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