India TB Program 2021

Notified Case Breakdown

Future TB Estimates (2021-2025)

@ JEET font color=\"#212121\

Patients with TB symptoms(those voluntarily seek health care)

JEET Background Established by: Centre for Health and Research and Innovation (CHRI)Partner with:    William J Clinton Foundation (WJCF) - Clinton Health Access                          Initiative (CHAI)                          Foundation for Innovative New Diagnostics (FIND)Funded by: Gov. of India (DBT)+ the Global Fund (40 million USD)

Pub.

Test Breakdown

systematic screening among vulnerable groupsfont color=\"#212121\

1.805 million  

Yes

notification target:  facilitate > 1.6 million TB case notifications across 478 districts     progress: collectively notified 0.9 million (56%) TB pt. span style=\"font-weight: normal;\

41%

smear (-) CXR (▲)

6 NRLs

India National Policy for Diagnosis

45% of IPAQT GX and LPA volume: National chain labs (#7)~ 60% of the total volume: span style=\"font-weight: normal;\

Case Finding

First Line LPAfont color=\"#1976d2\" style=\

Drug Susceptiblity Test

2. Project SHAQTI (Strengthening Health systems for sustainable Access to Quality diagnosis towards TB elimination in India)3. Unite to ACT (Amplifying Community action for TB elimination)

font color=\"#f57c00\

PPIA

67% of total notified TB pt. were offered U-DST

PRIVATE SECTOR

diagnostics tests uptake: provide for free

End-user 

Private

First Specimen tested at NAAT site font color=\"#1976d2\

Source: India TB Annual Report 2021

NEW

Chest X-ray

↓  avg. 6% YOY(2009-2019)

NAAT | LPA | MGIT

Total notified TB pt. (2020) : 1.805 million  

TB clinical suspicion

It's an font color=\"#f57c00\

TB Treatment Center:  DOTS centerProgrammatic Management of Drug-Resistant Tuberculosis centres (PMDT)

Public Sector

Active Case Finding (started in 2017)

18%

Private Lab Network

Notified Cases

IPAQT (Initiative for Promoting Affordable and Quality TB Tests) @ Clinton Health Access Initiative

Pvt.

State Level Lab: 50 LC DST | 64 LPAPvt. / corp Labs: 19 (LPA/LC DST)NRL: 6

replaced with novel skin tests like C-Tb 

treatment: ensure that at least 70% of patients will be successfully treated.

Cephid

Private Sector

Source: India TB Report 2021

serological test

Incentive* Patient: Positive patients get a direct benefit transfer (DBT) of Rs 500 under the Nikshay Poshan Yojana as a nutritional incentive every month.* Doctor: The private clinic or doctor making the referral gets a financial incentive (cash: Rs 500 for every notification + Rs 500 if pt. completed treatment).

TB Incidence Gap

Public & Private Sector Notified Cases

Active

Mantoux tuberculin skin test (TST)

CBNAAT: 3.53 million

Line Probe Assay (first & second line)

Laboratory Services and Diagnostics in Indiafont color=\"#212121\

Not if <2 years of age

2019

font color=\"#212121\

DS-TB regimen

span style=\"font-weight: 400;\

No. of tests conducted

H resistance detected

not detected

NTEP has expanded free access of anti-TB drugs to the patient seeking care in private sector. span style=\"font-size: inherit; font-weight: normal;\

rifampicin resistant (RR) patients

MDR-TB response to treatment

No

TB Funding 

95% of TB patients notified are put on treatment in 2019 and 2020. 

Xpert MTB/RIF contributed >80% of test volume 

< 15% CBNAAT uptake

TB National Strategic Plan (NSP) Goals 2025

determine resistance to rifampicin after diagnosed

pt who remain  smear (+) after ≥5 months of treatment

non-responders

NAAT

REIMBURSEMENT

pvt. hospitalclinicslabspractitioners (15k pvt. doctors enrolled across 15 states)

Stop DS-TB regimen

General Popl.

55%   55%  60%

Second Specimen tested at C&DST Lab

H mono/poly DR-TB regimen

Patients pay out-of-pocket

Symptoms

PUBLIC SECTORLab services are provided free of costs to patients attending public health facilities as well as for those referred from the private sector.

Source 1: Internal _ ACT FAST campaign Slide Deck

Second Line LC-DST span style=\"font-size: inherit;\

Source: Amrita Sivia's Poster

Rifampicin Resistance

Provide Treatmentspan style=\"font-weight: normal;\

Passive Case Finding

Price to patients

Drug Resistant TB

More difficult to interpret if previous BCG vaccine

Latent

GDF (Global Drug Facilities)Cost per test  font color=\"#1976d2\

N.A (2019)span style=\"font-size: inherit;\

TB diagnostic tests:US $ 30 million (5.1%)TB diagnostic equipment:US $ 26 million (4.4%)

NATIONAL STRATEGIC PLAN FOR TB: font color=\"#f57c00\

34 IRLs

font color=\"#fbc02d\

Source 1: The web of officialdom snaring India’s private sector TB funding

Source: WHO Tuberculosis Profile

Treatment

NATIONAL STRATEGIC PLAN FOR TB: 2017-25

Patient Diagnosis Process & Reimbursement

The NTEP aims to achieve font color=\"#1976d2\

Laboratories

Consider TB

span style=\"font-size: inherit; font-weight: normal;\

Quick Summary (2019)

70%

primary tool: sputum smear microscopy(3x sputum samples)

Public

IGRA

Tuberculosis Diagnostics Centre (TDC)

Future PPP Projects

First Line LPA

National TB Elimination Program(NTEP)

follow-up culture on Liquid Culture (MGIT) system

DB: IN TB Indicator (till 2021)

NSP Target 70%

lab cost: 30%

TB-HIV: 2%TB-Paediatric: 9%

Source 2: JEET Newletter 2020

detected

If TST or IGRA is positve exclude active TB and follow up

Key Popl. (PLHIV etc.)

30%

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