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Joint Monitoring Mission (JMM) REPORT OF THE JOINT MONITORING MISSION REVISED NATIONAL TUBERCULOSIS CONTROL PROGRAMME November 2019 #TBHaregaDeshJeetega Central TB Division, New Delhi REPORT OF THE JOINT MONITORING MISSION REVISED NATIONAL TUBERCULOSIS CONTROL PROGRAMME November 2019 The 2019 Joint Monitoring Mission (JMM) for the Revised National Tuberculosis Control Programme (RNTCP), India was jointly organized by the World Health Organization (WHO) Country Ofce (WCO) for India and the Central Tuberculosis Division (CTD) and led by Dr. Kenneth Castro. The TB mini-epidemiology review conducted just ahead of the JMM was led by Dr. Patrick Moonan. At the conclusion of the JMM eld visits and thematic team deliberations, team leads presented respective executive summaries with top-line recommendations to senior ofcials from Ministry of Health and Family Welfare (MoHFW), Government of India, including Mr. Sanjeeva Kumar, Dr. Arun Kumar Panda, Ms. Vandana Gurnani, Mr. Vikas Sheel, Dr. KS Sachdeva; senior ofcials from WHO including Dr. Soumya Swaminathan, Dr. Tereza Kasaeva, Dr. Henk Bekedam; and a wider international, national and state audience. The MoHFW ofcials shared their reections and commitments for action while the WHO ofcials followed by representatives from Global Coalition of TB Activists, Stop TB Partnership, Medecins Sans Frontieres, and Alliance India also shared their reections and expressed their continued commitment to support India in ending TB by 2025. The JMM (TB), India 2019 report was prepared by a writing group led by Kenneth Castro, with contributions from the thematic and state team leads (alphabetically) – Amy Piatek, Anand Date, Annabel Baddeley, Anuj Bhatnagar, Anurag Bhargava, Avinash Kanchar, A Venkatraman, Blessina Kumar, Daksha Shah, Dawran Faizan, DCS Reddy, Diana Weil, Douglas Fraser Wares, Erika Vitek, Kirankumar Rade, Lal Sadasivan S, L S Chauhan, Malik Parmar, Manoj Jain, Marion Grossmann, Miruna Mosincat, Mohammed Yasin, Mukta Sharma, Nevin Wilson, Patrick Moonan, Puneet Dewan, Rajendra Prasad, Rajesh Solanki, Ranjani Ramachandran, Rebecca Gupta Lawrence, Richard Cunliffe, Rohit Sarin, Ronald Mutasa, Rupak Singla, Sangeeta Sharma, Senait Kebede, SK Sharma, Sreenivas A Nair, Suvanand Sahu, Thomas M Shinnick, Urvashi Singh, Varinder Singh, Vineet Chadha, William Wells, Wilson Lo and Yamuna Mundade. Overall planning, organization, technical assistance, report compilation and coordination was led by the WCO for India (TB team) – Ranjani Ramachandran, Kirankumar Rade and Malik Parmar. Report of the Joint Monitoring Mission: Revised National Tuberculosis Control Programme, November 2019 ISBN: 978-92-9022-775-5 © World Health Organization 2020 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specic organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”. Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization. Suggested citation. Report of the Joint Monitoring Mission: Revised National Tuberculosis Control Programme, November 2019. New Delhi: World Health Organization, Country Ofce for India; 2020. Licence: CC BY-NC-SA 3.0 IGO. Cataloguing-in-Publication (CIP) data. CIP data are available at http://apps.who.int/iris. Sales, rights and licensing. To purchase WHO publications, see http://apps.who.int/bookorders. To submit requests for commercial use and queries on rights and licensing, see http://www.who.int/about/licensing. Third-party materials. If you wish to reuse material from this work that is attributed to a third party, such as tables, gures or images, it is your responsibility to determine whether permission is needed for that reuse and to obtain permission from the copyright holder. The risk of claims resulting from infringement of any third-party-owned component in the work rests solely with the user. General disclaimers. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specic companies or of certain manufacturers' products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use. Printed in India Contents Acknowledgements I Acronyms II Executive Summary 1 1. Introduction 5 1.1 Objectives 5 1.2 Methodology 6 1.3 Background: Epidemiology, Surveillance, Supervision, Monitoring and Evaluation 7 2. Findings and Recommendations 20 2.1 Build 20 2.1.1 Partnerships and Private Provider Engagement 20 2.1.2 Multisectoral Engagement and Accountability 29 2.1.3 Health System Strengthening 32 2.1.4 Tuberculosis in Urban Populations 38 2.1.5 Patient Support Systems 41 2.1.6 Community Engagement, Advocacy, Communication, and Social Mobilization 45 2.1.7 Research and Innovation 48 2.1.8 Technical Assistance to End Tuberculosis in India 55 2.2 Prevent 56 2.2.1 Preventive Services 56 2.3 Detect 62 2.3.1 Case Finding, Diagnostics and Laboratory Services 62 2.4 Treat 69 2.4.1 Treatment Services for Drug Sensitive Tuberculosis 69 2.4.2 Programmatic Management of Drug-resistant Tuberculosis 73 2.4.3 Commodities and Childhood Tuberculosis 82 2.4.3a Childhood TB 89 Annexes 95 3.1 State Level Reports 95 3.1.1 Assam 95 3.1.2 Chhattisgarh 103 3.1.3 Kerala 113 3.1.4 Rajasthan 125 3.1.5 Tamil Nadu 132 3.1.6 Uttar Pradesh 146 3.2 List of Participants 161 3.2.1 Thematic Groups 161 3.2.2 Field Visit Teams 168 Acknowledgements The 2019 Joint Monitoring Mission (JMM) level tuberculosis (TB) cells, in the six states would not have been possible without the visited (Assam, Chhattisgarh, Kerala, tireless efforts of various members of the now Rajasthan, Tamil Nadu, Uttar Pradesh) National TB Elimination Program (Revised welcomed the members of JMM with National Tuberculosis Control Program meticulous schedules and opportunities for (RNTCP) at the time of JMM), Ministry of eld visits to enable JMM participants to gain Health and Family Welfare (MoHFW), an understanding of the successes, Government of India (GoI), the World Health challenges, and ongoing efforts of the Organization Country Ofce (WCO) for respective TB program activities. Members of India, and multiple other stakeholders. this JMM extend their collective gratitude to all Months of careful planning and multisectoral the participating state and district level TB coordination were required to ensure the programs, WCO, and RNTCP/MoHFW/GoI successful implementation of this JMM. The for their painstaking preparation and RNTCP, along with the state level and district hospitality. I Acronyms AB-PMJAY Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana ACSM Advocacy, Communication, and Social Mobilization ACF Active Case Finding ADR Adverse Drug Reaction ADSM Active Drug Safety Monitoring and Management AE Adverse Events AFB Acid-fast bacillus AI Articial Intelligence AIC Airborne Infection Control Am Amikacin AMC Annual Maintenance Contract ART Antiretroviral Therapy ARTI Annual Rate of TB Infection ASHA Accredited Social Health Activist ATT Anti-tubercular Treatment AYUSH Ayurveda, Yoga & Naturopathy, Unani, Siddha, Sowa Rigpa and Homoeopathy BCG Bacille Calmette-Guerin vaccine BDQ Bedaquiline BDQ-CAP Bedaquiline Conditional Access Programme BK+ Bacille de Koch (or Koch bacillus) positive smear BMI Body Mass Index BRICS Brazil, Russia, India, China, and South Africa CB-NAAT Cartridge-based Nucleic Acid Amplication Test CBO Community-based Organization CDS Clinical Decision Support CDST Culture and Drug Sensitivity Testing CFZ Clofazimine II CHC Community Health Center CME Continuing Medical Education CMSS Central Medical Services Society CPT Cotrimoxazole Preventive Therapy Cs Cycloserine CSO Civil Society Organization CSR Corporate Social Responsibility CTD Central Tuberculosis Division CXR Chest X-Ray DBT Direct Benet Transfer DDS District Drug Stores DLM Delamanid DM Diabetes mellitus DMC Designated Microscopy
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