indian Medical Association CTD Central TB Division IPT Isoniazid Preventive Therapy DALYs Disability Adjusted Life Years IUALTD International Union Against Tuberculosis and Lung Disease DBS Domestic Budgeting Source JMM Joint Monitoring Mission DDG Deputy Director General LT Laboratory Technician DGHS Director General of Health Services MDGs Millennium Development Goals DMC Designated Microscopy Centre MDRTB Multi Drug Resistant DOTS Directly Observed Treatment Short Course MIS Management Information System DST Drug Susceptibility Testing MO Medical Officer DTC District Tuberculosis Centre MoHFW Ministry of Health and Family Welfare DTO District Tuberculosis Officer MOTC Medical Officer-Tuberculosis DRS Drug Resistance Surveillance Control DRTB Drug Resistant Tuberculosis MoU Memorandum of Understanding E Ethambutol NACO National AIDS Control Organisation EPTB Extra-pulmonary Tuberculosis TB India 2017

NACP National AIDS Control Programme R Rifampicin NCDC National Centre for Disease Control RBRC Random Blinded Re-Checking NEP New Extra Pulmonary RCH Reproductive and Child Health NGO Non Governmental Organisation RNTCP Revised National Tuberculosis NIRT National Institute of Research in Control Programme Tuberculosis S Streptomycin NRHM National Rural Health Mission SDS State Drug Store NRL National Reference Laboratory SHGs Self Help Groups NSN New Smear Negative SOP Standard Operating Procedure NSP New Smear Positive SPR Slide Positivity Rate NTF National Task Force STC State TB Cell NTI National Tuberculosis Institute STDC State Tuberculosis Training & NTP National Tuberculosis Programme Demonstration Centre NUHM National Urban Health Mission STF State Task Force OR Operational Research STLS Senior TB Laboratory Supervisor OSE On-Site Evaluation STO State TB Officer PHC Primary Health Centre STS Senior Treatment Supervisor PHI Peripheral Health Institution TB Tuberculosis PLHIV People Living with HIV and AIDS TU Tuberculosis Unit PP Private Practitioner UHC Urban Health Centre PPM Public-Private Mix USAID United States Agency for International Development PSU Public Sector Unit WHO World Health Organization PTB Pulmonary Tuberculosis WVI World Vision India IRL Intermediate Reference Laboratory XDR-TB Extensively Drug Resistant TB PWB Patient-Wise Box Z Pyrazinamide QA Quality Assurance ZTF Zonal Task Force

xiv CONTENTS

Chapter Content Page No. Number Executive summary and Forewords 1 Activities Underaken in 2016 1 2 TB disease burden in India 7 3 RNTCP Implementation Status 11 3.1 Diagnosis and Case Finding 13 3.2 Treatment Services 20 3.3 New Initiatives 25 4 TB Surveillance in India 27 5 Public Private Partnership 35 6 Planning Under RNTCP 47 7 Budgeting & Finance 53 8 Procurement & Supply Chain Management 59 9 Advocacy, communication and Social Mobilisation 65 10 Research 77 11 Monitoring &Evaluation 81 12 Success Stories 87 13 Human Resource 95 14 Infrastructure 99 15 RNTCP case finding and treatment outcome Performance, 1999-2016 103

EXECUTIVE SUMMARY

This Annual TB Report (TB India 2017) Single window delivery of HIV-TB services was provides an update on services provided expanded at all Anti-retroviral Treatment (ART) through the year under Revised National TB centres in the country. Along with it, ICT enabled Control Programme (RNTCP) and progress / treatment adherence support system (99 status of initiatives implemented in 2016. DOTS) was also extended for HIV-TB patients. E-NIKSHAY development and field testing began in Gujarat and Maharashtra. The programme The RNTCP, was launched in 1997 revised its Technical and Operational guidelines and expanded across the country in a phased with revision in diagnostic algorithm, change to manner. Nation-wide coverage was achieved in daily regime strategy and improved surveillance March 2006. Since inception, the programme systems. has treated more than 20 million TB patients. The programme aims to achieve ‘Universal Access’ for quality diagnosis and treatment The programme conducted key capacity for all TB patients in the country. This entails building activities for use of daily regimen sustaining the achievements of the programme for treatment of TB, CBNAAT laboratory roll to date, and extending the reach and quality of out, cartridge management , introduction services to all persons diagnosed with TB. of bedaquilline and implementation of revised technical and operational guidelines. Notifications from private health care providers Based on the newer in-country evidences, have enhanced through UATBC interventions, the Government of India together with the Project AXSHYA and state level efforts. World Health Organisation (WHO) revised the Nationwide large scale advocacy efforts were National TB estimates upwards. Accordingly, an made through Call to Action project. estimated 28 lakh incident TB patients occurred in a year (Global TB Report 2016). The revised estimates are based on data from various The programme was reviewed on the sources including sub-national prevalence PRAGATI platform by the Hon’ble Prime Minister surveys and enhanced TB notification from the with all the State / UTs and also subsequently private sector. The RNTCP notified 17.5 lakh TB by the Prime Minister’s Office (PMO) , reflecting patients in 2016 including both from public and politico-administrative commitment towards TB private health sector and 33,820 drug resistant control efforts. The programme identified 100 TB patients are notified additionally. priority districts for intensified efforts based on the recommendations from the PMO. Taking In 2016, the programme has expanded an edge forward, the program is developing its TB care services and made landmark changes in National Strategic Plan for TB elimination in India the strategy of diagnosis and treatment of TB. An (2017-25), five years ahead of the Sustainable additional 500 CBNAAT machines were installed Development Goals (SDGs). through the year, expanding the rapid molecular diagnostic facilities to 628 laboratories. The subsequent chapters in this report bring out details of implementation status, A new drug Bedaquiline was introduced various initiatives and activities undertaken for treatment of MDR-TB at 6 identified sites. during the year 2016.

xvii TB India 2017

Activities Undertaken in 2016 Chapter 1

1

TB India 2017

Activities Undertaken in 2016 Chapter 1

January March

1. Revised National Tuberculosis Control Program 1. World TB Day was observed on 21 March. (RNTCP) modular training was organised On the day, Shri J P Nadda, Union Minister of from 11 to 23 January at National Institute of Health and Family Welfare launched; Tuberculosis and Respiratory Diseases (NITRD), . Roll out of 500 additional CBNAAT New Delhi machines

2. A Training of Trainers (TOT) for introducing . New drug – Bedaquiline for treatment of daily regimen was organised on 12 and 13 drug TB January at Trivandrum, Kerala and on 22 and 23 . Third line ART Programme for People January at Patna, Bihar Living with HIV

3. Central Internal Evaluation of the RNTCP was On the same event, following guidelines were released undertaken from 18 to 22 January in the State of . Technical and operational guideline Bihar . Guideline for implementation of 4. National Training of Trainers (ToT) on Bedaquiline Conditional Access bedaquiline was organised from 5 to 8 January Programme at NTI, Bangalore . Guideline for prevention and management of adverse drug reaction February . Handbook of Health worker Surveillance 1. A Training of Trainers (TOT) for introducing for TB in India daily regimen was organised on 8 and 9 February in Shimla, Himachal Pradesh 2. State level training of trainers for implementation of Bedaquilline CAP under Programmatic 2. National Task Force meeting cum workshop was Management of Drug-resistant TB (PMDT)- organised on 15 and 16 February at Trivandrum, RNTCP was organized in the months of Kerala February and March in Mumbai, Ahmedabad, Chennai, Delhi and Gauwhati 3. Media Campaign on RNTCP from February onwards, which included various awareness April activities through outdoor publicity TV and Radio. 1. An expert committee meeting was organised on 11 April to examine type of drug regimen for 4. Eleventh Global meeting on Public-Private Mix drug sensitive TB under RNTCP TB care and prevention was organised from 29 Feburary to 2 Mar at Mumbai 2. Central Internal Evaluation was undertaken 5. The Global Fund Country Team Mission was from 18 to 22 April in the state of Arunachal undertaken from 9 to 13 February Pradesh

3 TB India 2017

3. Supervisory visit was undertaken from 18 to 22 2. Training of Trainers (ToT) for Technical and April in the districts of West Champaran and Operational Guidelines (TOG) for RNTCP was Gaya of the state of Bihar organised from 13 to 17 June at NTI Bangalore

4. Lab Monitoring visits were undertaken from 6 3. Regional Programmatic Management of Drug- to 8 April in the state of Madhya Pradesh resistant TB (PMDT) review of north zone states was organised from 8 to 10 June at Chandigarh 5. Workshop and meeting regarding implementation of daily regimen was organised 4. Consultative meeting with STOs for selection of on 13 April in 5 states at New Delhi. high priority districts was organised on 22 June in New Delhi 6. Audit of the Global Fund Grant to the Republic of India was undertaken by The Office of The July Inspector General, The Global Fund, Geneva 1. Research and academia conclave towards TB 7. Review and update on UATBC was organised on free India was organised on 9th July at Mumbai 7 April in New Delhi 2. Launch of Pediatric TB project on 9 July in 8. National TB prevalence meeting was organised Nagpur related to “ Accelerating access to quality from 27 to 29 April in Bangalore TB care for Pediatric TB” 3. CDC FIND meeting for piloting of EQA of May CBNAAT on 11 July at Mumbai

1. Modular training on RNTCP was organised from 4. Training of Trainers (ToT) for Technical and 2 to 14 May at National Institute of Tuberculosis Operational Guidelines for RNTCP from 11 to and Respiratory Diseases (NITRD), New Delhi 15 July at NTI, Bangalore

2. Review meeting of States implementing BDQ- 5. A meeting to track the progress of the ICT based CAP was organised on 9th May at New Delhi treatment adherence system, 99 DOTS, was organised on 22 July at New Delhi 3. Concurrent assessment of Universal Access to TB Care initiative (UATBC) project was undertaken 6. Teleconference on introduction of “Delamanid” from 16 to 21 May at Mehsana, Patna & Mumbai in India was organised on 12 July

4. Review of RNTCP on PRAGATI platform was 7. The Global Fund Country Team Mission was undertaken by Hon’ble Prime Minister with organised from 30 July to 03 August Chief Secretaries of all states on 25 May August 5. National Workshop on TB prevalance survey in India was organised from 10 to 12 May at New 1. BRICS (Brazil, Russia, India, China and South Delhi Africa) meeting for strengthening of Health surveillance system and best practices was June organised on 2 August

1. Training of Trainers (ToT) for rolling out of 2. Dissemination workshop on release of extra- daily regimen in the state of Maharashtra was pulmonary TB Guidelines (Index TB Guidelines) organised on 8 & 9 June in Pune was organised on 9 & 10 Aug

4 TB India 2017

3. Joint partners meeting to review Mumbai RNTCP on 6 October mission for TB control & bedaquiline CAP implementation was organised on 16th Aug in 2. Consultative meeting for the development of Mumbai National Strategic Plan for TB Control in India 2017-22 on 18 and 19 Oct 4. Regional workshop on introduction of new 3. National Technical Working Group for HIV/TB drugs and regimen for DRTB in SEAR was meeting was held on 14 October organised on 18 and 19 Aug at New Delhi

5. State Tuberculosis Officer (STOs)/ Consultant’s November review meeting was organised from 22 to 24 Aug at Hyderabad 1. Cartridge management training was organised from 28 Nov to 2 Dec at NTI, Bangalore September 2. Zonal Task Force South Zone meeting was 1. Central Internal Evaluation of the RNTCP was organised from 30 November to 03 December at undertaken from 29 Aug to 02 Sep January in Puducherry the state of Himachal Pradesh 3. Consultative meeting on Roll out of “Payment 2. Programmatic Management of Drug-resistant for Results” Model under The Global Fund Grant TB (PMDT) review meeting of North East Zone at Geneva was organised from 9 to 11 November was organised from 13 to 15 Sep December 2016 3. National Reference Laboratory (NRL) coordination meeting was organised on 20 & 21 1. Zonal Task Force South Zone II meeting Sep at Bhubaneswar organised on 1 and 2 Dec at Puducherry 2. Zonal Task Force West Zone meeting organised 4. TOG training for STO and Consultants was on 22 and 23 Dec at Ahmedabad conducted from 19 to 23 Sep at NTI, Banglore 3. Consultative meeting on drafting Guidance 5. Consultatve meeting with Partners on daily Document on Nutritional Support for TB regimen on on 29-30 Sep at Gaya patients held on 30 Dec

6. PVPI causality assessment workshop organised 4. Sensitization of STOs of 18 states / UTs on from 6 to 9 Sep at New Delhi Active Case Finding Campaign through video conference on 14 Dec 7. Review of DTO of Bihar regarding Daily regimen & Partnerships 5. Drug Safety & Monitoring Committee meeting was organised on 5 Dec in New Delhi 8. The Global Fund Country Team Mission was organised from 26 September to 05 October 6. The Global Fund Country Team Mission was organised from 5 to 14 December 2016 October 7. Workshop on revision of guidelines of PMDT 1. National Expert Committee Meeting on to align with WHO PMDT guidelines from 19 Diagnosis & Management of Tuberculosis under to 21 Dec

5

TB India 2017

TB Disease Burden in India Chapter 2

7

TB India 2017

TB Disease Burden in India Chapter 2

India accounts for one fourth of the global TB burden. the mortality due to TB has reduced from 56 per lac In 2015, an estimated 28 lakh cases occurred and 4.8 per year in 2000 to 36 per lac per year in 2015. lakh people died due to TB. The table below shows the estimated figures for TB burden globally and for Moreover, these revisions are interim in nature, with India reported in WHO Global TB Report for the further changes likely when India conducts its first year 2015 national tuberculosis prevalence survey in 2017–18. (source Global TB Report, 2016) Estimates of TB Burden Global India (2015) Incidence Incidence TB cases 104 lakh 28 Lakh Mortality of TB 14 lakh 4.8 lakh Incidence HIV TB 11.7 lakh 1.1 lakh Mortality of HIV-TB 3.9 lakh 37,000 MDR-TB 4.8 lakh 1.3 lakh

India has highest burden of both TB and MDR TB based on estimates reported in Global TB Report 2016. An estimated 1.3 lakh incident multi-drug resistant TB patients emerge annually in India which includes 79000 MDR-TB Patients estimates among notified pulmonary cases. India bears second highest number of estimated HIV associated TB in the world. Mortality An estimated 1.1 lakh HIV associated TB occurred in 2015 and 37,000 estimated number of patients died among them.

The estimates of TB for India has been revised upwards based on the newer evidences gained. This apparent increase in the disease burden reflects the incorporation of more accurate data. With backward calculations, both tuberculosis incidence and mortality rates are decreasing from 2000 to 2015.

The incidence of TB has reduced from 289 per lakh per year in 2000 to 217 per lakh per year in 2015 and

9

TB India 2017

RNTCP Implementation status Chapter 3

11

TB India 2017

RNTCP Implementation status Chapter 3

3.1 Diagnosis and Case Finding activities and also impart periodic training for the IRL staff in EQA sputum smear microscopy, Culture Diagnosis of Tuberculosis is done primarily using & DST, LPA and CB NAAT. Smear Microscopy and by rapid molecular test (CB NAAT) in selected key population e.g Pediatric, TB- Human Resource comprising of three microbiologists HIV and Extra-pulmonary Tuberculosis. RNTCP and four laboratory technicians have been provided has three tier laboratory network for diagnosis of by the RNTCP on a contractual basis to each NRL for Tuberculosis including Drug Resistance TB. supervision and monitoring of laboratory activities. For the purpose of supervision and technical support, National Reference Laboratories (NRL): the states are assigned to each NRL. The NRL There are six NRLs under the programme. These microbiologist and laboratory supervisor / technician

are National Institute for Research in Tuberculosis of NRLs visit each assigned state at least once a year (NIRT), Chennai; National Tuberculosis Institute for 2 to 3 days as a part of on-site evaluation under (NTI) Bangalore; National Institute of TB & the RNTCP EQA protocol. Respiratory Diseases (NITRD) Delhi, and National Japanese Leprosy Mission for Asia (JALMA) Institute Intermediate Reference Laboratory (IRL): One of Leprosy and other Mycobacterial Diseases, IRL has been designated at the STDC / Public Health Agra., Regional Medical Research Centre (RMRC), Laboratory /Medical College of the respective state. Bhubaneswar and Bhopal Memorial Hospital and In larger states like Uttar Pradesh, Madhya Pradesh Research Centre, (BMHRC), Bhopal. The NRLs work and Maharashtra two IRLs have been designated. The closely with the IRLs, monitor and supervise the IRL’s functions of IRL include supervision and monitoring

13 TB India 2017

NRL States and Union Ter- Total nos. of IRLs Total nos. of states/ No of OSE conducted ritories (UTs) Assigned assigned UTs assigned during the year (2016) for EQA NTI, Bangalore Karnataka, Maharashtra, 5 3 0 Rajasthan NIRT , Chennai Tamil Nadu, Puducherry, 5 9 2 Kerala, Gujarat, Anda- man & Nicobar, Telan- gana, Andhra Pradesh Dadar & Nagar Haveli, Daman & Diu, Lakshad- weep NITRD, New Delhi, Jammu & Kash- 8 7 6 Delhi mir, Chandigarh, Punjab Haryana, Bihar, Himachal Pradesh JALMA, Agra Uttar Pradesh, Uttara- 3 2 1 khand RMRC, Bhu- Odhisa, Meghalaya, As- 6 10 2 baneswar sam, Tripura, West Ben- gal, Sikkim, Arunachal Pradesh, Manipur, Nagaland, Mizoram BMHRC, Bhopal Madhya Pradesh, Chhat- 4 4 4 tisgarh, Jharkhand, Goa of EQA activities, providing Mycobacterial Culture for early diagnosis of MDR-TB and TB in high risk and DST services and training of STLS/LTs. The population e.g Presumptive TB cases in PLHIV, IRL ensures proficiency of staff in performing smear EP-TB and Pediatric populations. The CB NAAT microscopy activities by providing technical training machines have been placed at most of the districts in to district and sub-district laboratory technicians and the country at headquarter or Medical College, ART- STLSs. The IRLs undertake on-site evaluation to each Center or major Pediatric hospitals. The existing district in the state, at least once a year, during which staff deployed at these health care centers performs the STLSs are panel tested. activities related to the CB NAAT. The CB NAAT sites send the report to the respective hospitals/referral Culture and DST Laboratories(C & DST): In center and compiled report is sent to IRLs and NRLs. additional to IRLs, the programme also involves the Microbiology Department of Medical colleges for Designated Microscopy Centre (DMC): The providing diagnostic services for drug resistance most peripheral laboratory under the RNTCP Tuberculosis, Extra-Pulmonary Tuberculosis (EP-TB) network is the DMC which serves a population of and research. The RNTCP has provided additional around 100,000 (50,000 in tribal and hilly areas). human resources, equipments and trainings to C & EQA is implemented at all districts in the country. DST laboratories. For quality improvement purposes, the NRL OSE recommendations to IRLs and districts are discussed CB NAAT (Cartridges Based Nucleic Acid in the RNTCP laboratory NRL coordination Amplification Test) Laboratories: RNTCP has committee meetings and National Expert Committee deployed the CB NAAT machines across the country for Diagnosis and Management of Tuberculosis.

14 TB India 2017

Quality improvement workshops for the State level Dibrugarh, DMRC Jodhpur and RMRC- TB officers and laboratory managers are conducted Jabalpur) at NRLs based on the observations of the NRL-OSEs. • 3 Private laboratories (CMC-Vellore, Microcare- These workshops focus on issues such as human Surat and SVIMS-Tirupati) resources, trainings, AMC for binocular microscopes, quality specifications for ZN stains, RBRC blinding Liquid Culture Certification: 34 laboratories and coding issues, bio-medical waste disposal, certified by RNTCP for liquid culture include: infection control measures etc. • 4 NRL (NTI, Bangalore, NIRT-Chennai, JALMA The National Expert Committe on Diagnosis - Agra and NITRD-New Delhi) and Managment of TB under RNTCP: provides technical guidelines for diagnosis and management • 17 IRLs (Ahmedabad, Kolkata, Nagpur, Delhi, of all forms of Tuberculosis. Trivandrum, Puducherry, Bangalore, Pune, Indore, Chennai, Cuttack, Guwahati, Lucknow, At present under the program there are 68 RNTCP Hyderabad, Patiala, Ajmer and Ranchi) certified Culture and DST laboratories in the country • 6 Medical Colleges (SMS Jaipur, MPSMS which includes laboratories from Public sector (IRL, Jamnagar, JJ Mumbai, AIIMS Medicine, PGI Medical College), Private and NGO laboratories. Chandigarh and BHU Varanasi) RNTCP also encourages the Laboratories from • 5 Private laboratories (Metropolis, SRL- Medical Colleges, ICMR, Private sector and NGO Mumbai, SRL –Kolkata, Shankar Nethralaya- sector to apply for certification by providing technical Chennai and Infexn –Thane, Mumbai) assistance and training of the human resources at • 1 NGO Laboratories (P D Hinduja- Mumbai) National Reference Laboratories. • 1 Govt. laboratory – GTB Sewree, Mumbai Solid Culture Certification: 46 laboratories certified for solid C & DST includes: Proficiency testing for liquid culture is ongoing for other IRLs and C & DST labs for certification. • 6 NRLs (NTI-Bangalore, NIRT-Chennai, RNTCP envisages establishing 40 TB containment JALMA-Agra, NIRTD- New Delhi, BMHRC- laboratories for liquid culture as per laboratory scale Bhopal and RMRC-Bhubaneswar) up plan for liquid culture in selected Intermediate Reference laboratories and C & DST laboratories at • 22 IRLs (Hyderabad, Raipur, Delhi, Ahmedabad, Medical Colleges. Karnal, Ranchi, Thiruvananthapuram, Goa, Nagpur , Indore, Dharampur , Cuttack, Line probe Assay (LPA): 54 LPA laboratories Puducherry, Ajmer , Lucknow, Kolkata, certified by RNTCP include: Dehradun, Chennai, Pune, Jammu , Srinagar and Patiala) • 6 NRLs (NTI-Bangalore, NIRT-Chennai, • 6-Medical colleges (PGIMER-Chandigarh, JALMA -Agra, BMHRC-Bhopal and NITRD- AIIMS-Dept. of Medicine-New Delhi, JJ New Delhi, RMRC Bhubaneswar) Hospital-Mumbai, SMS- Jaipur and MGIMS- • 24 IRLs (Guwahati, Hyderabad, Delhi, Wardha, MPSMS, Jamnagar) Dehradun, Ahmedabad, Karnal, Raipur , • 5 NGOs (BPHRC-Hyderabad, Choithram Ranchi, Thiruvananthapuram, Nagpur, Pune , Hospital - Indore and DFIT Nellore, MGIMS- Patna, Indore , Cuttack, Chennai, Puducherry, Wardha, SVIMS-Tirupati) Ajmer, Kolkata, Lucknow, Dharampur, • 4 -ICMR institutes (RMRC-Port Blair, RMRC Bangalore , Agra, Srinagar and Patiala )

15 TB India 2017

• 17 Medical Colleges (Aurangabad, Puducherry, Guwahati, Indore, Kolkata, Lucknow, Vishakhapatnam, AIIMS- Dept. Of Medicine- Bangalore),6 Medical colleges (Jamnagar, JJ Mumbai, New Delhi , Govt. Med. College-Jamnagar, JJ AIIMS Medicine, SMS Jaipur, PGI Chandigarh, BHU Hospital-Mumbai , SMS- Jaipur, SNM-Jodhpur, Varanasi) and NG0- P D Hinduja and Private-SRL NBMC-Silliguri, PGI Chandigarh KIMS Hubli, Mumbai). All states are currently implementing BHU Varanasi, AMU Aligarh, AIIMS-Dept. of baseline second line DST for all diagnosed MDRTB Laboratory Medicine-New Delhi ,GTB Sewree cases as per RNTCP policy. Mumbai, JLNMCH Bhagalpur, GMC Raichur and GMC Madurai) National Reference Laboratories • 5 NGOs (DFIT-Dharbanga, DFIT-Nellore, Coordination Committee Meeting: CTD BPHRC-Hyderabad, Nazerath-Shillong and P convenes the NRL coordination meetings to update on D Hinduja- Mumbai) ,2 private laboratories the laboratory issue, newer development, discussing (Metropolis-Mumbai and Subharti Medical finding on on-site evaluation visit of IRLs and C & DST College, Meerut) labs, study finding, and deliberate on coordination issue with state and IRLs as per RNTCP plan. NRL Coordination Committee Meeting was held on 20th Performance of line Probe Assay in 2016 -21st September 2016 at RMRC Bhubaneswar. The No of test No of sensitive to both No of resistance to INH No of resistance to Rifampicin No of MDR-TB 1,00,885 71,449 9,643 2,695 12,037

Second Line DST (SLD): Currently, 27 discussions included: Updates on the TOG, Roles and laboratories have been certified for performing responsibilities of the NRL and stewardship for DR- SLDST and other laboratories in the process of being TB services, SLDST and inclusion of drugs for panel certified. Baseline 2nd line DST services are provided testing, Recording and reporting (EQA, Quarterly across the country by linking States and UTs to Performance), Training and Retraining plan and on- these certified laboratories. The laboratories that site training, Monitoring, Supervision, CB NAAT, are certified include 5 NRL (NIRT-Chennai, NTI- reporting and Annual Maintenance Contract (AMC) Bangalore and NIRTD-New Delhi, JALMA Agra, for lab equipment. The team also had the discussion RMRC Bhubaneswar) 14 IRL (Ajmer, Trivandrum, on the development of laboratory components of the Cuttack, Delhi, Pune, Chennai, Nagpur, Ahmedabad, National Strategic Plan from identification of newer

NRL Coordination Committee Meeting at Bhubaneshwar on September 2016 16 TB India 2017

labs, technology introduction, human resource and others

Trainings: RNTCP’s National Reference Laboratories conducts trainings of Microbiologist, Senior Laboratory Technician and Laboratory Technician in modular training in solid culture DST, EQA in sputum smear microscopy, Liquid Culture DST, Second Line DST, Preventive maintenance of Microscope. In, The current year all NRLs National, supervised by them Regional and On-site training for states. Progress of drug resistant TB diagnosis along with expansion of CBNAAT laboratory to these high sensitive rapid molecular diagnostic test for TB.

Currently, CBNAAT is used for;

• Diagnosis of drug resistant TB among previously treated TB patients, patients with smear microscopy positive result at any time during treatment, HIV-TB patients and TB patients who are contact of MDR-TB patients. • Diagnosis of TB among children, PLHIV, extra Onsite LC-DST Training at IRL Kolkata - 16-20 Aug 2016 pulmonary presumptive TB patients and person with Chest X-Ray suggestive of TB with smear New initiatives in laboratory services negative result. under RNTCP No of No of Test No of No of Rifampicin Expanding CBNAAT Services Across the machines performed MTB Resistant-TB Country: detected detected The time to diagnosis of TB and Drug Resistant TB 628 578173 221603 27822 has been significantly reduced with the availability of Cartridge Based Nucleic Acid Amplification With increase in CBNAAT laboratory network, there Testing, which is a rapid molecular assay that detects is exponential increase in drug resistant TB case M. tuberculosis and Rifampicin resistance. The test finding. In 2016, more than 33,820 drug resistant TB is fully automated and provides results within two patients diagnosed as compared to 29,057 in 2015. hours. Second line LPA Validation: RNTCP has In 2016, the RNTCP established 500 additional completed Validation of LPA for detecting resistance CBNAAT laboratories across country. With this to Fluoroquinolones, Aminoglycosides (Kanamycin, expansion of laboratory network, now, the country Amikacin) and Cyclic Peptides (Capreomycin) in has 628 CBNAAT laboratories linking every districts Programme Setting in India using MTBDRsl® test

17 TB India 2017

(Hain Life science).The study sites, NIRT Chennai, JJ Hospital Mumbai and IRL Ahmedabad have NITRD-Delhi, NDTBC-Delhi, IRL Ahmedabad and undertaken DST to extended panel of second line JJ hospital, Mumbai have completed the procedures drugs. All laboratories certified for second line DST and the interim results were submitted to the National will provide services for expansion of Bedaquiline Expert Committee. The National Expert Committee CAP across the country. has endorsed the use of Second line LPA for use under RNTCP. It is planned to conduct the National Laboratory Expansion Under RNTCP: Fifteen and regional level training for SL-LPA for roll-out laboratories were identified to be upgraded with across country from April 2017. containment facility and Liquid Culture systems under the New Funding Model of the Global Fund Technical and Operational Guidelines: Grant. Assessment visits to these laboratories RNTCP has revised it technical and operational have been completed and the upgradation will be guidelines and made significant changes in case completed by December 2017. In addition, two finding and diagnostic strategies. The key changes facilities have also been identified one each for Whole include the revision of diagnostic algorithm which Genome sequencing and Pyrosequencing. offer early use of chest X-Ray and CBNAAT for smear negative presumptive TB patients. Another important addition of strategy is Systematic Active TB Case Moving towards NABL accreditation: RNTCP Finding in special settings over and above passive and considers the quality assurance as a priority and as intensified TB case finding strategies which followed per the WHO global policy, plans to move towards under the programme. ISO:11002 accreditation. RNTCP as a part of first initiatives conducted the stakeholders meeting on Bedaquiline Conditional Access Programme: 14th November 2016 of NRLs, State TB Officers, For the introduction of Bedaquiline CAP, laboratory NARI, Microbiologist for formulating the plan for confirmation of drug resistance to additional second moving towards NABL accreditation with support line drugs as well as more frequent follow up cultures of FIND India under New Funding Model of Global is a prerequisite. The laboratories at NITRD New Fund. The follow-up meeting of NABL assessors and Delhi, NDTB Centre, IRL Guwahati, NIRT Chennai, site visits is planned as a part of next activities.

Stakeholders meeting for initiating preparatory activities towards NABL accreditation of select TB C&DST Laboratories at Pune, Maharashtra 18 TB India 2017

CBNAAT External Quality Assessment: National Drug Resistance Survey (NDRS): External Quality Assessment for CBNAAT is being The RNTCP has successfully competed drug planned to be rolled out in the country. As a first resistance surveillance across 120 TUs across the step, two master trainers have been trained at CDC country. The team from Central TB Division, World Atlanta for developing dried spot panels for testing Health Organization and other experts held detailed in CBNAAT. As a next step panels will be prepared discussion on the findings. The survey report will be in-house, pilot tested at laboratories in Mumbai and submitted in the standard WHO format by NTI after based on the experience gained expanded to the rest incorporating suggestions made by the team. The of the country. report of the NDRS will be released in the year 2017.

Team of National Drug Resistance Survey from NTI, Bengalore

19 TB India 2017

3.2 Treatment Services • The dose of drugs is according to body weight. It means that the patients will get appropriate The National Tuberculosis Programme of India dosages as per body weight. (NTP) was initiated in 1962 which was revised in • Fixed Dose Combination (FDC) tablets will be 1997 as Revised National Tuberculosis Control Programme (RNTCP) that used WHO recommended used which will reduce pill burden DOTS (Directly Observed Treatment, Short-course • Treatment regimen is likely to be more effective chemotherapy) strategy. Countrywide coverage with lesser relapses. This is expected to reduce was achieved in March, 2006. Since inception till drug resistance with greater compliance December 2016, more than 2 crores patients were initiated on treatment and more than 35 lakhs • For children, child friendly formulations as additional lives have been saved. dispersible tablets • Use of Information Communication Technology In March 2016, RNTCP revised its technical and (ICT) enabled treatment adherence support operational guidelines. The major additions reflected system in terms of strategies in treatment of TB are: • Regimen is acceptable to all health care providers • Daily regimen for treatment of TB • Use of Bedaquiline for treatment of drug Programmatic Management of resistant TB with Drug susceptibility testing Drug Resistant TB services (DST) guided treatment • ICT based adherence support and India began services for diagnostic and treatment services for multi-drug resistant TB (MDR-TB) • post treatment follow up. in 2007 and achieved complete coverage in 2013. Introduction of Daily Regimen for Till 2016, 1,39,369 persons with MDR-TB/ RR TB treatment of Drug Sensitive TB diagnosed and 1,26,136 (91%) patients were put on under RNTCP treatment under RNTCP.

Revised National TB Control Programme is changing Introduction of newer anti-TB drug – treatment strategy from Intermittent to Daily Bedaquiline: The new drug Bedaquiline has been Regimen in phased manner. To begin with, it has introduced at six sites in 5 states in the country in been initiated in 5 states – Bihar, Himachal Pradesh, march 2016. The drug has been a novel one introduced Kerala, Maharashtra and Sikkim covering 27 crore after 40 years. The drug currently is used under population of the country. Subsequently, remaining RNTCP for MDR/RR-TB patients with resistance to states will be covered by October 2017. Features of the fluoroquinolone and/or second line injectable, mixed daily regimen treatment strategy will be as follows: pattern of drug resistance. • The drugs will be given daily

Features of daily regimen of treatment of TB under RNTCP

20 TB India 2017

The programme has started planning on expansion of use of this new drug along with drug susceptibility testing guided treatment in other parts of the country.

Launch of new drug - Bedaquiline for treatment of DRTB under RNTCP at Guwahati

The Bedaquilline is used along with optimum background regimen designed based on drug susceptibility testing. Being a new drug, the RNTCP has established drug safety monitoring committee at the national level following recommendations of Global guidelines on use of Bedaquilline. A system of cohort event monitoring has been established at all sites to systematically report and monitor adverse drug reactions. Till December 2016, more than 207 drug resistant TB patients have been initiated on Bedaquiline containing treatment.

21 TB India 2017

Treatment services in TB-HIV single window delivery of services from all ART co-infected patients centres. The strategy focuses on comprehensive nterventionsto reduce the burden of TB among With collaborative efforts of the RNTCP and the People living with HIV/AIDS (PLHWA) from single National AIDS Control Organization (NACO) window service delivery at ART Centres. A package effective management of these dual infections are of services includes intensified TB case finding ensured. More than 88% TB patients registered by through screening by four symptom complex, rapid RNTCP tested for HIV and 90% of HIv infected TB diagnosis of TB among PLHIV with CBNAAT, patients received anti-retroviral treatment (ART) and Fixed Dose Combination daily treatment for TB, co-trimoxazole prophylaxis therapy (CPT). INH preventive therapy for prevention of TB among PLHIV, ICT enabled adherence support through 99 In 2016, India has expanded ‘Intensified TB DOT, Airborne Infection Control measures at ART case finding and appropriate treatment’ through centers and implementation of pharmacovigilance by establishing adverse drug reaction monitoring centres at ART centres.

Launch of single window delivery of HIV-TB care at ART centre, Indira Gandhi Medical College and Research Centre, Puducherry

Intervention package for TB care at ART centres

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ICT enabled adherence support - org from their computer / mobile (using Nikshay 99DOTS username and password) to see the patient adherence (as seen in figure below). Customized SMS reminders RNTCP has started using ICT enabled solutions for are also sent to patients and government healthcare patient centric adherence support. One among the staff (e.g. TBHV, STS) to alert missed doses and successor is 99 DOTS. It was first used under the trigger additional counseling. Senior District / State programme in 2015 in high-burden ART centers for TB-HIV co-infected patients along with use of daily / Country level program staff can also get actionable fixed-dose combination (FDC) medications. In 2016, reports for all patients. RNTCP expanded this ICT based adherence system to HIV-TB patients at all ART Centers in India.

99DOTS is an innovation that seeks to address issue of adherence by using basic mobile phones and augmented packaging for medication.

As illustrated, the approach utilizes a custom envelope into which each pack of medication is inserted and Patient adherence status on 99 DOTS website sealed.

The platform empowers staff with daily information about their patients’ adherence and allows them to use differentiated care to counsel those patients who need it the most. Similarly, patients are empowered to take their medication independently, and receive immediate outreach if they start to waver in adherence. When the patient takes out medication from the blister pack, the pills also break through perforated 99DOTS is also being integrated with Nikshay, flaps on the envelope. On the back side of each flap e-Nikshay and other patient management systems so is a hidden number. Patients call these numbers that patient adherence can also be visualized in them. using their mobile phone as evidence that they have consumed medicine. Patients make a call every day to the revealed toll-free number from any phone they have access to in order to report their adherence – the call is completely free, even when roaming, or from a landline. The number sequence for any patient is unique, so when a patient calls the correct number, the platform can assess with high confidence if the patient took medication that day.

Once the 99DOTS platform gets this real-time adherence information it can be used in multiple ways. Program staff can login into www.99dots.

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Index-TB Guidelines management, have made it a formidable challenge in the war against TB. The Department of Medicine, All India Institute There has been a substantial progress made of Medical Sciences, New Delhi, Global Health Advocates, in the diagnosis and treatment of pulmonary India, Cochrane Infectious Disease Group, Cochrane South TB. Systems are in place for management of Asia, WHO Country office for India in collaboration with such patients at the most peripheral level. the Central TB Division, Ministry of Health and Family At the same time, there is a huge amount Welfare, Government of India, brought forth the first time of uncertainty regarding the management evidence-informed guidelines for the management of various of extra-pulmonary TB (EPTB). The latter forms of EPTB. Using methodology of systematic reviews accounts for about one-fifth of all TB cases. The and based on GRADE approach of giving recommendations, EPTB, which can involve almost any system of evidence based guidelines are developed which features three the body, along with the ambiguity regarding key areas i) use of Xpert MTB/RIF for diagnosis; (ii) use of corticosteroids; and (iii) duration of treatment.

Dissemination Workshop For Launch of Index - TB Guidelines at AIIMS New Delhi on 9 August 2016

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3.3 New Initiatives

Revision of Technical and Operational Guidelines

The RNTCP has revised its technical and operational guidelines and published in March 2016. The guidelines incorporate components and principles of End TB Strategy and prepared using recommendations of WHO TB treatment guidelines, Compadium of management of drug resistant TB, Guidelines of management of children with TB, Standards for TB Care in India, recommendations of Joint Monitoring Missions. Key features of revised technical and operational guidelines are as follows:

Ø Revision in diagnostic algorithm with use of CXR in screening and early use of CBNAAT Ø Systematic active TB case finding strategy Ø Transition from intermittent to daily regimen Ø Treatment of all forms of drug resistant

TB These technical and operational guidelines are Ø Use of new drug Bedaquiline along with intended to be used by all the personnel engaged in DST guided treatment control of TB in the country. This is a living document Ø Use of ICT enabled adherence support open to further improvements and will be updated for patient centric care as lessons are learned through its use in the field. In addition, supportive guidelines are developed Ø Single window delivery approach for HIV- and disseminated by RNTCP for use of Bedaquiline TB care under RNTCP, Adverse Drug Reaction Management, Ø Improved TB surveillance strategy Health Worker Surveillance and Index TB (Indian Ø Effective strategies to reach TB patients Guidelines for management of extrapulmonary TB). in private sector

25 TB India 2017

Targeted Strategy for High Priority Districts

The programme has identified 100 high priority districts based TB case load, co- morbidity, drug resistance and case finding efforts. Targeted strategy will be implemented in these districts to intensify TB control

efforts. Decentralized district specific action Average High TB plans are prepared in these 100 districts. From High TB-HIV High DR-TB the centre, the programme has been using Very low case finding efforts High case finding but low TCNR active TB case finding campaign as a first Metro + Sikkim strategy to intensify early case detection and put TB patients promptly on treatment.

26 TB India 2017

TB Surveillance in India Chapter 4

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TB India 2017

TB Surveillance in India Chapter 4

Complete surveillance is an important public health Private sector: TB has been made a notifiable function in the prevention and control of any disease. disease in 2012 through Government of India Order. Prompt notification to the public health system is an It has expanded the ambit of surveillance of TB in the important component of the surveillance process and country covering all public as well as private health achieves essential public health objectives to measure facilities. TB patients seeking care in private sector disease burden, monitor epidemiological trends, and are being reported along with their demographic and plan and target preventative and treatment services. disease characteristics. The surveillance begins with It identifies people needing follow-up to ensure that the notification, and completed with acting on the treatment is completed, and enables contact tracing information gathered. and screening of close contacts. The Government of India has amended its notification A good TB surveillance system will require timely order with extension of public health services notification of all TB cases in the population and following TB notification. will be able to capture necessary variables for demographic, clinical, socio-economic, geographic, TB Notification amendment Government Order spatial characteristics to enable better understanding of the local epidemiology and trend of TB.

To ensure complete notification, all TB cases irrespective of method of diagnosis (microbiologically confirmed or clinically diagnosed), initiation of treatment (whether on treatment or not), source of treatment (Government or non-government), type of patients (TB or DR-TB), type of regimen used for treatment (daily or intermittent) should be notified to public health system. RNTCP has enhanced its surviellance system to notify all these patients.

Public sector: The RNTCP is moving from notification at treatment to notification at diagnosis. Henceforth, once a TB patient is diagnosed, s/he will be notified on the same day of diagnosis. For this, a TB notification register is being placed at each health facility. It brings those TB patients who are missing after diagnosis under the surveillance system and will enhance the programme capacity to address the issue of initial loss to follow up.

29 TB India 2017

NIKSHAY NIKSHAY Components

NIKSHAY platform is being used under the RNTCP as an ICT enabled state-of-art surveillance system to get notification of TB cases at diagnosis from both public and private sector including drug resistant TB patients. The programme also envisions continuous monitoring and treatment adherence for all TB patients registered with NIKSHAY, enable tracking of all notified TB patients across TB care cycle, geographies, transfers and referrals. Currently, following enhancements are underway in the NIKSHAY for patients support, logistics management, direct data transfers, adherence Information captured in NIKSHAY support and to support interface agencies which from 2012 are supporting programme to expand the reach.

TB patients reported 76,12,774 Public Sector 68,25,919 Enhancements Functions Private Sector 7,86,855 99 DOT Mobile based “Pill-in-Hand” Patients registered from CBNAAT and C & 8,78,009 adherence monitoring tool for DST laboratories electronic treatment record of TB Drug resistant TB patients reported 48,066 patient to monitor the treatment adherence. Contractual staff registered 10,526 Connected Extracting data from CBNAAT devices CBNAAT labs 629 diagnostics and making it available to Nikshay C & DST labs 65 via the use of a single component of Drug resistant TB centres 158 the CDP solution called Machine-to- Nikshay software Private Health Facilities 1,17,031 Drug and ICT solution for real time inventory logistics MIS and stock data for forecasting and TB Notification in 2016 quantification Direct Benefit ICT based benefit transfer system for Trends in notified TB patients Transfer patients and providers using NIKSHAY, PFMS and AADHAR Since inception of RNTCP, TB notification steadily Interface Projects like UATBC, AXSHAYA PPM increased. With complete coverage of RNTCP in agency initiatives have developed interface to link with NIKSHAY to support 2006, annual TB notification rate increased upto programme in getting TB notification 130 patients per lac population and remained stable and treatment outcome reports of or slightly declined from public sector. TB disease patients outside public sector. was made a notifiable disease in 2012, TB patients reported from private health care provider had started increasing and taken TB notification in increasing

30 TB India 2017

trend again. In 2016, the total TB notification rate was Effective system to get extra pulmonary samples 134 patients per 100,000 populations. for testing is a challenge. Efforts will be made to improve ability of district and sub-district hospital to overcome this challenge.

The distribution of TB patients notified from the public sector is as follows:

Trend of New and Previously Treated TB Patients ~20%TB patients notified from public Microbiological Confirmation among notified sector are previously treated and its trend remained TB Patients - Microbiological confirmation has almost same over period of decade been considered a quality parameter in diagnosis of TB. The programme has maintained ~55% TB patients diagnosed as microbiologically confirmed TB in public sector. Since inception, the RNTCP has used diagnostic algorithm which provide microbiological testing (smear microscopy) to all presumptive TB patients. Now, CBNAAT has been increasingly used for diagnosis of TB up front and as a sequential test would improve case finding efforts with maintaining microbiological testing.

Pulmonary and Extra Pulmonary TB Patients Extra-pulmonary TB patient reporting has been increased from 17% to 21% over period of 10 years. Better diagnostics availability, and improving access may have contributed to this sustained increase in detection of extra pulmonary TB patients.

Availability of 628 CBNAAT laboratories and strategy to offer CBNAAT upfront for diagnosis of extra pulmonary TB may further improve programme’s capacity to diagnose Extra Pulmonary TB patients.

31 TB India 2017

Male to Female ratio among notified TB patients has been declined steadily. In 2016, the M:F ratio was 1.7. The M:F ratio ranged from 1.07 to 2.25.

The proportion of children among new TB patients reported was 6% in 2016. Absence of appropriate samples coupled with decentralized capacity to get good samples from children to test for TB remains to be challenge in pediatric TB case detection. The programme has expanded scope of using CBNAAT and has been made available for Proportion of Notification of TB Patients from Public and Private diagnosis of TB among children presumptive to be Sector in 2016 TB. This strategy is expected to improve TB case detection in children. In a few states like Delhi, Chandigarh, Madhya Pradesh, Mizoram, Nagaland, Arunachal Pradesh could reported more than 10% TB patients were children.

State wise Proportion of Notification of TB Patients from Private Sector in 2016 TB Notification from Private Sector In 2016, with help of NIKSHAY the programme reported and NE states. almost one fifth of TB patients from private health care facilities out of total reported patients. Trend of Treatment outcome of TB patients notified from Public Sector under RNTCP There is a wide variation in from state to state in terms of proportionate reporting of TB patients from public Treatment success rate among microbiologically and private sector. confirmed new TB patients remains consistently above 85%. Among previously treated microbiolog- Reporting of TB patients from public and private sec- ically confirmed TB patients, the treatment success tor is almost equal in Kerala to nil in some of the UTs rate remained to be 70%.

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Treatment Outcome of Microbiologically Confirmed New TB Treatment Outcome of Microbiologically Confirmed Previously Patients Treated TB Patients

Treatment outcome of TB patients in private responsibilities of public health actions are begin tak- sector en under the programme. Treatment outcome of TB patients notified from private providers are reported TB Patients notifications are in increasing trend from from the 3 districts. Following are treatment out- private sector over the years. Along with, it the pro- comes of TB patients notified from private sector in gramme is making efforts for ensuring completion of these districts. care. The notification order has been amended and

Treatment Outcome of TB Patients Notified from Private Sectors in 2015

District Notified patients Treatment completed Died Lost to follow up Not evaluated Treatment Regimen Change Patna 14940 73% 3% 5% 18% 1% Mehsana 2909 73% 5% 5% 16% 1% Mumbai 11370 76% 2% 5% 13% 3%

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TB India 2017

Public Private Partnership Chapter 5

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TB India 2017

Public Private Partnership Chapter 5

Effective engagement of all health care providers Universal Access to TB Care (intervention to (private practitioners, chemists, laboratories, NGOs, engage private providers) AYUSH) at a scale commensurate to their presence is crucial to achieve Universal Access to TB Care. To engage private sector providers, a package Majority of times, these providers are first contact of interventions have been implemented in the project Universal Access to TB care (UATBC). The for care of patients. Since the inception of RNTCP, intervention are aimed at improving TB notifications multiple prior interventions through various by offering information and communication strategies have been deployed to engage NGOs and technology (ICT) support that is convenient to Private Providers for TB control efforts. providers, free TB drugs for notified TB patients, (free/subsidized diagnostic services in Patna and Engagement of Private Mumbai) and extending public health services Practitioners including adherence support to treatment outcome for patients diagnosed and treated in the private Since TB has been made a notifiable disease, more than sector. The interventions are implemented in the 1,13,961 private health establishments are registered districts of Patna in Bihar, Mehsana in Gujarat and under NIKSHAY till December 2016. Among them, Mumbai and Nagpur in Maharashtra. 70,146 are private practitioners/clinics (single), 34,105 In Patna and Mumbai, a private provider interface agency (PPIA) is used to enrol and extend public hospitals/clinics/nursing homes (multi) are and 9,710 health services for a large number of private providers are laboratories. Following chart shows how private to ensure efficient service delivery. In Mehsana and health establishment registration grew over period Nagpur, the RNTCP staffs are encouraged to manage of time. Maximum private health establishments the service delivery intervention. The interventions got registered in 2013. Since then, more than 15,000 began in 2014 except Nagpur which started in facilities are getting registered, every year. In 2016, September 2015. At the intervention sites, total TB 16,282 facilities registered and 3,30,186 TB patients case notification rates were increased 1.5-4 folds. were notified from private health establishments.

Private Health Establishment Register in NIKSHAY - Cumulative Over Years

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State wise Registration of Private Health Establishments

State Hospital/Clinic/Nursing Home etc.(multi) Laboratory Private Practitioner/Clinic etc.(single) Total Andhra Pradesh 4024 524 1757 6305 Andman and Nicobar 3 3 Islands Arunachal Pradesh 19 6 25 Assam 205 123 546 874 Bihar 448 366 3605 4419 Chandigarh 8 3 111 122 Chhattisgarh 603 249 994 1846 Dadra and Nagar Haveli 21 9 44 74 Daman and Diu 5 10 15 Delhi 716 288 1674 2678 Goa 56 29 531 616 Gujarat 2947 473 6449 9869 Haryana 722 119 433 1274 Himachal Pradesh 152 97 332 581 Jammu and Kashmir 197 370 314 881 Jharkhand 382 103 540 1025 Karnataka 2417 846 8105 11368 Kerala 3290 1471 3865 8626 Madhya Pradesh 1228 383 2751 4362 Maharashtra 7405 1464 19909 28778 Manipur 22 16 4 42 Meghalaya 33 4 42 79 Mizoram 19 12 83 114 Nagaland 15 9 24 Odisha 263 43 588 894 Puducherry 13 13 Punjab 874 297 846 2017 Rajasthan 975 105 780 1860 Sikkim 3 9 27 39 Tamil Nadu 2984 355 6939 10278 Telangana 239 27 109 375 Tripura 18 135 19 172 Uttar Pradesh 3252 852 6364 10468 Uttarakhand 78 40 104 222 West Bengal 1699 1213 3901 6813 Total 35322 10025 71804 117151

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Engagement of NGOs/Private Practitioners Additional HR support is made by providing about through Partnership Options 300 lab personel under NFM project for 46 sites. These include microbiologists, technical officers, lab- National Guidelines on Partnership provides 22 oratory technicians, laboratory attendants and data different partnership options for engagement of entry operators to support day-to-day functioning of NGOs and Private Practitioners. These engagements lab. are carried out at the State level and district level. Through these efforts, ~1900 collaborations were Under GFATM’s NFM, FIND as an implementing made with NGOs. partner is supporting the labs with supply of equip- ment and consumables. This is monitored on month- Partner support ly basis in order to ensure that the labs have sufficient In addition to programme activities, various consumables and reagents to support the programme. development partners and civil society organizations Training has been a major focus for FIND, and its help the programme in delivering TB care services key driver is the International Centre of Excellence effectively. Details of activities conducted by these for Laboratory Training (ICELT) at the National TB partners engaged at central level are given below. Institute Bangalore established with funding from UNITAID. This Centre has trained 386 lab personnel Foundation for Innovative New at the national level since its inception. In addition Diagnostics (FIND) to the trainings conducted at ICELT, FIND has so far provided hands-on on-site trainings to 2,399 lab staff FIND is the technical and implementing partner, (till November 2016). supporting the laboratory network for DR-TB services under RNTCP. This initiative began in India Performance in 2016 under EXPAND TB with funding support from UNITAID and was complemented by funding from 2016 Cumulative GFATM from 2011 to September 2015. From October till 2016 2015 under the New Funding Model (NFM) of the Presumptive MDR-TB test- 1,54,344 6,66,158 Global Fund, the FIND provides support for human ed by molecular diagnostics resources, training, quality assurance procedures, (LPA & CBNAAT) technical assistance, monitoring and supervision, MDR/RR- TB patients diag- 14,492 90,458 supply of equipment and consumables, and National nosed PMDT reviews. MDR/RR-TB patients diag- 1,997 4,641 nosed by LC-DST Details of laboratories supported

EXPAND TB GFATM GFATM NFM EXPAND TB CBNAAT Project Duration 2010 - 2015 2010 - 2015-2017 2012 - 2015 2015 No. of Sites planned LPA: 46, LC: 40 LC: 15 14 No. of Sites Functional LPA: 45*, LC: 40 14 + 24 additional sites

In addition to establishments of these laboratories, Accelerating access to quality TB comprehensive maintenance contract of these facil- Diagnosis for Paediatric Patients ities and equipment has been undertaken under the (supported by USAID) GFATM project. The mechanism for sustenance of these facilities beyond the corresponding project pe- Accurate and timely diagnosis of Paediatric TB riod is also being taken care of.

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continues to remain an impediment in management In the private sector, CHAI initiated the project of TB in children. FIND is implementing a project “Initiative for Promoting Affordable and Quality focussed on increasing access to TB/MDR TB in close TB tests” (IPAQT) in 2013. With this, it brought coordination with RNTCP and with funding support together various private labs with the support of test from USAID, since April, 2014, initially in four manufacturers and other major stakeholders. IPAQT major cities of India, namely New Delhi, Chennai, aimed to promote use of WHO-endorsed tests Hyderabad and Kolkata. In 2016, the project was (sputum microscopy, culture, GeneXpert & line probe expanded to 5 additional cities i.e. Surat, Nagpur, assay) to presumptive TB cases at affordable prices Guwahati, Vizag and Bengaluru. through an agreed upon ceiling price and by building awareness among health providers, laboratories, and patients.

• The initiative has networked with 139 private laboratories that have 5,500+ collection centers spanning over 52 cities across 20 states and two Union territories. • As part of the private provider awareness efforts, more than 4,000 private providers have been sensitized on diagnosis and treatment of TB according to the STCI through 48 continued medical education seminars in 26 cities in India.

Also, this year marked the consolidation of results Launch of accelerating access to TB diagnosis of from DENOTE- (a “Demand Generation & pediatric cases project in Nagpur Notification Effort” pilot project started in October Performance in 2016 2014 across seven cities namely Ahmedabad, Coimbatore, Delhi, Lucknow, Mumbai, Pune and Presumptive paediatric TB patients tested 30,977 Patna), to facilitate notification from private sector TB patients diagnosed 2,148 labs and increase adoption of quality TB diagnostic Out of TB patients, RR-TB patients diagnosed 185 practices in the private sector.

The Clinton Health Access • DENOTE helped sensitize over 2,300 private Initiative (CHAI) physicians treating TB patients on the importance of early and accurate diagnosis as per Clinton Health Access Initiative (CHAI) is supporting STCI. The learnings from the DENOTE project the RNTCP in increasing patient access to quality around working with private practitioners for drugs and diagnostics in both public and private microbiological testing are useful for capacity sector. building of staff under RNTCP.

In the public sector, CHAI collaborates and support • The project also facilitated establishment of the program in operational and analytical aspects of notification processes across 35 laboratories. PMDT scale up through data driven insights on areas It resulted in notification of over 31,000 such as sample collection to result delivery process microbiologically confirmed TB patients analysis, stock management among others to support through Nikshay. Efforts were also taken to further increase in patient enrolments. make laboratories self-sufficient at the end of

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the project period, to integrate the notification • Increasing access for TB patients to HIV process in the daily operations of labs to ensure screening and continued reporting from their end without any • Improving access to INH prophylaxis for the active involvement from the field team. children-contacts.

World Vision India Project operational areas: 21,000 villages in the vulnerable pockets and mapped high-risk World Vision as one of the Principal Recipient community groups of 100 cities which are located in of GFATM (Global Fund for AIDS, TB, Malaria) the 70 districts of 8 states. The estimated high-risk launched Project Axshya with support Round 9 Grant population planned to be screened under active case and Central TB Division in April 2010 in 74 districts finding of the project would be 26 million in these in 8 states (Andhra Pradesh, Bihar, Chhattisgarh, areas. Jharkhand, Madhya Pradesh, Odisha, Telangana and West Bengal) of India as an initiative to engage the Achievements under NFM-grant from Jan’16 vulnerable communities in TB care and treatment. to Sept’16: Six NGO-partners namely ADRA India, CARE India, GLRA India, LEPRA India, SHIS and TB alert 1) Active case finding: The project screened India are SRs (Sub-Recipients) to World Vision India. around 4.1 million people in the vulnerable The first two phases of Axshya were completed in urban and rural pockets of 70 districts and September 2015 and projected entered New Funding detected around 6,268 TB patients. Model phase (NFM) in October 2015. This phase is 2) Community referral: Around 1,851 TB patients currently implemented in 70 districts of the same 8 were detected through the referrals of the states (including in 100 cities). unqualified private providers whom the project had sensitized. The Global Fund Grant under the New 3) Private sector notification: The project had Funding Model: sensitized around 5,000 private doctors and facilities in 100 cities located in 70 project- The key objective of the NFM grant is to contribute districts on TB notification and assisted them towards the country’s efforts to detect the missing TB to notify the TB cases. Around 14,194 private patients. To achieve this, World Vision India along TB patients were notified and registered in the with partners has adopted following strategies: NIKSHAY e-system of RNTCP by the project. • Improving case notification from the KAP (Key 4) INH-prophylaxis: The project initiated INH- Affected Population) through ACF (Active Case prophylaxis to around 1,259 children-contacts Finding), who were identified during contact investigations by the project volunteers. • Enhancing referrals from the unqualified private providers and 5) HIV testing: The project assisted around 4,733 TB patients to utilise the HIV testing services • Facilitating TB case notification from the private at the ICTC (Integrated Counselling & Testing sector. Centre). Additionally, 6) Counselling of MDR TB patients: The project brought around 1,000 MDR-TB patients • The project provides home-based counselling under home-based counselling and food and dry ration support to patients with MDR- supplementation services. TB

41 TB India 2017

TB screening among inmates in West Bengal family members for symptoms of TB. Over 153,000 presumptive TB patients were identified and tested The project has initiated TB screening among the and this included collection and transportation of inmates of 4 prisons of West Bengal in collaboration sputum samples of nearly 130,000 presumptive TB with the State TB Cell and District TB Officers since patients. Almost 15000 TB patients were diagnosed December 2016. The results of the interventions are and initiated on treatment through the active case given below in tabular format: Number of prisons intervened 4 No. of inmates in the 4 prisons 6929

No. of inmates verbally screened by using 4 TB symptom complex 6135 (88.5%) No. of presemptive TB cases indentified by using 4 sysmptom complex 1232 (20%) No. of Identified Presumptive TB cases who were screened by CXR 1078 (88%) No. of cases suggestive of TB in CXR 147 Total no of presumptive TB cases whose sputum samples were tested at CBNAAT sites that in- 381 cluded 147 TB suggestive by CXR as well MTB detected (Rif Sensitive) 13 MTB detected (Rif Resistant ) 0 Clinically diagnosed TB 2

The International Union Against Tuberculosis and Lung Diseases: finding intervention.

Project Axshya (supported by the Global Axshya also focuses on empowerment of community Fund Grant) to enhance their participation in TB control. Over 25,000 TB patients including nearly 10,000 Project Axshya is a civil society initiative that supports women have been sensitised on their rights and Government of India’s Revised National Tuberculosis responsibilities during January to September 2016 Control Programme (RNTCP) to expand its reach, through District TB forums. visibility, and effectiveness. Supported by the Global Fund, it is implemented by The Union in 285 districts In 30 districts, counselling services have been across 19 states of India through eight civil society provided to over 8000 MDR-TB patients resulting in organizations; around 1000 local NGOs and nearly a significant reduction in loss to follow up and death 15000 community volunteers. amongst the MDR-TB patients by nearly two thirds. Over 200 personnel working with RNTCP have With a focus on enhancing access to vulnerable been trained in on key thematic areas. Preventive and marginalised communities including tribals, maintenance and emergency breakdown services have slum-dwellers, homeless, the trained community been provided for over 9000 binocular microscopes in volunteers of Axshya (called Axshya Mitras) have 23 states ensuring uninterrupted diagnostic services. reached over 14 million households disseminating information on TB and simultaneously screening the As part of the urban interventions in 40 sites across the country, the project is engaging qualified private

42 TB India 2017

providers including individual practitioners, hospitals supported for treatment adherence. The treatment and private labs and facilitating notification of TB success rate is over 84% among the patients who are patients and promoting rational management of TB being supported through this intervention. as per STCI and supporting treatment adherence through daily sms and weekly interactive calls. During Tata Institute of Social Sciences the reporting period the project has sensitised nearly (TISS) 3000 practitioners, over 700 private hospitals and 500 laboratories resulting in notification of over 9000 TB Counsellors’ Project for DRTB patients (sup- patients. ported by The Global Fund Grant) TISS is providing impetus to the outcomes of the The project is also promoting convenient TB services Drug Resistant TB cases to join and participate in through 82 Axshya Kiosks which provide flexi -DOT RNTCP by using the strategies developed for this for extended hours (6 am to 9 pm), serve as sputum purpose by the program, for patients suffering from collection and transportation centres, drop-in drug resistant tuberculosis. This is occurring by information and counselling centers. providing counselling services to the DR-TB patients and their families, linking them to social protection Engaging private practitioners in TB care schemes for improving the treatment outcomes in and prevention (supported by Eli-Lilly drug resistant TB cases registered under the program. Foundation) Meetings are being conducted with Government Departments and other stakeholders to advocate easier enrolment of TB patients under various The Union in collaboration with the Lilly MDR-TB Government Social Protection Schemes. partnership is strengthening engagement of private health care providers. Three contextually diverse TISS is operating in four states. These states are sites for involvement of Rural Health Care Providers Gujarat, Karnataka Maharashtra and Rajasthan (RHCP) are Khunti in Jharkhand, Alirajpur in Madhya DRTB Counsellors have been recruited and placed Pradesh and Ghazipur in Uttar Pradesh. RHCPs are in these states. being trained to identify and refer presumptive TB patients, collect and transport sputum and serve as TISS is also conducting a survey to assess the mental DOT providers in these three districts. During this status of DRTB patients and Improved knowledge period, RHCPs have contributed to referrals of 1210 about TB and reduce misconceptions among patients symptomatics and 100 of them have been diagnosed who received counselling services. and initiated on treatment. Training and workshops for staff recruited by The web based software developed for notification TISS under this project have been undertaken in and treatment adherence facilitates notification and collaboration with the State TB Cell and District TB promotes treatment adherence through daily mobile Centre functionaries. sms reminders and weekly interactive voice calls. It is being successfully used by Apollo Hospitals at Jubilee The program is looking forward to the demonstration Hills, Hydergudda & Secunderabad and KIMS, of results of treatment outcomes and attrition rates in Trivandrum. 411 TB patients have been notified Drug resistant TB cases as a positive outcome of this using the software and 370 (90%) of them are being project 43 TB India 2017

Tibetan Voluntary Health • TB awareness and community outreach Association (TVHA) campaign • Intensified case detection and contract tracing Active Case Finding in Tibetan population of in 15 remote refugee settlements and congregate the Country (supported by The Global Fund institutional settings Grant) • Treatment of diagnosed TB patients using DOTS strategy The Department of Health (DOH), one of the seven departments of Central Tibetan Administration • Capacity building of TB Control Program’s workforce and infrastructure (CTA) is registered in the name of Tibetan Voluntary Health Association (TVHA) under the Indian Society Registration Act XXI 1860. It is working as a registered charitable organization catering to the basic health care needs of Tibetan people living in India and Nepal. The total Tibetan refugee population in India is 94,203. Established in December 1981, its goal is to provide a comprehensive (preventive, promotive and curative) health care to the Tibetan refugee population in exile (India and Nepal) through a network of 54 health centers; 7 hospitals, 5 primary health centers and 42 clinics spread across India and Nepal. The Department plays a key and leadership role in overall policy in health, health care financing, Indian Council For Medical planning and implementation of all health programs Research (ICMR) and projects in Tibetan communities in exile. The TIE –TB Project (supported by The Performance Report (April- September 2016) Global Fund Grant) Number of persons screened for TB 3906 The Indian Council of Medical Research (ICMR) Number of presumptive TB cases identified 661 under the Department of Health Research/Ministry Number of presumptive TB cases tested for TB 571 of Health & family Welfare/Government of India, Number tested with CBNAAT 102 in collaboration with Central Tuberculosis Division Number of TB cases diagnosed 68 (CTD)/Department of Health & Family Welfare/ Number of TB cases notified in Nikshay 23 MOHFW/GOI has undertaken this project in certain defined hard to reach and tribal areas spread over Number of TB cases initiated on treatment 64 a few districts of the central, western and eastern Number of contacts screened for TB 159 parts of India. It is currently being implemented Active case finding activities in school/monas- 16 in 19 districts of 5 States (Chattisgarh, Gujarat, teries held Jharkhand, Madhya Pradesh, Rajasthan), covering a Number of presumptive Tb cases which under- 524 total population of approximately 17.6 million, out of went X-ray examination which about 13 million (74%) is predominantly tribal. The project will be carried out in an implementation TVHA is responsible for implementing the following research mode wherein the interventions will be strategies in coordination with Central TB Division’s evaluated as per defined protocols through rigorous RNTCP: research methods qualitatively and quantitatively, thereby serving evidence to RNTCP for decisions on 44 TB India 2017

further policy designing & scale up activities to the → Early initiation of treatment entire population, especially the tribal population. → Decreased out of pocket expenditure of TB patients The project is expected to improve the “Standard of → Decreased wage loss Care” among these extremely deprived populations → Decreased Provider Visits as well as which will be measured through various programmatic multiple provider visits. and socio-economic indicators. The efforts will lead to early seeking of care and reduction in out of pocket PATH expenditure of individual patients. The patients will have access to the correct and appropriate treatment PATH is supporting Public Private Interface Agency regimen and will help in curbing of the individual in Mumbai for UATBC interventions with support patients from being directed to multiple providers for of BMGF. In addition, the organization facilitated treatment which results in huge economic burden to the early diagnosis of HIV by providing TB patients the patient and his family. with a free Rapid Diagnostic Test for HIV at private facilities in Mumbai. This initiative was funded by A second component of the project carried out by USAID under Challenge TB Initiative. ICMR is towards strengthening implementation and operational research. Currently 11 OR studies The intervention supports a collaboration between are being conducted under NIRT Chennai with the the private and public sectors. Through trained link support of the Global Fund Grant. counselors, TB patients screened positive from private laboratories, are confirmed at the nearest Integrated Expected Outcomes of the TIE –TB project: Counselling and Testing center (ICTC) and linked for treatment to Anti-Retroviral Treatment centers 1. Quantitative (ART). Free TB treatment and adherence support is i. Increase in Case Detection of TB patients provided to all the TB/HIV patients for the duration under the RNTCP. This implies an of TB treatment. additional yield of 12240 cases from the project efforts for a period of ten months Medical Colleges Involvement from February 2017 to December 2017 ii. Increased Community Involvement Under RNTCP, the Medical Colleges play important iii. Increased Traditional Healer Involvement roles in service delivery, advocacy, training and operational research. With advancement in TB care, 2. Qualitative the medical colleges are supporting case management i. Improvement in Community Awareness of drug resistant TB patients, pharmacovigilance ii. Improved convenience to TB patients for and private sector engagement. RNTCP provided diagnosis as well as for treatment. a Medical Officer, a Laboratory Technician and a TB-HV to the involved Medical College for → Decrease in time to diagnosis

Achievements under HIV - TB intervention by PATH (April to September 2016)

45 TB India 2017

2011-12 2012-13 2013-14 2014-15 2015-16 No. of Medical Colleges involved 315 320 347 363 382 Pulmonary TB patients 136072 136130 156858 171627 159560 Extra pulmonary TB patients 82067 78200 91367 110083 101434 TB patients diagnosed 218139 214330 252066 281719 260994 managing and coordinating with the program. The Zonal Task Force Meetings are conducted from There is a Task Force Mechanism for regular Central level every year to review performance of coordination, monitoring and advocacy purpose State Task Force and share update of programme at the State, Zonal and National Level. Currently, policies and strategies. For 2016-17 F.Y., 6 Zonal 382 medical colleges are involved with RNTCP. Task Force Meetings were held in each of six They contribute 16-20% pulmonary TB patients zones. Medical college faculties were appraised and 50% extra pulmonary TB patients out on recent changes in technical and operational of total TB patients notified from RNTCP. guidelines of the programme during these meetings.

Zonal Task Force Workshop (West Zone) held at Ahmedabad on 22 and 23 December 2016

46 TB India 2017

Planning Under RNTCP Chapter 6

National Health Mission Central TB Division

Central Level

State Health Mission State TB Office

State Level

District Health Mission District TB Office

District Level

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TB India 2017

Planning Under RNTCP Chapter 6

RNTCP is one of the components under the National PIP 2016-17: Type of Activities Health Mission (NHM) which is a flagship scheme A. Continued /Existing Activities under Government of India. The Health Ministry follows equity-based approach to allocate funds under Based on the feedback of the Programme Divisions NHM. For the financial year 2016-17, states were and the districts, State may propose the same budget requested to submit PIP in the software application and activities as approved in 2015-16, or propose developed by NIC but due to technical issues all states changes which would fall in three categories: submitted PIPs in MS excel format. The underlying 1. Discontinuation of an activity: no budget principles and processes of planning remain the required same. The Framework for Implementation of the NHM remains the mainstay. 2. Increase in budget: change would be either be in number of units or cost per unit Preparation for PIP 2016-17 3. Decrease in budget: changes are likely to be in number of units and in some cases cost The State TB Cell is expected to submit its Programme per unit Implementation Plan (PIP) through State Health The changes required are to be clearly mentioned in Mission to NHM under MoHFW. RNTCP Program the budget sheet and its explanation is to be provided division has developed detailed PIP template in the remarks column. (MS Excel) for both state and districts, which was circulated to all the states. B. New Activities

Record of Proceedings (RoP)/approvals for 2015- For all new activities the norms laid down in manual 16 is the starting point for PIP 2016-17 preparation of PIP 2015-16 would apply. The State provided a brief description, rationale, data/ background information (Main and supplementary (if any) and progress both required to appraise the proposal and budget break- physical and financial against the approvals (State as up for each new activity. New activities also address well as district wise). State level Programme Divisions the priorities set for 2016-17. as well as districts was asked to reassess the approvals for 2015-16 and list down the changes required Planning Process in 2016-17. It is important that the action plan is realistic, practically implementable and correlates the As a part of NHM, RNTCP also follows a bottom up physical outputs with the cost estimates. approach for planning and budgeting. The process begins at the districts level, which prepares the States along with their districts assessed the progress, “District Health Action Plan” based on inputs from both physical and financial, made till November 2015 MO-TCs, STS, and STLS of Tuberculosis Centres in the districts. These Districts Health Action Plans are against the approvals given in 2015-16 and filled up then aggregated to form an “Integrated District Health the required annexures in the MS Excel sheets and Action Plan (IDHAP)” which is further sent to the upload as part of the PIP in the relevant sections. PIP State Level. The DHAPs of all districts are compiled 2016-17 is consolidated plan of districts and the State. and aggregated at the state level for framing the “State

49 TB India 2017

Program Implementation Plan (SPIP). All SPIPs are case of particular new activity, an additional reviewed and compiled to estimate the next year’s budget over and above state envelop may be fund requirements for programme implementation proposed with proper justification. activities under NHM/RNTCP. • Patients from tribal areas / difficult to access areas, the norm for aggregate PIP Planning Process amount for travel support has been revised for completion of treatment (guidelines National Health Mission Central TB Division circulated). Similarly, for MDR & XDR Central Level patients, revised norms are applicable for budgeting purpose. The revised honorarium norms to be used for budgeting purpose. • MDR TB and XDR TB suspects travel to State Health Mission State TB Office DMC or sputum collection centre or DTC State Level to be paid as per the actual with public transport. Similarly, travel cost to both MDR TB and XDR TB patients to DR-TB Centre or to district to be paid as per the District Health Mission District TB Office actual with public transport. District Level • Vehicle hiring cost for transportation of drugs from district drug store to TU drug RNTCP Guidelines and Priorities store to be included in the Office Operation. for 2016-17 • Training cost for ASHA or community DOT providers to be considered similar to The PIP addressed the following key paramedical staff. Training costs include priorities such as: cost of hiring vehicle for field visit during training and audio visual aids. • All the data for previous four last quarter’s means from October to September. All • Research proposals through task force figures are actual number, except for mechanisms to be considered under population which is to be written in lakh. Medical College Head. Research proposal other than from medical colleges to be • Norms in the NSP are indicative and not considered under Research & Studies & a limitation. In case of higher amount is Consultancy. Research proposals up to 5 budgeted, a proper justification is required. lakhs may be approved by OR Committee • Decentralization of Tuberculosis Units at of the STCS. block level or 1.5 to 2.5 lakh population • All TB patients residing in notified tribal to be considered in 2016-17. Budgets area (as per tribal department) to be proposed for NGO/PP schemes will be as provided with an amount of Rs. 750 per per new NGO/ PP Guidelines which has head under patients support system. been circulated. • Districts should plan for the PPM and Budget Format ACSM coordinator however the post of communication facilitator is discontinued. There was no major change in the activities listed or • As per the guidelines, a 10% increase in the the FMR in the budget sheet for FY 2016-17. However budget for FY 2016-17 is allowed; but in in line with the requirement of the department of

50 TB India 2017

Finance/Tribal Affairs, a few columns have been The NSP proposes bold strategies with commensurate added and budgets for activities have to be further resources to rapidly decline TB incidence and allocated/classified under Scheduled Caste sub plan, mortality in India by 2025, five years ahead of the Scheduled Tribe Sub Plan and General sub plan. global End TB targets and Sustainable Development Goals to attain the vision of a TB-free India. In the Budget Envelope 12th plan period, India’s Revised National TB Control Programme notified more than 70 lakh TB patients As communicated vide letter no. 7 (139)/2015- and put them on treatment. The NSP 2017-25 aims NRHM I dated 16th November 2015, the NHM to notify 260 lakh TB patients in 8 years including funding between the Centre and States would be in public and private sector. The process began with first the ratio of 60:40 (for all states except NE and 3 consultative workshops with various stakeholders Himalayan States), 60 from Central government and engaged with TB services conducted in October 2016. 40 from State.

It can be reasonably expected that there may be a 10% increase in the central budget over and above the budget given in 2015-16; Hence States are requested to estimate the resource envelope accordingly.

National Strategic Plan (2017-25)

The National Strategic Plan (NSP) 2017-25 for elimination of TB has been prepared as three year costed plan and eight year strategy document. The NSP incorporates recommendations of the Office of Hon’ble Prime Minister and abide to the framework National Consultation with all Stakeholders for prepration of of action submitted to his office in November 2017. the NSP (2017-25) on 18 and 19 October 2016 at New Delhi

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TB India 2017

Budgeting and Finance Chapter 7

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TB India 2017

Budgeting and Finance Chapter 7

RNTCP is being implemented in line with the (GC) and Externally Aided Component (EAC). National Strategic plan effective 01st April 2012 c. Funds flow and Releases: The fund flow with an increased allocation of approved budget of remains within the existing financial management Rs 4,500 crores for the program under the 12th Five system of the MoHFW, which operates through Year plan. The implementing agency continues to be the centralized Pay and Accounts office. Release the Central TB Division (CTD), Ministry of Health of funds to states is done in 2 to 3 installments & Family Welfare (MoH&FW), Government of India through State Treasury. (GoI). This is a centrally sponsored scheme and all the state governments who have agreed to implement d. Sanctions & Approvals: Multiple level the project as per RNTCP guidelines have signed a technical and financial approvals are required Memorandum of Understanding. for making individual payments after sanctions are approved. All procurements of commodities The disbursement and financial management of are processed by the Empowered Procurement project funds at Central and state level is being done Wing (EPW) and approved by the Secretary through trained staff. A Central Finance unit has been and Union Minister in line with the delegation staffed at Central TB Division. Similarly, Accountants of the financial powers. All funds releases for are available at state and district level for the financial commodity advances for approved contracts management of the project funds. The procedures for are routed through the Integrated Finance the financial management are being followed as per Division (IFD) and processed by the Drawing the manuals and guidelines available on the program and Disbursing Offices (DDO) and Pay and website (Financial Manual for RNTCP). Accounts Office (PAO). All the program expenditures follow the standard government The financial management arrangements to account systems of the PAO and are subject to control for and report on program funds, includes both as per the General Financial Rules (GFR) of Domestic Budgetary Support (DBS) and External the Government of India. Payments are made through electronic funds transfer through Aided Component (EAC). The arrangements are as treasury since the financial year 2014-2015. follows:

e. Accounting: The accounting records for all a. Institutional arrangements: Central TB payments are made against approved budget. Division (CTD), being a part of the National Budget lines are maintained by the Principal Health Mission (NHM) holds the overall Accounts Officer and compiled by the Controller responsibility of the financial management of the General of Accounts (CGA). The compiled program. Similarly, at the state and district level, monthly accounts are reconciled with the CTD the State TB Cell and the District TB Centre are record of transactions. responsible respectively. f. Financial reporting: A financial report b. Budget: Program expenditures are budgeted is submitted by CTD to MoHFW and the under the Demand for Grants of the MoHFW donors like The Global Fund and World Bank Flexible Pool for Communicable Diseases on periodic intervals based on the compiled funding arrangement. These are reflected in monthly accounts and CTD’s own record of two separate budget lines- General Component expenditures.

55 TB India 2017

g. External Audit: The Director General of Audit transform the Global Fund into the most effective and Central Expenditure (DGACE) under the vehicle for investing in impact on the three diseases. Office of the Controller and Auditor General The strategy commits the organization to a program (C&AG) of India is the statutory auditor. The of transformation and also outlines how the audits are being conducted as per the standard organization intends to work with countries and terms of reference agreed with the Department partners in order to sustain and accelerate existing of Economic Affairs (DEA), Ministry of Finance gains and contribute to ambitious international goals. and the World Bank. The audit reports are Central TB Division (CTD), MoHFW has been a being made available to all donors as per the Principal Recipient (PR) of the Global Fund Grants agreement. At state level audits are being done since Round 1 2003, when initially a grant fund of US$ as per state NHM manual and guidance for audit 8.78 million was allocated to the program. This grant by empanelled chartered accountancy firms of support has substantially increased over the years and the State. All the states are required to submit the the country has currently received an allocation of annual audit report to CTD by 30th September. nearly US$ 233 million for the TB program under the New Funding Model (NFM) for the implementation Financial Performance of RNTCP in period 01st October 2015 to 31ST December 2017. 12th Five Year Plan The Grant is supporting in scaling up of program activities across country including establishment The funds approved and release to RNTCP under the of 15 Liquid culture laboratories, deployment of 12th Five year plan are tabulated below: additional 200 CBNAAT machines, procurement of

Description 2012-2013 2013-2014 2014-2015 2015-2016 2016-2017 Total Budget requested 700 800 1358 1300 1000.00 5158.00 Budgetary estimates/approval 710 710 710.15 640 640.00 3410.15 Total Releases to states 224.72 323.52 373.87 483.19 342.43* 1747.73 Expenditure (Plan) 566.39 527 639.94 639.86 491.77* 2864.96 *Till 20th February 2017 #Figures In crores First line and Second line drugs, strengthening of Donor Supported Projects: supply chain management system, scale up of Public Financial Management System (PFMS), etc. The The goal of the donor supported funding to the proposed sub- recipients under the FM are: program is in line with the National strategic plan to achieve “Universal access to quality diagnosis → States of Andhra Pradesh, Bihar, Chhattisgarh, and treatment for all TB patients in the community’. Haryana, Jharkhand, Karnataka, Orissa, The donor supported funding contributing to the Telangana, Uttarakhand program under NSP 2012-2017 is from The Global → Indian Council for Medical Research (ICMR) Fund (TGF) and the World Bank. → Foundation for Innovative and New Diagnostics (FIND) The Global Fund: The Global Fund to Fight against AIDS, TB & Malaria spurs partnerships between → Tata Institute of Social Sciences (TISS) government, civil society, the private sector and → Tibetan Voluntary Health Association(TVHA) communities living with the diseases, to ensure that → World Health Organization (WHO) funding serves the men, women and children affected by these diseases in the most effective way. World Bank Project: Central TB Division is implementing the “Accelerating Universal Access to Investing for Impact is an ambitious framework to Early and Effective Tuberculosis Care” Project with

56 TB India 2017

an IDA Credit (5376-IN) of US$ 100 million. The Component 2: Scale-up and improve diagnosis and development objective of the project is to support treatment of drug-resistant tuberculosis. the aims of India’s National Strategic Plan (NSP) Component 3: Expand public tuberculosis services for Tuberculosis Control to expand the provision integrated with the primary health care system. and utilization of quality diagnosis and treatment The Bank has completed the two joint review missions services for people suffering from tuberculosis. The of the project (October 14-20; 2014 & April 10-25; project became effective on June 26, 2014 and while 2015) under which project has been categorised the Credit supports implementation of the National “Moderately Satisfactory”. The mission confirms that Strategic plan for TB control. The project has three the development objective of the project continues to components: be relevant and despite implementation delays, the project is on track to achieving it. Component 1: New strategies to reach more tuberculosis patients with earlier and more effective In 2016-17 project has been able to claim USD 63 care in the public and private sectors million. The project will end on 31st March 2018.

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TB India 2017 Procurement & Supply Chain Management Chapter 8

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TB India 2017 Procurement & Supply Chain Management Chapter 8

The Revised National Tuberculosis Control all formalities that are necessary for the procurement Programme (RNTCP) has been ensuring continuous activities starting from bidding processes under and uninterrupted supply and availability of Quality National and International Competitive Bidding as Assured Anti TB Drugs, Diagnostics, consumables may be needed and to supply the anti TB drugs as and all relevant health goods. per the specifications of the Programme within the delivery period as decided and intimated by RNTCP This is an important and critical activity for the timely to the Procurement Agents. These Procurement diagnosis and treatment of the patients. Considering Agents are also responsible to ensure that the drugs the importance of this activity, the procurement procured are in compliance with the Quality Policy of Anti-TB drugs, equipments and diagnostics is of the RNTCP/WB/TGF. planned, coordinated and carried out centrally, on annual basis through a well-defined procurement An Additional Deputy Director General (TB) under mechanism with the financial support from Domestic the RNTCP administers, coordinates and supervises Budgetary Source (DBS), World Bank (WB) and The all these procurement and its related activities duly Global Fund (TGF). While laboratory consumables supported by consultants and an outsourced agency procurement is decentralized to states, anti-TB drugs comprising of support staff. This logistics team is also are allowed for procurement by states only in case responsible for comprehensive inventory management of emergency and estimated for a limited period of of the anti-TB drugs and ensures availability of drugs requirement after due authentication from Central at the desired points by inter/intra state transfers of the Drugs and appropriate Release Orders (ROs) from TB Division (CTD). the Central Level under the supervision and approval of the Additional DDG (TB). The Procurement and The Procurement of 1st &, 2nd Line (MDR & XDR) Supply chain Management (PSM) Unit in Central TB Anti TB Drugs and Laboratory Equipments is Division (CTD) also caters and performs functions undertaken at the Central level through a Procurement like procurement planning and monitoring, Agent, who is contracted by the Ministry of Health & coordination with Procurement Agents, reporting Family Welfare (MoHFW) to undertake procurement and coordination with the Bank, implementation of for various Programme Divisions including RNTCP. procurement risk mitigation plan etc. On a day to Currently, M/s Central Medical Services Society day basis communication is maintained with State (CMSS), an autonomous body under the MoHFW, TB Officers, Pharmacists of the State Drug Stores and GoI has been assigned the task of procuring first & the Regional Government Medical Stores Depots at second line drugs under the DBS and WB funding. Chennai, Hyderabad, Mumbai, Karnal, Kolkata and The CMSS also undertakes the procurement of First Guwahati. Line Drugs supported by the Global Fund. To strengthen and to provide a more dynamic However, procurement of 2nd line drugs supported professional approach to this PSM unit and access by the Global Fund is done through the Global Drug to real time data on the availability of the anti-TB Facility (GDF) of the Stop TB Partnership housed and drugs it is planned to equip them with a well-defined administered by the United Nations Office for Project Logistics Management and Information System Services (UNOPS). These authorized procurement (LMIS) and more number of PSM professionals in agent/s are responsible for ensuring compliance of the near future.

61 TB India 2017

Summary of activities related to Procurement & is expected to be rolled out by 2nd/3rd Quarter Supply Chain Management during the year are of 2017 for the remaining states and to cover all briefed below: the states uniformly.

1) Anti TB Drugs: Monitoring of drug logistics and 3) Implementation of Bedaquiline under supply chain management activities like drug Conditional Access Programme (CAP): requirements, consumption and stock position Bedaquiline, a new class of drug, effective against of state and district levels are monitored at Drug Resistant Tuberculosis has been rolled out Central TB Division (CTD) through Quarterly in six selected RNTCP sites under Conditional Reports submitted by the districts. The 1st Access Programme (CAP) with 600 patients Line Anti-TB Drugs procured are stored at six courses of Bedaquiline. Programme received Government Medical Store Depots (GMSDs) Tab Bedaquiline-100 mg from M/s Janssen across the country and issued to states based on Pharmaceutical for six selected centers and the the District Quarterly Programme Management expansion plan for BQ has also been approved Reports (PMR) and the monthly State Drug to roll-out BQ in the entire country by end of Stores (SDS) Reports. Whereas, the 2nd line 2017. A request for 10,000 courses has already drugs (MDR & XDR) are delivered directly at been sent to Global Drug Facility (GDF) of the SDS from the supplier after which the drugs Stop TB Partnership. are released further to districts and sub-district levels. 4) TB-HIV daily regimen: The treatment of HIV infected TB persons is being implemented To strengthen the Inventory Management using daily regimen as per national policy. The system under RNTCP, new supplies of 2nd line programme is supplying daily regimen drugs to anti TB drugs procured through GDF, are now all States in close co-ordination with National being stored at GMSDs as primary consignee Aids Control Organization (NACO), funded and based on Release Orders from CTD, drugs by USAID, for this intervention of the targeted are supplied further to the states for onward patients. distribution. The inter State transfers of second line drugs are done from CTD based on First 5) Implementation of Isoniazid preventive Expiry First Out principle to ensure there are no therapy (IPT): RNTCP recommends screening losses of drugs due to expiry, in form of Drug of all household contacts of tuberculosis patients Transfer Advice (DTAs) which are prepared as and 6-month isoniazid preventive therapy (IPT) per a state’s requirement on day to day basis. is provided for children below 6 years. Similarly, The States are required to maintain the required all People Living with HIV/AIDS (PLHIV) are buffer stocks at each level i.e. PHIs, TUs, DTCs & screened with four symptom complex and after the SDS as per the guidelines of the programme. ruling out active TB, they are provided INH for 6 months for prevention of TB. For effective 2) Implementation of Daily Regimen: In implementation of IPT among PLHIV patients, pursuance of the policy adopted by the all States were supplied with drug - Isoniazid 100 programme, the fixed dose combinations (FDCs) mg (PC-7) for pediatric patients and Isoniazid drugs for daily regimen has been successfully 300 mg (PC-11) for adult patients. procured for both adult and pediatric TB patients for 5 states. All the STOs, DTOs, Pharmacists 6) Procurement of Diagnostic Equipment: and the dealing staff members of the SDSs and the District Drugs Stores have been trained for a) CB-NAAT: The Programme had procured receipt, store and distribute daily regimen drugs. 500 CB-NAAT machines along with 7.8 The next phase of daily regimen implementation lakh cartridges in 2016. Further, to ensure

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uninterrupted supply of cartridges, approx the various Quality Assurance Policies of the 26 lakh cartridges have been budgeted anti-TB drugs depending upon the funding under The Global Fund and to be supplied sources. In addition, three separate trainings before end of 2017. were conducted for Cartridge Management practices in which the tools to monitor the b) LED Fluorescence Microscopes (LED) & consumption, guidelines to store and report Binocular Microscopes (BM):- To provide cartridges was disseminated to all the States. better and faster diagnostic equipment’s for the management of drug sensitive TB, 9) Quality Assurance of Anti TB Drugs: programme has procured and distributed Procurement of quality assured drugs is a 2500 LEDs to facilities having high load major area of focus in RNTCP. Accordingly, of cases and 1500 BMs to the Designated procurement of Anti TB drugs under Global Microscopic Centres (DMCs) all across the Fund supported financing are WHO Pre- States in India. Qualified, from a country of Stringent Regulatory Authority (SRA) or evaluated to be 7) ICT Based Solution: Programme has finalized of an acceptable quality by an Expert Review a software through Centre for Development Panel (ERP). In case of funding from WB/DBS of Advanced Computing (C-DAC). The the product is expected from a WHO GMP customization process of this software has certified site or the vendor is expected to have been initiated by the Programme and expected at least one product as WHO Pre Qualified. In for implementation in 2017. This software addition, pre-dispatch inspection and testing is expected to monitor and take care of the of all batches of anti TB drugs are mandatory comprehensive inventory management of drugs, that are being procured. The programme has diagnostics on real time basis with regard to the developed a protocol in which drug samples stock in hand, supply in pipe line and the future from various stocking / delivery points under orders with corresponding funding support etc., the programme are taken and tested by an to manage the Inventories irrespective of the Independent Quality Assurance Laboratory geographical location within the country. contracted by RNTCP in a periodical manner or as and when felt necessary in the interest 8) Training on Procurement & Supply Chain of the programme. Under the protocol, each Management: To ensure that the States are able quarter, random samples of 1st and 2nd line to manage their drug logistics as per RNTCP Anti-TB Drugs are drawn from GMSDs, State guidelines, regular trainings and refresher Drug Stores & District Drug Stores and sent for trainings on Procurement and Supply Chain testing to the identified QA Lab. Based on test Management have been conducted by Central and analysis reports, appropriate action is taken TB Division for the state level staff during the by the Programme, if required. year. This activity will be continuing in the year 2017 and onwards also to update the knowledge 10) Other procurement – Several miscellaneous and in accordance with the latest National, procurement activities have also been International policies and WHO guidelines. undertaken by the programme which includes In addition the overall procurement system procurement of PC Tablets for capturing data of the Government, Financial rules, Good by STLS under Project ‘Nikshay’, hiring media Storage Practices, critical components and documentation on the Procurement and Supply agency for IEC & awareness activities and QA Chain Management activities etc., are specifically testing agency for quality testing of anti-TB covered. The participants are also sensitized on drugs.

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TB India 2017 Advocacy Communication & Social Mobilization Chapter 9

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TB India 2017 Advocacy Communication & Social Mobilization Chapter 9

Advocacy Communication & Social Mobilization National Level (ACSM) is an important cornerstone in the RNTCP program. Moreover, with the proposed new World TB Day National Strategic Plan of Tuberculosis, focusing on elimination of tuberculosis from the country, ACSM The World TB Day was observed in 2016 at the has become more important than ever. National level. The event was organized on 21st March 2016 under the august presence of the Although advocacy, communication, and social Hon’ble Minister of Health and Family Welfare, mobilization are different sets of activities with Shri J. P. Naddaji, the then Secretary of Health, Shri different objectives, they are interlinked, mutually B. P. Sharma, the then AS&MD Shri C. K. Mishra, reinforcing, and most effective when used together Regional Director, WHO South East Asia Region, Dr and can contribute immensely in the efforts to Poonam Khetrapal Singh, the Director General of eliminate TB from the country. ACSM activities not Health Service Dr Jagdish Prasad, s and the Secretary only helps in increasing the TB case detection, but (DHR), Dr Soumya Swaminathan, Dr Lucica Deteu, also helps in increasing the TB treatment outcomes Executive Director, Stop TB Partnership and the then and reducing mortality due to TB. Joint Secretary, Shri Anshu Prakash. Out of ACSM, advocacy targets decision-makers and people with influence, such as national and local politicians, government ministers, and department managers to bring about policy level changes, communication aims to improve knowledge about TB and its services and change attitudes and practices and to encourage people to seek care and complete treatment of TB, while social mobilization focuses on facilitating stakeholders engagement in planning and implementation of the TB program. Hon’ble Minister of Health and Family Welfare, Shri J. P. Naddaji ACSM creates positive behaviour change, influences addressing the gathering during observation of World TB Day decision-makers, and empowers communities to on 21st March 2016 at New Delhi change. Issues that can be addressed through ACSM are delayed detection and treatment, lack of access On the day, Shri J P Nadda,Union Minister of Health to TB treatment, difficulty in completing treatment, and Family Welfare launched lack of knowledge and information about TB that can • Roll out of 500 additional CBNAAT machines lead to stigma, discrimination & delayed diagnosis and/or treatment, stigma and discrimination that • New drug – Bedaquiline for treatment of drug can prevent people from seeking care and diagnosis, resistant TB myths surrounding TB and insufficient funding for • Third line ART Programme for People Living TB programme. with HIV In the same event, following guidelines were released The initiatives which are being undertaken at the National, State and District levels in 2016 are as • Technical and operational guideline 2016 follows:

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• Guideline for implementation of Bedaquiline Conditional Access Programme • Guideline for prevention and management of adverse drug reaction • Handbook of Health worker Surveillance for TB in India

Newspaper ad in Published on 24th March

Release of Publications under RNTCP during World TB Day 2016 at Delhi on 21 March 2016

Exhibition stalls were established at the event place of World TB Day Observation. All RNTCP partners had supported and displayed the activities conducted by them for TB control. National AIDS Control Organization had collaborated with RNTCP during the World TB Day activities.

Media Campaigns

Media Campaign was run for 30 Days in which Radio spots on TB awareness were broadcasted through FM Radio Stations. Another Media Campaign was conducted using TV and Radio medium to create

Exhibition Stall of NACO during World TB Day Observation Event on 21 March 2016, visited by the Hon’ble Minister of Health and Family Welfare, Shri J. P. Nadda

Two Print Advertisements were Published with TB awareness messages were published in English and Hindi in vaious leading newspapers on 21st and 24th March 2016.

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awareness on TB. It incorporated various outdoor In collaboration with the Indian Association of Publicity activities like bus panels, queue shelters, Parliamentarians for Population and Development display boards, gantries, glow science, hoardings, TV (IAPPD), the Call to Action reached out to screens and unipoles. parliamentarians, members of legislative assembly and garnered their support for a TB-Free India.

Call to Action for TB Free India initiative Parliamentarians across party lines sensitized on TB in New Delhi The International Union against TB and Lung Leading corporates and Public Sector Undertakings Diseases has been supporting the Call to Action (PSUs) joined hands and committed resources initiative under Challenge TB project supported (estimated at US $3 million) for a TB-Free India: by USAID. The initiative has reached out to a wide DLF Foundation, TCI Foundation, Jubilant Bhartia, range of stakeholders in engaging them for TB Free Johnson & Johnson, Ambuja Cement, I L & FS, India Capaign. Crompton Greaves have so far announced CSR projects on TB. Shri Ratan Tata, who also participated Mr. Amitabh Bachchan lends his support as an in the Mumbai Dialogue organized by the Call to ambassador for the TB-Free India Campaign. As Action for a TB-Free India, announced the launch of a TB survivor, Mr Bachchan has spoken about his the India Health Fund to support efforts in Malaria tryst with TB, advocating for increased awareness, and TB in India. combating stigma, and collaborating to end TB in India. He played a key role in the integrated Dr. Naresh Trehan, noted cardiologist and Managing advertising and social media campaign on radio, FB Director of Medanta, emerged as a Champion and Twitter.

Mr. Amitabh Bachchan lends his support as an ambassador for the TB-Free India Campaign.

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for TB and launched Mission TB-Free Haryana REACH - TB Call to Action Project : in partnership with CTD and the Government of Raising profile of TB at State Level Haryana. The mission was expanded by launching five diagnostic Mission TB Free Haryana vans, equipped The Resource Group for Education and Advocacy with digital X-ray. for Community Health (REACH) is a non-profit organization dedicated to the fight against tuberculosis Call to Action reached out to central universities and (TB). REACH seeks to transform the TB landscape state level universities with departments specializing in India by improving access to high quality services in public health, social work and encouraged them and reducing suffering and deaths. to mainstream TB in their curriculum and promote research on TB and also prom ote student involvement Over the next four years, the Call to Action project and action in raising TB awareness. will focus on at least six priority states - Assam, Bihar, Jharkhand, Odisha, Uttar Pradesh and Rajasthan. In September 2016, TBC2A was launched in Bihar as part of a 2-day event in Bodhgaya, Bihar, organized in association with the Central TB Division. The event saw discussion on the RNTCP’s Universal Access to TB Care and brought together key government stakeholders and NGO partners to develop a roadmap for the upcoming implementation of the daily regimen in the state.

Research and Academia Conclave at Mumbai on 9 July 2016 In December 2016, the project was launched in Bhubaneswar, Odisha. The launch was inaugurated by Shri Priyadarshi Mishra, MLA, Bhubaneswar State & District Level North. The launch was followed by a Civil Society Consultation, attended by various partners working In order to increase awareness about TB, referrals in TB and Health at the district and state levels. of presumptive TB cases, notification, strengthen patient support systems etc, a large number of the activities are being undertaken at State levels.

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District Level Activities

TB awareness activities and sputum collection camp conducted in Pachamalai

District Collector inaugrating TB awareness Flex Hon’ble Chief Minister of Tamil Nadu inaugurating banners at Collectorate, Villupuram District TB exhibition in Salem

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TB awareness stickers pasted in state run buses

hool Awareness Campaign on Tuberculosis in Government Kolasib High School, Kolasib Awareness Campaigns in Bairabi

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College Awareness Campaign held at Mizoram Display of Hoardings on roadside & waiting shed, College of Nursing, Falkawn Phullen

Active Case finding with TB awareness message for Display of Hoardings: prison inmates in Central Jail , Salem

School Awareness Campaign at Little Diamond English School, Siaha.

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School Awareness campaign was held at Christian English School.

Awareness campaign at JB college Lunglei

Community Meeting at Keitum village : Patient Provider Meeting at DTC, Serchhip:

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Students as awareness Volunteers in RNTCP Competitions among the students about knowledge of Tuberculosis- Students became Messenger of RNTCP

Community Meeting at Kawnpui South KTP:

Students of Mai Bhago Group of Institute(Girls) Ralla Distt Mansa participated in awareness session of TB

District Health Society-RNTCP Mansa (Punjab) organized competitions about TB-RNTCP in different parts of districts in schools and in village Gurdwaras under the leadership of Civil Surgeon Mansa and team. With help of these competitions knowledge about TB, RNTCP & DOTs disseminated among masses up to grass root level. DTO Mansa creating awareness among students

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Research Chapter 10

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Research Chapter 10

The RNTCP has been actively involved in conducting Structure for operational research under research since inception in the form of operational RNTCP research which helps the programme to develop in- country evidence to guide the policy decisions from • National OR Committee time to time. As new evidence became available, • Zonal OR Committee RNTCP has made necessary changes in its policies • State OR Committee and programme management practices. In view of the • Medical colleges End TB Strategy, RNTCP is incorporating innovative and more comprehensive approaches to TB control. Priority Areas of Research include the Efforts of RNTCP to promote OR has resulted in following success and most of the studies has are linked to the main priorities of TB control. Operational research 1. Strengthening surveillance and tuberculosis aims to improve the quality, effectiveness, efficiency notifications and accessibility (coverage) of the control efforts. 2. Improvement of TB disease burden estimation 3. Understanding TB transmission and how best to As the programme requires in depth knowledge and interrupt it sufficient evidence to optimize policies, improve service quality and increase operational efficiency, 4. Demand generation, Prevention, systematic mechanisms for strengthening operational research screening of high-risk groups, and early case have been put in place to leverage the enormous finding technical expertise and generate evidence sufficient 5. Improving the cascade of care in public and to guide changes in the programme policy. private sector care

East North East North South 1 South 2 West Total Number of State OR Committee meetings held 9 8 14 7 7 7 52 Number of OR projects received by the State OR 23 5 64 44 18 36 190 Committee Number of OR proposals approved by the State OR 10 5 51 18 13 9 106 Committee Number of OR proposals reviewed by the State OR 7 2 6 2 2 1 20 Committee and forwarded to the Zonal OR Commit- tee for approval Number of OR proposals approved by the Zonal OR 3 2 5 1 0 0 11 Committee Number of thesis proposals received by the State 13 6 32 38 6 31 126 OR Committee Number of thesis Proposals approved 12 4 30 34 6 24 110 Number of thesis initiated with RNTCP as a topic in 9 4 30 34 6 24 107 the Zone

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6. Socio-economic impact and poverty alleviation strong financial and technical commitment from 7. Strengthening RNTCP management all stakeholders, including representatives from the private sector. Summary of Operational Research Proposals National Institutes (NIRT, JALMA, NITRD & NTI) Status of Operational Research proposals submitted are exclusively focusing on TB research. ICMR & and approved by different levels of OR Committees its basic science institutes, Department of Health for FY 2016-17. Research (ICMR), Departments of Science and Technology (DST), Department of Biotechnology Developments in Research (DBT), Council of Scientific and Industrial Research (CSIR) and Indian Institute of Science (IISc) India Research Consortium for Tuberculosis: are also leaders in basic, clinical, translational and ICMR with the programme has established a operational research. Tuberculosis Research Consortium for streamlining all research related to TB within the country. This In addition various technical partners like WHO, will include participation of, DBT, CSIR, DST and The Union support in capacity building and other academic/research institutions. implementation of researches under RNTCP. Funding through various institutes could be harnessed to The consortium will drive the development of a promote integrated research. pioneer national TB Research Strategy in line with the WHO End-TB Strategy and create a scientific National Research Committee provides technical network and develop a country specific prioritized guidance to Central TB Division on the RNTCP OR research agenda that will allow India to be a model priority areas identified and helps the programme in country for TB research. This forum will have taking evidence based policy decisions.

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Monitoring and Evaluation Chapter 11

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Monitoring and Evaluation Chapter 11

Monitoring and evaluation (M&E) is about collecting, • Identify the unintended results and consequences storing, analyzing and finally transforming data of interventions into strategic information so it can be used to make • Contributes to organisational learning on informed decisions for program management, policy development effectiveness. formulation, and advocacy, to ensure universal access to quality care for all TB patients. • Provides evidence to base programmatic changes through informed management decisions. Monitoring is a continuous process of collecting and analysing information to compare how well a project, Overall, monitoring and evaluation provides programme, or policy is being implemented against government representatives, policy makers and expected result. The key questions that monitoring program managers, civil society and development seeks to answer includes the following: partners to

• Are the identified outputs being produced as • Learn from past experiences planned? • Improve service delivery planning and allocation • What are the issues (risks and assumptions) of resources that need to be taken into account to ensure the • Demonstrate results during and after the achievement of results? implementation • What decisions need to be made concerning changes to the plan of work? The Revised National Tuberculosis Control Program (RNTCP) has completed ninteen years of • Will the delivered outputs continue to be relevant implementation. While RNTCP consolidated these for the achievement of the expected outcomes? achievements, it is also attempting to expand the • Are the expected outcomes relevant and effective horizon. The program is moving towards achieving for achieving the overall priorities goals and ‘universal access’, reaching out to the unreached impacts? and ensuring that all TB patients receive the highest • What are we learning from the trend data quality diagnostic and treatment facilities as early as provided by the monitoring process? possible. The programme is also facing the challenge of Drug Resistant – TB and that of HIV co-infection On the other hand, evaluation is an important part of with TB. The programme has initiated steps to tackle programme planning as it provides an independent these challenges. and in-depth assessment of what worked and what did not work, and why this was the case. It is recognized that management of TB control program is challenging both from technical as well During and after the implementation of plan of work, as operational point of view. Although RNTCP has it is an important to take stock of the situation through standardized set of program management guidelines, a formal evaluation. An evaluation provides evidence people tend to deviate over time especially, when that can be used to improve future programming, supervision slackens. Another concern is the policies and strategies. Information provided by competing local priorities for which the programme evaluations: managers had to find solutions with the ambit of the health system.

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The following M&E activites are undertaken at the • Communication of Key observations to district National level under RNTCP; authorities • De-briefing of the findings to RNTCP staff • National RNTCP Review Meeting with State Tuberculosis Officers • Submission of IE report to STC and CTD

• Regional Review of RNTCP and Programmatic In the year 2016, CIE was undertaken in three states Management of Drug Resistant Tuberculosis - Bihar, Arunachal Pradesh and Himachal Pradesh. (PMDT) • Central Internal Evaluations • Zonal Task Force Meetings • National Task Force Meeting • Regional TB/ DR-TB-HIV Review Meetings • Coordination committee meeting of National Reference Laboratories (NRLs) • World Bank Mission • GFTAM Mission Field Visit by the CIE team in Himachal Pardesh The M&E activities of the year 2016 included the following;

Central Internal Evaluations (CIE)

Central Internal Evaluation (CIE) forms an integral component of RNTCP supervision and monitoring strategy. It acts as a tool to evaluate if good program practices are adopted and quality services are provided to the community. The evaluations also offer an opportunity for program managers to look into all aspects of program critically and swiftly. These activities help program managers in understanding determinants of good as well as poor performance for replication of good practices in other states /districts and take appropriate measures for improvement. The following activities are undertaken during the CIEs;

• Triangulation of data, for all the TB Units in the selected district • Visit to DMC, DOT Centre, ICTC, ARTcentre, Medical College etc. Patient home visit for interview

• Compilation of the report CIE team debriefing the state officials

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National Review Meeting of State TB Officers and RNTCP Consultants

As every year, Central TB Division had conducted a national review meeting of the State TB Officers and RNTCP Consultants. The meeting was held in Hyderabad from 22 to 24 August 2016 with the objectives to review RNTCP performance from States/UTs and deliberate upon way forward towards implementation of components of RNTCP technical PMDT Zonal Review Meeting- Guwahati and operational guidelines. Concurrent Assessment of Universal Access to TB Care Private Sector Engagement Intervention

The interventions under UATBC are being implemented in three sites – Patna, Mehsana and Mumbai since 2014. The interventions gained encouraging results in terms of attracting TB notification from private health care providers. In May 2016, the Central TB Division (CTD) and the World Health Organization Country Office for India (WCO) jointly conducted an assessment of UATBC to understand the efficacy of engaging the private National Review Meeting of State TB Officers and RNTCP Con- sector through these interventions, understand the sultants at Hyderabad operational and technical challenges and provide Programmatic Management of recommendations for further improvement as Drug resistant TB (PMDT) review

Regional (PMDT) review meetings are conducted to review state PMDT activities for further improvement on critical indicators. The meetings are attended by all stake holders from Central TB Division, State TB office, partners and Medical College faculties. The detail deliberation on each and every aspect on PMDT provides learning for all states. The meeting also provides an opportunity to apprises states on Field Visit in Mumbai during Concurrent Assessment of Univer- newer initiatives and future scale up plans. sal Access to TB Care Interventions

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• Provision of high sensitive diagnostic tools with appropriate linkages improved the microbiological confirmation • Relationship management of skills of staff and additional strength of field staff are needed to complete cycle of patients management • Contracting and partnership management capacity are key to success

Eleventh Global Meeting on Visit to chemist during concurrent assessment of UATBC at Public-Private Mix for TB Care and Mehsana Prevention well as feasibility for scaling up such interventions. Experts in the field of public–private partnerships, The 11th PPM Subgroup meeting was held in members from National Technical Working Group, Mumbai from 29 February to 02 March 2016. The CTD, national institutes, development partners, meeting reviewed global progress and problems experts from management schools, state programme in scaling up private sector engagement in TB officers and WCO had carried out 5 day assessment care and prevention; discussed innovations in activities from 16 to 21 May 2016. Key findings of the engaging private practitioners and frontline care assessment are given below, the detail report is placed providers, including laboratories and pharmacies, at tbcindia.gov.in. through collaborative and regulatory approaches, made field visits to an ongoing innovative project • Value proposition to the private providers and to engage private practitioners practicing in the service transactions in turn led to increase in TB slums of Mumbai, and discussed strategies to scale notification up and replicate innovations in collaboration and • Effective use of ICT advancement makes the regulation of private care providers in the context process of notification and patient support more of the new End TB Strategy acceptable to providers and patient centric

Eleventh Global Meeting on Public-Private Mix for TB Care and Prevention at Mumbai

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Sucess Stories Chapter 12

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Sucess Stories Chapter 12

Andhra Pradesh and generates output in the form of graphs, charts, tables, etc. Digitalization of Microscopy Centers in Andhra Pradesh – ‘E-Lab Register’ To sustain this project Hon’ble Chief Minister of Andhra Pradesh has launched “E-LAB Register State TB Cell of AP State was the recipient of TB software” on 22nd November, 2016 in the presence Reach Wave 4 grant in 2015. Under this grant, the of Hon’ble Minister for Health, Principal Secretary State had developed and implemented the E-Lab Health, Commissioner of Health & Family Welfare, register (Web version of the Lab register) across all Director of Public Health, Director of Medical DMCs (273) of 6 Districts in the State. All sputum Education, Commissioner APVVP. The programme testing centres were provided with computers. An has relocated 275 computers to all high load DMCs SMS and Interactive Voice Response System (IVRS) across 13 districts of the State. This way, information gateway sent out pre-recorded messages and SMS of 67% of overall Presumptive TB case load in the templates defined points in the diagnostic algorithm. State is now digitalized. Patients giving single sputum samples, those not Till now (from 1st Nov 2016 to 28th Feb 2017) completing the diagnostic algorithm, those not initiated on treatment and information of referred 48,887 Presumptive TB cases data is entered real cases were sent SMS/IVRS. The SMS were also sent time, with 93% Mobile numbers captured (increased to the RNTCP key staff to help them initiate action from 23% in 2015 to 93% in 2016) and 95% Aadhaar and track cases to ensure they complete diagnosis and linked data. Around 2,55,730 SMS have been sent to patients/Health workers as reminders to inform start treatment on time. The application is linked with results of 48,887 TB suspects, 1104 B sample pending

a server that automatically updates the e-Lab register, patients retrieved with SMS/IVRS reminders, 41,628 sends auto SMS/IVRS, performs backend functions, Smear negative patients are followed up for repeat

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examination after 14 days, 1599 inter district referral Deaths and Defaults in the Tribal TUs. Deaths have cases retrieved and initiated treatment and 350 Initial decreased to 11 in 2016 from 25 in 2015, whereas defaulters were retrieved during this 4 month period. Defaulters have decreased to 2 in 2016 from 15 in With the success of this intervention, the State has 2015. now gone ahead to deploy the e- Lab registers across all 611 DMCs of the State.

Nutritional Supplementation for Tribal TB patients in AP (Girijan Anurag Hastham)

Nutritional supplementation has been recognized as an incentive to TB patients to motivate them to stay on treatment and adhere to regimens. Poor nutritional TB patient receiving the monthly food packets under the status combined with the pill burden and long duration scheme Girijan Anurag Hastham of treatment in TB especially MDR TB leads to poor treatment outcomes among the TB patients. There Assam are 8 Tribal TB units in Visakhapatnam covering a population of 672621. On an average, there are around Use of ICT in better RNTCP management 600 cases on at any given point of time in these units of Visakhapatnam and about 100 new cases are newly The new forms of media has brought paradigm shift diagnosed and initiated on treatment every month. in communication arena. It has also impacted in Nutritional supplementation to all TB patients in health communication as a whole and RNTCP in the tribal PHC’s of Visakhapatnam District -“Girijan Assam has started innovative ways of supervision and Anurag Hastham”, has been launched from Feb 1st monitoring through WhatsApp. 2016 with the support of the District Collector and Project Officer, ITDA, Paderu. In this, monthly food Jorhat district of Assam is the pioneer as they have packets containing Rajma, Eggs, Ragi powder and dal created a WhatsApp group for supervision and monitoring namely “Let us fight against TB”. The (worth Rs.200) are distributed to every diagnosed TB basic objective of the group is not only to help patient till end of treatment. Jorhat District TB cell feel united to stands against Tuberculosis but also communicate messages regarding field level activities to District Magistrate (Deputy Commissioner), State TB officer and all WHO consultants. The supervisory staffs like STS, STLS including LT feel motivated by the words of encouragement from administrative heads as they are also the members of this group.

On the other, DTO who is the administrator of the group asked all staff to upload important information As a result of this, patients have the opportunity of as well as photographs so that one can monitor the monthly clinical examination by the Medical Officers, activities. The greatest success of the group is its role and other morbidities like anaemia etc. are detected in enabling start of an active case detection program and treated early. This also helped to reduce the in few high risk tribal villages and Tea Garden area of the district. 90 TB India 2017

The WhatsApp group has ensured quick communication between district officials thereby helping the program. During the review meeting, STO Assam encouraged all DTOs to use this ICT tool of communication to enable the TB program to become more effective.

Madhya Pradesh

Nutrition Support to TB patients A petty shop provided to a TB patient through a partner NGO in Telangana In the district Indore of the state of Madhya Pradesh, nutritional support is being provided to poor TB patient with the help of Jain Swetambar Social Group Professional Unity. The nutrition pack consists of dry ration which include wheat flour, dhal, Poha, Rice, edible oil and spices. This facility is given for poor TB patients for whole TB treatment duration ( First Line/MDR/XDR). Till date more than 250 patients have got benefited. Protein Powder supplementation is also given to all MDR/ XDR patient with the help of Vaklpik Padhiti Chikitsak Sangh. An extra pulmonary patient back to school as family provided with livelihood source

TB patient receiving the nutrition pack TB patient preparing brass pots from the support of brass ma- Telangana terials provided by the NGO partner

Support to TB Patients Successful Efforts of a Chemist

In the state of Telangana several success stories TB Alert India with the support of the State TB related to supporting the TB patient have been Cell, Telanagana is implementing a project called documented thereby helping the TB patient to PRATAM (Pharmacist and RHCPs activism in TB tide over the challenging times of their treatment. Care and control as animators and motivators) in The support through NGO partners, ranged from the state since Oct 2012. The project aims at making providing sustainable source of livelihood (petty chemists and RHCPs (Rural Health Care Providers) shop, goats, shoe making materials, brass materials important players in Revised National TB Program etc.) to providing dwelling houses.

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(RNTCP) by building their capacities in identifying, referring presumptive TB patients and linking them to government health facilities.

Project identified a chemist who is managing a pharmacy outlet in Mancherial district. Project trained and enrolled him in 2013. The chemist referred 48 presumptive TB patients to Government DMCs during the period since Oct 2013 to Dec 2016. Sensitization of Rural Clinical Society members on Private TB Out of those, 45 presumptive TB patients reached Referral and Notification in Salem district of Tamil Nadu DMC and undertook the TB test and were diagnosed. end of month of August 2016. Resultantly, 47 patients 5 patients were identified as TB positive and all were were referred from the RCS members, of which that put on DOTS. The chemist extended support and 11 were taking private ATT and they were notified made follow-up on treatment cases and ensured them in NIKSHAY. 05 cases were referred for CBNAAT to take full course of treatment. Treatment outcome Testing. in 4 cases were cured and 1 case is on treatment. The chemist was also enrolled as DOTS provider and gave DOTS to one TB patient. He was also carried out 2 Active Case Finding awareness programs in Mancherial urban slums and made aware community people about TB. In order to improve the case finding, active case finding activity was undertaken in the slum and adjoining schools of the various towns of Salem district. A total of 67 samples were collected, out of which 06 were found positive and 01 Extra- pulmonary case was found.

A chemist’s shop, who is involved in the RNTCP program as part of PRATAM (Pharmacist and RHCPs activism in TB Care and control as animators and motivators) in the state of Telangana

Tamil Nadu

Rural Clinical Society members Sensitization in Private TB Referral and Notification

The Rural Clinical Society (RCS) member consists of the rural peripheral doctors of various towns of the district of Salem, which have high TB case load. The society members were sensitized on RNTCP updates, private TB referrals and notifications in the

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Punjab there is huge problem of uncontrolled unqualified practitioners who are first point of contact of TB Cure of MDR patient inspite of drug menace suspects/patients in the rural and tribal areas of the state. The border district of Ferozpur is quite backward and has a huge drug addiction problem. However, due These unqualified practitioners may also be to persistent efforts of the RNTCP staff two MDR prescribing anti-tuberculosis medicines which are patients with support from their family members easily available over-the-counter in the pharmacies. have been cured. Government of Chhattisgarh has sought help of gazette notification of Schedule H1 policy of Government of Chhattisgarh India as an opportunity to tackle with problems of getting notification from all qualified practitioners Campaign to find, treat and cure TB in and to stop over-the-counter sale of anti-TB drugs prisons of Chhattisgarh based on prescription from unqualified practitioners.

In an effort to intensify TB case finding efforts, under the leadership of Director Health Services a state- wide campaign to find TB, treat TB & cure TB in all the prisons was conducted. In addition, this was done under the broader vision of giving ownership of health to other non-health departments thereby establishing inter-departmental coordination.

Hence guidance was issued from Director Health Services to all the CMHOs; similarly letter of TB Notifications from chemists in the state of Chhattisgarh support was issued by Commissioner Jail to all Jail (2016) Superintendent. Jail Campaign was successfully done The Food and Drug Administration (FDA) under in all the 28 Jails in the state in last week of December the Department of Health and Family Welfare, 2016. Considering jail inmates as high risk group Government of Chhattisgarh is already implementing for TB, all presumptive TB cases were subjected to the Schedule H1 Policy. The Chief Medical and Health CBNAAT for diagnosis of TB. Officer (CMHO) of the district are the nodal officers for implementation of schedule H1 policy in their District Prison in Kabirdham, Chhatisgarh respective districts with the help of Assistant Drug Controllers and Drug Inspectors. TB Notification from Private Chemists in Chattisgarh Leveraging on the successful implementation of schedule H1 policy in the state an order has been In spite of TB Notification from private health issued to all the CMHOs to gather information on establishments, still there are many health anti-TB drugs sold, name and address of the patient, establishments not notifying TB cases to the name of the prescribing physician. A monthly government authority which is leading to inadequate reporting format has been circulated to all the information on actual burden of TB in the state. Also, concerned for the same.

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Maharashtra Currently registered at Rajawadi Hospital-ART center, the yong man is all praises for his Challenge Private Public Partnership helping TB link counselor. According to him, these counselors young patients have touched the lives of patients, been their constant support, and through selfless service have “I thought my life was over. A lot of people think this is motivated patients to continue the treatment. He also the end, but it is not. There is an urgent need to create mentioned that being a private sector patient, he had awareness and let people know that TB & HIV go hand no trouble getting free medicines from a government in hand and both can be treated successfully. All you facility. He is now working towards starting his own have to do is take your medicines. Ever since I’m on the garments business. His case reinforces the private - treatment for TB and HIV, I feel happier and healthier” public partnership within the TB /HIV program in says 18-year old who was first diagnosed with TB Mumbai due to innovative interventions like PPIA under PPIA and then HIV under the Challenge TB and Challenge TB. initiative at Fauziya Hospital (a private facility in the slums) in Mumbai.

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Human Resource Chapter 13

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Human Resource Chapter 13

Human resource management and human resource training requirements by conducting a series of development under RNTCP goes beyond ‘training training sessions in year 2016 to train the trainers specific personnel for specific tasks’. It includes on new Technical & Operational Guidelines (TOG). management of personnel, in addition to maintaining Cumulatively, ¬¬____trainers from across the country constant, high quality standards of training. Hence, were trained at National Tuberculosis Institute, the target is to achieve sustained professional Bangalore, who went on to train and sensitize State competency in TB control activities that will benefit and District level staff and other stakeholders on the not just the States, but also the country at large. new TOG. Overall, more than 80% of the personnel manning key posts are trained in RNTCP. Newer categories The programme plans to transition from conventional of human resources sanctioned in 12th five-year stand-alone modular training methodologies to plan have also been included in various training newer composite tools which enable self-learning. programmes. These training tools will be designed in a way that they can be administered as per specific need and Being under the overall umbrella of NHM, the HR level of use. policy and practice is mostly governed by the State NHM setup. The Central TB Division supplements These can be taken by the participant at his or her own this by provisioning contractual staff at strategic pace. The National TB Institute, Bengaluru shall be positions of the programme network, developing playing a pivotal role in facilitating this transition and terms of reference for hiring of these staff and authoring and testing these e-learning tools. The first formulating standardized training material for of a series of such meetings was held at NTI Bangalore creating a uniform knowledge base among workers. in October 2016 to kick-off activities on development Apart from general health system staff, RNTCP has of e-learning. The STDCs will act as resource centres provisioned dedicated programme staff at various for translating the content to vernacular and adding levels. The organogram enumerates key RNTCP relevant content as per local needs at the State level. positions at various levels: The STDCs will also continue to act as centres for final certification of successful completion of In the past one year, several new components like Daily training by interacting with the participants after Regimen, New Technical & Operational Guidelines, culmination of e-learning and administering a post- Nikshay enhancement, Pharmacovigilance, etc. have test questionnaire, if needed. been added to RNTCP, creating an increased training need. Moreover, the alignment of TB Units with These steps will not only help in rapidly filling the gap NHM Blocks has resulted in an increase in number of untrained staff but will also prove to be an effective of human resource under RNTCP, who need to be and sustainable way to keep-up with changing policy trained. guidelines and percolating correct knowledge to every level of staff. RNTCP has managed to meet with the enhanced

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Infrastructure Chapter 14

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TB India 2017

Infrastructure Chapter 14

The central theme of Country’s 12th five year Plan also undertake periodic training for the IRL staff in (2012-2017) is the goal of “Universal Access to EQA, culture & Drug Susceptibility Testing activities. quality TB diagnosis and treatment for all TB patients The first National Drug Resistance Survey is being in the community”. This entails sustaining the conducted by NTI Bangalore with the support of achievements till date, finding unreached TB cases CTD and WHO India. before they can transmit infection, and treating all of them more effectively, preventing the emergence The programme has strengthened the Intermediate of MDR-TB. These ambitious goals are achievable Reference Laboratories (IRLs) at the state level to because the TB programme has established a robust supervise and monitor the DMC and efficiently management infrastructure, focused on effective achieve the external quality assurance function implementation, decentralizing patient-friendly (EQA) by providing human resource support. 68 services to impoverished and vulnerable populations, Laboratories with a capacity to diagnose drug resistant and improving quality of care for all. bacilli using different technologies including solid culture, liquid culture and line probe assay (LPA) and The programme is now focusing on re-engineering 628 CBNAAT machines have been established which programme system for optimal alignment with carry out Culture & Drug Susceptibility Testing. The NRHM at block level. The current basic programme Program provides free testing facilities for patients management unit for RNTCP, the “Tuberculosis Unit” and suspects of Multi Drug Resistant (MDR), TB- for 500,000 persons is now being realigned nationwide HIV co-infected, paediatric and Extra-Pulmonary with the NHM health blocks and urban wards TB. Quality assured diagnosis is being provided anticipating NUHM expansion. The programme has by laboratories through Line Probe Assay, liquid also effectively engaged the community in creating culture, Solid culture & Cartridge Based Nucleic awareness and providing DOTS treatment through Acid Amplification Tests (CB-NAAT) labs across community volunteers the country for rapid diagnosis of Drug Resistance Tuberculosis. Under the current strategy, Program Considering the technical and operational feasibility, is rapidly expanding the laboratory and newer the RNTCP built up its infrastructure, wherein, the technology platform capacity to achieve universal RNTCP has quality assured laboratory network access to quality assured diagnosis. for bacteriological examination of sputum in three tier system of Designated Microscopy Centre (DMC), Intermediate Reference laboratory (IRL), All TB patients including patients with co- and National Reference laboratory (NRL). DMC is morbidities such as TB-HIV, TB- Diabetes, registered the most peripheral laboratory under the RNTCP under the programme are provided free quality catering to a population of around 100,000 (50,000 assured treatment services through the network of in tribal and hilly areas). There are more than 14,000 providers, ranging from the community volunteers to Designated Microscopy Centres (DMCs) across the tertiary care dedicated institutions specialized in TB country. treatment and care. Currently, there are more around Currently, there are six National Reference 4.6 lac DOT centers, 143 specialized Drug Resistant Laboratories – NTI Bangalore, NIRT Chennai, TB Centers providing services across the country. For NITRD Delhi, JALMA Agra, RMRC Bhubaneshwar further decentralizing and making treatment services and BMHRC Bhopal. The NRLs work closely with patient friendly for DRTB patients, 55 Linked DR TB IRLs, monitor and supervise the IRL activities and Centers have been established in states

101 TB India 2017

Procurement, Supply & Logistics Unit has been stocks. Receipts from GMSDs/ SDSs (in other states) established in Central TB Division (CTD) for are coordinated by Central TB Division (CTD) and procurement and logistics functions at the Central are usually in response to quarterly reports/ additional level. Government Medical Stores Depots (GMSDs) stock requests made by State TB Officers (STO) and/ are the primary stocking points, for receipt of first or District TB Officers (DTO). line anti-TB drugs from the manufacturers and distribution to State Drug Stores across the country. The Deputy Director General (DDG), Additional In case of 2nd line drugs, the suppliers are required to Deputy Director General (ADDGs), representative deliver drugs directly to the consignees which are the from National Institutes, NRL, RNTCP Consultants State Drug Stores of the implementing State. and representative from partners constitute the Central Monitoring Unit for supervision, monitoring Currently, there are 6 GMSDs at Karnal, Mumbai, and surveillance of TB control activities in the Kolkata, Chennai, Guwahati and Hyderabad, 40 SDSs country. and 730 DDSs for stacking and distribution of drug

102 TB India 2017 Case Finding and Treatment Outcome under RNTCP in 2016 Chapter 15

103

TB India 2017 Case Finding and Treatment Outcome under RNTCP in 2016 Chapter 15

INDEX

Table No. Title Page Number

1. TB Case Notification in 2016 – State level performance status 106

Treatment Outcome of Microbiologically Confirmed TB patients notified in 2. 108 2015 from public sector

Treatment Outcome of Clinically diagnosed TB patients notified in 2015 from 3. 110 public sector

Case finding of M/XDR-TB patients and 6 months interim report of MDR-TB 4a. 112 patients (Reported by DR-TB centres in 2016)

12 months culture conversion report of MDR-TB patients 4b. 113 (Reported by DR-TB centres in 2016)

Treatment outcome report of MDR-TB patients 4c. 114 (Reported by DR-TB centres in 2016)

5. Programme Staffing Status in 2016 115

6. TB Case Notification from Districts in 2016 – District level performance status 121

105 TB India 2017

Table : 1 TB Case Notification in 2016 – State level performance status

State Popula- TB patients Pulmo- % Pulmo- Extra pul- % Extra New % of New Previously % Microbi- % of Micro- tion (in notified from nary nary TB monary Pulmonary TB treated Previously ologically biologically Lakhs) public sector TB treated confirmed confirmed TB

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13)

Andhra Pradesh 511 64420 56137 87% 8283 13% 52273 81% 12147 19% 38799 60%

Andman and Nicobar 4 509 357 70% 152 30% 421 83% 88 17% 227 45% Islands Arunachal Pradesh 15 2758 1905 69% 853 31% 2111 77% 647 23% 1117 41%

Assam 333 36724 30143 82% 6581 18% 29798 81% 6926 19% 18229 50%

Bihar 1154 59020 54995 93% 4025 7% 49543 84% 9477 16% 34566 59%

Chandigarh 11 2980 1906 64% 1074 36% 2527 85% 453 15% 1456 49%

Chhattisgarh 286 30821 26998 88% 3823 12% 27441 89% 3380 11% 14948 48%

Dadra and Nagar Haveli 4 510 359 70% 151 30% 406 80% 104 20% 257 50%

Daman and Diu 3 368 287 78% 81 22% 275 75% 93 25% 169 46%

Delhi 180 55657 32024 58% 23633 42% 43740 79% 11917 21% 19900 36%

Goa 15 1576 1183 75% 393 25% 1340 85% 236 15% 778 49%

Gujarat 656 89293 75273 84% 14020 16% 64134 72% 25159 28% 57468 64%

Haryana 277 41389 32836 79% 8553 21% 31922 77% 9467 23% 21201 51%

Himachal Pradesh 72 14070 10545 75% 3525 25% 11180 79% 2890 21% 7480 53%

Jammu and Kashmir 138 9244 6591 71% 2653 29% 7237 78% 2007 22% 4506 49%

Jharkhand 366 35130 32782 93% 2348 7% 29865 85% 5265 15% 18654 53%

Karnataka 652 59732 49814 83% 9918 17% 47145 79% 12587 21% 35041 59%

Kerala 340 20969 16690 80% 4279 20% 18407 88% 2562 12% 11494 55%

Lakshadweep 1 23 23 100% - 0% 23 100% 0 0% 10 43%

Madhya Pradesh 791 113172 98863 87% 14309 13% 96680 85% 16492 15% 55779 49%

Maharashtra 1193 122172 95693 78% 26479 22% 96068 79% 26104 21% 59449 49%

Manipur 29 1768 1336 76% 432 24% 1453 82% 315 18% 862 49%

Meghalaya 33 3934 2513 64% 1421 36% 3290 84% 644 16% 1658 42%

Mizoram 12 2162 1274 59% 888 41% 1850 86% 312 14% 699 32%

Nagaland 20 2274 1736 76% 538 24% 1837 81% 437 19% 1112 49%

Odisha 444 41807 34093 82% 7714 18% 36065 86% 5742 14% 22475 54%

Puducherry 14 1415 1048 74% 367 26% 1199 85% 216 15% 836 59%

Punjab 293 37093 28343 76% 8750 24% 30224 81% 6869 19% 19035 51%

Rajasthan 749 90032 76181 85% 13851 15% 70324 78% 19708 22% 47242 52%

Sikkim 6 1463 988 68% 475 32% 1169 80% 294 20% 593 41%

Tamil Nadu 771 82107 67427 82% 14680 18% 67585 82% 14522 18% 48448 59%

Telangana 365 38829 32813 85% 6016 15% 30712 79% 8117 21% 23074 59%

Tripura 39 2344 1948 83% 396 17% 1987 85% 357 15% 1473 63%

Uttar Pradesh 2178 260572 226235 87% 34337 13% 216041 83% 44531 17% 145631 56%

Uttarakhand 110 13255 10489 79% 2766 21% 10450 79% 2805 21% 6931 52%

West bengal 962 85179 67656 79% 17523 21% 71380 84% 13799 16% 50695 60%

Total 13029 1424771 1179484 83% 245287 17% 1158102 81% 266669 19% 772292 54%

106 TB India 2017

Table : 1 TB Case Notification in 2016 – State level performance status

State Clinically % of Pediatric % of TB % TB Total TB Annual TB Annual TB Annual TB Proportion Proportion of Proportion of diag- Clinically TB Pediatric patients notifica- patients notification notifica- notifica- of regis- TB patients TB patients nosed diag- TB notified tion from notified rate (public tion rate tion rate tered TB known to be known to be nosed from private sector) (private (Total) cases with HIV infected HIV infected private sector sector) known HIV among among sector status tested registered

(1) (14) (15) (16) (17) (18) (19) (20) (21) (22) (23) (24) (25) (26)

Andhra Pradesh 25621 40% 2163 3% 9953 13% 74373 126 19 145 99% 10% 10%

Andman and Nicobar 282 55% 32 6% 25 5% 534 132 6 139 87% 0% 0% Islands Arunachal Pradesh 1641 59% 410 15% 30 1% 2788 181 2 183 84% 0% 0%

Assam 18495 50% 1526 4% 4127 10% 40851 110 12 123 50% 1% 0%

Bihar 24454 41% 3666 6% 37981 39% 97001 51 33 84 66% 2% 1%

Chandigarh 1524 51% 248 8% 433 13% 3413 266 39 305 97% 1% 1%

Chhattisgarh 15873 52% 1350 4% 8663 22% 39484 108 30 138 93% 1% 1%

Dadra and Nagar Haveli 253 50% 32 6% 42 8% 552 123 10 133 94% 2% 2%

Daman and Diu 199 54% 15 4% 119 24% 487 126 41 166 99% 1% 1%

Delhi 35757 64% 6677 12% 7049 11% 62706 309 39 348 90% 2% 1%

Goa 798 51% 71 5% 390 20% 1966 105 26 131 93% 6% 5%

Gujarat 31825 36% 3561 4% 37372 30% 126665 136 57 193 97% 3% 3%

Haryana 20188 49% 2066 5% 6156 13% 47545 150 22 172 94% 1% 1%

Himachal Pradesh 6590 47% 610 4% 891 6% 14961 195 12 207 88% 1% 1%

Jammu and Kashmir 4738 51% 601 7% 693 7% 9937 67 5 72 74% 0% 0%

Jharkhand 16476 47% 1342 4% 4385 11% 39515 96 12 108 74% 1% 0%

Karnataka 24691 41% 3191 5% 8730 13% 68462 92 13 105 96% 11% 10%

Kerala 9475 45% 1399 7% 26324 56% 47293 62 77 139 96% 1% 1%

Lakshadweep 13 57% 16 70% 0 0% 23 35 0 35 100% 0% 0%

Madhya Pradesh 57393 51% 9855 9% 16743 13% 129915 143 21 164 82% 1% 1%

Maharashtra 62723 51% 6394 5% 72967 37% 195139 102 61 164 94% 7% 6%

Manipur 906 51% 69 4% 625 26% 2393 60 21 81 89% 6% 5%

Meghalaya 2276 58% 260 7% 652 14% 4586 117 19 137 52% 3% 2%

Mizoram 1463 68% 295 14% 43 2% 2205 182 4 186 81% 12% 9%

Nagaland 1162 51% 185 8% 547 19% 2821 112 27 139 84% 5% 5%

Odisha 19332 46% 1922 5% 2044 5% 43851 94 5 99 93% 2% 1%

Puducherry 579 41% 64 5% 6 0% 1421 102 0 103 99% 2% 2%

Punjab 18058 49% 2031 5% 2743 7% 39836 126 9 136 91% 1% 1%

Rajasthan 42790 48% 3731 4% 16724 16% 106756 120 22 143 90% 1% 1%

Sikkim 870 59% 100 7% 76 5% 1539 229 12 241 98% 1% 1%

Tamil Nadu 33659 41% 3176 4% 13972 15% 96079 106 18 125 98% 5% 5%

Telangana 15755 41% 1624 4% 6174 14% 45003 106 17 123 97% 6% 6%

Tripura 871 37% 39 2% 30 1% 2374 61 1 61 72% 2% 1%

Uttar Pradesh 114941 44% 13941 5% 37174 12% 297746 120 17 137 84% 1% 1%

Uttarakhand 6324 48% 720 5% 1826 12% 15081 121 17 138 78% 1% 1%

West bengal 34484 40% 3093 4% 4477 5% 89656 89 5 93 88% 2% 1%

Total 652479 46% 76475 5% 330186 19% 1754957 109 25 135 88% 3% 3%

107 TB India 2017

Table : 2 (a) Treatment Outcome of Microbiologically Confirmed New TB patients notified in 2015 from public sector

Switched to State/UT Registered Cured Completed Died Failure Defaulted Transfer out Cat IV Andaman & Nicobar 148 86% 3% 2% 1% 3% 3% 3% Andhra Pradesh 28752 89% 2% 4% 1% 3% 0% 0% Arunachal Pradesh 837 84% 2% 3% 2% 4% 1% 4% Assam 15814 79% 7% 5% 2% 7% 1% 0% Bihar 32057 77% 13% 3% 1% 6% 0% 1% Chandigarh 1061 85% 1% 3% 3% 4% 3% 1% Chhattisgarh 13072 85% 4% 5% 1% 4% 0% 0% Dadar & Nagar Haveli 205 86% 0% 3% 2% 3% 4% 1% Daman & Diu 83 80% 0% 5% 1% 0% 11% 4% Delhi 11367 86% 0% 3% 2% 5% 1% 2% Goa 559 87% 0% 3% 3% 3% 3% 1% Gujarat 39093 88% 1% 5% 2% 3% 0% 1% Haryana 14850 86% 2% 4% 2% 5% 1% 1% Himachal Pradesh 5198 86% 4% 4% 2% 4% 1% 0% Jammu & Kashmir 3667 83% 5% 4% 2% 4% 2% 0% Jharkhand 16724 86% 5% 3% 1% 4% 0% 0% Karnataka 25913 84% 1% 6% 2% 6% 1% 1% Kerala 10586 85% 2% 5% 4% 3% 1% 0% Lakshadweep 23 91% 0% 4% 0% 0% 0% 4% Madhya Pradesh 42445 87% 4% 4% 1% 4% 0% 0% Maharashtra 49108 82% 2% 5% 2% 5% 2% 2% Manipur 725 78% 5% 5% 3% 9% 1% 0% Meghalaya 1675 83% 3% 4% 2% 5% 1% 3% Mizoram 519 88% 3% 4% 2% 3% 0% 1% Nagaland 1523 53% 19% 1% 4% 9% 6% 8% Orissa 20553 85% 4% 5% 1% 5% 1% 0% Pondicherry 590 89% 0% 4% 2% 4% 0% 1% Punjab 14525 82% 5% 5% 2% 5% 1% 0% Rajasthan 34146 88% 3% 4% 1% 4% 0% 0% Sikkim 470 77% 0% 2% 3% 1% 1% 16% Tamil Nadu 34540 83% 3% 6% 2% 7% 0% 0% Telangana 17246 85% 4% 4% 2% 3% 0% 1% Tripura 1360 86% 2% 6% 2% 3% 0% 0% Uttar Pradesh 116630 82% 5% 4% 1% 6% 1% 0% Uttarakhand 5468 80% 6% 4% 1% 6% 2% 1% West Bengal 43242 85% 2% 4% 2% 6% 1% 1% Total 604774 84% 4% 4% 1% 5% 1% 1%

108 TB India 2017

Table : 2 (b) Treatment Outcome of Microbiologically Confirmed Previously treated TB patients notified in 2015 from public sector

Switched to State/UT Registered Cured Completed Died Failure Defaulted Transfer out Cat IV Andaman & Nicobar 36 56% 11% 0% 14% 3% 6% 11% Andhra Pradesh 8514 75% 3% 8% 3% 6% 0% 5% Arunachal Pradesh 310 61% 8% 4% 4% 9% 1% 14% Assam 3685 53% 13% 9% 3% 15% 2% 5% Bihar 6989 60% 18% 5% 2% 10% 1% 5% Chandigarh 330 78% 0% 6% 5% 7% 2% 2% Chhattisgarh 2016 61% 11% 10% 3% 10% 1% 4% Dadar & Nagar Haveli 77 74% 0% 8% 0% 9% 6% 3% Daman & Diu 53 68% 11% 11% 0% 2% 2% 6% Delhi 5165 71% 0% 6% 3% 10% 2% 7% Goa 189 67% 1% 5% 8% 13% 2% 5% Gujarat 15014 72% 2% 10% 5% 8% 0% 2% Haryana 7246 69% 5% 8% 4% 10% 1% 3% Himachal Pradesh 2092 73% 9% 6% 2% 6% 0% 4% Jammu & Kashmir 1381 69% 8% 6% 4% 9% 2% 2% Jharkhand 2704 67% 11% 6% 3% 9% 1% 3% Karnataka 8295 58% 4% 11% 4% 16% 1% 6% Kerala 2037 67% 5% 7% 5% 11% 1% 5% Lakshadweep 1 0% 0% 0% 0% 0% 0% 100% Madhya Pradesh 9967 62% 11% 8% 3% 11% 1% 4% Maharashtra 15287 54% 5% 10% 4% 15% 3% 9% Manipur 195 64% 8% 6% 2% 13% 2% 6% Meghalaya 473 59% 6% 7% 3% 12% 3% 11% Mizoram 173 73% 6% 7% 1% 6% 1% 6% Nagaland 334 73% 9% 4% 6% 6% 0% 3% Orissa 4192 60% 11% 8% 3% 14% 2% 2% Pondicherry 185 71% 1% 8% 6% 12% 0% 2% Punjab 5508 69% 9% 7% 3% 9% 1% 2% Rajasthan 13768 72% 6% 7% 2% 8% 1% 4% Sikkim 158 70% 0% 3% 1% 3% 0% 23% Tamil Nadu 10295 60% 7% 9% 4% 17% 0% 3% Telangana 5882 68% 9% 8% 4% 8% 0% 3% Tripura 264 70% 3% 8% 3% 13% 0% 3% Uttar Pradesh 27417 61% 10% 7% 3% 11% 2% 6% Uttarakhand 2243 63% 10% 6% 3% 9% 5% 4% West Bengal 10103 65% 3% 9% 4% 13% 1% 5% Total 172578 64% 7% 8% 3% 11% 1% 5%

109 TB India 2017

Table : 3 (a) Treatment Outcome of Clinically diagnosed New TB patients notified in 2015 from public sector

Switched to State/UT Registered Completed Died Failure Defaulted Transfer out Cat IV Andaman & Nicobar 241 85% 5% 0% 6% 2% 2% Andhra Pradesh 20562 94% 4% 0% 2% 0% 0% Arunachal Pradesh 1252 94% 2% 0% 3% 1% 2% Assam 14980 88% 4% 0% 7% 0% 0% Bihar 20073 91% 2% 0% 5% 2% 0% Chandigarh 1403 97% 1% 0% 1% 1% 0% Chhattisgarh 13761 92% 4% 0% 4% 0% 0% Dadar & Nagar Haveli 176 94% 3% 1% 1% 2% 0% Daman & Diu 130 91% 3% 0% 2% 5% 0% Delhi 23674 95% 1% 0% 2% 1% 0% Goa 756 97% 2% 0% 1% 0% 0% Gujarat 20907 93% 4% 0% 2% 0% 0% Haryana 15960 92% 2% 0% 5% 0% 0% Himachal Pradesh 6235 94% 3% 0% 2% 1% 0% Jammu & Kashmir 4416 92% 2% 0% 4% 1% 0% Jharkhand 12419 91% 3% 0% 6% 0% 0% Karnataka 22024 89% 6% 0% 4% 1% 0% Kerala 9494 93% 3% 0% 3% 1% 0% Lakshadweep 15 100% 0% 0% 0% 0% 0% Madhya Pradesh 44322 92% 3% 0% 4% 1% 0% Maharashtra 52106 89% 4% 0% 4% 2% 0% Manipur 836 90% 3% 0% 7% 0% 0% Meghalaya 2091 90% 4% 0% 4% 1% 0% Mizoram 1232 93% 4% 0% 4% 0% 0% Nagaland 2175 82% 4% 4% 4% 3% 3% Orissa 18498 90% 5% 0% 4% 1% 0% Pondicherry 476 96% 3% 0% 0% 0% 0% Punjab 16051 92% 4% 0% 3% 1% 0% Rajasthan 37394 93% 3% 0% 4% 0% 0% Sikkim 748 94% 2% 0% 0% 1% 2% Tamil Nadu 31903 94% 3% 0% 3% 0% 0% Telangana 12688 93% 5% 0% 2% 0% 0% Tripura 814 87% 7% 0% 5% 0% 0% Uttar Pradesh 91242 91% 3% 0% 6% 1% 0% Uttarakhand 5966 93% 2% 0% 4% 1% 0% West Bengal 29764 90% 4% 0% 5% 1% 0% Total 536784 91% 3% 0% 4% 1% 0%

110 TB India 2017

Table : 3 (b) Treatment Outcome of Clinically diagnosed Previously treated TB pa- tients notified in 2015 from public sector

Switched to State/UT Registered Completed Died Failure Defaulted Transfer out Cat IV Andaman & Nicobar 35 89% 3% 3% 0% 3% 3% Andhra Pradesh 3997 90% 5% 0% 4% 0% 1% Arunachal Pradesh 349 83% 4% 0% 8% 1% 5% Assam 3496 81% 6% 0% 11% 1% 1% Bihar 5820 87% 3% 0% 8% 1% 1% Chandigarh 154 93% 1% 1% 3% 1% 1% Chhattisgarh 1628 87% 5% 0% 7% 0% 0% Dadar & Nagar Haveli 29 86% 3% 0% 3% 7% 0% Daman & Diu 18 94% 0% 0% 6% 0% 0% Delhi 4598 90% 3% 0% 4% 1% 1% Goa 95 95% 1% 0% 3% 0% 1% Gujarat 7570 88% 6% 0% 4% 1% 1% Haryana 2857 85% 5% 0% 9% 0% 0% Himachal Pradesh 775 88% 5% 1% 5% 1% 1% Jammu & Kashmir 409 86% 4% 0% 8% 2% 0% Jharkhand 2951 87% 4% 0% 9% 0% 0% Karnataka 3787 80% 9% 0% 8% 2% 1% Kerala 744 87% 6% 0% 6% 1% 0% Lakshadweep 1 100% 0% 0% 0% 0% 0% Madhya Pradesh 6057 85% 5% 1% 8% 3% 1% Maharashtra 13524 77% 7% 0% 9% 5% 3% Manipur 127 82% 6% 0% 12% 1% 0% Meghalaya 436 79% 7% 0% 10% 1% 3% Mizoram 165 81% 9% 1% 8% 1% 1% Nagaland 165 91% 2% 0% 7% 0% 0% Orissa 2521 84% 7% 0% 8% 1% 0% Pondicherry 37 97% 3% 0% 0% 0% 0% Punjab 1888 88% 4% 1% 6% 1% 0% Rajasthan 4987 86% 6% 0% 7% 0% 1% Sikkim 132 79% 5% 0% 2% 1% 13% Tamil Nadu 3601 84% 7% 1% 7% 0% 1% Telangana 2440 91% 5% 0% 4% 0% 0% Tripura 90 90% 2% 0% 8% 0% 0% Uttar Pradesh 15002 84% 4% 0% 8% 2% 1% Uttarakhand 962 86% 3% 1% 8% 2% 0% West Bengal 4680 83% 7% 0% 7% 2% 1% Total 96127 84% 5% 0% 7% 2% 1%

111 TB India 2017

Table : 4 (a) Case finding of M/XDR-TB patients and 6 months interim report of MDR-TB patients (Reported by DR-TB centres in 2016)

Diagnosis Indicators on 6 months interim report Number Number Number Number of Number of Number of MDR Out of a, No. Out of a, Out of a, No. of DR TB of Pre- of MDR MDR TB Cases XDR TB Cases TB Case registered (%) who No. (%) (%) who State Centres sumptive TB detected that detected that and initiated on are alive, on who died defaulted functional DRTB Cases were registered were registered Cat IV in the 4 co- treatment in the subject- detect- and initiated on and initiated horts 6-9 months and culture state ed to ed treatment in on treatment in prior negative$ C-DST 2016# 2016 (2q15 to 1q16) (a) Andaman & Nicobar 1 1239 56 52 2 51 26 51% 5 10% 2 4% Andhra Pradesh 10 19045 946 849 28 802 560 70% 84 10% 61 8% Arunachal Pradesh 2 1832 182 233 4 196 137 70% 5 3% 22 11% Assam 3 6246 409 375 19 384 242 63% 33 9% 40 10% Bihar 6 24832 1914 1762 102 1342 589 44% 102 8% 85 6% Chandigarh 1 916 73 67 1 46 31 67% 1 2% 4 9% Chhattisgarh 4 7801 242 198 2 175 101 58% 19 11% 12 7% Delhi 4 16499 1367 1760 138 1600 824 52% 141 9% 185 12% Goa 1 436 49 42 4 44 24 55% 3 7% 5 11% Gujarat* 5 36248 2437 2222 245 2009 1097 55% 214 11% 247 12% Haryana 2 10120 589 582 15 537 355 66% 82 15% 47 9% Himachal Pradesh 2 3148 250 260 9 179 101 56% 11 6% 10 6% Jammu & Kashmir 3 2837 124 106 5 102 68 67% 10 10% 9 9% Jharkhand 4 6102 392 355 15 232 120 52% 9 4% 16 7% Karnataka 6 29652 1338 1099 48 925 542 59% 123 13% 107 12% Kerala* 2 4989 213 220 12 134 85 63% 10 7% 7 5% Madhya Pradesh 9 26512 1794 1506 82 1298 743 57% 180 14% 130 10% Maharashtra 17 55827 6286 7221 873 6056 2735 45% 596 10% 584 10% Manipur 1 1673 60 60 1 41 16 39% 4 10% 4 10% Meghalaya 2 1787 225 278 18 218 126 58% 21 10% 12 6% Mizoram 1 1105 50 45 1 45 34 76% 3 7% 4 9% Nagaland 2 896 47 52 0 64 30 47% 1 2% 4 6% Orissa 3 6563 229 281 16 237 126 53% 21 9% 10 4% Puducherry 1 940 14 18 2 8 4 50% 2 25% 1 13% Punjab 3 10713 616 541 26 414 232 56% 45 11% 37 9% Rajasthan 7 27248 2118 2031 127 1744 805 46% 205 12% 149 9% Sikkim 1 1007 231 241 15 217 157 72% 20 9% 11 5% Tamil Nadu 6 76334 1546 1209 35 1037 609 59% 108 10% 127 12% Telangana 7 27796 726 628 22 700 457 65% 97 14% 52 7% Tripura 1 453 13 15 2 14 11 79% 1 7% 1 7% Uttar Pradesh 15 51848 6928 6143 376 4682 2472 53% 572 12% 414 9% Uttarakhand 2 3286 364 269 50 242 136 56% 19 8% 26 11% West Bengal 9 24005 1992 1962 161 1600 966 60% 153 10% 154 10% Total 143 489935 33820 32682 2456 27375 14561 53% 2900 11% 2579 9% Notes: * Data from Daman-Diu & Dadra Nagar Haveli is included in Gujarat: Lakshdweep is included in Kerala # These numbers are NOT from the same cohort of patients from which MDR diagnosed are reported, but rather from treatment initiation registers only. The denominator also includes patients diagnosed from the private sector. The numerator includes patients diagnosed in the previous year and initiated in the current year. $ This also excludes extra pulmonary patients put on treatment

112 TB India 2017

TABLE : 4 (b) 12 months culture conversion report of MDR-TB patients (Reported by DR-TB centres in 2016)

Indicators on 12 months Culture Conversion Report Number of MDR TB Out of b, No. (%) Out of b, No. (%) Out of b, No. (%) Out of b, No. (%) Out of b, No. (%) who State cases registered who are alive, on who are alive, on who are alive, on who died defaulted in the 4 cohorts, treatment and treatment and treatment and 12-15 months prior culture negative$ culture positive culture not known (4q14 to 3q15) (b) Andaman & Nicobar 22 13 59% 0 0% 7 32% 1 5% 1 5% Andhra Pradesh 497 294 59% 26 5% 18 4% 73 15% 72 14% Arunachal Pradesh 143 71 50% 0 0% 36 25% 8 6% 24 17% Assam 296 162 55% 17 6% 17 6% 42 14% 43 15% Bihar 984 343 35% 37 4% 352 36% 115 12% 103 10% Chandigarh 35 16 46% 0 0% 0 0% 8 23% 7 20% Chhattisgarh 124 60 48% 5 4% 13 10% 19 15% 17 14% Delhi 1177 577 49% 37 3% 107 9% 127 11% 187 16% Goa 20 11 55% 1 5% 0 0% 2 10% 2 10% Gujarat* 1392 618 44% 66 5% 106 8% 214 15% 214 15% Haryana 322 165 51% 5 2% 20 6% 64 20% 54 17% Himachal Pradesh 126 70 56% 5 4% 21 17% 7 6% 13 10% Jammu & Kashmir 114 66 58% 3 3% 10 9% 14 12% 16 14% Jharkhand 144 56 39% 6 4% 36 25% 16 11% 21 15% Karnataka 993 479 48% 44 4% 77 8% 174 18% 173 17% Kerala* 145 84 58% 4 3% 29 20% 12 8% 10 7% Madhya Pradesh 892 454 51% 35 4% 90 10% 165 18% 122 14% Maharashtra 3987 1454 36% 146 4% 541 14% 536 13% 578 14% Manipur 21 13 62% 3 14% 2 10% 1 5% 1 5% Meghalaya 141 80 57% 9 6% 23 16% 15 11% 6 4% Mizoram 38 24 63% 1 3% 3 8% 3 8% 5 13% Nagaland 52 16 31% 0 0% 24 46% 3 6% 13 25% Orissa 211 92 44% 12 6% 65 31% 22 10% 13 6% Puducherry 11 2 18% 3 27% 0 0% 3 27% 3 27% Punjab 278 149 54% 10 4% 20 7% 37 13% 41 15% Rajasthan 1227 532 43% 54 4% 196 16% 198 16% 203 17% Sikkim 110 73 66% 4 4% 3 3% 13 12% 10 9% Tamil Nadu 795 385 48% 32 4% 53 7% 136 17% 148 19% Telangana 504 282 56% 15 3% 34 7% 99 20% 59 12% Tripura 32 24 75% 1 3% 4 13% 3 9% 0 0% Uttar Pradesh 3745 1846 49% 288 8% 313 8% 608 16% 494 13% Uttarakhand 192 91 47% 5 3% 30 16% 33 17% 24 13% West Bengal 1123 656 58% 72 6% 56 5% 131 12% 161 14% Total 19893 9258 47% 946 5% 2306 12% 2902 15% 2838 14% Notes: * Data from Daman-Diu & Dadra Nagar Haveli is included in Gujarat: Lakshdweep is included in Kerala # These numbers are NOT from the same cohort of patients from which MDR diagnosed are reported, but rather from treatment initiation registers only. The denominator also includes patients diagnosed from the private sector. The numerator includes patients diagnosed in the previous year and initiated in the current year. $ This also excludes extra pulmonary patients put on treatment

113 TB India 2017

TABLE : 4 (c) Treatment outcome report of MDR-TB patients (Reported by DR-TB centres in 2016)

Indicators on Treatment Outcome of MDR TB Cases Number of MDR TB Out of c, No. Out of c, No. Out of c, Out of c, No. (%) Out of c, No. Out of c, No. State cases registered in the reported as Cured reported as Treat- Success who died (%) who (%) who 4 cohorts, 31-33 months ment Completed Rate defaulted failed treat- prior (3q13 to 2q14) (c) ment Andaman & Nicobar 47 11 9 43% 11 23% 13 28% 1 2% Andhra Pradesh 690 285 38 47% 166 24% 137 20% 14 2% Arunachal Pradesh 168 63 28 54% 15 9% 50 30% 1 1% Assam 406 151 43 48% 91 22% 76 19% 9 2% Bihar 527 182 113 56% 102 19% 82 16% 13 2% Chandigarh 32 18 0 56% 6 19% 5 16% 0 0% Chhattisgarh 156 64 25 57% 21 13% 31 20% 3 2% Delhi 826 336 85 51% 123 15% 183 22% 21 3% Goa 88 28 6 39% 21 24% 17 19% 0 0% Gujarat* 1839 629 160 43% 402 22% 344 19% 88 5% Haryana 426 187 24 50% 115 27% 76 18% 1 0% Himachal Pradesh 230 56 27 36% 38 17% 29 13% 2 1% Jammu & Kashmir 145 47 11 40% 35 24% 32 22% 7 5% Jharkhand 235 110 66 75% 44 19% 57 24% 8 3% Karnataka 739 270 66 45% 194 26% 142 19% 15 2% Kerala* 182 88 18 58% 36 20% 17 9% 3 2% Madhya Pradesh 755 294 47 45% 187 25% 148 20% 39 5% Maharashtra 4632 1110 580 36% 930 20% 978 21% 99 2% Manipur 43 13 16 67% 8 19% 5 12% 0 0% Meghalaya 129 47 35 64% 21 16% 16 12% 3 2% Mizoram 54 21 5 48% 13 24% 10 19% 0 0% Nagaland 144 65 28 65% 15 10% 27 19% 0 0% Orissa 369 140 43 50% 78 21% 71 19% 4 1% Puducherry 23 4 1 22% 11 48% 5 22% 0 0% Punjab 334 129 32 48% 75 22% 67 20% 2 1% Rajasthan 1531 595 131 47% 374 24% 327 21% 37 2% Sikkim 177 99 6 59% 35 20% 18 10% 2 1% Tamil Nadu 1323 441 130 43% 278 21% 381 29% 18 1% Telangana 775 340 28 47% 209 27% 151 19% 11 1% Tripura 44 15 11 59% 9 20% 3 7% 1 2% Uttar Pradesh 2309 632 450 47% 593 26% 358 16% 55 2% Uttarakhand 135 53 25 58% 24 18% 19 14% 1 1% West Bengal 1549 619 210 54% 289 19% 289 19% 73 5% Total 21062 7142 2497 46% 4569 22% 4164 20% 531 3% Notes: * Data from Daman-Diu & Dadra Nagar Haveli is included in Gujarat: Lakshdweep is included in Kerala # These numbers are NOT from the same cohort of patients from which MDR diagnosed are reported, but rather from treatment initiation registers only. The denominator also includes patients diagnosed from the private sector. The numerator includes patients diagnosed in the previous year and initiated in the current year. $ This also excludes extra pulmonary patients put on treatment

114 TB India 2017

Table : 5 (a) Programme Staffing Status in 2016 States State Level Epidemiologist MO-STC TB-HIV Coordinator Accounts Officer/ Secreterial Assis- Data Entry operator (APO) State accountant tant (STC) Sanc- In Place Sanc- In Place Sanc- In Place Sanc- In Place Sanc- In Place Sanc- In Place tioned tioned tioned tioned tioned tioned (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) Andaman & Nicobar 0 0 1 1 1 0 1 1 1 1 1 1 Andhra Pradesh 1 0 1 0 1 0 1 1 1 0 1 0 Assam 0 0 1 1 1 1 1 1 1 1 1 1 Bihar 1 0 1 0 1 0 1 0 1 0 1 1 Chandigarh 0 0 1 1 1 1 1 1 1 1 1 1 Chhattisgarh 1 1 1 1 1 0 1 0 1 0 1 1 Dadar & Nagar Haveli 1 0 1 1 0 0 1 1 1 1 1 1 Daman & Diu 1 1 1 1 0 0 1 1 0 0 1 1 Delhi 1 1 1 1 1 0 1 1 1 1 1 1 Goa 1 1 1 1 1 0 1 1 1 1 1 1 Gujarat 1 1 1 1 1 1 1 1 1 1 2 2 Haryana 1 0 1 0 1 0 1 1 1 1 1 1 Himachal Pradesh 1 0 1 0 1 0 1 1 1 0 1 1 Jammu & Kashmir 2 2 2 1 2 2 Jharkhand 1 0 1 0 1 0 2 1 1 0 1 1 Karnataka 1 1 1 0 1 0 2 2 1 0 2 2 Kerala 1 0 1 1 1 1 1 1 1 1 1 1 Lakshadweep 0 0 0 0 0 0 1 1 0 0 1 1 Madhya Pradesh 1 1 1 0 1 0 1 1 1 1 2 2 Maharashtra 2 1 1 0 1 1 3 3 2 2 2 2 Manipur 1 1 1 1 1 0 1 1 1 1 1 1 Meghalaya 1 1 1 1 1 1 1 1 1 1 1 1 Mizoram 1 1 1 1 1 1 1 1 1 1 1 1 Nagaland 1 1 1 1 1 1 1 1 1 1 1 1 Orissa 1 1 1 1 1 1 1 1 1 1 1 1 Pondicherry 0 0 1 1 1 1 1 1 1 1 1 1 Punjab 1 0 1 1 1 1 1 1 1 0 1 1 Rajasthan 1 0 1 0 1 0 1 1 1 1 1 1 Sikkim 1 0 1 1 1 0 1 1 1 1 1 1 Tamil Nadu 1 0 1 1 1 0 1 1 1 0 2 1 Telangana 1 0 1 0 1 1 1 0 1 0 1 1 Tripura 1 0 1 1 1 0 1 1 1 1 1 1 Uttar Pradesh 2 2 2 0 2 1 2 1 1 1 2 1 Uttarakhand 0 0 1 0 0 0 1 1 1 0 1 1 West Bengal 2 1 1 1 2 1 2 2 1 1 2 1 Total 87 76 92 72 90 91 108 91 97 101 105 70

115 TB India 2017

Table : 5 (b) Programme Staffing Status in 2016 States State Level DR-TB Coordinator DEO-STF Chairman Data Analyst TO-Procurement & ACSM Officer PPM Coordinator Logistics Sanc- In Place Sanc- In Place Sanc- In Place Sanc- In Place Sanc- In Place Sanc- In Place tioned tioned tioned tioned tioned tioned (1) (14) (15) (16) (17) (18) (19) (20) (21) (22) (23) (24) (25) Andaman & Nicobar 0 0 0 0 1 0 0 0 1 1 0 0 Andhra Pradesh 1 0 1 0 1 1 1 0 1 0 1 0 Assam 1 1 1 1 1 1 1 1 1 1 1 1 Bihar 1 0 1 0 1 0 1 0 1 1 1 0 Chandigarh 0 0 0 0 0 0 0 0 1 1 0 0 Chhattisgarh 0 0 0 0 0 0 0 0 1 1 1 1 Dadar & Nagar Haveli 0 0 0 0 0 0 0 0 1 1 0 0 Daman & Diu 1 0 0 0 0 0 0 0 0 0 0 0 Delhi 1 0 1 1 1 0 1 0 1 1 1 0 Goa 0 0 0 0 0 0 0 0 1 1 0 0 Gujarat 1 1 0 0 0 0 1 0 1 1 1 0 Haryana 0 0 0 0 0 0 0 0 1 0 1 0 Himachal Pradesh 1 0 1 0 1 0 0 0 1 1 1 0 Jammu & Kashmir 0 0 0 0 0 0 1 0 2 1 0 0 Jharkhand 1 0 1 0 1 0 1 0 1 1 1 0 Karnataka 1 0 1 0 0 0 1 0 1 0 1 1 Kerala 1 0 0 0 0 0 1 0 1 0 0 0 Lakshadweep 0 0 0 0 0 0 0 0 0 0 0 0 Madhya Pradesh 1 0 1 0 0 0 1 1 1 0 1 1 Maharashtra 1 0 1 0 2 2 1 0 1 1 1 0 Manipur 1 1 0 0 0 0 1 0 1 1 1 1 Meghalaya 1 1 0 0 1 0 1 0 1 0 1 0 Mizoram 1 0 0 0 0 0 0 0 1 1 1 1 Nagaland 1 0 0 0 1 0 1 1 1 1 1 1 Orissa 1 0 0 0 0 0 0 0 1 0 1 0 Pondicherry 0 0 0 0 0 0 0 0 1 1 0 0 Punjab 1 0 0 0 0 0 1 0 1 1 1 0 Rajasthan 1 0 1 0 1 1 1 1 1 1 1 1 Sikkim 1 1 0 0 1 1 1 0 1 0 1 1 Tamil Nadu 1 0 1 0 1 1 1 1 1 1 1 1 Telangana 1 0 1 0 1 0 1 0 1 1 1 0 Tripura 0 0 0 0 1 1 0 0 1 1 0 0 Uttar Pradesh 2 0 1 0 2 2 2 0 2 2 2 2 Uttarakhand 0 0 0 0 0 0 0 0 1 1 0 0 West Bengal 2 0 1 1 2 0 1 1 2 2 2 0 Total 47 23 37 33 52 38 64 69 91 68 68 51

116 TB India 2017

Table : 5 (c) Programme Staffing Status in 2016 States IRL CDST Lab SDS Microbiologist-EQA Microbiologist Sr.Lab.Tech for IRL DEO(IRL) Pharmacist cum Store Assistant storekeeper Sanc- In Place Sanc- In Place Sanc- In Place Sanc- In Place Sanc- In Place Sanc- In Place tioned tioned tioned tioned tioned tioned (1) (26) (27) (28) (29) (30) (31) (32) (33) (34) (35) (36) (37) Andaman & Nicobar 1 0 0 0 1 1 1 1 1 0 1 1 Andhra Pradesh 1 0 1 0 1 0 1 0 1 0 1 0 Assam 1 1 1 1 1 0 1 1 1 1 1 1 Bihar 1 0 3 0 3 1 3 1 1 1 1 1 Chandigarh 0 0 1 1 2 2 1 1 1 1 1 1 Chhattisgarh 1 1 1 1 1 0 1 1 1 1 1 1 Dadar & Nagar Haveli 0 0 0 0 0 0 0 0 1 1 0 0 Daman & Diu 0 0 0 0 0 0 0 0 1 1 0 0 Delhi 2 0 1 1 2 1 2 1 2 1 2 0 Goa 0 0 1 1 1 1 1 1 1 1 1 1 Gujarat 1 0 2 2 1 1 1 1 1 1 1 1 Haryana 0 0 1 1 1 1 1 1 1 1 1 1 Himachal Pradesh 1 0 1 1 1 1 1 1 1 1 1 1 Jammu & Kashmir 0 0 2 2 2 2 2 2 2 2

Jharkhand 1 0 1 1 1 1 1 0 1 1 1 1 Karnataka 1 0 3 3 2 1 1 1 2 2 2 1 Kerala 1 0 1 1 1 1 1 1 1 1 1 1 Lakshadweep 0 0 0 0 0 0 0 0 0 0 0 0 Madhya Pradesh 2 2 3 2 2 1 2 2 1 1 1 1 Maharashtra 2 2 7 2 3 3 3 2 5 3 6 4 Manipur 1 1 1 1 1 1 1 1 1 1 1 1 Meghalaya 0 0 0 0 0 0 0 0 1 1 1 0 Mizoram 1 0 1 0 1 1 1 1 1 1 1 1 Nagaland 0 0 0 0 0 0 0 0 1 0 1 1 Orissa 1 0 1 1 1 0 1 1 1 0 1 0 Pondicherry 0 0 1 1 1 1 1 0 1 1 1 1 Punjab 1 0 1 1 1 0 1 1 1 0 1 0 Rajasthan 1 1 3 1 3 1 3 1 2 1 3 2 Sikkim 1 1 0 0 1 1 1 1 1 1 1 1 Tamil Nadu 1 0 1 1 3 2 2 0 2 2 3 2 Telangana 1 0 2 0 3 0 1 0 1 1 1 1 Tripura 0 0 1 0 1 0 1 0 1 1 1 1 Uttar Pradesh 2 2 4 2 4 2 4 1 4 4 8 2 Uttarakhand 0 0 1 1 1 1 1 1 2 2 2 2 West Bengal 1 0 2 2 1 1 1 1 2 2 4 2 Total 87 91 128 108 118 95 114 112 142 130 319 369 117 TB India 2017

Table : 5 (d) Programme Staffing Status in 2016 States District Level MO-DTC STS STLS LT Driver DEO Sanc- In Place Sanc- In Place Sanc- In Place Sanc- In Place Sanc- In Place Sanc- In Place tioned tioned tioned tioned tioned tioned (1) (38) (39) (40) (41) (42) (43) (44) (45) (46) (47) (48) (49) Andaman & Nicobar 1 0 9 9 4 4 4 3 1 1 3 3 Andhra Pradesh 5 4 225 135 134 113 242 188 1 0 13 11 Assam 10 1 153 149 78 76 98 92 28 24 27 27 Bihar 35 28 534 138 240 145 561 376 1 1 38 35 Chandigarh 1 1 4 4 5 5 11 11 0 0 1 1 Chhattisgarh 9 3 155 115 67 60 140 120 16 13 27 24 Dadar & Nagar Haveli 0 0 2 2 1 1 1 1 0 0 0 0 Daman & Diu 1 1 2 2 2 2 2 2 0 0 1 1 Delhi 11 9 72 32 38 32 185 169 12 12 38 23 Goa 0 0 6 5 4 4 6 4 1 1 2 2 Gujarat 4 4 306 303 150 146 189 172 7 7 38 37 Haryana 5 0 74 73 52 50 73 74 2 1 21 19 Himachal Pradesh 5 1 72 70 51 46 75 69 44 36 12 12 Jammu & Kashmir 59 47 43 41 7 7 14 14 Jharkhand 8 1 207 64 101 65 415 370 24 24 24 23 Karnataka 8 6 189 184 134 131 181 181 0 0 32 31 Kerala 73 72 73 70 62 56 3 1 14 14

Lakshadweep 1 0 1 1 1 1 19 19 0 0 1 1 Madhya Pradesh 20 9 248 157 166 144 246 202 5 5 51 35 Maharashtra 34 11 460 404 318 297 0 0 19 18 87 74 Manipur 3 1 22 21 16 16 23 21 8 8 9 9 Meghalaya 2 0 18 18 13 13 19 1 4 3 7 7 Mizoram 2 2 12 12 9 9 7 7 9 9 8 8 Nagaland 2 1 18 13 13 13 44 44 8 8 11 11 Orissa 9 4 314 204 109 87 163 112 31 15 31 15 Pondicherry 0 0 7 6 5 5 4 4 1 0 0 0 Punjab 9 3 134 116 59 40 142 104 1 1 22 15 Rajasthan 0 0 283 265 152 87 67 20 5 5 34 30 Sikkim 0 0 5 5 5 5 4 3 5 5 4 4 Tamil Nadu 20 7 461 321 143 134 263 216 25 19 34 25 Telangana 5 5 171 148 96 77 150 141 0 0 11 11 Tripura 3 1 20 15 13 9 13 8 0 0 8 5 Uttar Pradesh 3 2 997 806 410 387 978 912 16 6 89 81 Uttarakhand 0 0 95 63 31 29 72 68 3 2 13 13 West Bengal 12 0 462 373 194 186 380 333 13 11 39 33

Total 6203 10327 13152 9812 10306 11486 9249 4639 1293 1654 2155 2046

118 TB India 2017

Table : 5 (e) Programme Staffing Status in 2016 States District Level Sr PMDT-TBHIV DRTB Center Sr MO DRTB SA District PPM Coor- TBHV Counsellor DRTB Supervisor dinator Center Sanc- In Place Sanc- In Place Sanc- In Place Sanc- In Place Sanc- In Place Sanc- In Place tioned tioned tioned tioned tioned tioned (1) (50) (51) (52) (53) (54) (55) (56) (56) (58) (59) (60) (61) Andaman & Nicobar 3 3 1 0 1 1 0 0 4 3 1 0 Andhra Pradesh 13 11 9 1 9 4 0 0 165 123 9 3 Assam 27 27 5 3 5 3 27 27 40 38 5 3 Bihar 38 28 6 4 7 6 0 0 95 28 6 0 Chandigarh 1 1 1 1 1 1 0 0 16 16 0 0 Chhattisgarh 27 23 4 2 4 3 27 23 48 34 4 4 Dadar & Nagar Haveli 1 1 0 0 0 0 0 0 1 1 0 0 Daman & Diu 1 1 0 0 0 0 0 0 0 0 0 0 Delhi 26 23 4 3 4 4 25 0 202 185 4 0 Goa 2 2 1 0 1 1 2 2 10 9 1 1 Gujarat 38 38 5 4 5 5 35 33 262 252 5 4 Haryana 21 19 0 0 1 1 21 0 79 67 0 0 Himachal Pradesh 12 12 3 1 3 2 0 0 13 1 3 0 Jammu & Kashmir 2 2 2 1

Jharkhand 24 20 5 0 5 2 24 6 72 47 5 1 Karnataka 32 31 6 2 6 6 32 25 250 232 6 4 Kerala 14 14 2 1 2 2 0 0 45 45 0 0 Lakshadweep 1 0 0 0 0 0 0 0 0 0 0 0 Madhya Pradesh 51 40 9 3 9 0 51 0 224 151 9 3 Maharashtra 84 70 21 11 24 17 79 30 505 453 20 6 Manipur 9 7 1 1 1 2 9 9 10 10 1 1 Meghalaya 7 7 2 1 2 2 7 0 6 6 2 0 Mizoram 8 8 1 1 1 1 8 8 4 4 1 1 Nagaland 11 11 2 2 2 2 11 0 2 2 2 0 Orissa 31 30 4 2 4 3 31 22 71 57 3 1 Pondicherry 1 1 1 0 1 1 0 0 19 17 0 0 Punjab 22 18 3 1 3 2 22 0 111 78 3 0 Rajasthan 34 28 7 5 7 6 34 29 90 29 7 5 Sikkim 4 4 1 1 1 1 4 4 2 2 1 1 Tamil Nadu 34 32 8 4 8 7 35 32 410 343 8 4 Telangana 11 11 7 1 7 2 11 0 122 96 7 0 Tripura 8 5 1 1 1 1 0 0 6 5 1 0 Uttar Pradesh 89 83 23 17 23 18 89 73 534 465 23 18 Uttarakhand 13 12 2 1 2 2 0 0 32 28 2 2 West Bengal 39 34 9 5 9 9 36 13 315 201 9 3

Total 1548 892 398 360 899 1074 4721 7129 6941 3241 860 1139

119 TB India 2017

Table : 5 (f) Programme Staffing Status in 2016 States District Level Medical College Accountant District programme MO LT-MC Coordinator Sanc- In Place Sanc- In Place Sanc- In Place Sanc- In Place tioned tioned tioned tioned (1) (62) (63) (64) (65) (66) (67) (68) (69) Andaman & Nicobar 3 2 3 3 0 0 0 0 Andhra Pradesh 13 6 13 8 22 10 22 21 Assam 27 27 27 0 6 3 6 6 Bihar 0 0 38 0 13 4 13 7 Chandigarh 0 0 0 0 2 2 2 1 Chhattisgarh 27 17 27 22 7 3 7 6 Dadar & Nagar Haveli 0 0 1 1 0 0 0 0 Daman & Diu 0 0 0 0 0 0 0 0 Delhi 25 0 25 0 13 7 13 6 Goa 1 0 0 0 1 0 1 1 Gujarat 36 34 35 31 17 12 26 22 Haryana 0 0 0 0 4 1 4 4 Himachal Pradesh 12 0 0 0 4 0 4 2 Jammu & Kashmir 14 7 14 7 5 4 5 5 Jharkhand 24 9 24 8 3 1 3 3 Karnataka 31 19 31 21 41 26 45 43 Kerala 14 14 14 0 18 13 24 23 Lakshadweep 0 0 0 0 0 0 0 0 Madhya Pradesh 51 18 51 18 13 8 13 9 Maharashtra 81 51 34 0 41 25 41 40 Manipur 9 9 9 9 2 2 2 2 Meghalaya 7 7 7 0 1 1 1 1 Mizoram 8 8 0 0 0 0 0 0 Nagaland 11 11 11 0 0 0 0 0 Orissa 31 28 31 24 4 1 4 3 Pondicherry 1 0 0 0 4 2 9 9 Punjab 22 0 0 0 9 5 9 9 Rajasthan 34 27 34 32 6 2 8 5 Sikkim 5 5 4 4 1 0 1 1 Tamil Nadu 34 28 33 28 41 21 49 36 Telangana 11 0 11 0 22 9 22 15 Tripura 8 5 0 0 2 1 2 2 Uttar Pradesh 75 70 75 69 36 21 40 30 Uttarakhand 13 10 13 11 4 1 4 3 West Bengal 19 15 19 12 14 9 15 12 Total 1658 1319 1248 858 945 916 722 327 120 TB India 2017 2 170 127 167 120 170 124 155 140 148 122 141 142 165 Annual TB noti - fication rate (public sector) 4 0 8 32 39 16 31 10 24 13 27 13 10 21 Annual TB noti - fication rate (private sector) 2 138 123 128 105 139 114 131 126 121 110 130 121 157 Annual TB noti - fication rate (public sector) 9 144 7548 3549 5878 3701 7132 5836 7846 7456 4422 5279 5726 6003 3997 Total Total patients notified 3% 8% 0% 0% 7% 5% 19% 23% 13% 18% 15% 10% 18% 10% 15% % TB notifi - cation from private sector 112 491 482 714 813 548 417 879 198 1417 1372 1304 1206 TB patients notified from private sector 5% 4% 3% 3% 4% 2% 3% 3% 2% 3% 0% 2% 3% 5% 13% % of - Pediat ric TB 94 78 18 303 127 144 255 112 208 215 155 130 146 196 - Pediat ric TB 41% 39% 43% 34% 47% 42% 38% 38% 38% 55% 34% 56% 38% 38% 45% % of Clin - ically diag - nosed 5 79 2515 1330 1958 1078 2735 2234 2500 2595 1388 1619 2030 1923 1716 Clin - ically diag - nosed 59% 61% 57% 66% 53% 58% 62% 62% 62% 45% 66% 44% 62% 62% 55% % of Micro - biologi - cally con - firmed 4 65 3616 2107 2548 2132 3093 3120 4140 4147 2221 3112 3279 3201 2083 Micro - biologi - cally con - firmed 15% 17% 23% 22% 22% 20% 19% 15% 22% 20% 22% 17% 18% 19% 19% % Pre - viously treated TB 2 29 913 577 712 801 800 958 981 729 Table : 6 Table 1030 1310 1068 1260 1008 Previ - ously treated 85% 83% 77% 78% 78% 80% 81% 85% 78% 80% 78% 83% 82% 81% 81% % of New TB 7 115 3070 5218 2860 3476 2498 4518 4286 5380 5734 2808 3931 4351 4143 New 8% 8% 0% 8% 18% 20% 10% 10% 15% 14% 14% 13% 20% 14% 11% % Extra Pulmo - nary TB 29 695 338 374 255 590 807 940 956 459 682 410 574 1203 Extra pulmo - nary 82% 80% 90% 92% 92% 90% 85% 86% 86% 87% 80% 86% 92% 89% 100% % Pul - monary TB 9 115 3104 4928 3099 4132 2955 5238 4547 5700 5786 3150 4049 4899 4550 Pulmo - nary 9 144 3799 6131 3437 4506 3210 5828 5354 6640 6742 3609 4731 5309 5124 TB patients notified from public sector 385317 2426095 4440443 2795366 3513288 3071448 4190352 5062914 2986993 4318619 4228370 4689896.458 5334551.424 4074560.277 Population TB Case Notification from Districts in 2016 – District level performance status from Districts in 2016 – District level TB Case Notification Vizianaga - ram Visakhapa - tnam Srikakulam Prakasam Nellore Kurnool Krishna Guntur East Godavari Cuddapah Nicobars Andamans & Nicobars Chittoor West West Godavari Anantapur District Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Andman and Nicobar Islands Andman and Nicobar Islands Andhra Pradesh Andhra Pradesh Andhra Pradesh State

121 TB India 2017 83 82 78 82 83 69 508 109 107 107 116 209 113 347 111 117 130 226 Annual TB noti - fication rate (public sector) 0 0 4 0 0 0 7 0 0 0 0 0 0 0 0 0 15 31 Annual TB noti - fication rate (private sector) 83 85 82 71 82 83 69 226 492 105 107 107 209 113 347 111 117 130 Annual TB noti - fication rate (public sector) 46 98 81 76 27 279 988 197 877 228 300 102 112 135 277 119 104 2024 1363 1119 Total Total patients notified 0% 0% 3% 4% 0% 0% 0% 9% 0% 0% 0% 0% 0% 0% 0% 9% 0% 0% 0% 27% % TB notifi - cation from private sector 30 71 25 234 122 TB patients notified from private sector 4% 4% 3% 5% 3% 5% 2% 5% 3% 5% 2% 21% 15% 16% 23% 31% 10% 13% 13% 15% % of - Pediat ric TB 2 9 4 4 2 4 58 76 16 18 36 19 11 18 94 10 15 12 16 148 - Pediat ric TB 66% 54% 65% 60% 69% 45% 39% 69% 56% 52% 47% 72% 51% 26% 39% 52% 57% 61% 53% 37% % of Clin - ically diag - nosed 25 68 89 56 52 20 52 58 72 55 10 185 619 252 689 119 526 216 143 1178 Clin - ically diag - nosed 34% 46% 35% 31% 40% 55% 61% 31% 44% 48% 53% 28% 74% 49% 61% 48% 43% 39% 47% 63% % of Micro - biologi - cally con - firmed 94 21 30 25 84 56 50 83 54 47 49 17 339 775 108 391 552 109 593 109 Micro - biologi - cally con - firmed 7% 22% 26% 20% 10% 21% 19% 21% 18% 23% 20% 41% 36% 13% 20% 21% 17% 16% 13% 19% % Pre - viously treated TB 5 19 10 20 41 17 52 27 13 27 23 43 19 14 250 201 120 220 222 124 Previ - ously treated 93% 78% 74% 80% 90% 79% 81% 79% 82% 77% 80% 59% 64% 87% 80% 79% 83% 84% 87% 81% % of New TB 36 78 64 49 89 89 90 22 260 708 156 523 176 897 176 108 209 100 1752 1021 New 1% 40% 35% 37% 36% 29% 13% 11% 44% 13% 23% 13% 36% 28% 15% 21% 34% 28% 36% 22% % Extra Pulmo - nary TB 1 6 16 35 25 71 36 53 29 20 24 86 33 37 111 355 568 167 141 109 Extra pulmo - nary 60% 65% 63% 64% 71% 87% 89% 56% 87% 77% 87% 64% 72% 99% 85% 79% 66% 72% 64% 78% % Pul - monary TB 30 63 45 73 75 88 86 67 21 168 603 172 572 175 978 191 115 166 1385 1074 Pulmo - nary 46 98 81 76 27 279 958 197 643 228 300 102 135 112 252 119 104 1953 1241 1119 TB patients notified from public sector 55092 91367 98953 86485 68310 95971 91771 38922 123527 194543 183780 756222 109213 992168 123830 163182 1856350 1742210 Population Tirap Tawang Papumpare Lower Subansiri Cachar Lohit Bongaigaon Kurung Kurung Kumey Barpeta East Siang Baksa East Kameng West Siang West Dibang Valley Changlang West West Kameng South Anda4 man Upper Subansiri North & Middle Andaman District Upper Siang Arunachal Pradesh Arunachal Pradesh Arunachal Pradesh Arunachal Pradesh Assam Arunachal Pradesh Assam Arunachal Pradesh Assam Arunachal Pradesh Assam Arunachal Pradesh Arunachal Pradesh Arunachal Pradesh Arunachal Pradesh Arunachal Pradesh Andman and Nicobar Islands Arunachal Pradesh Andman and Nicobar Islands State Arunachal Pradesh

122 TB India 2017 70 23 71 73 89 72 69 95 70 80 75 119 158 115 139 163 240 155 122 130 210 129 106 102 109 102 110 155 129 Annual TB noti - fication rate (public sector) 2 1 0 5 0 3 9 0 6 2 0 8 8 2 2 6 12 49 25 37 15 48 11 25 29 23 15 12 20 Annual TB noti - fication rate (private sector) 58 22 71 48 53 56 69 97 78 94 91 95 62 90 77 68 118 109 110 136 154 193 143 130 181 123 104 147 126 Annual TB noti - fication rate (public sector) 509 693 485 295 917 753 975 679 678 1232 2300 2123 1163 2033 1339 2235 1238 1843 3385 3182 1320 1599 2988 2217 3300 1226 1491 1040 2524 Total Total patients notified 1% 4% 0% 4% 0% 2% 5% 7% 0% 5% 2% 0% 5% 2% 3% 9% 17% 31% 34% 41% 21% 20% 20% 14% 23% 14% 11% 11% 18% % TB notifi - cation from private sector 3 3 18 22 55 27 99 14 51 86 74 78 13 32 380 659 692 284 475 670 236 269 412 212 465 224 215 TB patients notified from private sector 2% 8% 3% 4% 5% 2% 4% 6% 4% 3% 8% 4% 6% 3% 7% 7% 4% 3% 3% 3% 2% 3% 4% 3% 3% 1% 3% 13% 10% % of - Pediat ric TB 8 30 45 18 62 28 18 71 17 39 72 30 12 24 62 91 11 26 43 21 44 34 148 229 206 179 107 178 233 - Pediat ric TB 50% 48% 54% 52% 26% 50% 43% 54% 44% 55% 55% 60% 51% 40% 49% 54% 52% 49% 37% 52% 53% 34% 55% 44% 49% 44% 35% 53% 48% % of Clin - ically diag - nosed 607 930 787 252 345 577 177 696 767 267 667 512 868 137 263 227 538 445 299 628 236 536 1105 1055 1372 1174 1331 1135 1493 Clin - ically diag - nosed 52% 50% 52% 46% 48% 74% 50% 57% 46% 56% 45% 45% 40% 49% 60% 51% 46% 48% 51% 63% 48% 47% 66% 45% 56% 51% 56% 65% 47% % of Micro - biologi - cally con - firmed 607 990 677 235 996 586 232 588 993 218 544 689 539 728 144 442 440 434 557 306 785 429 472 1204 1343 1772 1245 1031 1342 Micro - biologi - cally con - firmed 8% 18% 19% 18% 37% 13% 25% 22% 15% 18% 15% 21% 14% 16% 17% 19% 15% 16% 23% 14% 23% 22% 17% 25% 22% 14% 24% 17% 16% % Pre - viously treated TB 61 63 73 65 99 83 414 228 354 539 333 255 234 141 251 237 437 493 198 236 421 502 631 113 247 216 335 112 158 Previ - ously treated 82% 81% 82% 63% 87% 75% 78% 85% 82% 92% 85% 79% 86% 84% 83% 81% 85% 84% 77% 86% 77% 78% 83% 75% 78% 86% 76% 83% 84% % of New TB 986 925 426 908 346 412 960 853 216 606 554 725 786 522 553 850 1895 1566 1008 1050 1619 1507 2278 2453 1360 2155 1664 2204 1078 New 6% 5% 3% 4% 5% 2% 5% 8% 7% 5% 17% 16% 17% 25% 28% 15% 22% 30% 16% 16% 29% 32% 16% 23% 14% 14% 14% 11% 19% % Extra Pulmo - nary TB 75 16 48 20 34 46 95 70 86 34 386 105 234 200 324 137 181 390 820 168 486 460 831 161 110 232 143 158 193 Extra pulmo - nary 83% 94% 95% 84% 97% 96% 83% 95% 75% 98% 72% 85% 70% 78% 84% 84% 71% 68% 84% 77% 95% 92% 86% 93% 86% 86% 89% 95% 81% % Pul - monary TB 471 963 389 960 348 883 235 544 572 902 859 519 631 815 1923 1139 1815 1230 1293 1726 1030 1895 1354 2460 1136 1745 2056 2603 1255 Pulmo - nary 487 409 485 281 705 667 972 605 665 2309 1214 1920 1464 1341 1163 1284 1760 1211 2715 1744 2946 1051 1596 2576 2166 2835 1002 1413 1008 TB patients notified from public sector 777869 704805 890378 228358 903424 735690 970903 963013 527051 3371641 1032044 3285067 1341615 2256495 2792341 1641997 1166764 3120315 1408007 1131890 2059108 1078740 1229795 1419553 2083331 3021318 1024103 1112614 1301156 Population Karimganj Bhagalpur Karbi Anglong Begusarai Kamrup Metro Banka Aurangab - ad-BI Kamrup Arwal Jorhat Araria Hailakandi Udalguri Tinsukia Golaghat Sonitpur Goalpara Sibsagar Dibrugarh North Cachar Hills Nalbari Dhubri Nagaon Dhemaji Marigaon Lakhimpur Darrang Kokrajhar Chirang District Assam Bihar Assam Bihar Assam Bihar Bihar Assam Bihar Assam Bihar Assam Assam Assam Assam Assam Assam Assam Assam Assam Assam Assam Assam Assam Assam Assam Assam Assam Assam State

123 TB India 2017 68 58 63 49 33 78 65 52 50 35 70 45 91 63 51 80 45 54 38 88 62 31 47 71 57 52 62 441 112 126 Annual TB noti - fication rate (public sector) 1 2 3 3 7 0 3 6 1 4 2 2 1 7 6 4 15 13 17 13 19 11 12 26 46 19 16 35 34 394 Annual TB noti - fication rate (private sector) 54 45 62 47 30 61 52 48 43 35 67 39 72 52 39 55 48 44 65 35 35 73 60 29 90 47 37 50 46 58 Annual TB noti - fication rate (public sector) 762 461 898 230 908 731 878 594 1082 3436 2224 2439 1487 3330 1236 2867 2283 1973 5436 1329 1226 3852 3298 1897 2362 2151 2108 1161 2357 28330 Total Total patients notified 1% 3% 8% 6% 0% 5% 3% 9% 3% 7% 1% 6% 22% 22% 22% 20% 15% 14% 21% 18% 23% 32% 89% 41% 35% 18% 28% 48% 12% 12% % TB notifi - cation from private sector 6 1 30 18 42 53 87 43 25 164 239 764 436 145 133 213 696 223 652 727 468 116 680 534 250 141 142 2250 1028 25274 TB patients notified from private sector 5% 4% 7% 9% 7% 5% 5% 6% 4% 3% 6% 8% 6% 5% 4% 5% 3% 6% 5% 6% 7% 7% 6% 6% 5% 5% 3% 6% 7% 11% % of - Pediat ric TB 32 37 31 78 14 83 32 24 72 68 48 90 80 64 39 64 86 34 51 60 64 129 131 154 333 187 208 213 124 160 - Pediat ric TB 51% 34% 24% 33% 33% 50% 48% 24% 56% 38% 36% 41% 45% 36% 38% 43% 37% 61% 31% 53% 31% 39% 33% 54% 56% 28% 30% 38% 33% 25% % of Clin - ically diag - nosed 302 759 202 148 288 105 438 294 260 517 376 943 383 955 581 587 263 434 758 153 704 428 619 252 1293 1277 1862 1700 1055 1732 Clin - ically diag - nosed 49% 66% 76% 67% 67% 50% 52% 76% 44% 62% 64% 59% 55% 64% 62% 57% 63% 39% 69% 47% 69% 61% 67% 46% 44% 72% 70% 62% 67% 75% % of Micro - biologi - cally con - firmed 296 641 307 580 107 481 470 757 460 630 975 598 676 605 398 695 768 1456 1379 1350 1017 1691 1260 1194 1333 1486 2117 1479 1633 1239 Micro - biologi - cally con - firmed 9% 7% 8% 26% 10% 17% 11% 38% 24% 16% 14% 19% 17% 17% 18% 12% 13% 21% 19% 16% 12% 13% 19% 12% 23% 21% 12% 34% 18% 16% % Pre - viously treated TB 87 77 93 81 49 156 201 634 282 321 151 211 138 220 186 256 205 654 370 524 105 142 588 384 307 117 287 378 330 161 Previ - ously treated 74% 91% 90% 83% 89% 62% 76% 84% 86% 81% 93% 83% 83% 92% 82% 88% 87% 79% 81% 84% 88% 87% 81% 88% 77% 79% 88% 66% 82% 84% % of New TB 442 756 378 775 131 624 681 698 827 756 968 434 745 859 2014 2038 1506 1973 1063 2414 1959 1351 2402 1550 2662 2584 2827 1056 2050 1528 New 6% 6% 5% 4% 8% 4% 5% 5% 3% 1% 2% 5% 4% 4% 3% 4% 3% 4% 3% 5% 7% 2% 8% 9% 1% 3% 13% 20% 15% 10% % Extra Pulmo - nary TB 8 33 43 19 69 88 23 10 26 43 40 64 68 63 28 60 13 99 23 30 135 143 306 111 596 135 491 226 138 194 Extra pulmo - nary 94% 94% 95% 96% 96% 92% 95% 95% 87% 97% 99% 98% 95% 96% 96% 97% 80% 96% 97% 97% 96% 95% 85% 93% 90% 98% 92% 99% 91% 97% % Pul - monary TB 565 800 436 204 799 752 720 793 973 833 538 990 2080 2529 1700 1988 1248 2523 2151 2460 1488 1857 3051 1050 2681 2985 1225 2143 1835 1024 Pulmo - nary 598 843 455 212 868 775 730 836 861 551 2215 2672 1788 2294 1274 2634 1013 2215 3056 1556 1920 3186 1110 3172 3211 1363 2337 1858 1123 1020 TB patients notified from public sector 730449 705998 1112733 3802401 1880226 1843144 4384473 3411585 4731045 1809009 2109456 3294214 1250012 3639508 1952646 5651824 6418989 2844373 4361880 2464776 4869594 3194062 4360981 5313508 1511181 1898790 4977074 3689599 3024638 2217888 Population Madhepura Lakhisarai Sitamarhi Kishanganj Sheohar Sheikhpura Khagaria Saran Katihar Samastipur Kaimur Saharsa Rohtas Jehanabad Purnia Jamui Purba Champaran Patna Gopalganj Pashchim Pashchim Champaran Nawada Gaya Nalanda Darbhanga Muzaffarpur Munger Buxar Madhubani Siwan Bhojpur District Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar State

124 TB India 2017 94 81 67 32 174 184 155 127 173 108 166 111 100 115 120 118 305 123 122 171 Annual TB noti - fication rate (public sector) 0 0 6 0 8 5 1 63 82 16 18 22 21 46 22 11 14 39 23 49 Annual TB noti - fication rate (private sector) 77 86 89 68 59 31 111 102 155 109 151 120 100 104 114 118 266 100 118 122 Annual TB noti - fication rate (public sector) 415 819 754 633 817 965 867 781 1484 4253 1449 1586 2199 1654 1041 1084 3413 2237 2600 3234 Total Total patients notified 0% 0% 5% 0% 4% 2% 36% 45% 17% 14% 13% 20% 28% 19% 10% 17% 13% 19% 12% 29% % TB notifi - cation from private sector 47 33 16 538 202 143 149 200 609 322 100 136 433 415 317 927 1894 TB patients notified from private sector 2% 4% 7% 3% 5% 4% 6% 5% 5% 3% 3% 3% 3% 2% 8% 3% 6% 3% 3% 9% % of - Pediat ric TB 19 89 27 17 59 62 35 79 68 21 24 21 30 25 63 23 26 248 142 201 - Pediat ric TB 46% 50% 40% 53% 41% 58% 51% 57% 44% 44% 58% 42% 72% 50% 51% 55% 42% 45% 32% 51% % of Clin - ically diag - nosed 439 164 357 510 806 306 910 586 277 548 284 657 540 963 372 247 1191 1524 1008 1185 Clin - ically diag - nosed 54% 50% 60% 47% 59% 42% 49% 43% 56% 56% 42% 58% 28% 50% 49% 45% 58% 55% 68% 49% % of Micro - biologi - cally con - firmed 507 251 319 737 580 299 680 746 356 393 397 261 544 814 462 518 1168 1456 1320 1122 Micro - biologi - cally con - firmed 7% 8% 8% 7% 11% 10% 13% 11% 14% 13% 13% 10% 14% 13% 15% 11% 13% 13% 14% 11% % Pre - viously treated TB 27 91 81 63 78 94 77 100 231 139 194 206 102 117 453 195 307 109 109 246 Previ - ously treated 89% 90% 93% 87% 89% 86% 87% 92% 87% 90% 92% 86% 87% 93% 85% 89% 87% 87% 86% 89% % of New TB 846 388 585 524 570 863 587 801 725 656 2128 1108 1192 1230 1384 1007 2527 1627 1976 2061 New 9% 8% 6% 8% 8% 4% 4% 4% 3% 3% 2% 26% 10% 15% 21% 10% 17% 12% 36% 14% % Extra Pulmo - nary TB 96 38 52 75 61 50 27 33 43 73 27 18 592 347 292 105 263 112 257 1074 Extra pulmo - nary 74% 90% 85% 91% 92% 94% 90% 79% 83% 92% 92% 88% 96% 96% 96% 64% 86% 97% 97% 98% % Pul - monary TB 850 377 624 544 583 829 654 885 807 747 1715 2012 1172 1094 1327 1227 1041 1906 1565 2210 Pulmo - nary 946 415 676 605 633 941 681 918 834 765 2307 2359 1247 1386 1590 1332 1084 2980 1822 2283 TB patients notified from public sector 853793 267753 873902 700630 915731 635265 907295 804880 915506 708007 1891000 2308570 1140090 1326869 1494498 1002614 1120481 1813314 3886493 2477835 Population Durg Dhamtari Bilaspur-CG Bijapur Bemetara Mahasa - mund Koriya Bastar Korba Baloda Bazar Kondagaon Balod Kabirdham (Kawardha) Balarampur Jashpur Chandigarh Janjgir Vaishali Gariyaband Supaul District Chhattis - garh Chhattis - garh Chhattis - garh Chhattis - garh Chhattis - garh Chhattis - garh Chhattis - garh Chhattis - garh Chhattis - garh Chhattis - garh Chhattis - garh Chhattis - garh Chhattis - garh Chhattis - garh Chhattis - garh Chandigarh Chhattis - garh Bihar Chhattis - garh Bihar State

125 TB India 2017 68 143 103 164 159 117 137 318 151 475 434 164 341 174 169 102 193 133 Annual TB noti - fication rate (public sector) 2 5 0 7 2 0 0 0 10 14 20 19 64 35 23 11 52 198 Annual TB noti - fication rate (private sector) 96 87 91 68 123 130 101 159 159 118 311 276 432 129 318 174 169 141 Annual TB noti - fication rate (public sector) 43 552 892 431 474 267 842 444 1154 1058 2330 3644 3870 2719 2487 2675 1807 1620 Total Total patients notified 8% 9% 2% 3% 0% 2% 0% 7% 0% 0% 0% 17% 14% 42% 42% 21% 11% 27% % TB notifi - cation from private sector 42 14 14 80 10 89 109 185 330 569 122 119 1638 1135 TB patients notified from private sector 6% 3% 6% 3% 7% 6% 4% 4% 4% 6% 9% 3% 3% 12% 15% 11% 11% 14% % of - Pediat ric TB 6 9 32 32 55 13 34 55 86 96 74 17 25 445 232 278 177 150 - Pediat ric TB 50% 50% 63% 46% 53% 69% 54% 64% 42% 63% 67% 52% 60% 47% 58% 48% 30% 57% % of Clin - ically diag - nosed 13 253 518 557 192 249 599 948 998 126 943 364 186 1080 2291 1668 1100 1005 Clin - ically diag - nosed 50% 50% 37% 54% 47% 31% 46% 36% 58% 37% 33% 48% 40% 53% 42% 52% 70% 43% % of Micro - biologi - cally con - firmed 30 257 527 321 225 225 274 920 586 809 680 141 677 389 139 1273 1284 1006 Micro - biologi - cally con - firmed 8% 7% 5% 5% 20% 11% 16% 11% 11% 15% 19% 20% 15% 17% 22% 23% 16% 26% % Pre - viously treated TB 7 74 65 51 98 13 41 86 104 111 299 691 313 341 418 137 372 373 Previ - ously treated 80% 89% 92% 84% 89% 89% 85% 81% 80% 85% 83% 93% 78% 95% 77% 84% 95% 74% % of New TB 36 406 934 804 352 423 775 254 712 239 1701 2873 1271 1891 2059 1969 1313 1247 New 6% 7% 5% 30% 11% 15% 10% 16% 45% 39% 18% 43% 39% 15% 41% 12% 16% 23% % Extra Pulmo - nary TB 5 49 29 71 83 41 76 151 111 326 619 409 115 662 663 119 1621 1059 Extra pulmo - nary 70% 89% 94% 93% 85% 90% 84% 55% 61% 82% 57% 95% 61% 85% 59% 88% 84% 77% % Pul - monary TB 38 359 934 829 388 403 790 965 226 957 634 249 1674 1943 1823 1418 1991 1023 Pulmo - nary 43 510 878 417 474 873 267 753 325 1045 2000 3564 1584 2232 2477 2106 1685 1620 TB patients notified from public sector 62800 413618 806891 869402 262431 297389 908081 572938 572938 529384 153454 959667 825692 230247 1694747 1145039 2559851 1633271 Population Dadra & Nagar Haveli Uttar Bastar Kanker Surajpur Sukma South Bastar Dantewada Sarguja Rajnand - gaon DDU CHEST CLINIC CD CHEST CLINIC Raipur BSA CHEST CLINIC Raigarh-CG BJRM CHEST CLINIC Narayanpur Bijwasan Diu Mungeli District Daman Dadra and Nagar Haveli Chhattis - garh Chhattis - garh Chhattis - garh Chhattis - garh Chhattis - garh Chhattis - garh Delhi Delhi Chhattis - garh Delhi Chhattis - garh Delhi Chhattis - garh Delhi Daman and Diu Chhattis - garh State Daman and Diu

126 TB India 2017 76 387 761 579 337 143 208 653 220 162 356 462 303 235 349 149 182 453 377 466 461 Annual TB noti - fication rate (public sector) 6 7 0 4 8 5 5 72 27 44 36 15 13 15 37 18 23 72 123 141 124 Annual TB noti - fication rate (private sector) 58 71 381 637 507 196 116 164 617 213 147 344 462 299 220 312 141 435 372 442 389 Annual TB noti - fication rate (public sector) 760 752 2458 4833 3063 3375 1206 1094 3743 1746 1048 2241 3804 2212 1378 1915 1546 3662 2242 5311 3246 Total Total patients notified 1% 6% 3% 9% 4% 0% 1% 6% 6% 7% 4% 1% 5% 16% 12% 42% 19% 21% 10% 68% 16% % TB notifi - cation from private sector 35 56 97 79 32 88 43 49 29 784 381 227 231 209 201 144 266 510 1416 1052 TB patients notified from private sector 4% 9% 8% 10% 12% 12% 10% 16% 17% 13% 14% 13% 13% 13% 12% 14% 13% 13% 12% 11% 10% % of - Pediat ric TB 42 87 67 88 233 467 310 188 135 606 155 122 304 491 278 172 144 466 272 539 271 - Pediat ric TB 60% 59% 65% 58% 56% 50% 69% 76% 61% 63% 68% 67% 73% 62% 51% 62% 52% 64% 74% 63% 62% % of Clin - ically diag - nosed 491 596 601 796 872 443 259 450 1650 1431 2623 1546 1088 2696 1035 1465 2564 1588 2614 1395 3140 Clin - ically diag - nosed 40% 41% 35% 42% 44% 50% 31% 24% 39% 37% 32% 33% 27% 38% 49% 38% 48% 36% 26% 37% 38% % of Micro - biologi - cally con - firmed 992 871 488 267 838 655 350 697 592 494 842 274 235 253 904 818 1086 1426 1136 1240 1905 Micro - biologi - cally con - firmed 22% 25% 23% 19% 18% 14% 22% 24% 21% 29% 26% 20% 18% 29% 21% 20% 25% 18% 19% 22% 22% % Pre - viously treated TB 597 597 924 514 351 141 189 847 353 272 570 777 400 377 362 142 123 130 659 480 1086 Previ - ously treated 78% 75% 77% 81% 82% 86% 78% 76% 79% 71% 74% 80% 82% 71% 79% 80% 75% 82% 81% 78% 78% % of New TB 838 674 679 913 575 371 573 2139 1826 3125 2168 1608 2687 1337 1592 3027 1780 1352 2859 1733 3959 New 41% 35% 42% 39% 37% 24% 48% 53% 40% 44% 46% 46% 43% 42% 37% 49% 35% 46% 42% 44% 40% % Extra Pulmo - nary TB 857 718 232 415 669 415 989 935 542 641 352 172 320 966 1110 1710 1038 1889 1762 1482 2027 Extra pulmo - nary 59% 65% 58% 61% 63% 76% 52% 47% 56% 60% 54% 54% 57% 58% 63% 51% 65% 54% 58% 56% 60% % Pul - monary TB 747 448 536 748 365 322 383 1626 1566 2339 1644 1241 1645 1021 1173 2042 1245 1073 2036 1247 3018 Pulmo - nary 979 863 951 717 494 703 2736 2423 4049 2682 1959 3534 1690 2162 3804 2180 1290 1714 3518 2213 5045 TB patients notified from public sector 703930 635245 635245 529182 843859 525607 572939 645135 792791 629100 823590 729295 586992 549497 509137 847682 984467 808897 594471 1001393 1140237 Population - NDMC NARELA MOTI NAGAR MNCH CHEST CLINIC LRS North Goa LN CHEST CLINIC SPMH CHEST CLINIC SPM MARG KINGSWAY SHAHADRA KARAWAL KARAWAL NAGAR SGM CHEST CLINIC JHANDE - WALAN RTRM RTRM CHEST CLINIC HEDGEWAR HEDGEWAR CHEST CLINIC RK MISSION GULABI BAGH PATPAR GANJ GTB CHEST CLINIC District NEHRU NAGAR Delhi Delhi Delhi Delhi Delhi Goa Delhi Delhi Delhi Delhi Delhi Delhi Delhi Delhi Delhi Delhi Delhi Delhi Delhi Delhi State Delhi

127 TB India 2017 159 184 127 167 225 176 258 166 143 233 166 224 250 265 279 218 209 136 152 139 222 143 150 177 218 115 103 245 Annual TB noti - fication rate (public sector) 17 67 29 37 98 59 62 25 19 42 62 79 66 62 30 40 41 58 25 35 46 78 25 12 75 103 132 164 Annual TB noti - fication rate (private sector) 98 92 98 90 91 171 143 117 130 127 117 196 141 124 131 124 188 185 114 152 147 106 112 165 119 115 131 140 Annual TB noti - fication rate (public sector) 886 760 838 5658 1852 6046 1061 3281 4617 4599 2791 2062 1494 5606 2344 2697 2933 6182 4949 4650 2214 3440 2295 2158 1971 2819 3279 13472 Total Total patients notified 30% 10% 37% 23% 22% 44% 34% 24% 15% 14% 44% 25% 59% 25% 30% 59% 30% 30% 22% 26% 30% 26% 17% 23% 26% 36% 21% 12% % TB notifi - cation from private sector 99 192 200 235 425 280 657 673 880 491 903 680 370 462 731 163 1721 2217 1553 1428 1102 1420 1382 3644 1506 1379 3500 1173 TB patients notified from private sector 7% 2% 5% 4% 6% 3% 4% 4% 4% 3% 2% 3% 4% 2% 2% 3% 3% 2% 3% 4% 3% 5% 5% 3% 4% 6% 5% 3% % of - Pediat ric TB 28 25 53 61 83 62 14 37 42 35 78 78 59 91 48 93 51 88 29 21 256 175 127 155 143 106 541 121 - Pediat ric TB 26% 21% 33% 28% 42% 27% 29% 28% 34% 36% 28% 31% 33% 30% 47% 30% 35% 37% 24% 34% 26% 51% 33% 32% 39% 44% 51% 33% % of Clin - ically diag - nosed 356 190 351 504 890 983 796 650 237 314 607 971 771 416 857 422 593 486 823 917 307 244 1039 1249 1317 1218 1206 5121 Clin - ically diag - nosed 74% 79% 67% 58% 72% 73% 71% 72% 64% 66% 72% 69% 67% 70% 53% 70% 65% 63% 76% 66% 74% 49% 67% 68% 61% 56% 49% 67% % of Micro - biologi - cally con - firmed 475 496 600 648 290 495 2898 1304 2580 1349 2174 2514 1132 1570 2869 1417 1082 1767 2225 2065 1307 1680 1193 4851 1195 1023 1265 1189 Micro - biologi - cally con - firmed 31% 27% 25% 23% 28% 36% 28% 35% 22% 23% 27% 33% 27% 37% 38% 28% 30% 29% 22% 26% 25% 28% 27% 28% 29% 27% 16% 34% % Pre - viously treated TB 95 445 941 186 191 672 855 390 554 225 261 749 775 699 933 382 666 399 482 415 597 564 248 1237 1216 1398 1050 2814 Previ - ously treated 69% 73% 75% 77% 72% 64% 72% 65% 78% 77% 73% 67% 73% 63% 62% 72% 70% 71% 78% 74% 75% 72% 73% 72% 71% 73% 84% 66% % of New TB 640 495 612 701 502 491 2700 1215 2888 1181 2209 2281 1392 1812 2788 1275 1278 1839 2393 2338 1341 1871 1216 7158 1306 1094 1491 1542 New 7% 7% 8% 9% 9% 5% 6% 9% 8% 9% 16% 16% 11% 10% 15% 21% 15% 18% 10% 14% 12% 14% 22% 31% 17% 21% 27% 12% % Extra Pulmo - nary TB 73 78 92 293 118 613 130 191 472 287 367 364 175 381 101 132 236 361 276 366 212 231 394 129 357 448 161 3129 Extra pulmo - nary 93% 93% 84% 84% 89% 90% 85% 92% 79% 85% 91% 82% 91% 95% 94% 91% 90% 92% 86% 88% 86% 78% 69% 91% 83% 79% 73% 88% % Pul - monary TB 696 613 759 787 436 647 3644 1542 3216 1662 2592 3210 1415 2002 3805 1923 1921 2302 3082 2995 2171 1511 1384 1394 6843 1380 1731 1658 Pulmo - nary 826 686 837 962 597 739 3937 1660 3829 1853 3064 3497 1782 2366 4186 2024 2053 2538 3443 3271 2537 1723 1615 1788 9972 1509 2088 2106 TB patients notified from public sector 634491 700133 640560 660386 816557 2308204 1163096 3284684 1458151 2617563 1782105 1442892 1683086 1047470 3386212 1079315 1107580 2217726 2270939 2228644 2270533 1632853 1653378 1504252 6061127 1313842 1595813 1500880 Population Dahod Chhota Udepur Rajkot Porbandar Botad Patan Bhavnagar Panch Panch Mahals Navsari Bharuch Narmada Morbi Banaskan - tha Mahisagar Arvalli Mahesana Anand Kheda Kachchh Amreli Junagadh Jamnagar Ahmadabad MC Gir Somnath Ahmadabad Gandhi - nagar South Goa District Devbhumi dwarka 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 Goa State Gujarat

128 TB India 2017 165 162 180 196 158 183 147 161 154 168 150 148 180 191 148 177 152 132 150 171 153 193 209 220 128 234 270 Annual TB noti - fication rate (public sector) 3 9 0 7 5 0 1 6 12 25 14 40 10 31 19 33 20 68 20 19 50 28 58 65 50 97 42 Annual TB noti - fication rate (private sector) 153 137 166 193 149 142 147 151 124 161 130 115 161 122 128 172 133 132 149 121 125 135 144 171 122 137 229 Annual TB noti - fication rate (public sector) 328 1905 1583 2368 1194 1797 3248 1749 1999 1551 1468 1574 2742 2967 3626 1730 2578 2217 1567 2957 2902 9339 3462 3859 1312 3574 5310 Total Total patients notified 7% 8% 2% 6% 0% 6% 4% 3% 0% 0% 5% 15% 22% 20% 13% 23% 11% 36% 14% 13% 29% 18% 30% 31% 23% 41% 15% % TB notifi - cation from private sector 7 19 61 73 62 137 245 187 822 103 719 129 308 202 619 321 236 280 865 525 873 1300 2803 1075 1475 TB patients notified from private sector 4% 6% 6% 6% 9% 6% 3% 7% 4% 4% 4% 3% 4% 4% 5% 2% 3% 3% 5% 4% 3% 4% 5% 8% 3% 3% 3% % of - Pediat ric TB 78 77 73 98 82 79 46 50 48 75 34 73 59 17 63 62 86 92 34 68 129 386 127 107 113 340 189 - Pediat ric TB 45% 56% 55% 70% 65% 47% 39% 48% 48% 50% 37% 39% 35% 43% 34% 38% 35% 38% 41% 44% 28% 39% 41% 63% 37% 38% 42% % of Clin - ically diag - nosed 790 750 828 797 994 848 890 622 524 533 741 798 563 880 737 133 691 579 933 470 879 1205 2910 1130 2666 1511 1097 Clin - ically diag - nosed 55% 44% 45% 30% 35% 53% 61% 52% 52% 50% 63% 61% 65% 57% 66% 62% 65% 62% 59% 56% 72% 61% 59% 37% 63% 62% 58% % of Micro - biologi - cally con - firmed 978 588 976 347 897 901 980 621 883 839 931 195 869 876 780 1578 1535 1382 1516 1528 1625 1200 1513 1444 3870 1889 1220 Micro - biologi - cally con - firmed 21% 22% 21% 14% 19% 27% 26% 27% 23% 26% 23% 26% 24% 21% 25% 24% 26% 27% 23% 25% 29% 26% 26% 19% 24% 26% 31% % Pre - viously treated TB 74 375 301 453 166 851 458 648 468 424 323 330 358 500 567 589 365 659 528 387 617 626 453 707 325 654 1685 Previ - ously treated 79% 78% 79% 86% 81% 73% 74% 77% 73% 77% 74% 76% 74% 75% 79% 74% 76% 77% 73% 71% 75% 74% 74% 76% 81% 69% 74% % of New TB 920 254 925 1393 1037 1728 1009 3637 1236 1881 1446 1281 1077 1623 1014 1737 2079 1846 1129 1409 1475 1173 1751 4851 2279 1934 1445 New 8% 6% 18% 25% 19% 29% 38% 15% 12% 27% 24% 15% 16% 17% 16% 20% 19% 11% 14% 15% 10% 19% 11% 29% 13% 27% 10% % Extra Pulmo - nary TB 26 70 327 336 411 345 250 294 500 420 213 205 353 221 469 503 282 203 298 210 290 268 379 650 215 1718 1867 Extra pulmo - nary 82% 75% 81% 71% 62% 85% 88% 76% 73% 84% 85% 84% 83% 81% 80% 86% 89% 85% 92% 81% 90% 89% 71% 73% 87% 94% 90% % Pul - monary TB 830 302 1441 1002 1770 2770 1444 2235 1329 1370 1038 1194 1151 1770 2143 1857 1291 2223 1639 1270 1882 2109 4669 1737 2607 1180 1884 Pulmo - nary 328 1768 1338 2181 1175 4488 1694 2529 1749 1870 1243 1407 1372 2123 2646 2326 1494 2505 1937 1560 2092 2377 6536 2387 2986 1250 2099 TB patients notified from public sector 978081 610001 875739 247730 1155500 1312809 1963469 1135647 1778092 1189033 1240744 1005968 1052410 1850914 1644077 1901583 1170975 1455644 1453858 1044417 1725409 1902196 4848223 1652549 1750914 1027625 1527800 Population ROHTAK REWARI PANIPAT PANCHKULA FARIDABAD PALWAL BHIWANI MEWAT AMBALA MAHEN - DRAGARH Vyara (Surat) KURUK - SHETRA Valsad KARNAL Vadodara Vadodara Corp KAITHAL Vadodara JIND The Dangs JHAJJAR Suren - dranagar HISAR SURAT SURAT MUNICIPAL CORP GURGAON Surat FATEHABAD Sabarkan - tha District Haryana Haryana Haryana Haryana Haryana Haryana Haryana Haryana Haryana Haryana Gujarat Haryana Gujarat Haryana Gujarat Haryana Gujarat Haryana Gujarat Haryana Gujarat Haryana Gujarat Haryana Gujarat Haryana Gujarat State

129 TB India 2017 63 32 32 37 230 181 336 247 115 185 167 222 156 141 126 184 267 161 202 200 Annual TB noti - fication rate (public sector) 0 0 4 0 5 0 0 2 0 2 0 8 1 19 35 19 12 21 34 10 Annual TB noti - fication rate (private sector) 63 31 31 35 211 181 301 247 111 167 162 222 156 129 126 175 247 127 200 190 Annual TB noti - fication rate (public sector) 60 219 645 797 487 263 627 608 692 2419 1544 2331 2938 1209 1866 2967 1621 2277 1124 1711 Total Total patients notified 8% 0% 0% 3% 0% 3% 1% 0% 5% 0% 4% 8% 0% 5% 8% 1% 5% 10% 10% 21% % TB notifi - cation from private sector 3 6 81 24 14 27 82 197 159 298 158 136 125 485 TB patients notified from private sector 3% 0% 7% 3% 4% 6% 7% 2% 8% 6% 3% 3% 3% 6% 3% 3% 3% 4% 11% 13% % of - Pediat ric TB 7 60 74 92 81 47 16 37 69 27 18 74 59 24 43 54 38 169 158 - Pediat ric TB 52% 48% 58% 63% 46% 50% 43% 58% 35% 42% 39% 54% 39% 50% 41% 36% 55% 51% 40% 46% % of Clin - ically diag - nosed 35 846 874 100 371 274 201 469 135 245 290 702 250 762 713 516 1072 1121 1147 1571 Clin - ically diag - nosed 48% 52% 42% 37% 54% 50% 57% 42% 65% 58% 61% 46% 61% 50% 59% 64% 45% 49% 60% 54% % of Micro - biologi - cally con - firmed 25 783 511 119 274 499 283 740 114 382 291 442 734 602 1150 1129 1493 1006 1260 1079 Micro - biologi - cally con - firmed 19% 24% 12% 17% 21% 30% 19% 20% 23% 13% 25% 24% 22% 13% 22% 19% 19% 18% 27% 22% % Pre - viously treated TB 7 47 61 61 77 312 527 238 667 493 129 174 302 136 384 134 524 271 483 249 Previ - ously treated 81% 76% 88% 83% 79% 70% 81% 80% 77% 87% 75% 76% 78% 87% 78% 81% 81% 82% 73% 78% % of New TB 53 172 516 599 423 907 188 491 504 558 869 1317 1695 1147 1583 2147 1324 2307 1225 1309 New 34% 29% 37% 32% 26% 23% 23% 32% 19% 29% 20% 28% 20% 30% 22% 14% 22% 26% 19% 13% % Extra Pulmo - nary TB 22 58 69 94 554 643 440 525 605 204 145 140 245 123 175 379 626 382 214 239 Extra pulmo - nary 66% 71% 63% 68% 74% 77% 77% 68% 81% 71% 80% 72% 80% 70% 78% 86% 78% 74% 81% 87% % Pul - monary TB 38 945 161 441 628 344 964 180 504 406 598 904 1075 1579 1725 2035 1329 2205 1114 1553 Pulmo - nary 60 219 645 773 484 249 627 581 692 1629 2222 1385 2250 2640 1209 1708 2831 1496 1118 1792 TB patients notified from public sector 33165 88675 855613 460186 477879 545781 810506 401891 548109 606609 557689 1051410 2032471 1585474 1017797 1542903 1644612 1325198 1615434 1413553 Population - Shimla Mandi Lahul & Spiti Kullu Kinnaur Jammu Kangra Doda Hamir pur-HP Baramula Chamba Badgam Bilaspur-HP Anantnag - YAMU NANAGAR Una SONIPAT Solan Sirmaur SIRSA District Himachal Pradesh Himachal Pradesh Himachal Pradesh Himachal Pradesh Himachal Pradesh Jammu and Kashmir Himachal Pradesh Jammu and Kashmir Himachal Pradesh Jammu and Kashmir Himachal Pradesh Jammu and Kashmir Himachal Pradesh Jammu and Kashmir Haryana Himachal Pradesh Haryana Himachal Pradesh Himachal Pradesh Haryana State

130 TB India 2017 85 40 95 85 68 79 74 99 63 64 53 80 97 98 57 86 85 71 122 164 102 102 131 123 186 143 Annual TB noti - fication rate (public sector) 0 0 1 0 0 0 8 0 7 0 0 5 0 0 6 1 0 1 3 0 0 41 23 39 10 10 Annual TB noti - fication rate (private sector) 85 39 95 77 90 60 79 51 94 63 64 46 79 96 98 53 76 85 71 121 164 102 102 123 147 133 Annual TB noti - fication rate (public sector) 438 825 317 560 983 891 900 432 487 420 159 546 968 134 2611 1636 2989 1302 1182 1275 1440 1733 1419 2723 2552 1179 Total Total patients notified 0% 0% 1% 0% 1% 0% 0% 0% 0% 5% 0% 0% 1% 0% 1% 6% 7% 0% 0% 10% 31% 11% 31% 12% 21% 12% % TB notifi - cation from private sector 4 3 3 1 4 3 6 5 4 1 10 96 66 59 33 66 931 141 401 570 301 TB patients notified from private sector 7% 3% 3% 6% 3% 4% 3% 3% 1% 4% 4% 4% 3% 4% 5% 4% 7% 4% 2% 3% 9% 1% 5% 13% 10% 21% % of - Pediat ric TB 8 3 46 12 46 45 14 27 11 76 51 42 24 50 22 72 41 30 60 54 47 12 28 192 110 110 - Pediat ric TB 47% 41% 43% 40% 46% 29% 48% 41% 38% 50% 38% 47% 39% 66% 51% 44% 29% 40% 47% 56% 59% 50% 43% 57% 54% 76% % of Clin - ically diag - nosed 94 664 188 332 144 345 268 368 334 444 553 353 578 697 190 503 172 196 785 220 515 102 1221 1019 1081 1206 Clin - ically diag - nosed 53% 59% 57% 60% 54% 71% 52% 59% 62% 50% 62% 53% 61% 34% 49% 56% 71% 60% 53% 44% 41% 50% 57% 43% 46% 24% % of Micro - biologi - cally con - firmed 64 32 972 246 493 170 831 292 519 556 717 625 544 296 677 242 256 220 629 293 387 1380 1039 1224 1072 1045 Micro - biologi - cally con - firmed 9% 9% 16% 15% 11% 22% 13% 18% 26% 20% 14% 25% 15% 10% 18% 17% 16% 29% 12% 19% 11% 17% 30% 19% 21% 26% % Pre - viously treated TB 65 89 68 70 85 72 51 18 35 242 256 105 158 233 412 159 299 137 252 273 126 269 369 153 173 467 Previ - ously treated 91% 84% 85% 89% 78% 91% 88% 82% 74% 80% 86% 75% 85% 90% 82% 83% 71% 84% 88% 81% 89% 70% 83% 81% 79% 74% % of New TB 99 369 736 246 490 729 657 879 760 789 360 302 365 140 360 729 2359 1380 1071 1646 1002 1122 1454 1145 1784 1784 New 4% 3% 4% 4% 6% 8% 1% 2% 6% 6% 3% 7% 2% 8% 15% 14% 31% 46% 35% 20% 35% 49% 16% 31% 12% 32% % Extra Pulmo - nary TB 8 95 50 63 34 12 70 45 22 69 52 43 86 78 49 43 295 363 402 151 120 145 223 160 112 190 Extra pulmo - nary 96% 97% 85% 96% 96% 94% 92% 99% 98% 86% 94% 69% 94% 54% 97% 65% 80% 93% 65% 84% 51% 69% 98% 88% 92% 68% % Pul - monary TB 80 91 371 791 302 515 879 868 815 845 472 281 342 271 353 790 2506 1586 1106 1763 1092 1331 1607 1191 2104 2061 Pulmo - nary 434 825 314 560 887 890 897 874 432 428 416 158 513 902 134 2601 1636 1176 2058 1161 1178 1374 1727 1414 2153 2251 TB patients notified from public sector 997758 512348 805212 795776 588423 876819 958470 682183 920960 525265 162050 964521 678267 157956 2148553 1655399 1156547 2287918 1924064 1138075 1725936 1455118 2713214 1467329 1465897 2976700 Population Palamu Pakur Lohardaga Lathehar Kodarma Deoghar Khunti Chatra Jamtara Bokaro Hazaribagh Udhampur Gumla Srinagar Godda Rajouri Pulwama Giridih Poonch Garhwa Leh Kupwara Dumka Kathua Dhanbad Kargil District Jharkhand Jharkhand Jharkhand Jharkhand Jharkhand Jharkhand Jharkhand Jharkhand Jharkhand Jharkhand Jharkhand Jammu and Kashmir Jharkhand Jammu and Kashmir Jharkhand Jammu and Kashmir Jammu and Kashmir Jharkhand Jammu and Kashmir Jharkhand Jammu and Kashmir Jammu and Kashmir Jharkhand Jammu and Kashmir Jharkhand Jammu and Kashmir State

131 TB India 2017 87 99 84 93 88 84 91 78 72 68 99 189 124 120 130 145 150 127 111 100 134 116 181 104 Annual TB noti - fication rate (public sector) 5 4 9 6 3 1 9 4 1 0 1 0 1 4 0 11 22 45 11 10 55 11 11 12 Annual TB noti - fication rate (private sector) 83 95 75 75 87 85 73 90 77 56 99 72 67 88 91 178 102 121 141 140 126 123 112 181 Annual TB noti - fication rate (public sector) 608 952 761 2393 4438 1412 1040 1659 9424 1938 1779 1867 2304 1711 1919 1695 3602 1089 1578 3406 2105 3010 2676 5286 Total Total patients notified 6% 6% 4% 6% 3% 1% 7% 3% 1% 7% 0% 1% 0% 2% 8% 4% 0% 12% 18% 11% 37% 13% 49% 11% % TB notifi - cation from private sector 6 5 7 1 44 55 51 12 30 77 631 132 260 248 175 125 235 164 127 282 307 3526 1778 TB patients notified from private sector 5% 5% 9% 4% 7% 5% 4% 5% 4% 2% 4% 3% 7% 6% 3% 4% 7% 5% 7% 3% 3% 3% 4% 10% % of - Pediat ric TB 38 98 67 81 60 15 86 44 67 57 71 71 35 56 77 90 459 109 229 102 321 102 107 100 - Pediat ric TB 39% 44% 43% 36% 35% 37% 42% 44% 57% 39% 31% 39% 51% 44% 62% 40% 47% 33% 36% 49% 52% 51% 54% 40% % of Clin - ically diag - nosed 991 421 350 544 791 987 631 189 824 854 417 672 860 362 276 757 955 1836 1794 2470 1104 1615 1041 1626 Clin - ically diag - nosed 61% 56% 57% 64% 65% 63% 58% 56% 43% 61% 69% 61% 49% 56% 38% 60% 53% 67% 64% 51% 48% 49% 46% 60% % of Micro - biologi - cally con - firmed 743 646 940 737 413 806 523 688 964 720 484 791 987 2819 1270 2384 3428 1022 1001 1316 1018 1509 1384 1414 Micro - biologi - cally con - firmed 9% 16% 28% 24% 20% 21% 21% 23% 24% 17% 20% 21% 10% 20% 12% 18% 14% 23% 20% 18% 16% 24% 10% 23% % Pre - viously treated TB 56 761 624 999 229 205 312 431 295 334 445 160 191 210 305 263 246 155 272 487 485 310 535 1337 Previ - ously treated 84% 72% 76% 80% 79% 79% 77% 76% 83% 80% 91% 79% 90% 80% 88% 82% 86% 77% 80% 82% 84% 76% 90% 77% % of New TB 935 791 546 749 836 605 3894 1637 3179 1172 4561 1382 1429 1298 1695 1500 1582 1385 1561 1276 2637 1543 2700 1834 New 9% 5% 2% 6% 8% 8% 8% 6% 16% 22% 12% 16% 22% 28% 16% 10% 12% 11% 23% 18% 13% 16% 13% 16% % Extra Pulmo - nary TB 30 38 60 436 362 934 142 157 330 296 181 201 237 213 116 308 236 178 130 250 255 178 377 1676 Extra pulmo - nary 91% 84% 78% 88% 84% 78% 72% 84% 90% 88% 95% 89% 98% 77% 94% 82% 87% 84% 92% 92% 92% 87% 94% 84% % Pul - monary TB 839 572 727 904 700 4219 1899 3244 1022 1154 4222 1517 1543 1431 1903 1622 1676 1382 1588 1418 2874 1773 2832 1992 Pulmo - nary 996 602 940 760 4655 2261 4178 1164 1484 5898 1813 1724 1632 2140 1660 1792 1690 1824 1082 1548 3124 2028 3010 2369 TB patients notified from public sector 665557 5098542 2736711 2353191 1136594 1053392 1970721 7878070 2077326 2017490 2223205 1771605 1180020 1213970 1276090 1338406 3231199 1089355 1053193 2320810 2542144 1813900 1666206 2702025 Population BELGAUM GULBARGA Bangalore Urban GADAG BANGALORE RURAL DHARWAD BANGALORE CITY - DAVANA GERE BAGALKOT DAKSHINA KANNADA Simdega CHITRADU - RGA CHIKMAG - ALUR Sahibganj CHIKKA - BALLAPUR Ranchi CHAMARA - JANAGAR Ramgarh BIJAPUR Purbi Singh - bhum BIDAR Pashchimi Pashchimi Singhbhum District BELLARY Saraikela - Kharsawan Karnataka Karnataka Karnataka Karnataka Karnataka Karnataka Karnataka Karnataka Karnataka Karnataka Jharkhand Karnataka Jharkhand Karnataka Jharkhand Karnataka Jharkhand Karnataka Jharkhand Karnataka Jharkhand Karnataka Jharkhand State Karnataka

132 TB India 2017 67 98 58 94 86 80 98 69 97 70 69 178 186 172 140 130 126 109 115 147 219 134 102 145 127 185 154 122 Annual TB noti - fication rate (public sector) 4 5 4 2 1 1 1 2 8 71 54 53 21 17 21 42 22 67 18 87 37 87 32 105 118 106 147 121 Annual TB noti - fication rate (private sector) 74 68 66 69 77 73 46 82 38 89 73 72 82 66 84 58 43 64 97 67 67 96 90 69 62 104 124 125 Annual TB noti - fication rate (public sector) 899 406 1482 5890 5790 1703 3732 1589 3112 2806 1839 1839 1086 2308 3016 5851 2739 1770 1973 3727 1879 6167 1606 3329 1662 1528 1330 1062 Total Total patients notified 4% 5% 4% 1% 1% 2% 1% 2% 59% 63% 62% 50% 41% 42% 32% 17% 36% 36% 15% 67% 50% 17% 60% 46% 65% 56% 26% 11% % TB notifi - cation from private sector 7 59 26 19 21 29 870 860 667 124 886 310 658 838 461 113 890 344 413 400 117 3732 3577 1540 3933 2226 4022 1879 TB patients notified from private sector 6% 3% 5% 5% 4% 4% 4% 8% 3% 5% 4% 5% 6% 3% 6% 5% 5% 6% 3% 7% 6% 5% 3% 6% 18% 11% 11% 13% % of - Pediat ric TB 77 46 33 65 91 33 67 95 45 96 93 26 51 26 91 60 42 59 108 140 105 122 220 100 104 151 133 213 - Pediat ric TB 53% 47% 42% 42% 34% 43% 42% 51% 38% 50% 36% 38% 41% 44% 39% 47% 35% 49% 45% 50% 36% 40% 41% 45% 46% 43% 34% 45% % of Clin - ically diag - nosed 325 934 355 318 946 984 582 595 367 565 839 414 565 741 832 241 571 859 165 656 761 487 444 426 1021 1247 1050 1033 Clin - ically diag - nosed 47% 53% 58% 58% 66% 57% 58% 49% 62% 50% 64% 62% 59% 56% 61% 53% 65% 51% 55% 50% 64% 60% 59% 55% 54% 57% 66% 55% % of Micro - biologi - cally con - firmed 287 488 604 936 947 586 660 905 466 760 245 234 794 880 641 857 519 1137 1279 1246 1741 1505 1079 1593 1064 1021 1016 1286 Micro - biologi - cally con - firmed 9% 9% 13% 15% 11% 20% 11% 20% 12% 15% 11% 21% 12% 24% 22% 11% 22% 10% 24% 11% 17% 17% 15% 14% 18% 28% 19% 19% % Pre - viously treated TB 54 95 96 53 61 273 329 185 245 585 223 227 131 220 174 604 170 581 356 152 451 269 359 208 301 316 250 175 Previ - ously treated 91% 87% 85% 89% 80% 89% 80% 88% 85% 89% 79% 88% 76% 91% 78% 89% 78% 90% 76% 89% 83% 83% 85% 86% 82% 72% 81% 81% % of New TB 558 748 737 807 784 433 338 812 770 1885 1884 1947 2403 1697 1302 1050 1296 1951 1748 2045 1273 1349 1402 1318 1786 1242 1340 1051 New 7% 8% 8% 18% 20% 19% 17% 19% 21% 22% 30% 19% 29% 20% 18% 16% 17% 26% 19% 26% 21% 20% 12% 19% 18% 14% 16% 17% % Extra Pulmo - nary TB 74 93 108 422 430 147 178 452 667 568 289 343 208 265 177 311 456 233 310 394 100 149 312 247 259 225 207 160 Extra pulmo - nary 82% 80% 81% 83% 81% 79% 78% 70% 81% 71% 80% 82% 93% 84% 83% 74% 81% 74% 79% 92% 80% 88% 81% 82% 86% 92% 84% 83% % Pul - monary TB 504 696 744 838 819 647 386 325 785 1736 1783 1740 2321 1352 1240 1205 2378 1607 2170 1319 1107 1704 1275 1898 1191 1416 1035 1094 Pulmo - nary 612 843 922 880 486 399 945 2158 2213 2192 2988 1920 1529 1181 1027 1470 2555 1918 2626 1629 1501 1853 1587 2145 1450 1641 1128 1301 TB patients notified from public sector 830888 591925 3164910 3365324 1216517 1256815 2860220 2861076 4183099 1873112 3143761 1155271 2014120 2053711 2675852 3195359 1325459 1929842 2569959 1126888 1484493 1643409 3337418 2159181 1705588 1251562 1895208 1533100 Population Wayanad Thrissur Thiruvanan - thapuram - Pathana mthitta UDUPI Palakkad TUMKUR Malappuram SHIMOGA Kozhikode RA - MANAGARA Kottayam RAICHUR Kollam MYSORE Kasaragod MANDYA Kannur Idukki KOPPAL KOLAR Ernakulam KODAGU Alappuzha HAVERI YADGIRI HASSAN District UTTARA KANNADA Kerala Kerala Kerala Kerala Karnataka Kerala Karnataka Kerala Karnataka Kerala Karnataka Kerala Karnataka Kerala Karnataka Kerala Karnataka Kerala Kerala Karnataka Karnataka Kerala Karnataka Kerala Karnataka Karnataka Karnataka State Karnataka

133 TB India 2017 90 35 188 274 111 152 208 141 138 224 126 159 154 123 196 177 156 146 205 Annual TB noti - fication rate (public sector) 1 0 0 0 0 0 3 0 7 0 15 65 25 31 27 62 21 31 55 Annual TB noti - fication rate (private sector) 90 35 173 209 109 127 177 141 111 163 105 128 154 123 196 174 156 138 150 Annual TB noti - fication rate (public sector) 23 717 859 1554 7082 2058 2058 3576 1085 2091 5344 2332 2709 1419 1008 1681 2439 3321 3945 Total Total patients notified 8% 1% 0% 0% 0% 0% 0% 2% 0% 5% 0% 24% 16% 15% 20% 27% 17% 19% 27% % TB notifi - cation from private sector 27 44 126 337 530 410 390 525 170 1066 1678 1469 TB patients notified from private sector 8% 9% 9% 6% 6% 5% 5% 3% 4% 6% 4% 3% 10% 12% 11% 10% 10% 17% 70% % of - Pediat ric TB 93 76 27 29 32 99 16 233 125 567 241 158 180 121 100 380 215 284 141 - Pediat ric TB 46% 47% 61% 58% 64% 62% 56% 40% 58% 63% 51% 58% 36% 59% 24% 33% 33% 43% 57% % of Clin - ically diag - nosed 13 676 607 673 817 365 987 172 801 281 1324 3313 1184 1100 1884 2230 1227 1124 1352 Clin - ically diag - nosed 54% 53% 39% 42% 36% 38% 44% 60% 42% 37% 49% 42% 64% 41% 76% 67% 67% 57% 43% % of Micro - biologi - cally con - firmed 10 752 847 621 478 715 602 643 694 545 578 1555 2091 1162 1008 1645 1060 1594 1799 Micro - biologi - cally con - firmed 6% 9% 7% 9% 3% 0% 14% 20% 14% 10% 10% 11% 10% 10% 22% 14% 15% 16% 17% % Pre - viously treated TB 87 97 41 96 405 291 165 304 187 268 202 202 367 101 367 134 534 1073 Previ - ously treated 86% 94% 80% 86% 90% 90% 91% 89% 93% 90% 97% 91% 90% 78% 86% 85% 84% 83% 100% % of New TB 23 988 912 616 725 2474 1341 4331 1740 1556 2742 1494 3607 1740 1378 1982 1314 2028 2617 New 6% 9% 7% 4% 0% 4% 7% 8% 8% 0% 27% 11% 11% 11% 12% 15% 15% 11% 13% % Extra Pulmo - nary TB 80 82 40 48 65 175 122 233 188 346 200 573 333 181 310 267 1439 Extra pulmo - nary 94% 91% 73% 89% 89% 89% 93% 88% 85% 96% 85% 96% 89% 93% 87% 92% 92% 100% 100% % Pul - monary TB 23 968 669 794 2704 1306 3965 1798 1533 2700 1005 1481 3302 1860 1419 1851 1500 2085 2884 Pulmo - nary 23 717 859 2879 1428 5404 2031 1721 3046 1085 1681 3875 1942 1419 2184 1008 1681 2395 3151 TB patients notified from public sector 65454 825031 767513 920926 816888 857054 794170 549428 1921302 2580994 1856678 1352473 1716830 1510202 2381030 1854056 1703599 1377285 2278183 Population Chhatarpur Burhanpur Bhopal Bhind Guna Betul Dindori Barwani Dhar Balaghat Ashoknagar Dewas Anuppur Datia Alirajpur Damoh Agar Malwa Chhindwara Lakshad - weep District 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 Lakshad - weep State

134 TB India 2017 218 183 180 129 131 138 159 159 193 132 220 128 187 124 237 216 137 228 169 Annual TB noti - fication rate (public sector) 1 0 0 0 5 0 0 66 22 18 18 44 32 14 68 78 22 48 55 Annual TB noti - fication rate (private sector) 151 183 158 111 131 138 159 140 149 127 188 128 173 124 168 138 115 180 114 Annual TB noti - fication rate (public sector) 3179 2103 3680 1835 1850 3547 1773 2519 5169 2219 7839 1864 2529 1375 1471 1948 1627 5043 3613 Total Total patients notified 0% 0% 0% 0% 4% 0% 7% 0% 30% 12% 14% 12% 23% 14% 29% 36% 16% 21% 32% % TB notifi - cation from private sector 6 82 968 450 251 293 184 706 425 263 1186 1130 1070 1174 TB patients notified from private sector 9% 9% 8% 8% 7% 7% 8% 5% 5% 5% 9% 4% 10% 14% 10% 14% 14% 15% 16% % of - Pediat ric TB 93 65 67 203 206 445 158 161 284 147 155 272 164 926 338 207 172 353 104 - Pediat ric TB 51% 57% 40% 48% 59% 52% 58% 50% 50% 53% 54% 45% 59% 33% 48% 61% 37% 51% 37% % of Clin - ically diag - nosed 756 837 453 600 635 510 894 1124 1196 1291 1089 1840 1020 1104 1973 1132 3643 1372 2041 Clin - ically diag - nosed 63% 49% 43% 60% 52% 41% 48% 42% 50% 50% 47% 46% 55% 41% 67% 52% 39% 63% 49% % of Micro - biologi - cally con - firmed 901 828 761 753 973 922 642 411 854 1545 1087 1939 1707 1122 2010 1005 3066 1027 1932 Micro - biologi - cally con - firmed 7% 6% 7% 6% 19% 25% 11% 12% 20% 24% 21% 17% 18% 19% 19% 18% 10% 23% 21% % Pre - viously treated TB 98 461 547 152 354 217 700 118 539 817 362 349 135 267 223 102 314 819 1203 Previ - ously treated 81% 75% 93% 89% 94% 88% 80% 93% 76% 79% 83% 82% 81% 94% 81% 90% 82% 77% 79% % of New TB 944 1978 1664 1945 2876 1486 1633 2847 1655 1687 3166 1775 5506 1515 2210 1108 1019 1050 3154 New 4% 2% 7% 7% 8% 7% 7% 10% 12% 13% 16% 14% 17% 12% 17% 25% 10% 13% 15% % Extra Pulmo - nary TB 77 41 73 92 247 269 273 517 214 600 270 684 160 182 171 112 183 598 1706 Extra pulmo - nary 90% 88% 87% 84% 86% 96% 83% 98% 88% 83% 93% 75% 90% 93% 92% 93% 93% 87% 85% % Pul - monary TB 973 2192 1942 1824 2713 1370 1773 2947 1732 1956 3299 1977 5003 1682 2174 1263 1150 1181 3375 Pulmo - nary 2439 2211 2097 3230 1584 1850 3547 1773 2226 3983 2137 6709 1864 2345 1375 1242 1046 1364 3973 TB patients notified from public sector 900195 621561 2141763 1460256 1148212 2040705 1427136 1407780 2576197 1116136 1585212 2681883 1685544 3566452 1451392 1352514 1107349 1190303 2213048 Population Morena Mandsaur Mandla Khargone Khandwa Katni Rewa Jhabua Ratlam Jabalpur Rajgarh Indore Raisen Hoshang - abad Panna Neemuch Harda Narsinghpur Gwalior District 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 State

135 TB India 2017 81 107 106 114 101 208 156 115 107 119 214 138 144 101 196 161 137 127 138 Annual TB noti - fication rate (public sector) 0 0 7 0 9 3 0 7 3 2 5 0 21 16 64 18 21 14 121 Annual TB noti - fication rate (private sector) 85 94 91 93 74 80 107 114 208 146 112 119 135 100 178 140 132 127 124 Annual TB noti - fication rate (public sector) 976 538 892 1686 1359 1400 1896 1558 1713 1334 2558 1795 1205 1965 4519 4764 2557 3540 2995 Total Total patients notified 0% 0% 7% 0% 6% 2% 0% 9% 2% 2% 9% 4% 0% 20% 15% 56% 45% 13% 10% % TB notifi - cation from private sector 1 1 33 43 71 274 136 104 374 551 103 240 431 330 130 300 TB patients notified from private sector 6% 6% 4% 4% 4% 4% 6% 3% 6% 6% 3% 7% 6% 9% 6% 10% 11% 17% 14% % of - Pediat ric TB 69 81 71 53 82 67 24 33 18 51 367 161 174 277 113 149 313 142 295 - Pediat ric TB 53% 54% 51% 46% 39% 30% 47% 51% 41% 40% 50% 42% 43% 66% 49% 65% 52% 50% 47% % of Clin - ically diag - nosed 905 554 649 685 470 752 666 905 717 211 464 836 198 417 1437 2184 2816 1158 1704 Clin - ically diag - nosed 47% 46% 49% 54% 61% 70% 53% 49% 59% 60% 50% 58% 57% 34% 51% 35% 48% 53% 50% % of Micro - biologi - cally con - firmed 781 531 751 857 635 214 638 100 474 1258 1075 1087 1279 1078 1086 2264 1517 1069 1706 Micro - biologi - cally con - firmed 5% 19% 16% 17% 19% 19% 20% 11% 16% 21% 16% 25% 21% 11% 17% 13% 15% 15% 10% % Pre - viously treated TB 52 514 269 183 270 343 317 176 209 467 279 107 228 221 571 209 335 133 336 Previ - ously treated 81% 84% 83% 81% 81% 80% 89% 84% 79% 84% 75% 79% 89% 83% 87% 95% 85% 85% 90% % of New TB 902 318 874 246 758 2181 1417 1130 1417 1240 1433 1092 1717 1516 1701 3877 4124 1892 3074 New 7% 4% 7% 3% 8% 7% 6% 17% 15% 15% 17% 12% 32% 16% 30% 16% 16% 12% 12% % Extra Pulmo - nary TB 96 64 34 88 54 469 253 158 103 280 266 137 140 175 139 733 699 270 399 Extra pulmo - nary 83% 85% 85% 93% 96% 93% 83% 97% 88% 68% 92% 84% 70% 93% 84% 84% 88% 94% 88% % Pul - monary TB 927 288 927 210 837 2226 1433 1304 1696 1454 1329 1267 1918 1655 1783 3715 3634 1957 3011 Pulmo - nary 425 298 891 2695 1686 1085 1400 1760 1557 1609 1301 2184 1795 1102 1922 4448 4333 2227 3410 TB patients notified from public sector 749785 455343 374069 701424 2165156 1574789 1284022 1227766 1880934 1098855 1160710 2388962 1502809 1483326 1428841 4468917 2428927 1589276 2592056 Population Ujjain Tikamgarh Singrauli Sidhi Shivpuri Sheopur Shajapur Shahdol Amravati Akola MC Seoni Akola Ahmed - nagar MC Sehore Ahmad - nagar Satna Vidisha Umaria Sagar District Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Maharash - tra Maharash - tra Madhya Pradesh Maharash - tra Maharash - tra Madhya Pradesh Maharash - tra Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh State

136 TB India 2017 77 78 247 109 321 360 260 758 764 115 663 137 485 427 117 343 144 197 1393 Annual TB noti - fication rate (public sector) 0 19 77 23 11 45 49 53 21 197 198 570 573 264 346 293 216 104 1196 Annual TB noti - fication rate (private sector) 91 91 66 92 68 91 93 57 247 197 124 162 183 188 191 398 138 135 127 Annual TB noti - fication rate (public sector) 996 2156 1875 1398 9070 1205 1591 1682 3452 3865 2686 2065 2062 1705 2378 3311 3228 3085 1125 Total Total patients notified 0% 27% 17% 86% 61% 55% 29% 75% 75% 20% 14% 40% 33% 71% 68% 42% 63% 37% 53% % TB notifi - cation from private sector 3 589 241 739 875 496 548 285 822 558 366 595 7789 2597 2900 1699 2267 1356 1944 TB patients notified from private sector 5% 9% 5% 5% 3% 9% 8% 3% 4% 7% 6% 9% 3% 6% 4% 5% 11% 10% 11% % of - Pediat ric TB 77 60 24 25 76 78 67 67 80 39 95 56 68 26 26 166 136 117 137 - Pediat ric TB 62% 73% 47% 71% 58% 66% 69% 55% 70% 41% 34% 65% 50% 58% 63% 41% 66% 48% 62% % of Clin - ically diag - nosed 973 539 904 268 470 815 469 679 869 601 810 578 391 654 769 758 302 326 1373 Clin - ically diag - nosed 38% 27% 53% 29% 42% 34% 31% 45% 30% 59% 66% 35% 50% 42% 37% 59% 34% 52% 38% % of Micro - biologi - cally con - firmed 594 499 618 377 198 246 371 386 286 430 569 288 390 383 328 204 1269 1179 1103 Micro - biologi - cally con - firmed 22% 33% 21% 32% 35% 35% 30% 29% 23% 18% 18% 31% 16% 34% 25% 22% 22% 25% 31% % Pre - viously treated TB 352 611 245 410 163 249 354 250 224 391 313 386 181 231 266 416 251 155 165 Previ - ously treated 78% 67% 79% 68% 65% 65% 70% 71% 77% 82% 82% 69% 84% 66% 75% 78% 78% 75% 69% % of New TB 912 871 303 467 832 605 741 854 966 448 778 890 475 365 1215 1261 1747 1467 1456 New 24% 24% 19% 39% 32% 22% 30% 33% 27% 18% 13% 34% 27% 35% 37% 36% 18% 23% 21% % Extra Pulmo - nary TB 381 450 216 502 147 154 359 283 261 395 229 418 314 241 390 411 329 148 110 Extra pulmo - nary 76% 76% 81% 61% 68% 78% 70% 67% 73% 82% 87% 66% 73% 65% 63% 64% 82% 77% 79% % Pul - monary TB 941 779 319 562 827 572 704 822 833 438 654 731 482 420 1186 1422 1743 1551 1543 Pulmo - nary 466 716 855 965 679 630 530 1567 1872 1157 1281 1186 2138 1780 1240 1147 1044 1141 1872 TB patients notified from public sector 758286 651215 375194 442432 646579 455610 506147 311242 490574 775006 900285 689498 570612 2756669 1277947 2339112 2691255 1248653 2758884 Population Bid Bhiwandi Nizampur Bhandara Dadar Bandra West Colaba Bandra East Chembur Bail Bazar Road Chandrapur Aurangab - ad-MH Centenary Aurangabad MC Byculla Andheri West Andheri East Buldana Amravati MC District Borivali Maharash - tra Maharash - tra Maharash - tra Maharash - tra Maharash - tra Maharash - tra Maharash - tra Maharash - tra Maharash - tra Maharash - tra Maharash - tra Maharash - tra Maharash - tra Maharash - tra Maharash - tra Maharash - tra Maharash - tra Maharash - tra State Maharash - tra

137 TB India 2017 88 80 86 114 388 345 141 111 782 665 282 126 229 304 102 126 420 155 1055 Annual TB noti - fication rate (public sector) 9 27 10 50 36 15 10 13 21 71 305 739 180 654 510 206 101 150 293 Annual TB noti - fication rate (private sector) 87 78 83 91 75 76 70 89 65 84 316 165 128 155 111 129 155 117 127 Annual TB noti - fication rate (public sector) 920 759 4593 1103 1642 4642 1682 1984 2901 5367 2301 1653 1435 2820 1946 1814 1676 1790 1698 Total Total patients notified 7% 24% 11% 79% 70% 52% 36% 32% 84% 77% 73% 12% 12% 44% 49% 13% 25% 70% 46% % TB notifi - cation from private sector 121 877 706 931 170 346 404 957 124 231 439 348 1095 1291 3251 4490 1764 1206 1184 TB patients notified from private sector 3% 2% 3% 7% 2% 5% 7% 8% 6% 2% 3% 5% 7% 4% 4% 4% 6% 6% 15% % of - Pediat ric TB 9 22 54 31 40 74 26 28 70 28 70 61 58 56 29 23 116 215 100 - Pediat ric TB 51% 40% 60% 74% 65% 40% 47% 65% 67% 50% 39% 39% 39% 62% 22% 62% 45% 58% 46% % of Clin - ically diag - nosed 391 211 521 506 923 568 362 223 499 954 201 613 343 958 607 299 188 1791 1027 Clin - ically diag - nosed 49% 60% 40% 26% 35% 60% 53% 35% 33% 50% 61% 61% 61% 38% 78% 38% 55% 42% 54% % of Micro - biologi - cally con - firmed 591 140 364 284 772 309 175 224 766 315 376 594 744 215 223 1707 1047 1520 1240 Micro - biologi - cally con - firmed 16% 20% 24% 25% 28% 17% 21% 25% 26% 21% 21% 17% 16% 10% 33% 10% 25% 29% 19% % Pre - viously treated TB 85 94 80 79 576 197 349 225 213 404 135 231 266 424 100 517 162 337 148 Previ - ously treated 84% 80% 76% 75% 72% 83% 79% 75% 74% 79% 79% 83% 84% 90% 67% 90% 75% 71% 81% % of New TB 785 266 580 402 646 353 999 436 889 366 332 2922 1042 1065 1566 2050 1035 1421 1014 New 6% 13% 18% 28% 40% 24% 13% 23% 30% 35% 32% 12% 13% 12% 36% 24% 16% 25% 22% % Extra Pulmo - nary TB 98 61 89 452 177 563 192 161 451 267 190 144 158 331 353 372 100 219 129 Extra pulmo - nary 87% 82% 72% 60% 76% 87% 77% 65% 70% 68% 88% 87% 88% 64% 76% 94% 84% 75% 78% % Pul - monary TB 805 253 828 613 347 610 303 455 636 385 322 3046 1117 1519 1107 2143 1180 1483 1132 Pulmo - nary 982 351 805 537 877 447 516 989 514 411 3498 1391 1278 1970 1265 2474 1552 1583 1351 TB patients notified from public sector 422707 439890 487798 346025 686574 585543 400920 639467 404627 490865 4012446 1256801 1409622 2617641 1142548 3544208 1328659 1783107 2087769 Population Jalgaon MC Jalgaon Hingoli Grant Road Govandi Goregaon Gondiya Latur Kurla Ghatkopar Kolhapur Kolhapur MC Gadchiroli Kolhapur Dhule MC Kandivali Kalyan Dombivli MC Dhule Jalna Dahisar District Maharash - tra Maharash - tra Maharash - tra Maharash - tra Maharash - tra Maharash - tra Maharash - tra Maharash - tra Maharash - tra Maharash - tra Maharash - tra Maharash - tra Maharash - tra Maharash - tra Maharash - tra Maharash - tra Maharash - tra Maharash - tra Maharash - tra State

138 TB India 2017 78 93 95 68 143 169 152 155 159 104 149 217 127 143 534 244 426 260 3763 Annual TB noti - fication rate (public sector) 4 45 54 11 63 42 20 43 64 37 28 89 22 10 58 110 151 222 2639 Annual TB noti - fication rate (private sector) 98 75 42 82 92 83 90 73 58 115 117 106 154 115 383 155 204 202 1123 Annual TB noti - fication rate (public sector) 892 900 2264 3472 2963 2768 3979 7754 2481 4933 1370 2339 1243 2466 1223 1860 1201 3759 3104 Total Total patients notified 5% 31% 32% 72% 12% 41% 26% 20% 29% 29% 70% 29% 20% 28% 37% 23% 15% 52% 22% % TB notifi - cation from private sector 706 173 948 646 324 488 263 961 683 246 699 426 447 182 698 1612 2037 1418 1958 TB patients notified from private sector 9% 5% 5% 7% 3% 5% 5% 4% 3% 6% 6% 6% 3% 3% 4% 8% 5% 8% 11% % of - Pediat ric TB 17 72 63 37 23 34 54 58 63 51 135 154 110 115 267 138 101 141 257 - Pediat ric TB 55% 38% 39% 62% 59% 45% 46% 36% 44% 62% 69% 55% 45% 67% 61% 48% 41% 62% 58% % of Clin - ically diag - nosed 850 793 153 714 396 281 917 448 477 691 416 1240 1450 1058 2636 1531 1177 1108 1401 Clin - ically diag - nosed 45% 62% 61% 38% 41% 55% 54% 56% 64% 38% 32% 45% 55% 33% 52% 39% 59% 38% 42% % of Micro - biologi - cally con - firmed 93 708 994 241 129 739 549 590 743 299 603 693 2059 1222 1309 3081 1984 1279 1005 Micro - biologi - cally con - firmed 12% 11% 20% 17% 16% 22% 14% 22% 18% 32% 26% 19% 51% 29% 26% 13% 17% 25% 26% % Pre - viously treated TB 43 98 186 364 412 392 532 797 778 349 203 108 321 897 291 372 174 447 615 Previ - ously treated 88% 89% 80% 83% 84% 78% 86% 78% 82% 68% 74% 81% 49% 71% 74% 87% 83% 75% 74% % of New TB 203 434 302 870 706 678 845 1372 2935 1603 2052 1835 4920 2737 1644 1335 1062 1354 1791 New 13% 13% 13% 36% 17% 27% 18% 25% 18% 35% 28% 30% 27% 20% 19% 33% 18% 34% 27% % Extra Pulmo - nary TB 89 210 442 265 407 643 867 353 223 113 502 271 362 272 257 185 621 657 1013 Extra pulmo - nary 87% 87% 87% 64% 83% 73% 82% 75% 82% 65% 72% 70% 73% 80% 81% 67% 82% 66% 73% % Pul - monary TB 157 414 296 726 519 834 1348 2857 1750 2037 1724 4704 2648 1640 1154 1405 1162 1180 1749 Pulmo - nary 246 637 409 997 776 1558 3299 2015 2444 2367 5717 3515 1993 1656 1767 1434 1019 1801 2406 TB patients notified from public sector 36409 586908 414038 868433 461950 502099 881623 1585133 4425098 1754846 2991235 2564210 4884652 3321090 2396131 1843519 1957181 1769913 1193377 Population Nashik Corp Nashik Nandurbar Nanded MC Waghela Nanded Nagpur MC Pune Rural Pune Nagpur Prabhadevi Mulund Pimpri Chinchwad Mira Bhayander Parel Parbhani Malegoan Corporation Osmanabad Malad District Navi Mumbai - Maharash Maharash - tra Maharash - tra Maharash - tra Maharash - tra Maharash - tra Maharash - tra Maharash - tra Maharash - tra Maharash - tra Maharash - tra Maharash - tra Maharash - tra Maharash - tra Maharash - tra Maharash - tra Maharash - tra Maharash - tra Maharash - tra State tra

139 TB India 2017 89 49 62 98 193 138 100 475 120 107 103 134 124 115 110 326 125 170 143 214 Annual TB noti - fication rate (public sector) 4 0 0 0 16 14 34 61 10 10 63 23 60 23 37 14 16 28 266 211 Annual TB noti - fication rate (private sector) 86 55 59 49 97 62 93 71 74 64 91 73 178 133 209 115 110 170 127 186 Annual TB noti - fication rate (public sector) 77 352 971 160 663 3745 5431 1014 3209 2794 3050 4297 1246 1584 2722 2454 2146 2199 4027 1158 Total Total patients notified 8% 3% 0% 9% 0% 9% 0% 14% 38% 56% 51% 47% 24% 48% 20% 34% 65% 12% 11% 13% % TB notifi - cation from private sector 90 302 177 145 179 286 296 319 324 919 247 458 154 1224 1566 2015 1587 TB patients notified from private sector 5% 5% 4% 9% 9% 8% 4% 3% 5% 4% 3% 3% 3% 4% 9% 2% 6% 4% 5% 10% % of - Pediat ric TB 6 5 46 77 15 33 86 33 10 33 81 75 38 53 335 251 112 128 135 142 - Pediat ric TB 64% 50% 50% 45% 73% 46% 53% 49% 53% 56% 46% 45% 57% 43% 50% 63% 44% 67% 47% 56% % of Clin - ically diag - nosed 79 41 84 432 884 897 436 432 195 546 904 544 841 567 2207 2629 1550 1051 1481 1695 Clin - ically diag - nosed 36% 50% 50% 55% 27% 54% 47% 51% 48% 44% 54% 55% 43% 57% 50% 37% 56% 33% 53% 44% % of Micro - biologi - cally con - firmed 94 36 76 437 331 445 518 149 714 899 323 718 437 1236 2625 1101 1214 1231 1058 1874 Micro - biologi - cally con - firmed 23% 22% 25% 18% 20% 24% 17% 16% 17% 19% 16% 21% 19% 21% 19% 25% 20% 26% 24% 29% % Pre - viously treated TB 34 13 25 64 804 214 363 300 147 522 369 202 265 336 218 385 567 863 287 1159 Previ - ously treated 77% 78% 75% 82% 80% 76% 83% 84% 83% 81% 84% 79% 81% 79% 81% 75% 80% 74% 76% 71% % of New TB 64 655 139 928 135 734 748 280 995 649 717 2639 4095 1622 2242 1913 1467 1514 1632 2706 New 8% 34% 17% 25% 16% 21% 43% 17% 23% 14% 18% 23% 15% 22% 18% 19% 31% 33% 19% 20% % Extra Pulmo - nary TB 36 13 36 77 914 214 310 528 124 486 515 141 225 344 272 156 720 693 204 1160 Extra pulmo - nary 66% 83% 75% 84% 79% 57% 83% 78% 86% 82% 77% 85% 78% 82% 81% 69% 92% 67% 81% 80% % Pul - monary TB 64 655 137 700 124 757 809 267 595 800 2283 4340 1675 2278 1767 1035 1459 1743 1479 2876 Pulmo - nary 77 869 173 160 881 950 344 867 3443 5254 1985 1228 2764 2282 1260 1803 1899 2199 3569 1004 TB patients notified from public sector 293503 588205 155830 260059 904904 535882 752445 540402 1938941 3936859 1013904 3586504 2958674 3202220 1275713 1381720 2470888 1719130 1295985 2809365 Population Ulhasnagar Thane MC Thane Solapur MC Solapur Churachan - dpur Sion Chandel Bishnupur Sindhudurg Yavatmal Satara Washim Sangli MC Wardha Sangli Vikhroli Ratnagiri Vasai Virar Vasai Raigarh-MH District MC Maharash - tra Maharash - tra Maharash - tra Maharash - tra Maharash - tra Manipur Maharash - tra Manipur Manipur Maharash - tra Maharash - tra Maharash - tra Maharash - tra Maharash - tra Maharash - tra Maharash - tra Maharash - tra Maharash - tra Maharash - tra Maharash - tra State

140 TB India 2017 96 73 91 56 93 98 87 35 60 57 81 38 56 154 203 142 260 234 198 197 194 133 163 106 300 101 121 129 Annual TB noti - fication rate (public sector) 0 0 0 2 0 0 0 0 0 0 0 0 0 5 0 0 0 0 0 0 56 78 25 10 38 46 12 101 Annual TB noti - fication rate (private sector) 96 73 89 56 93 98 87 35 55 57 81 38 56 62 75 154 148 142 159 155 198 172 194 133 163 106 290 117 Annual TB noti - fication rate (public sector) 93 80 91 69 81 58 144 662 563 108 273 508 119 127 222 119 261 104 147 145 214 561 591 564 1011 1037 1832 1318 Total Total patients notified 0% 0% 0% 3% 0% 0% 0% 0% 0% 0% 0% 0% 0% 8% 0% 0% 0% 0% 0% 0% 3% 9% 27% 39% 34% 13% 38% 38% % TB notifi - cation from private sector 18 10 43 52 154 393 348 234 213 223 TB patients notified from private sector 3% 6% 3% 2% 3% 8% 5% 9% 7% 9% 1% 6% 2% 5% 9% 2% 2% 3% 4% 9% 10% 11% 18% 16% 12% 10% 20% 15% % of - Pediat ric TB 3 9 8 3 7 1 6 6 5 1 4 21 10 12 22 31 61 91 11 14 22 13 29 10 16 44 108 194 - Pediat ric TB 52% 56% 38% 31% 51% 26% 45% 44% 50% 54% 61% 76% 68% 71% 57% 44% 64% 38% 54% 54% 47% 33% 51% 48% 74% 52% 59% 57% % of Clin - ically diag - nosed 48 80 30 24 49 47 85 46 56 41 56 69 19 74 197 210 119 306 373 311 143 140 103 943 182 217 292 1215 Clin - ically diag - nosed 48% 44% 63% 69% 49% 74% 55% 56% 50% 46% 39% 32% 24% 29% 43% 56% 62% 36% 46% 46% 53% 67% 49% 52% 26% 48% 41% 43% % of Micro - biologi - cally con - firmed 45 64 50 67 59 22 34 35 71 68 79 48 78 39 71 447 199 154 312 316 197 383 121 111 332 166 151 220 Micro - biologi - cally con - firmed 6% 18% 22% 21% 11% 22% 13% 21% 17% 22% 22% 16% 13% 17% 19% 12% 11% 27% 18% 14% 11% 14% 16% 27% 15% 20% 13% 15% % Pre - viously treated TB 9 9 8 17 32 17 68 89 12 23 46 83 23 10 14 29 40 15 30 21 58 71 46 78 135 154 272 186 Previ - ously treated 82% 78% 79% 89% 78% 87% 79% 83% 78% 78% 84% 87% 83% 81% 88% 89% 73% 82% 86% 89% 86% 84% 94% 73% 85% 80% 88% 85% % of New TB 76 63 79 85 60 96 71 80 89 49 112 576 320 227 483 535 425 113 182 231 126 137 156 277 322 434 1326 1089 New 5% 5% 27% 18% 14% 35% 18% 34% 21% 34% 27% 43% 36% 48% 40% 13% 21% 42% 30% 33% 35% 12% 32% 31% 20% 44% 26% 42% % Extra Pulmo - nary TB 5 5 7 39 14 93 19 93 30 43 32 16 23 94 31 86 51 46 66 68 97 142 128 236 135 762 561 216 Extra pulmo - nary 95% 73% 83% 86% 65% 95% 82% 66% 79% 66% 73% 57% 64% 52% 60% 87% 79% 58% 70% 67% 65% 88% 68% 69% 80% 56% 74% 58% % Pul - monary TB 88 66 86 89 39 76 49 86 73 96 51 99 105 551 267 180 490 453 373 836 111 128 175 148 280 714 271 296 Pulmo - nary 93 80 91 69 81 58 144 644 409 108 273 618 689 508 119 127 109 222 104 261 147 145 214 348 368 512 1598 1275 TB patients notified from public sector 97337 51863 75891 70493 61247 93183 90246 198020 435806 726631 276842 161137 292021 389301 444001 256963 931351 358972 198120 167438 127614 454976 151627 136227 384060 556858 439044 489754 Population PEREN MOKOK - CHUNG West Khasi West Hills LONGLENG West Garo West Hills KOHIMA South Garo Hills KIPHIRE Ri Bhoi DIMAPUR Jaintia Hills MON Serchhip Saiha East Khasi Hills Mamit East Garo Hills Ukhrul Lunglei Lawngtlai Thoubal Kolasib Tamenglong Champhai Senapati Imphal West Aizawl Imphal East District Nagaland Nagaland Meghalaya Nagaland Meghalaya Nagaland Meghalaya Nagaland Meghalaya Nagaland Meghalaya Nagaland Mizoram Mizoram Meghalaya Mizoram Meghalaya Manipur Mizoram Mizoram Manipur Mizoram Manipur Mizoram Manipur Manipur Mizoram Manipur State

141 TB India 2017 0 69 50 62 85 62 81 98 80 72 44 82 91 64 98 73 58 96 130 164 127 138 115 126 116 127 213 Annual TB noti - fication rate (public sector) 2 0 0 3 0 0 0 0 5 9 0 0 2 6 9 2 0 1 0 0 0 0 0 0 21 11 12 Annual TB noti - fication rate (private sector) 0 67 50 62 80 54 81 96 74 63 42 82 90 64 98 73 58 96 128 164 127 138 115 105 116 117 201 Annual TB noti - fication rate (public sector) 0 93 97 761 889 995 712 375 531 124 318 3461 1066 1845 1030 2637 1729 1119 1413 1536 1550 1765 4735 1430 1225 1298 1235 Total Total patients notified 1% 0% 0% 4% 0% 0% 1% 0% 5% 0% 0% 2% 8% 4% 8% 0% 1% 6% 0% 0% 0% 0% 0% 17% 14% 13% #DIV/0! % TB notifi - cation from private sector 9 1 49 38 11 76 31 22 72 185 138 121 223 396 TB patients notified from private sector 2% 5% 7% 3% 4% 5% 5% 5% 3% 4% 3% 3% 4% 3% 3% 4% 5% 5% 4% 4% 5% 7% 8% 6% 12% 11% % of - Pediat ric TB 4 9 8 82 50 34 39 80 42 41 34 22 10 62 47 53 20 69 45 62 20 131 101 113 217 140 - Pediat ric TB 46% 30% 42% 44% 44% 38% 57% 37% 53% 38% 45% 56% 41% 53% 50% 37% 48% 55% 58% 47% 46% 53% 35% 30% 43% 40% #DIV/0! % of Clin - ically diag - nosed 49 37 42 320 776 436 286 981 329 498 503 389 396 155 796 718 567 246 790 569 568 431 127 1578 1173 2505 Clin - ically diag - nosed 54% 70% 58% 56% 56% 60% 62% 43% 63% 47% 62% 55% 44% 59% 47% 50% 63% 52% 45% 42% 53% 54% 47% 65% 70% 57% % of Micro - biologi - cally con - firmed 44 87 55 746 556 191 475 737 560 436 834 468 316 220 709 711 975 263 640 647 658 803 1834 1069 1464 1834 Micro - biologi - cally con - firmed 9% 8% 8% 9% 5% 10% 11% 20% 17% 16% 14% 15% 17% 14% 18% 16% 12% 13% 17% 11% 13% 17% 12% 15% 16% 18% #DIV/0! % Pre - viously treated TB 5 25 70 61 54 19 17 330 100 198 195 447 119 248 143 229 124 128 174 184 261 131 561 205 147 195 Previ - ously treated 90% 91% 89% 80% 92% 83% 86% 84% 92% 85% 83% 86% 84% 82% 88% 87% 83% 89% 91% 87% 83% 88% 95% 85% 84% 82% #DIV/0! % of New TB 88 80 966 797 293 642 819 791 733 314 584 455 105 3082 1647 2190 1470 1108 1331 1245 1281 1299 3778 1011 1079 1039 New 1% 8% 6% 11% 16% 17% 13% 32% 20% 18% 38% 30% 12% 21% 19% 30% 23% 19% 29% 22% 24% 14% 18% 15% 36% 22% #DIV/0! % Extra Pulmo - nary TB 8 7 25 77 14 35 359 301 168 351 545 151 162 351 255 167 137 448 322 293 148 315 169 220 269 1045 Extra pulmo - nary 89% 99% 84% 83% 87% 92% 80% 68% 82% 62% 88% 70% 79% 81% 70% 77% 71% 81% 78% 76% 86% 82% 85% 94% 78% 64% % Pul - monary TB 79 62 824 293 610 727 583 602 298 575 361 117 965 3053 1058 1544 2286 1173 1170 1057 1107 1249 1115 3294 1047 1006 Pulmo - nary 0 93 97 992 318 761 889 934 857 375 712 509 124 3412 1066 1845 2637 1718 1337 1505 1429 1542 1430 4339 1216 1226 1234 TB patients notified from public sector 648197 330235 774324 886233 465383 613046 609217 144553 170412 201741 167393 2659422 1456644 1490147 1907138 1523245 2770303 1664117 1593733 1564441 1931997 1202401 2451573 1744009 3723930 1345321 1262007 Population - MAYUR BHANJ MALKAN - GIRI KORAPUT KHORDHA KENDUJHAR DEBAGARH - KENDRAPA RA CUTTACK KAND - HAMAL Bhubanesh - war MC KALAHANDI BHADRAK BAUDH JHARSU - GUDA BARGARH JAJAPUR - JAGATSING HAPUR BALESH - WAR BALANGIR GANJAM ANUGUL GAJAPATI ZUNHEBOTO WOKHA TUENSANG DHENKANAL PHEK District Odisha Odisha Odisha Odisha Odisha Odisha Odisha Odisha Odisha Odisha Odisha Odisha Odisha Odisha Odisha Odisha Odisha Odisha Odisha Odisha Odisha Odisha Nagaland Nagaland Nagaland Odisha Nagaland State

142 TB India 2017 72 71 91 97 62 93 99 96 115 118 116 165 129 103 208 110 137 125 160 163 153 136 118 123 120 128 189 143 136 Annual TB noti - fication rate (public sector) 8 0 4 8 0 0 1 7 5 0 0 0 9 9 0 0 0 0 0 9 5 0 21 22 26 10 23 16 31 Annual TB noti - fication rate (private sector) 72 71 91 74 53 93 99 87 122 107 114 108 143 129 102 182 109 131 115 155 147 153 106 109 123 120 128 184 136 Annual TB noti - fication rate (public sector) 988 488 747 754 490 788 773 947 631 2097 2297 4361 1232 1421 2178 1154 3020 1015 5902 1067 3767 1558 2285 2069 1105 1299 1395 1236 1235 Total Total patients notified 0% 7% 0% 4% 7% 0% 0% 1% 5% 8% 3% 0% 0% 0% 8% 0% 0% 0% 0% 0% 9% 3% 15% 14% 13% 24% 10% 22% 14% % TB notifi - cation from private sector 6 7 2 28 53 80 32 307 153 589 274 146 173 251 374 514 159 160 113 TB patients notified from private sector 3% 4% 6% 4% 9% 5% 7% 5% 6% 5% 5% 2% 3% 7% 3% 6% 3% 6% 7% 3% 4% 7% 5% 3% 3% 4% 5% 6% 6% % of - Pediat ric TB 26 79 20 62 37 62 64 57 70 29 17 44 27 57 74 65 70 27 45 34 30 66 67 119 251 119 425 218 102 - Pediat ric TB 39% 47% 48% 39% 45% 40% 58% 48% 41% 52% 45% 49% 49% 54% 47% 51% 43% 53% 37% 42% 34% 48% 36% 44% 42% 34% 42% 40% 54% % of Clin - ically diag - nosed 388 848 283 218 278 587 579 984 512 455 231 414 341 572 744 643 454 465 342 581 326 267 446 655 1039 2179 1410 3116 1800 Clin - ically diag - nosed 61% 53% 52% 61% 55% 60% 42% 52% 59% 48% 55% 51% 51% 46% 53% 49% 57% 47% 63% 58% 66% 52% 64% 56% 58% 66% 58% 60% 46% % of Micro - biologi - cally con - firmed 600 942 436 270 423 645 836 920 635 480 257 402 447 986 491 834 431 814 621 364 677 548 1105 1593 1464 2613 1593 1027 1267 Micro - biologi - cally con - firmed 22% 19% 15% 23% 17% 18% 15% 18% 19% 15% 20% 17% 23% 19% 12% 18% 14% 18% 10% 21% 18% 19% 22% 10% 22% 25% 19% 10% 11% % Pre - viously treated TB 59 78 217 349 332 112 123 129 561 217 362 216 227 476 216 140 114 600 161 370 353 183 281 304 235 121 107 138 1083 Previ - ously treated 78% 81% 85% 77% 83% 82% 85% 82% 81% 85% 80% 83% 77% 81% 88% 82% 86% 82% 90% 79% 82% 81% 78% 90% 78% 75% 81% 90% 89% % of New TB 771 376 596 572 920 719 429 648 702 762 695 712 510 1441 1812 3211 1015 1542 1199 2398 4646 2793 1397 1401 1557 1018 1091 1016 1065 New 9% 16% 19% 27% 26% 20% 24% 33% 18% 31% 26% 16% 15% 23% 29% 23% 24% 21% 27% 12% 14% 16% 21% 17% 10% 13% 15% 30% 19% % Extra Pulmo - nary TB 97 80 163 341 584 187 171 227 581 367 188 421 214 111 194 162 902 182 256 313 195 219 180 141 190 104 234 1230 1646 Extra pulmo - nary 84% 73% 81% 80% 74% 76% 67% 82% 69% 74% 84% 77% 85% 71% 77% 79% 76% 73% 86% 88% 84% 79% 83% 90% 87% 85% 70% 91% 81% % Pul - monary TB 825 391 532 530 959 721 377 626 622 750 693 806 441 969 1560 1449 2542 1005 1323 1048 2453 4083 2491 1515 1376 1597 1080 1215 1019 Pulmo - nary 988 488 719 701 935 488 788 816 945 773 947 631 2144 1790 3772 1232 1904 1415 1147 2874 5729 3393 1771 1558 1910 1299 1395 1123 1203 TB patients notified from public sector 723879 676245 631661 650801 956243 814407 689857 866165 641599 635390 654663 2004516 1471234 2638629 1044637 1384136 1051143 2201112 3694753 1104870 2311156 1676671 1017646 1759139 1796278 1058249 1088796 1017917 1289315 Population Rupnagar Patiala Bathinda Pathankot Barnala Nawanshahr Amritsar Muktsar Mohali Puducherry Moga Mansa-PN SUNDAR - GARH Ludhiana Sonapur Kapurthala SAMBAL - PUR Jalandhar Hoshiarpur RAYAGADA Gurdaspur PURI Firozpur NUAPADA Fazilka NAYAGARH Fatehgarh Fatehgarh Sahib NABARAN - GAPUR District Faridkot Punjab Punjab Punjab Punjab Punjab Punjab Punjab Punjab Punjab Puducherry Punjab Punjab Odisha Punjab Odisha Punjab Odisha Punjab Punjab Odisha Punjab Odisha Punjab Odisha Punjab Odisha Punjab Odisha State Punjab

143 TB India 2017 92 95 71 64 84 85 98 77 123 191 104 164 131 238 100 131 124 181 169 144 184 148 152 187 128 147 203 203 123 #DIV/0! Annual TB noti - fication rate (public sector) 9 4 4 2 3 8 2 6 3 0 3 0 5 1 57 20 19 37 76 13 18 15 49 14 16 37 55 12 46 Annual TB noti - fication rate (private sector) 71 85 87 80 69 61 84 83 94 76 114 133 127 127 162 113 120 132 155 129 176 111 150 133 116 140 200 156 123 Annual TB noti - fication rate (public sector) 466 991 2791 2319 3316 2687 3488 2083 6265 4028 3649 2210 1903 2024 3607 2258 4838 3897 5816 2960 7502 2743 4138 3082 2671 1526 1693 2163 2192 1723 Total Total patients notified 8% 3% 3% 3% 5% 8% 4% 2% 9% 4% 2% 0% 3% 0% 0% 5% 2% 30% 22% 19% 22% 32% 13% 14% 16% 27% 11% 25% 29% 23% % TB notifi - cation from private sector 66 60 51 21 46 53 48 33 213 697 738 503 780 510 345 493 973 185 520 165 255 180 611 108 1992 1467 2192 TB patients notified from private sector 2% 3% 4% 6% 5% 3% 3% 4% 4% 5% 3% 3% 3% 4% 4% 6% 7% 4% 5% 4% 3% 3% 6% 4% 5% 4% 2% 4% 5% 3% % of - Pediat ric TB 62 53 52 58 67 47 75 54 16 78 78 94 78 46 62 38 94 109 141 147 133 137 149 269 305 149 149 212 247 100 - Pediat ric TB 34% 54% 57% 57% 51% 53% 54% 39% 62% 48% 59% 46% 45% 53% 35% 38% 51% 54% 32% 41% 55% 42% 41% 59% 38% 38% 60% 31% 60% 36% % of Clin - ically diag - nosed 873 906 920 900 849 897 154 796 779 381 888 532 746 1476 1121 1447 1092 1683 2172 1847 1391 2199 2350 1177 1206 2946 1034 1243 2344 1294 Clin - ically diag - nosed 66% 46% 43% 43% 47% 49% 46% 61% 38% 52% 41% 54% 47% 55% 65% 62% 49% 46% 68% 59% 45% 58% 59% 41% 62% 62% 40% 69% 40% 64% % of Micro - biologi - cally con - firmed 784 702 925 965 994 291 610 590 869 1705 1102 1261 1063 2590 1346 1309 1243 1076 1277 2119 1999 2555 1708 2364 1454 1786 1614 1281 1161 1338 Micro - biologi - cally con - firmed 9% 28% 22% 21% 27% 24% 24% 28% 27% 27% 27% 17% 26% 25% 16% 26% 25% 23% 22% 13% 22% 21% 14% 26% 29% 23% 20% 16% 19% 27% % Pre - viously treated TB 714 367 334 700 644 515 555 948 505 552 486 661 320 117 519 993 965 500 634 497 533 436 590 223 296 275 411 554 1173 1012 Previ - ously treated 72% 78% 79% 73% 76% 76% 72% 73% 73% 73% 83% 74% 75% 84% 74% 75% 77% 78% 87% 78% 91% 79% 86% 74% 71% 77% 80% 84% 81% 73% % of New TB 328 768 1864 1323 1288 1878 2064 1669 1462 3100 2570 1360 2604 1357 1973 1653 1554 3325 3384 3232 2280 4813 1955 2593 2946 1470 1182 1418 1752 1530 New 6% 6% 7% 7% 6% 15% 16% 14% 16% 23% 27% 11% 17% 21% 13% 11% 11% 12% 16% 13% 21% 26% 12% 21% 15% 26% 16% 15% 23% 11% % Extra Pulmo - nary TB 72 97 386 275 231 410 631 587 216 711 723 248 348 198 147 227 261 915 215 341 369 198 142 163 220 502 238 1121 1127 1033 Extra pulmo - nary 85% 84% 86% 84% 77% 73% 89% 83% 79% 87% 89% 89% 94% 88% 84% 87% 79% 74% 94% 88% 79% 85% 93% 74% 93% 84% 85% 94% 77% 89% % Pul - monary TB 373 828 2192 1415 1391 2168 2077 1597 1801 3562 2795 1617 2808 1645 2487 1746 1812 3403 3228 3517 2573 4183 2119 2831 2925 1918 1258 1596 1661 1846 Pulmo - nary 445 991 2084 2578 1690 1622 2578 2708 2184 2017 4273 3518 1865 3156 1843 2634 1973 2073 4318 4349 3732 2914 5310 2488 3029 3958 2060 1478 1693 2163 TB patients notified from public sector 0 733360 2227523 2269476 2224643 1215404 3611354 2128563 2583911 1591610 2630524 4022169 2335000 2781846 1540176 1997236 2842229 1335660 3353935 3918430 2121133 1942125 4007238 2149329 1515708 2820905 1317514 1186503 1786698 1752533 Population Churu Chittaurgarh Pali Bundi Nagaur Kota Bikaner Karauli Bhilwara Jodhpur Jhunjhunun Bharatpur Jhalawar Jalore Barmer Jaisalmer Baran Jaipur DTC II Jaipur Banswara Hanuman - garh Alwar Ganganagar Dungarpur Ajmer Dhaulpur Tarn Taran Tarn Dausa Pratapgarh Sangrur District 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 Punjab Rajasthan Rajasthan Punjab State

144 TB India 2017 83 89 93 109 150 102 102 117 174 152 226 110 244 231 319 119 176 119 165 136 156 130 106 151 180 146 Annual TB noti - fication rate (public sector) 0 2 5 8 9 0 3 7 0 0 9 3 5 59 12 18 33 10 15 13 10 39 10 50 57 53 Annual TB noti - fication rate (private sector) 97 94 80 98 71 83 80 93 109 148 108 115 152 219 244 231 286 109 162 109 153 126 117 103 146 123 Annual TB noti - fication rate (public sector) 217 348 232 105 637 1512 2712 1879 1760 4018 5669 1677 1264 1781 4325 6262 2870 2566 3142 1767 1491 3810 2952 2201 2275 5342 Total Total patients notified 0% 1% 5% 8% 8% 0% 4% 3% 0% 0% 8% 8% 8% 8% 7% 3% 3% 34% 11% 20% 10% 25% 11% 39% 32% 36% % TB notifi - cation from private sector 35 97 67 11 65 87 72 140 311 133 358 351 523 226 195 226 441 160 717 1935 1471 1936 TB patients notified from private sector 4% 5% 3% 6% 4% 3% 6% 4% 2% 6% 3% 8% 5% 3% 4% 1% 5% 5% 4% 4% 3% 5% 3% 3% 2% 10% % of - Pediat ric TB 8 64 49 14 57 34 19 13 39 31 26 52 47 77 72 41 67 124 101 138 124 114 201 129 151 148 - Pediat ric TB 41% 49% 33% 33% 45% 34% 59% 48% 57% 42% 52% 34% 57% 64% 42% 45% 41% 48% 39% 37% 42% 45% 46% 49% 37% 40% % of Clin - ically diag - nosed 60 622 591 535 128 769 193 480 121 486 368 484 554 972 577 1316 1684 1288 1677 2603 1073 1140 1148 1046 1395 1372 Clin - ically diag - nosed 59% 51% 67% 67% 55% 66% 41% 52% 43% 58% 48% 66% 43% 36% 58% 55% 59% 52% 61% 63% 58% 55% 54% 51% 63% 60% % of Micro - biologi - cally con - firmed 89 45 890 841 144 651 111 937 204 842 777 981 1361 1191 1085 2023 2446 2297 3136 1571 1231 1768 1293 1157 1470 2034 Micro - biologi - cally con - firmed 18% 20% 20% 17% 20% 23% 19% 20% 22% 19% 20% 19% 17% 20% 19% 15% 20% 24% 13% 27% 24% 28% 24% 18% 22% 20% % Pre - viously treated TB 42 74 46 20 265 529 351 268 747 849 328 218 240 112 765 889 529 562 389 363 315 648 512 509 339 670 Previ - ously treated 82% 80% 80% 83% 80% 77% 81% 80% 78% 81% 80% 81% 83% 80% 81% 85% 80% 76% 87% 73% 76% 72% 76% 82% 78% 80% % of New TB 85 175 263 913 186 460 963 1247 2148 1431 1352 2960 2885 1282 1183 3209 4850 2115 1809 2527 1016 1691 1617 2356 1219 2736 New 25% 25% 15% 11% 23% 14% 37% 20% 28% 15% 28% 34% 13% 35% 23% 13% 11% 15% 14% 11% 16% 14% 17% 19% 16% 19% % Extra Pulmo - nary TB 80 96 65 36 372 662 261 180 846 538 318 171 189 198 914 733 288 347 407 142 217 330 368 544 244 633 Extra pulmo - nary 75% 75% 85% 89% 77% 86% 63% 80% 72% 85% 72% 66% 87% 65% 77% 87% 89% 85% 86% 89% 84% 86% 83% 81% 84% 81% % Pul - monary TB 69 137 241 960 167 374 1140 2015 1521 1440 2861 3196 1292 1234 3060 5006 2356 2024 2509 1184 1114 2009 1761 2321 1314 2773 Pulmo - nary 217 337 232 105 572 1512 2677 1782 1620 3707 3734 1610 1131 1423 3974 5739 2644 2371 2916 1326 1331 2339 2129 2865 1558 3406 TB patients notified from public sector 95272 45501 143049 154009 199950 1391988 1809383 1843780 1729041 3420180 3257654 2008734 1153274 1995889 3635161 3552243 2420562 1551508 2315323 1131876 1609953 2922204 1460278 2786143 1264030 3670324 Population Perambalur North Chennai Namakkal Nagapat - tinam Centeral Chennai Madurai West West District Krishnagiri South District Karur Singtam North District Kanniyaku - mari East District Kancheep - uram Udaipur Erode Tonk Dindigul Sirohi Dharmapuri Sikar Sawai Madhopur Cuddalore Rajsamand District Coimbatore Tamil Nadu Tamil Tamil Nadu Tamil Tamil Nadu Tamil Tamil Nadu Tamil Tamil Nadu Tamil Tamil Nadu Tamil Sikkim Tamil Nadu Tamil Sikkim Tamil Nadu Tamil Sikkim Sikkim Tamil Nadu Tamil Sikkim Tamil Nadu Tamil Rajasthan Tamil Nadu Tamil Rajasthan Tamil Nadu Tamil Rajasthan Tamil Nadu Tamil Rajasthan Rajasthan Nadu Tamil Rajasthan State Nadu Tamil

145 TB India 2017 81 99 69 91 93 138 125 135 143 172 142 113 136 173 158 106 109 165 107 132 108 203 103 125 109 107 139 Annual TB noti - fication rate (public sector) 2 0 8 1 0 1 1 5 2 9 1 38 25 38 60 17 10 20 24 14 26 11 17 77 21 15 29 Annual TB noti - fication rate (private sector) 97 79 99 95 68 77 96 91 93 92 100 100 135 113 142 126 152 134 106 108 140 127 126 101 104 100 110 Annual TB noti - fication rate (public sector) 540 3652 4029 4512 2514 2537 4141 1949 3493 3488 4444 1785 7171 1377 2738 3102 1795 3442 1542 4901 4025 8414 2713 1791 2892 1619 3508 Total Total patients notified 2% 0% 6% 0% 7% 1% 0% 1% 4% 2% 8% 1% 27% 21% 20% 28% 35% 15% 12% 15% 16% 16% 10% 16% 38% 17% 14% % TB notifi - cation from private sector 8 3 63 16 13 29 50 11 999 839 911 702 112 688 126 843 212 279 535 161 203 637 302 242 486 1208 3193 TB patients notified from private sector 2% 3% 3% 5% 4% 4% 2% 2% 3% 2% 3% 8% 2% 4% 3% 3% 8% 3% 4% 5% 5% 4% 6% 2% 4% 5% 10% % of - Pediat ric TB 63 95 44 39 92 64 43 45 23 96 43 41 94 91 49 64 109 106 108 145 605 104 221 202 157 280 142 - Pediat ric TB 33% 43% 35% 33% 37% 41% 29% 32% 37% 37% 38% 54% 42% 25% 39% 43% 46% 35% 42% 52% 52% 38% 38% 30% 42% 38% 35% % of Clin - ically diag - nosed 875 598 919 527 738 633 228 292 691 574 452 611 1376 1247 1685 1295 1401 3443 1052 1307 1021 2421 2713 1290 1008 1114 1065 Clin - ically diag - nosed 67% 57% 65% 67% 63% 59% 71% 68% 63% 63% 62% 46% 58% 75% 61% 57% 54% 65% 58% 48% 48% 62% 62% 70% 58% 62% 65% % of Micro - biologi - cally con - firmed 309 873 825 807 997 1778 1814 2354 1214 1555 2448 1310 1547 2177 2355 1026 2885 1673 1766 1886 2277 2508 2098 1655 1037 1536 1957 Micro - biologi - cally con - firmed 12% 12% 21% 16% 21% 18% 20% 26% 18% 24% 16% 18% 12% 25% 22% 19% 19% 15% 14% 18% 13% 18% 18% 16% 21% 12% 16% % Pre - viously treated TB 62 322 372 748 281 519 753 376 585 631 908 259 289 599 587 282 428 198 824 669 617 472 242 561 187 490 1121 Previ - ously treated 88% 88% 79% 84% 79% 82% 80% 74% 82% 76% 84% 82% 88% 75% 78% 81% 81% 85% 86% 82% 87% 82% 82% 84% 79% 88% 84% % of New TB 475 876 2331 2818 2853 1531 1955 3380 1461 1700 2841 2848 1400 5207 2126 2486 1234 2479 1183 3874 4552 2771 2191 1247 2089 1421 2532 New 9% 8% 8% 8% 8% 20% 10% 16% 13% 10% 19% 18% 32% 22% 16% 11% 23% 10% 13% 20% 28% 17% 22% 13% 14% 11% 14% % Extra Pulmo - nary TB 97 250 645 378 403 240 400 151 179 652 314 302 119 444 334 346 298 183 952 584 591 193 374 184 421 1994 1461 Extra pulmo - nary 91% 80% 90% 84% 87% 90% 92% 92% 81% 92% 82% 68% 78% 92% 84% 89% 77% 90% 87% 80% 72% 83% 78% 87% 86% 89% 86% % Pul - monary TB 418 2403 2545 3223 2071 1572 3733 1686 2106 2820 3442 1357 4334 1068 2281 2739 1170 2609 1198 3746 3760 2804 2072 1296 2276 1424 2601 Pulmo - nary 537 2653 3190 3601 2474 1812 4133 1837 2285 3472 3756 1659 6328 1165 2725 3073 1516 2907 1381 4698 5221 3388 2663 1489 2650 1608 3022 TB patients notified from public sector 787431 2642732 2907168 3607400 3139581 1862202 4185786 1358421 2449103 3947145 1314991 4152697 2573933 2834993 1966952 2081733 1436788 3709977 4151792 3727892 2644831 1432836 2647250 1734028 3291764 2028332.178 869284.9232 Population Nizamabad - Tiruchirap palli Nalgonda Medak Thoothukudi Mahbub - nagar Thiruvarur Khammam Thiruvallur Karimnagar Theni Hyderabad The Nilgiris Bhadracha - lam Thanjavur Adilabad South Chennai Virudhun - agar Sivaganga Viluppuram Vellore Salem - Tiruvan namalai Ramanatha - puram Tiruppur Pudukkottai District Tirunelveli Telangana Tamil Nadu Tamil Telangana Telangana Tamil Nadu Tamil Telangana Tamil Nadu Tamil Telangana Tamil Nadu Tamil Telangana Tamil Nadu Tamil Telangana Tamil Nadu Tamil Telangana Tamil Nadu Tamil Telangana Tamil Nadu Tamil Tamil Nadu Tamil Tamil Nadu Tamil Tamil Nadu Tamil Tamil Nadu Tamil Tamil Nadu Tamil Tamil Nadu Tamil Tamil Nadu Tamil Tamil Nadu Tamil Tamil Nadu Tamil State Tamil Nadu Tamil

146 TB India 2017 74 87 67 43 56 58 81 74 55 55 86 74 166 113 139 121 113 152 136 130 106 137 Annual TB noti - fication rate (public sector) 9 3 2 0 6 1 0 8 0 1 0 0 0 1 4 8 3 18 19 10 23 22 Annual TB noti - fication rate (private sector) 94 72 85 67 42 56 58 80 74 55 55 86 70 99 148 130 111 106 144 113 108 135 Annual TB noti - fication rate (public sector) 709 194 198 281 274 251 250 217 6671 2227 6663 2831 3069 4272 2162 4070 2037 1736 4740 1932 5834 8918 Total Total patients notified 7% 8% 4% 3% 0% 5% 3% 0% 5% 0% 1% 0% 0% 0% 1% 5% 7% 2% 11% 17% 17% 17% % TB notifi - cation from private sector 5 25 86 46 13 719 373 434 233 234 111 346 794 100 419 163 TB patients notified from private sector 6% 5% 6% 4% 2% 4% 1% 4% 2% 3% 5% 1% 4% 1% 1% 4% 3% 3% 2% 5% 6% 4% % of - Pediat ric TB 1 3 8 3 3 3 6 95 12 61 58 64 83 351 375 116 115 148 103 167 303 358 - Pediat ric TB 44% 26% 42% 59% 38% 55% 41% 43% 32% 35% 39% 55% 67% 36% 24% 19% 32% 42% 37% 31% 44% 37% % of Clin - ically diag - nosed 79 61 97 90 60 69 478 263 806 152 326 717 569 2627 2620 1545 1632 1754 2685 1477 2371 3238 Clin - ically diag - nosed 56% 74% 58% 41% 62% 45% 59% 68% 57% 65% 61% 45% 33% 64% 76% 81% 68% 58% 63% 69% 56% 63% % of Micro - biologi - cally con - firmed 421 115 132 184 122 161 190 148 3325 1376 3609 1053 1351 2284 1245 1339 1365 1006 2469 1263 3044 5517 Micro - biologi - cally con - firmed 9% 16% 26% 42% 10% 17% 11% 16% 10% 19% 24% 14% 15% 11% 17% 19% 13% 19% 31% 13% 20% 23% % Pre - viously treated TB 32 20 54 37 27 43 28 944 490 267 116 339 349 484 618 317 323 234 2606 1227 1058 2020 Previ - ously treated 84% 74% 58% 90% 83% 89% 84% 90% 91% 81% 76% 86% 85% 89% 83% 81% 87% 81% 69% 87% 80% 77% % of New TB 568 162 173 227 237 224 207 189 5008 1364 3623 2331 2644 3689 1567 3406 1374 1400 2719 1598 4357 6735 New 6% 9% 6% 8% 9% 8% 8% 14% 13% 15% 23% 10% 13% 17% 15% 21% 13% 16% 18% 10% 25% 11% % Extra Pulmo - nary TB 26 33 41 35 40 45 19 847 234 904 167 157 293 370 432 259 138 130 331 188 941 1336 Extra pulmo - nary 86% 87% 85% 94% 77% 90% 87% 83% 91% 85% 79% 87% 84% 94% 82% 92% 91% 92% 92% 90% 75% 89% % Pul - monary TB 527 168 160 240 239 211 205 198 5105 1620 5325 2431 2690 3668 1619 3765 1553 1593 3615 1644 4079 7814 Pulmo - nary 684 194 193 281 274 251 250 217 5952 1854 6229 2598 2983 4038 2051 4024 1691 1723 3946 1832 5415 8755 TB patients notified from public sector 955713 288819 457472 503619 469031 339963 457472 394326 2010912 5484540 2345267.13 3517947.62 6503903.718 4009256.718 1963831.895 4780741.878 3795807.951 1421037.634 5037977.806 1497571.314 3647781.583 2617701.537 Population Allahabad Aligarh Banda Agra Balrampur West Tripura West Ballia Unakoti South Tripura Bahraich Sepahijala Baghpat North Tripura Khowai Azamgarh Gomati Auraiya Dhalai Amethi Warangal Ambedkar Nagar Rangareddi District Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Tripura Uttar Pradesh Tripura Tripura Uttar Pradesh Tripura Uttar Pradesh Tripura Tripura Uttar Pradesh Tripura Uttar Pradesh Tripura Uttar Pradesh Telangana Uttar Pradesh Telangana State

147 TB India 2017 83 84 62 177 144 115 131 207 276 119 238 171 170 132 126 162 136 138 110 Annual TB noti - fication rate (public sector) 4 6 4 1 2 1 5 17 16 11 31 16 10 33 34 10 14 44 35 Annual TB noti - fication rate (private sector) 79 80 61 160 128 109 120 175 260 117 227 137 136 122 112 118 101 137 105 Annual TB noti - fication rate (public sector) 3047 2771 2792 1241 4901 1781 2446 7891 4823 4341 6863 4640 3532 3608 7882 2797 4913 2964 10011 Total Total patients notified 9% 5% 5% 8% 4% 1% 6% 2% 4% 7% 1% 5% 11% 15% 20% 20% 11% 27% 26% % TB notifi - cation from private sector 62 79 33 93 36 287 304 135 407 584 191 932 260 395 726 138 1202 1339 2120 TB patients notified from private sector 5% 8% 5% 4% 7% 4% 3% 6% 4% 8% 5% 4% 4% 5% 6% 7% 11% 10% 16% % of - Pediat ric TB 51 74 69 146 186 142 330 429 172 428 465 600 160 134 229 103 273 200 1009 - Pediat ric TB 32% 35% 40% 38% 53% 39% 52% 58% 64% 33% 50% 52% 51% 60% 40% 29% 43% 39% 58% % of Clin - ically diag - nosed 881 864 443 666 898 1073 2375 1262 3891 5999 1577 2080 2854 1898 1948 1288 1691 1902 1638 Clin - ically diag - nosed 68% 65% 60% 62% 47% 61% 48% 42% 36% 67% 50% 48% 49% 40% 60% 71% 57% 61% 42% % of Micro - biologi - cally con - firmed 736 1879 1603 1584 2119 1036 1151 2798 3428 3153 2070 2670 1810 1324 1925 4071 1173 2975 1188 Micro - biologi - cally con - firmed 9% 11% 19% 17% 19% 17% 10% 17% 14% 18% 18% 20% 18% 27% 12% 19% 16% 13% 15% % Pre - viously treated TB 318 522 429 502 205 458 290 224 963 857 813 397 597 908 262 719 1693 1011 1003 Previ - ously treated 89% 81% 83% 81% 83% 90% 83% 91% 86% 82% 82% 80% 82% 73% 88% 81% 84% 87% 85% % of New TB 974 2508 2238 2038 2155 4036 1412 2189 5726 7734 3873 3337 4513 2705 2875 2616 4854 1809 4158 New 9% 6% 7% 4% 10% 17% 15% 12% 10% 15% 35% 26% 23% 21% 15% 14% 10% 12% 14% % Extra Pulmo - nary TB 67 287 473 380 232 544 173 157 188 784 481 462 558 242 699 1018 3297 1082 1248 Extra pulmo - nary 90% 83% 85% 91% 94% 88% 90% 93% 85% 65% 96% 74% 77% 79% 85% 86% 90% 88% 86% % Pul - monary TB 2539 2287 2087 2425 1112 3950 1529 2256 5671 6130 4542 3068 4276 2924 2791 2751 5204 1829 4178 Pulmo - nary 2826 2760 2467 2657 1179 4494 1702 2413 6689 9427 4730 4150 5524 3708 3272 3213 5762 2071 4877 TB patients notified from public sector 3626024 2059905.23 2693723.399 1723330.991 1921938.133 3381530.164 1081066.191 3744657.816 2130987.886 3953467.484 3817906.695 4051696.128 1827608.689 4020220.969 2724705.292 2685740.569 2873037.518 4873012.046 3555423.816 Population Faizabad Etawah Etah Deoria Chitrakoot Gonda Chandauli Ghazipur Bulandsha - har Ghaziabad Budaun Gautam Budh Nagar Bijnor Firozabad Basti Fatehpur Bareilly Farrukhabad Barabanki District 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 State

148 TB India 2017 68 83 112 111 114 187 101 163 184 138 159 142 129 187 120 114 122 155 191 Annual TB noti - fication rate (public sector) 3 1 3 1 4 0 10 15 65 39 27 27 40 11 25 11 17 52 55 Annual TB noti - fication rate (private sector) 99 65 72 102 109 121 101 124 157 111 118 141 126 162 120 103 105 103 136 Annual TB noti - fication rate (public sector) 2191 2017 2297 4074 4951 1971 2977 9217 2360 2108 6322 3233 5665 2735 2084 1368 1911 7480 9551 Total Total patients notified 9% 3% 1% 4% 1% 3% 0% 9% 13% 35% 24% 15% 20% 25% 14% 14% 14% 34% 29% % TB notifi - cation from private sector 1 53 34 87 39 196 308 712 466 537 441 167 372 127 259 1424 1376 2510 2767 TB patients notified from private sector 4% 5% 2% 4% 3% 4% 4% 6% 4% 3% 3% 4% 3% 7% 4% 4% 4% 4% 6% % of - Pediat ric TB 72 95 47 80 84 73 44 91 50 68 117 153 486 217 121 183 159 212 377 - Pediat ric TB 22% 42% 38% 37% 56% 34% 53% 39% 41% 19% 60% 38% 45% 48% 41% 40% 40% 43% 42% % of Clin - ically diag - nosed 440 831 748 981 637 775 297 847 492 665 2731 1206 3033 1675 2371 2472 1143 2147 2864 Clin - ically diag - nosed 78% 58% 62% 63% 44% 66% 47% 61% 59% 81% 40% 62% 55% 52% 59% 60% 60% 57% 58% % of Micro - biologi - cally con - firmed 749 987 1555 1133 1241 1669 2186 1247 1059 4808 1119 1274 1117 3912 3026 1220 1236 2823 3920 Micro - biologi - cally con - firmed 8% 26% 15% 11% 21% 11% 14% 19% 24% 28% 16% 10% 11% 10% 14% 15% 11% 18% 23% % Pre - viously treated TB 514 295 216 547 522 267 425 534 249 287 692 455 230 297 187 188 874 1905 1571 Previ - ously treated 74% 85% 89% 79% 89% 86% 81% 76% 72% 84% 90% 89% 92% 90% 86% 85% 89% 82% 77% % of New TB 5213 1481 1669 1773 2103 4395 1617 1840 5936 1360 1322 2505 5591 5043 2133 1786 1054 1464 4096 New 8% 9% 4% 7% 6% 5% 8% 5% 4% 8% 20% 11% 11% 19% 11% 19% 10% 10% 16% % Extra Pulmo - nary TB 85 150 225 172 117 518 141 140 213 226 319 245 452 167 121 166 774 1341 1497 Extra pulmo - nary 80% 92% 89% 91% 96% 89% 93% 94% 81% 89% 95% 92% 95% 96% 81% 92% 90% 90% 84% % Pul - monary TB 5443 1845 1739 1817 2533 4399 1743 2125 6344 1681 1486 2566 5964 5253 1911 1916 1120 1486 4196 Pulmo - nary 6784 1995 1964 1989 2650 4917 1884 2265 7841 1894 1571 2792 6283 5498 2363 2083 1241 1652 4970 TB patients notified from public sector 1461000 4380062.73 1569453.89 4990443.134 1958976.719 1809374.224 2006643.437 2183415.928 4884719.469 2908622.498 1823247.871 5007362.588 1708618.139 1329200.711 3885919.536 4464906.628 1742700.404 1204813.701 4841289.162 Population - Kanpur Nagar Kanpur Dehat Kannauj Jyotiba Phule Nagar Jhansi Jaunpur Maharajganj Jalaun Lucknow Hathras Lalitpur Kushinagar Hardoi Kheri Hapur Kaushambi Hamir pur-UP Kanshiram Nagar Gorakhpur District 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 State

149 TB India 2017 90 84 84 91 110 103 123 142 240 168 117 165 204 115 222 130 112 177 161 Annual TB noti - fication rate (public sector) 4 2 1 3 5 4 21 14 69 15 48 26 16 14 10 81 11 27 13 Annual TB noti - fication rate (private sector) 89 99 70 74 87 106 102 101 129 171 152 114 118 178 140 119 107 150 148 Annual TB noti - fication rate (public sector) 871 3556 3579 2729 4510 1090 7050 2267 3198 5422 7663 1947 2015 1579 6150 2945 2265 6681 4100 Total Total patients notified 4% 2% 1% 9% 3% 9% 5% 4% 8% 17% 10% 29% 29% 13% 14% 17% 12% 37% 15% % TB notifi - cation from private sector 7 58 86 38 129 477 437 208 971 274 337 193 251 105 330 2024 1569 2254 1019 TB patients notified from private sector 5% 4% 3% 7% 6% 6% 5% 4% 4% 5% 7% 5% 4% 6% 4% 3% 6% 2% 4% % of - Pediat ric TB 78 62 76 62 99 65 19 156 146 268 291 112 119 166 367 109 251 348 159 - Pediat ric TB 41% 46% 33% 43% 27% 53% 30% 50% 34% 42% 53% 54% 61% 45% 33% 29% 44% 17% 41% % of Clin - ically diag - nosed 744 291 612 892 912 841 888 624 144 1407 1615 1740 2661 1570 1302 2840 1757 2498 1545 Clin - ically diag - nosed 59% 54% 67% 57% 73% 47% 70% 50% 66% 58% 47% 46% 39% 55% 67% 71% 56% 83% 59% % of Micro - biologi - cally con - firmed 792 781 766 545 689 2020 1906 1508 2333 2365 1447 1542 2551 3852 2139 1806 1536 3164 2225 Micro - biologi - cally con - firmed 8% 9% 13% 12% 25% 20% 16% 16% 14% 13% 19% 18% 14% 15% 12% 12% 26% 19% 18% % Pre - viously treated TB 91 481 423 863 448 660 795 289 274 490 303 238 204 479 321 564 154 1250 1098 Previ - ously treated 87% 88% 75% 80% 84% 92% 84% 86% 91% 87% 81% 82% 86% 85% 88% 88% 74% 81% 82% % of New TB 992 679 3289 3004 2658 1804 3413 4231 1770 2838 3363 5442 1370 1440 1182 3417 2373 1596 4564 New 8% 5% 8% 4% 7% 8% 6% 9% 9% 6% 11% 12% 28% 17% 18% 17% 12% 11% 23% % Extra Pulmo - nary TB 85 52 401 266 419 114 879 379 135 288 136 102 125 473 241 233 1129 1164 1306 Extra pulmo - nary 89% 92% 88% 95% 72% 92% 83% 82% 96% 93% 83% 92% 94% 91% 88% 91% 89% 77% 94% % Pul - monary TB 998 781 3369 3161 3102 2138 2944 4147 1680 2977 3565 5528 1537 1576 1261 3423 2453 1927 4356 Pulmo - nary 833 3770 3427 3521 2252 4073 1083 5026 2059 3112 3853 6692 1673 1678 1386 3896 2694 2160 5662 TB patients notified from public sector 3240718 3165443 2940906 1351000 2268000 2406493.2 2548610.496 3463502.863 2223215.494 1216374.891 2722273.885 3276480.919 3762139.287 1696095.517 1870808.733 2773958.755 2015835.423 3780498.159 956035.3173 Population - Rampur Rae Bareli Pratapgarh Pilibhit Muzaffar nagar Shravasti Moradabad Shamli Mirzapur Shahjah - anpur Meerut Sant Ravi - das Nagar Mau Sant Kabir Nagar Mathura Sambhal Mainpuri Saharanpur Mahoba District 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 State

150 TB India 2017 91 73 92 95 74 196 102 111 110 111 117 110 132 116 102 195 168 149 124 Annual TB noti - fication rate (public sector) 0 0 0 0 0 0 0 5 7 4 5 6 0 58 20 10 50 15 10 Annual TB noti - fication rate (private sector) 91 73 97 85 98 90 68 138 102 111 110 111 110 121 111 145 153 139 124 Annual TB noti - fication rate (public sector) 255 430 313 393 494 732 298 537 921 3607 1981 4721 4464 2405 1933 2018 8204 3102 2058 Total Total patients notified 0% 0% 0% 0% 0% 0% 0% 8% 5% 8% 4% 5% 9% 7% 8% 0% 30% 17% 26% % TB notifi - cation from private sector 14 22 98 812 355 195 518 729 207 161 1065 TB patients notified from private sector 6% 5% 5% 4% 6% 5% 6% 7% 4% 4% 5% 5% 3% 5% 5% 5% 6% 3% 6% % of - Pediat ric TB 12 23 11 25 25 26 13 14 86 72 58 55 160 123 270 158 113 344 161 - Pediat ric TB 63% 38% 43% 46% 50% 45% 57% 53% 37% 41% 42% 35% 27% 24% 40% 48% 43% 48% 39% % of Clin - ically diag - nosed 97 187 144 197 220 274 118 765 141 438 601 915 363 1599 1135 2068 1672 3620 1248 Clin - ically diag - nosed 37% 62% 57% 54% 50% 55% 43% 47% 63% 59% 58% 65% 73% 76% 60% 52% 57% 52% 61% % of Micro - biologi - cally con - firmed 943 158 243 169 196 274 846 458 166 374 899 982 558 1841 2437 1445 1397 3855 1647 Micro - biologi - cally con - firmed 19% 10% 23% 22% 21% 17% 22% 18% 28% 20% 25% 16% 27% 15% 25% 17% 19% 10% 19% % Pre - viously treated TB 25 68 81 86 71 491 101 432 720 208 837 363 140 281 380 550 190 172 1298 Previ - ously treated 81% 90% 77% 78% 79% 83% 78% 82% 72% 80% 75% 84% 73% 85% 75% 83% 81% 90% 81% % of New TB 230 329 245 312 408 524 213 375 749 2051 1549 3189 3272 1847 1554 1120 6177 2345 1707 New 8% 6% 7% 7% 25% 16% 13% 27% 29% 22% 19% 16% 24% 12% 23% 12% 23% 18% 20% % Extra Pulmo - nary TB 41 57 86 65 62 630 113 111 367 637 175 509 178 113 344 494 533 135 182 Extra pulmo - nary 80% 75% 84% 87% 73% 71% 78% 81% 84% 76% 88% 77% 92% 88% 94% 77% 93% 82% 93% % Pul - monary TB 739 214 373 227 280 383 557 219 453 1912 1614 3272 3600 2032 1722 1156 6981 2362 1762 Pulmo - nary 921 255 430 313 393 494 732 284 515 2542 1981 3909 4109 2210 1835 1500 7475 2895 1897 TB patients notified from public sector 743585 280867 423620 281436 357087 673616 667639 256542 526384 1839729 1785365 2600164 1034510 2087186 2786652.71 4018363.583 3394579.881 2032661.025 4882945.022 Population - GARHWAL DEHRADUN CHAM - PAWAT CHAMOLI BAGESH - WAR UTTARKASHI ALMORA UDHAMS - INGH NAGAR Varanasi TEHRI GARHWAL Unnao Sultanpur PITHOR - AGARH Sonbhadra NAINITAL Sitapur HARDWAR Siddharth - nagar District RUDRAPRAY AG Uttara - khand Uttara - khand Uttara - khand Uttara - khand Uttara - khand Uttara - khand Uttara - khand Uttara - khand Uttar Pradesh Uttara - khand Uttar Pradesh Uttara - khand Uttar Pradesh Uttara - khand Uttar Pradesh Uttara - khand Uttar Pradesh Uttara - khand Uttar Pradesh State

151 TB India 2017 89 98 41 64 90 95 90 94 117 168 139 148 100 111 126 117 102 143 159 Annual TB noti - fication rate (public sector) 1 2 2 8 0 2 4 0 0 4 8 2 5 8 2 10 20 12 58 Annual TB noti - fication rate (private sector) 88 95 36 64 90 92 85 86 85 115 158 119 140 100 109 114 109 100 158 Annual TB noti - fication rate (public sector) 545 554 338 475 649 486 646 5151 4973 3264 2593 6261 4097 2173 7749 4921 3870 2661 6485 Total Total patients notified 1% 2% 2% 6% 5% 0% 2% 1% 0% 4% 7% 2% 5% 8% 1% 14% 11% 10% 41% % TB notifi - cation from private sector 9 2 53 80 90 63 80 41 67 118 197 132 235 290 323 137 263 TB patients notified from private sector 3% 7% 6% 6% 3% 2% 2% 3% 3% 3% 9% 3% 8% 5% 3% 2% 4% 5% 4% % of - Pediat ric TB 40 16 52 56 11 43 46 57 20 19 153 305 194 102 109 253 220 114 253 - Pediat ric TB 45% 61% 45% 48% 44% 35% 40% 36% 35% 34% 49% 40% 43% 40% 42% 46% 37% 46% 40% % of Clin - ically diag - nosed 329 207 867 676 114 235 251 166 177 2288 2169 1462 2509 1424 2982 1858 1584 1170 2590 Clin - ically diag - nosed 55% 39% 55% 52% 56% 65% 60% 64% 65% 66% 51% 60% 57% 60% 58% 54% 63% 54% 60% % of Micro - biologi - cally con - firmed 207 267 222 240 335 279 206 2810 2687 1605 1594 3752 2583 1262 4477 2740 2206 1354 3828 Micro - biologi - cally con - firmed 20% 20% 20% 18% 11% 12% 13% 15% 17% 23% 25% 18% 23% 15% 10% 11% 25% 22% 15% % Pre - viously treated TB 53 76 83 993 105 984 559 290 819 600 332 120 137 685 389 281 113 1016 1309 Previ - ously treated 85% 80% 80% 80% 82% 89% 88% 87% 85% 83% 77% 75% 82% 77% 85% 90% 89% 75% 78% % of New TB 431 421 260 355 449 332 300 5425 4082 3872 2508 2171 5442 3407 1606 6150 3913 3401 2243 New 20% 20% 44% 25% 25% 27% 18% 16% 13% 18% 26% 31% 33% 17% 18% 17% 28% 26% 34% % Extra Pulmo - nary TB 89 238 771 130 437 514 358 146 191 844 650 126 655 132 1309 1023 1238 1018 1277 Extra pulmo - nary 80% 80% 56% 75% 75% 73% 82% 84% 87% 82% 74% 69% 67% 83% 82% 83% 72% 74% 66% % Pul - monary TB 298 344 247 329 395 319 251 5109 4075 3618 2296 2024 5243 3493 1580 6182 3754 3140 1869 Pulmo - nary 536 474 336 475 586 445 383 6418 5098 4855 3067 2461 6261 4007 1938 7459 4598 3790 2524 TB patients notified from public sector 466499 399548 524829 528316 514920 517389 451981 4071026.44 1937880.86 5807632.315 5093563.752 1757874.829 6252548.713 3684627.283 5359307.329 8125549.636 4205997.035 3783418.457 2969658.179 Population Jalpaiguri Hugli Hazi Haora Darjiling MTMTB Dakshin Dinajpur Medinipur West Birbhum Medinipur East Behala Manshatala Maniktala Barddha - man Maldah Bankura Bagbazar Koch Bihar Koch Alipore District West West Bengal West West Bengal West West bengal West West Bengal West West Bengal West West bengal West West Bengal West West Bengal West West Bengal West West Bengal West West bengal West West bengal West West bengal West West Bengal West West Bengal West West Bengal West West bengal West West Bengal West West bengal State

152 TB India 2017 90 55 68 70 92 69 76 94 135 208 Annual TB noti - fication rate (public sector) 5 0 0 4 2 3 7 25 39 11 Annual TB noti - fication rate (private sector) 85 55 68 65 90 66 69 83 109 170 Annual TB noti - fication rate (public sector) 256 298 2827 1100 5981 2829 7346 4122 7005 1754955 Total Total patients notified 6% 0% 0% 6% 2% 4% 9% 19% 19% 12% % TB notifi - cation from private sector 70 157 204 370 307 363 826 330186 TB patients notified from private sector 5% 5% 5% 9% 7% 3% 2% 3% 3% 4% % of - Pediat ric TB 14 78 21 68 95 128 173 216 237 76475 - Pediat ric TB 46% 39% 39% 46% 44% 40% 40% 39% 40% 34% % of Clin - ically diag - nosed 100 416 131 1050 2230 1116 2752 1506 2125 652479 Clin - ically diag - nosed 54% 61% 61% 54% 56% 60% 60% 61% 60% 66% % of Micro - biologi - cally con - firmed 156 480 167 1620 3381 1643 4287 2253 4054 772292 Micro - biologi - cally con - firmed 19% 16% 18% 24% 23% 15% 16% 19% 17% 13% % Pre - viously treated TB 45 68 414 215 839 455 651 797 1371 266669 Previ - ously treated 81% 84% 82% 76% 77% 85% 84% 81% 83% 87% % of New TB 211 681 230 2256 4772 2304 5668 3108 5382 1158102 New 17% 20% 32% 35% 33% 21% 11% 23% 25% 21% % Extra Pulmo - nary TB 81 97 523 312 296 931 1200 1623 1314 245287 Extra pulmo - nary 83% 80% 68% 65% 67% 79% 89% 77% 75% 79% % Pul - monary TB 175 584 201 2147 4411 2463 5416 2828 4865 1179484 Pulmo - nary 256 896 298 2670 5611 2759 7039 3759 6179 1424769 TB patients notified from public sector 466081 528081 437149 1302880739 3156992.673 8577411.557 3080316.288 10607494.71 5437420.792 7471991.916 Population Uttar Dinajpur Tollygunge Tangra Strand Bank South 24 Parganas Puruliya North 24 Parganas Nadia Murshi - dabad District Total West West Bengal West West bengal West West bengal West West bengal West West Bengal West West Bengal West West Bengal West West Bengal West West Bengal State

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