|PRJ GANGADHARAM AWARD ORATION
|Year : 2019 | Volume
| Issue : 1 | Page : 17-18
The national strategic plan for tuberculosis step toward ending tuberculosis by 2025
Sunil D Khaparde
Advisor (Leprosy), Directorate General of Health Services, Ministry of Health and Family Welfare, New Delhi, India
|Date of Web Publication||14-Mar-2019|
Dr. Sunil D Khaparde
Advisor (Leprosy), Directorate General of Health Services, Ministry of Health and Family Welfare, New Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Khaparde SD. The national strategic plan for tuberculosis step toward ending tuberculosis by 2025. J Mahatma Gandhi Inst Med Sci 2019;24:17-8
|How to cite this URL:|
Khaparde SD. The national strategic plan for tuberculosis step toward ending tuberculosis by 2025. J Mahatma Gandhi Inst Med Sci [serial online] 2019 [cited 2019 Sep 17];24:17-8. Available from: http://www.jmgims.co.in/text.asp?2019/24/1/17/254128
The National Strategic Plan (NSP) for Tuberculosis (TB) Elimination (2017–2025) is a statement of commitment to eliminate TB by 2025 by the Ministry of Health and Family Welfare, Government of India. The NSP builds on the success and learnings of the last NSP and encapsulates the bold and innovative steps required to eliminate TB in India. It is in line with other health sector strategies and global efforts, such as the National Health Policy 2015, the World Health Organization's (WHO) end TB Strategy, and the Sustainable Development Goals (SDGs) of the United Nations. It proposes bold strategies with commensurate resources to rapidly decline TB incidence and mortality in India by 2025, 5 years ahead of the global End TB targets and SDGs. The NSP 2017–2025 aims to notify 260 lakh TB patients in 8 years, including public and private sector.
In the 12th Plan period (2012–2017), the Revised National TB Control Program was implemented under the umbrella of the National Health Mission. The same is proposed to be continued in the current plan period. The program has successfully achieved the Millennium Development Goal for Incidence and Prevalence of TB
- The incidence of TB has come down from 289/lakh population in 2000 to 217/lakh (58%) population in 2015
- The mortality of TB has reduced from 56 in 2000 to 36/lakh population (28%) in 2015.
The WHO's Global TB Report of 2016 mentions India having achieved the Millennium Development Goals related to TB and achieved the set targets to half of the prevalence and mortality rates by 2015 compared with the baseline of 1990. However, India still accounts for an estimated 27% of the global incident TB cases (28 lakh) and 27% of the global multidrug-resistant (MDR)-TB cases (1.3 lakh).
The activities under the program currently ongoing would be continued and specific activities/focus areas proposed are as under the following:
- Increase participation of private sector TB care provider: A scheme to engage all private providers to ensure that every TB patient seeking care in private sector receives good quality free diagnosis and treatment is planned based on the program's successful experience with projects in the private sector. TB notification increased substantially in these pilot areas. These approaches will be adapted countrywide with providing free TB diagnostics and drugs either provided directly by the State Public Health System or through nongovernmental organizations/agencies supporting the States. It is also proposed to provide incentives to the private sector TB care provider through direct beneficiary transfer to promote TB case notification, ensure treatment adherence and treatment completion
- Intensified TB control activities in high priority districts: active case-finding (ACF) or intensive case-finding activity is a provider-initiated activity with the primary objective of detecting TB cases early by ACF in targeted groups and to initiate treatment promptly. It can target people who anyway have sought health care with or without symptoms or signs of TB and also people who do not seek care. Increased coverage can be achieved by focusing on clinically, socially, and occupationally vulnerable populations. The activities primarily would be to screen for TB symptoms, to conduct sputum examination of symptomatic using a high sensitive and specific tool in the field, and to find and treat additional infectious TB patients
- Providing incentive to prevent catastrophic expenditure to the TB patients and their families due to TB and for nutritional support: in TB, as in many other infectious diseases, there is a bidirectional interaction between nutritional status and active disease. Undernutrition is a risk factor for TB which, in turn, worsens the nutritional status, generating a vicious cycle which can lead to adverse outcomes (during and following therapy) for patients with active TB, including those with MDR-TB. This interaction is particularly important in the Indian context where poverty and undernutrition coexist with a large burden of TB. To address financial and nutritional hardship, the patient and family undergoes due to TB and to prevent catastrophic cost to patient's family due to TB; it is proposed to launch a scheme to provide a monthly cash incentive for every TB patient through the direct beneficiary transfer. This will further help in ensuring treatment adherence
- Deploy a world-class national surveillance and tracking system for TB patients: NIKSHAY will be enhanced to establish comprehensive real-time TB surveillance system. Information and communication technology (ICT) platform with handheld ICT devices for health staff, 250 seats call centers, adherence mechanisms through 99-DOTS, SMS reminders, and other ICT-based platforms are proposed with corresponding HR and maintenance capacity.
The Government of India envisages TB Control as one of the key priority activities and committed to an aspirational target of achieving this ahead of schedule by the year 2025.
- India as developed NSP for TB in India. The NSP for TB elimination in India has essentially four pillars to address the major challenges for TB control, namely, “Detect, Treat, Build and Prevent.” This plan requires a significant increase in the budget compared to previous NSP (2 billion USD for first 3 years: 2017–2020), and this plan is fully funded and most of this is through domestic resources
- Priority for TB control in India are as follows:
- The first priority is “Reaching the unreached.” We have to ensure access to care for some vulnerable populations such as tribals and people in urban slums.
- Nearly half of the TB patients in the country are taking treatment in private sector, with unknown quality of care and no support to those patients
- Early diagnosis of all patients and putting them on right treatment and ensuring their complete treatment is crucial.
- To reach the unreached, in the NSP, 25% of the budget is earmarked for direct interventions for addressing the quality of care for patients managed in the private sector. This include free diagnosis with rapid molecular tests, free treatment with best quality drugs and regimens, financial and nutritional support to patients, online TB notification systems, mobile technology-based adherence monitoring system, interphase agencies for better private sector engagements, policy for transparent service purchase schemes, stronger community engagements, communication campaigns, regulatory systems to capture information on all those consuming anti-TB drugs, etc.
- To provide access to patients in difficult to reach areas, both socially and geographically, we have started active TB case-finding campaigns in selected areas. In 2017, ACF campaigns covered 500+ districts and screened over 50 million vulnerable persons and detected over 25,000 additional TB cases
- Policy has been in place now for using rapid molecular testing for TB diagnosis and universal drug resistance testing; now we have GeneXpert tests available in every district.
- Recently, validation and field feasibility tests of a “Make in India” rapid molecular test – “Trunat” has been completed. The results are good and we plan to deploy these tests as a replacement for sputum smear microscopy.
- Daily fixed-dose course regimen for drug-sensitive TB has been now used in India with mobile-based adherence monitoring system (99-DOTS). For drug-resistant TB patients, bedaquiline has been introduced and shorter MDR-TB regimen will be used for treatment
- Patient support such as nutritional support and financial enablers are ready to be rolled out through JAN scheme (Jan Dhan Yojana [bank account to citizen] Aadhar [Unique identity card], Nikshay [electronic TB notification system] linked, and Direct Beneficiary Transfer of financial incentives/nutritional support to TB patients). 20% of NSP budget has been earmarked for financial and nutritional support to TB patients and families
- Health system strengthening is one of my top priorities; in the NSP, we have included a section called “Build.” For strengthening TB program management, we have now an efficient, transparent, Public Finance Management System, electronic procurement management system, and we will be further strengthening the Central, State, and District level TB programme management structure. An effective TB surveillance system is being developed in the country, and in 2 years, we expect to have a state-of-the-art TB surveillance system in place to better understand and react to local TB epidemic
- Ambitious targets can only be achieved with aggressive research on better point of care tests, better vaccines, better drugs, etc. In India, we have engaged the Department of Biotechnology and the Indian Council of Medical Research to work on a series of scientific ventures, including development of newer vaccines, newer molecular diagnostics, and treatment regimens.