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National Tuberclosis Elimination Programme

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National Tuberclosis Elimination Programme

Background Information 

TB is one of the most ancient diseases. It has been referred to in the Vedas and AyurvedicSamhitas. The TB    burden in India is staggering. Tuberculosis (TB) is a contagious disease caused by Mycobacterium tuberculosis. Left untreated, each person with infectious pulmonary TB will infect an average of between 10 and 15 people every year.

Tuberculosis generally affects the lungs, but can also affect other parts of the body. Most infections do not have symptoms, in which case it is known as latent tuberculosis. About 10% of latent infections progress to active disease which, if left untreated, kills about half of those infected. The classic symptoms of active TB are a chronic cough with blood-containingsputum, fever, night sweats, and weight loss.

Tuberculosis is spread through the air when people who have active TB in their lungs cough, spit, speak, or sneeze. People with latent TB do not spread the disease. Active infection occurs more often in people with HIV/AIDS and in those who smoke. Diagnosis of active TB is based on chest X-rays, as well as microscopic examination and culture of body fluids.

Prevention of TB involves screening those at high risk, early detection and treatment of cases, and vaccination with the bacillus Calmette-Guérin (BCG) vaccine. Those at high risk include household, workplace, and social contacts of people with active TB. Treatment requires the use of multiple antibiotics over a long period of time. Antibiotic resistance is a growing problem with increasing rates of multiple drug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB).

Situation of TB Uttarakhand

In Uttarakhand the estimated total TB Cases are 275/Lac per year in 2020 including both public and private sector. 

The National Tuberculosis Elimination Programme is based on the daily DOTS (Directly Observed Treatment with short course chemotherapy) strategy. In Uttarakhand Program has introduced daily regimen for treatment of drug sensitive TB in the year 2017, October month.  This is a major shift in the TB treatment policy being followed by the Central TB Division. WHO revised its TB management guidelines in 2010, recommending that the daily drug regimen be adopted under NTEP.

Under the new daily drug regimen, TB patients will be given fixed drug combinations (FDCs) — three or four drugs in specific dosages in a single pill — on a daily basis. The drugs will be administered according to the weight of the patient.

 

 



Infrastructure of NTEP in state:-

State TB Cell

01

 

Intermediate Reference Lab

01

 IRL, Dehradun

State Drug Store

02

1-Dehradun

2- US Nagar

District TB Centre

13

 

Tuberculosis Unit

95

 

Designated Microscopy Centers

153

 

Nodal Drug Resistant TB Centers

02

1-       HIHT Jolly Grant

2-      GMC, Haldwani, Nainital

CBNAAT Site

15

 


Laboratory Services
 

Diagnostic services under the program are provided through a network of various types of laboratories operating in a three tier fashion. At the service/ facility level there are microscopy and rapid molecular tests, constituting the first tier. The second tier is constituted by Intermediate Reference Laboratories(IRL) and Culture and Drug Susceptibility Testing (C&DST) Labs, which provide advanced DST facilities and supervisory support to the first tier. The National Reference Laboratories constitute the third tier, and provide quality assurance and certification services for C&DST labs and co-ordinate with WHO Supra National Reference Laboratory Network[3]. In addition to the above, Chest Radiography, available at tertiary and secondary healthcare levels, also play an important role in screening for Tuberculosis signs and clinical diagnosis.

Designated Microscopy Centers (DMC)

Sputum smear microscopy, using the Ziehl – Neelsen staining technique, is conducted at the DMCs. This is the most widely available test with over 156 quality controlled laboratories across Uttarakhand. For diagnosis, two sputum samples are collected over two days (as spot-morning/morning-spot) from presumptive TB case (patients with presenting with a history of cough for two weeks or more or any symptom of TB). State also has….. LED microscope available with high burden DMCs.

Rapid Molecular Testing Labs

Cartridge Based Nucleic Acid Amplification Test (CBNAAT) using the GeneXpert Platform, and TrueNat are rapid molecular test for TB diagnosis and Rifampicin resistance detection. This test is the first choice of diagnostic test for high risk population, children, contact of drug resistant cases and PLHA (Patient Living With HIV AIDS). Currently there are about 14 CBNAAT and 18 TrueNat laboratories in the state, established at the district and in some cases at a sub-district level.

Culture and Drug Susceptibility Testing Labs

Advanced tests such as the Line Probe Assay, Solid Culture, and Drug Susceptibility Testing are available at IRL, this provide additional drug resistance/ susceptibility testing services for a number of Anti-TB drugs.

Treatment Services

Standardized treatment regimen composed of multiple anti- Tuberculosis drugs are provided through the program. Treatment of TB is consisting of an intensive phase of two months for drug sensitive TB and of six months for drug resistant TB and the continuation phase is of four months for the drug sensitive TB and of one and half years for MDR TB.

Based on the nature of anti- microbial to the disease different treatment regimen are offered through the program. New Cases and those which exhibit no resistance are offered a six month, short course of the four first line drugs; Isoniazid-H, Rifampicin-R , Pyrazinamide –Z , and Ethambutol -E. The drugs are administered through daily weight band based doses of Fixed Dose Combinations, consisting of HRZE for the intensive phase of two months and HRE for the continuation phase of four months. For drug resistant cases, depending upon the pattern of drug resistance a number of regimen are available composed of a combination of 13 drugs.

 

 

 

 

 



Contact Details ( District TB Officer ) 

S.No

District

Name of DTO

Mobile Number

Office Phone Number

Email

1

Almora

Dr. Deepanker Dainial

7454897364

05962-254355

dtouramr@rntcp.org

2

Bageshwar

Dr.N.S. Tolia

8057998101

05963-221088

dtourbgw@rntcp.org

3

Chamoli

Dr.  Uma Rawat

9410134056

01372-252247

dtourcml@rntcp.org

4

Champawat

Dr. Indrejeet Pandey

8006691889

05965-230922

dtourcpv@rntcp.org

5

Dehradun

Dr. Sudhir Pandey

9411143986, 8191085234

0135-2656534

dtourddn@rntcp.org

6

Pauri Garhwal

Dr. Ramesh Kunwar

7500232844

01368-223846

dtourgrw@rntcp.org

7

Haridwar

Dr. Ajay Kumar

7579212002

01334-265315

dtourhrd@rntcp.org

8

Nanital

Dr. R.K. Joshi

7500482007

05946-254232

dtournnt@rntcp.org

9

Pithoragarh

Dr. Kundan Kumar

9012807228

05964-228674

dtourprg@rntcp.org

10

Rudraprayag

Dr. J.S. Negi

7534902802

01364-233924

dtourrdp@rntcp.org

11

Tehri Garhwal

Dr. Manoj Verma

9634242111 / 9897900000

01378-227521

dtourtgl@rntcp.org

12

U.S. Nagar

Dr. Harinder Malik

9456437914, 7017843947

05944-247337

dtouruds@rntcp.org

13

Uttarkashi

Dr. Sujata Singh

9411723371

01374-222485

dtouruks@rntcp.org

 

 

Contact Details (District Program Cordinator )- RNTCP

S.No.

District

Name of DPC

Mobile No.

1

Almora

Mr. Kamlesh Bhatt

9599650845

2

Bageshwar

Mr. Amit Tiwari

9759453583

3

Dehradun

Mr. Ankur Negi

9997242517, 8077287996

4

Pauri Garhwal

Mr. Damodar Prasad Mamgain

9639897561

5

Hardwar

Mr. Anil Negi

9927177931

6

Nainital

Mr. Ajay Bhatt

7454820194, 7983357507

7

Pithoragarh

Mr. Vikas Bhandari

8057438575

8

Rudraprayag

Mr. Mukesh Bagwadi

9568250737

9

Tehri Garhwal

Ms. Kamla Topwal

9997894159

10

U.S. Nagar

Mr. Naveen Pandey

8958888128

11

Uttarkashi

Mr. Ajay Bisht

7088838804