TB India 2012 - Annual Report

This Publication can be obtained from
Central TB Division
Directorate General of Health Services Ministry of Health and Family Welfare Nirman Bhawan, New Delhi - 110 108 http://www.tbcindia.nic.in March 2012 Central TB Division, Directorate General of Health Services Printed by I G Printers Pvt. Ltd. email: igprinter@rediffmail.com
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GHULAM NABI AZAD
Minister of Health & Family Welfare Government of India Nirman Bhavan, New Delhi-110108
FOREWORD
Tuberculosis is a disease with devastating social and economic costs. Tuberculosis and the enormous burden on persons afflicted by the disease in India can be seen by the fact that more adults die from TB than any other infectious disease and most of these are avoidable deaths. TB control contributes substantially to the social and economic development of the country by reducing the suffering from TB and averting untimely deaths of lakhs of Indians in their prime years of life. Since 1998, RNTCP has treated more than 14.2 million TB patients and saved 2.6 million additional lives using the DOTS strategy. The Programme has been consistently achieving global benchmark of a treatment success rate of more than 85 % in new smear positive patients and detecting 70 % of such cases consecutively for the last five years. However with nearly 40% of the Indian population infected with the TB bacillus, this large pool of infected people means that TB will continue to be a major problem in the foreseeable future. Programme activities need to sustain over several years before TB can be controlled. To effectively control TB, the Government of india has now shifted its focus from 70/85 target approach to universal access to quality assured services for TB for all patients. The Union Government is also conscious of the fact that several new challenges like drug resistant tuberculosis, TB-HIV co-infection and TB-Diabetes co-morbidity have the potential to reverse the gains made by the programme in the last decade. The government has taken proactive steps to respond to these challenges. The services for diagnosis and management of dru resistant TB and TB-HIV co-infected patients are being scaled up for complete geographical coverage by 2012. Active collaboration and cooperation with civil society partners can help achieve the ambitious targets of Universal Access to Quality TB Care in India. The increase in budgetary allocation for tuberculosis control this year alone is more than 80% of allocation in the previous year. All steps will be taken to ensure to implement the National Strategic Plan for Tuberculosis which will be crucial in achieving a major victory against TB, and will bring the country closer to the vision of a "TB-free India".
(Gulam Nabi Azad) March 2012
P. K. PRADHAN Secratary Department of Health & FW Tel: 23061863 Fax 23061252 e-mailL: secyhfw@nic.in
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Government of India Ministry of Health & Family Welfare Nirman Bhavan, New Delhi-110108
MESSAGE
India has the highest burden of Tuberculosis in the world with over two million incident cases amounting to more than fifth of global burden. Tuberculosis has been known to have devastating effects on the socioeconomic development especially in the developing countries due to its association with dreaded disease like HIV/AIDS and malnutrition in the poorest of the poor. Drug resistance, diabetes, smoking and other associated factors complicate TB scenario further making it difficult to control tuberculosis. Having treated 14.2 million TB cases, saving additional 2.6 million lives, Revised National Tuberculosis Control Programme has moved beyond the objectives of 70% case detection rate and 85% cure rate in new smear positive patients and has set new objective of 'Universal access to TB Care'. After achieving complete nationwide coverage for implementation of DOTS in 2006, TB-HIV intensified package, for management of TB-HIV co infected cases, has been made available to total population across the country 2011. While, key focus of the programme is to prevent the emergence of drug resistance by provision of quality DOTS services, the management of Multi Drug Resistant-TB (MDR-TB) patients is now an integral component of RNTCP. 37 Culture and DST laboratories have been accredited nationwide to provide quality diagnostic services for drug resistant TB cases. All 35 States/UTs have introduced Programatic Management of Drug-resistant TB Services (PMDT) services in some districts with variable access and are being scaled up to achieve complete geographical coverage by end of 2012. Dramatic growth in information communication technology allows unprecedented opportunities to ensure that TB cases are promptly diagnosed and optimally treated. This opportunity builds upon an existing strength of the Programme in rigorous data collection and analysis, a spectrum of ongoing activities. Case based web enabled system for recording and reporting of the TB case is being developed to enable better surveillance and tracking of TB cases. Rational use of anti-TB drugs by every health care provider needs to be ensured. This responsibility when exercised properly will prevent development of drug resistant Tuberculosis and will accelerate TB Control. The Govt of India is committed for providing requisite resources for fighting both stigma and disease due to TB.
P. K. Pradhan
National Rural Health Mission
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GOVERNMENT OF INDIA
Dr. Jagdish Prasad

M.S. M.Ch, FIACS
Director General of Health Service
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DIRECTORATE GENERAL OF HEALTH SERVICES Ministry of Health & Family Welfare Nirman Bhavan, New Delhi-110108 Tel : 23061063, 23061438 (O) 23061924 (F), 26161026 (SJH) E-mail : Dghs@nic.in
Universal Access to early quality diagnosis and quality TB care

Revised National TB Control Programme has made historical achievements in the recent past years and the Programme stands at the point where achieving the ambitious goal of Universal Access to TB care is in sight. The programme has been continuously been innovative and progressive in addressing issues related to TB control in the country. The programme has reached in every corner of the country providing adequate, decentralized quality assured diagnostic and treatment services, operational through the primary health care system. In addition, in rural India, at least one trained 'Community DOT Provider' is in place in every village of the country to provide DOT services. Newer diagnostic technologies are being piloted and found appropriate will be scaled up for ensuring early diagnosis with greater sensitivity and quality to further reduce the diagnostic delays and cutting the chain of transmission and preventing the drug resistant TB. Despite all this, due to inadequate infrastructure, and the different health seeking behaviour pattern in urban areas, TB control faces unique challenges. Issues regarding availability and access to preventive, curative and informative TB services in urban areas, especially with migrants and urban poor, needs to be addressed. Targeted intervention are being planned to address TB problems in migrant labourers in the peri-urban areas, prisons and the urban poor in slums. For reaching population groups who are hard-to-reach and difficult-to-access, specific target oriented issues based strategies for demand generation are being processed as Behavioural change communication interventions. Better involvement of all relevant health-care providers in tuberculosis (TB) care and control through publicprivate and public-public mix approaches (PPM) will be crucial to achieve the objective of 'Universal Access'. Involvement of private sector is being explored to provide diagnostic interventions to diagnose TB especially drug resistant TB. 'Civil Societies Organizations' will have increasing role in advocacy, communication and social mobilization needed for the programme and partnerships with the CSOs will definitely accelerate the TB control efforts in India in coming years. The rich technical and managerial capabilities of the programme with the support from all stakeholders aiming towards "Universal Access to TB Care" will ensure that the programme is able to overcome all challenges successfully and will contribute to developing a healthy and economically productive population.
Dr Jagdish Prasad
Telephone : +91-11-23062980 Telefax : +91-11-23063226 Email: ddgtb@tbcindia.nic.in website : www.tbcindia.nic.in

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GOVERNMENT OF INDIA
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D IRECTORATE G ENERAL
OF
H EALTH
SERVICES
Dr. Ashok kumar, M.D

Deputy Director General
Head, Central TB Division Project Director RNTCP
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MINISTRY
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HEALTH & FAMILY WELFARE
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Nirman Bhavan, New Delhi-110108
Preface
The first edition of the 'Annual Status Report on RNTCP' was published eleven years ago providing an overview of the progress made in TB control efforts in India and has been consistently released every year, since then, on the World TB Day, the 24th March. India has made an enormous progress towards in TB control and the twelfth edition of RNTCP status report "TB India 2012" contains a comprehensive and up-to-date assessment of TB control activities in India and progress made at district, states/UTs and country levels during the calendar year 2011. The state/ UT and district wise performance indicators have been presented on various parameters, alongwith their success stories picturing the vital efforts of the health care providers down to most peripheral levels, in taking the TB control services to the doorsteps of the TB patients. The recent advances in the programme have also been presented in this report. The enormous efforts made by the concerned authorities and functionaries of the 35 States/ UTs, all the RNTCP Consultants as well as various experts towards ensuring the efficient implementation and achieving the objectives of RNTCP in our country, are highly appreciated. The Central TB Division is also thankful for the invaluable contributions and collaboration of the multilateral & bilateral agencies and donors like Global Fund, World Health Organization, World Bank, USAID, BMGF, UNION, World Vision, FIND, PATH to name a few of the many other non-governmental agencies and institutions for their support and expertise in helping RNTCP which is being recognized as one of the best disease control programme not only in the country but also globally. As in the past years, this Annual Status Report 'TB India 2012' will serve as a National Reference Document on RNTCP. The information contained in this report will prove useful to policy makers, programme implementers, health administrators, researchers and academicians as well as to the community at large for providing better services for universal quality TB care and control of TB in our country. The Central TB Division thanks the esteemed readers for popularizing this national document and solicits their suggestions and valuable comments for improving the future editions. We are grateful to all the authorities, officers & staff of the Ministry of Health and Family Welfare and Directorate General Health Services, Govt. of India for their continued support to RNTCP for its efficient and effective implementation. Personal appreciations are extended to all those who have committedly contributed towards bringing out this edition of 'TB India-2012'.
(Dr.Ashok Kumar)
TB'is fully curable with complete course of DOTS
Abbreviations
ACSM AIDS AIIMS ANSV ART ARTI ASHA CBCI CDC CDR CGHS CHAI CHC CII CMAI CTD DALYs DDG DFID DGHS DMC DOTS DRS DRTB DST DTC DTCS DTO E EPTB EQA GMSD GoI H HBCs HIV HRD
Advocacy, Communication and Social Mobilization Acquired Immune Deficiency Syndrome All India Institute of Medical Sciences Annual Negative Slide Volume Anti Retroviral Therapy Annual Risk of Tuberculosis Infection Accredited Social Health Activist Catholic Bishop's Conference of India Centre for Disease Control and Prevention Case Detection Rate Central Government Health Scheme Catholic Health Association of India Community Health Centre Confederation of Indian Industries Christian Medical Association of India Central TB Division Disability Adjusted Life Years Deputy Director General Department For International Development Director General of Health Services Designated Microscopy Centre Directly Observed Treatment Short Course Drug Resistance Surveillance Drug Resistant Tuberculosis Drug Susceptibility Testing District Tuberculosis Centre District TB Control Society District Tuberculosis Officer Ethambutol Extra-pulmonary Tuberculosis External Quality Assessment Government Medical Store Depot Government of India Izoniazid High Burden Countries Human Immuno Deficiency Virus Human Resource Development
IEC Advisory Committee International Competitive Bidding International Centre for Excellence in Laboratory Training ICMR Indian Council of Medical Research ICTC Integrated Counselling and Testing Centre IDSP Integrated Disease Surveillance Project IEC Information, Education and Communication IMA Indian Medical Association IPT Isoniazid Preventive Therapy IRL Intermediate Reference Laboratory ISTC International Standards for Tuberculosis Care IUALTD International Union Against Tuberculosis and Lung Disease JMM Joint Monitoring Mission KAP Knowledge, Attitude and Practices LT Laboratory Technician MDGs Millennium Development Goals MDP Model Dots Project MDRTB Multi Drug Resistant TB MIFA Management of Information For Action MIS Management Information System MO Medical Officer MoHFW Ministry of Health and Family Welfare MOTC Medical Officer-Tuberculosis Control MoU Memorandum of Understanding NACO National AIDS Control Organisation NACP National AIDS Control Programme NCDC National Centre for Disease Control NEP New Extra Pulmonary NGO Non Governmental Organisation NIRT National Institute of Research in Tuberculosis NJIMOD Naitonal Jalma Institute of Mycobacterial and Other Diseases NRHM National Rural Health Mission NRL National Reference Laboratory NSN New Smear Negative
IAC ICB ICELT
NSP NTF NTI NTP NUHM OR OSE PHC PHI PI PLHIV PP PPM ProMIS PSU PTB PWB QA R RBRC RCH RNTCP
New Smear Positive National Task Force National Tuberculosis Institute National Tuberculosis Programme National Urban Health Mission Operational Research On-Site Evaluation Primary Health Centre Peripheral Health Institution Protease Inhibitor People Living with HIV and AIDS Private Practitioner Public-Private Mix Procurement Management Information System Software Public Sector Unit Pulmonary Tuberculosis Patient-Wise Box Quality Assurance Rifampicin Random Blinded Re-Checking Reproductive and Child Health Revised National Tuberculosis Control Programme
S SDS SHGs SOP SPR STC STDC STF STLS STO STS TB TRC TU UHC UNOPS USAID WHO WVI XDR-TB Z ZTF
Streptomycin State Drug Store Self Help Groups Standard Operating Procedure Slide Positivity Rate State TB Cell State Tuberculosis Training & Demonstration Centre State Task Force Senior TB Laboratory Supervisor State TB Officer Senior Treatment Supervisor Tuberculosis Tuberculosis Research Centre Tuberculosis Unit Urban Health Centre United Nations Office for Project Services United States Agency for International Development World Health Organization World Vision India Extensively Drug Resistant TB Pyrazinamide Zonal Task Force
Contents
India Profile Executive summary TB Epidemiology India Evolving strategies of TB Control in India RNTCP: Implementation status and activities in 2011 Annexure: Training guidelines under RNTCP Supervision, Review & Monitoring guidelines Success stories RNTCP Performance 1999-2011
1 2 7 12 17
82 85 93 104
INDIA Profile
North of the equatorbetween 6 44' and 35 30' north latitude and 68 7' and 97 25' east longitude. Seventh-largest country by geographical area of 3287263 sq km Second most populous country in the world with 1210 million people. Population density of 382 per sq. km 51.5% males and 48.5% females Sex ratio : 940 females for every 1000 males. 30 states and 5 Union Territories 640 districts, 5924 sub-districts& 7936 Towns 0.641 Million villages as per census 2011 data Decadal growth of 17.64%in last decade Literacy rate is 74%, in males 82% and in females 65% No of Govt. hospitals12760, CHCs 4510, PHCs 23391, Sub-centers 145894 Beds in Government Sector, 576793; Population per Government Hospital Bed 2012. No of medical colleges 314; Blood banks - 2445, Eye Banks - 586, Diverse socio-economic, cultural, political conditions Large unregulated private sector in health care
TB INDIA 2012
Revised National TB Control Programme: ANNUAL STATUS REPORT
Executive Summary
The Revised National TB Control Programme (RNTCP), based on the internationally recommended Directly Observed Treatment Short-course (DOTS) strategy, was launched in 1997 expanded across the country in a phased manner with support from the World Bank and other development partners. The objectives of the programme are To achieve and maintain cure rate of at least 85% among New Sputum Positive (NSP) patients To achieve and maintain case detection of at least 70% of the estimated NSP cases in the community. RNTCP has achieved the NSP case detection rate of more than 70% and the treatment success rate of >85% in 2007 and is persistently maintaining these global targets for TB control since then. Current focus of the programme is on ensuring "universal access" to good quality early diagnosis and treatment for all TB patients from which ever provider they choose to seek care. The program is covering the entire nation since March 2006 reaching over a billion population (1164 million) in 632 districts/reporting units. Annually more than 1.5 million TB patients are placed on DOTS treatment under RNTCP. In 2011, RNTCP has achieved the NSP CDR of 71% and treatment success rate of 88% which is in line with the global targets for TB control. Since its inception, the Programme has initiated more than 15 million patients on treatment, thus saving more than 2.5 million additional lives while the rate of TB Suspects examined has increased substantially from 397 per 100000 population per annum to 652 per 100000 population over the last 10 years. This success of Revised National TB Control Programme
is a result of a comprehensive and appropriate strategy, systematic and timely planning, robust systems of quality assurance for diagnosis & treatment, methodological logistics management, well defined HRD strategy including trainings, clear defined technical and operational guidelines and a built in supervision & monitoring mechanism. Required infrastructure has been developed under the programme over years and in 2011 the number of RNTCP District Units stand at 662 with 2698 functional sub-district Tuberculosis Units for effective & decentralized supervision and over 13,000 Designated Microscopy Centers for quality sputum microscopy for diagnosis of TB. Throughout the country a network of more than 6 lakh trained DOT Providers provide DOT to more than a 1.5 million patients diagnosed as TB each year. All states are implementing the 'Supervision and Monitoring strategy' - detailing guidelines, tools and indicators for monitoring the performance from the PHI level to the national level. Regular internal and external evaluations ensure quality program implementation. The program is focusing on the reduction in the default rates among all new and retreatment cases and is undertaking steps for the same. Quality assured, anti-TB drugs for the full course of treatment is provided to the patients through patient wise boxes. Decentralized treatment is provided through a network of more than 6,00,000 DOT providers, to provide treatment to the patients as near to their home as possible.The utilization of Pediatric patient wise boxes is on the increase since its introduction in 2006, under the programme for the treatment of pediatric patients suffering from TB. These boxes are designed according to the dosages used for different weight bands. The programme had revised its categorization of patients from the earlier 3 categories (Cat I, Cat II and Cat III) to
Executive Summary
2 categories (New and Previously treated cases) based on the recommendations of experts and endorsement by National Task Force for Medical colleges. Comprehensive training materials have been developed for all categories of staff. The training materials are modular in content and a number of them have been recently revised keeping in view the new developments in RNTCP. Modular trainings ensures uniform standard and avoids possible subjectivity and bias in trainings. To improve access to tribal and other marginalized groups the programme has developed a Tribal action plan which is being implemented with the provision of additional TB Units and DMCs in tribal/difficult areas, provision of TBHVs (peripheral health worker) for urban areas, compensation for transportation of patient & attendant in tribal areas, higher rate of salary to contractual staff posted in tribal areas and enhanced vehicle maintenance and travel allowance in tribal areas Studies to document utilization by marginalized groups Drug Resistance Surveillance (DRS) of Gujarat, Maharashtra and Andhra Pradesh, estimated the prevalence of Multidrug Resistant TB (MDR-TB) to be about 2-3% in new cases and 12-17% in retreatment cases. These surveys also indicate that the prevalence of MDRTB is not increasing in the country. The programme is in the process of establishing a network of accredited Culture and Drug Susceptibility Testing (DST) Intermediate Reference Laboratories (IRLs) across the country in a phased manner for diagnosis and follow up of MDR TB patients. Currently 38 labs are accredited and are functioning across the country. The RNTCP has initiated evaluation of the Gene-Xpert TB-RIF in line with the global consultation guidelines to gather evidence for use within the country in various settings including non-risk settings. LAMP (Loop mediated isothermal amplification) is a manual NAAT that can be performed at microscopy level is currently undergoing validation by FIND in IGMS Wardha. Multi Drug resistant TB (MDR TB): MDR-TB services have been initiated in all states in the country. All 35 States/UTs have introduced PMDT services in some districts with variable access and scaling up. 508 million (43%) population have access to services that varies from states to state as depicted in the figure below. 38287 MDR TB suspects have been examined till the end of 2011, 10267 MDR-TB patients have been diagnosed and 6994 have been put on treatment.
TB/HIV: The "National framework of Joint TB/HIV Collaborative activities" was revised in 2009 which establishes uniform activities at ART centres and ICTCs nationwide for intensified TB case finding and reporting, and set the ground for better monitoring and evaluation jointly by the two programmes with a new monitoring framework and revised reporting formats and mechanisms. Intensified TB-HIV package has been introduced in the entire country in 2011.In 2011 with close to 7 lakh TB suspects identified and tested for TB in HIV care settings; of them, close to 84,000 TB cases were diagnosed and linked to TB treatment services. Among the 23 states reported in 2011, close to 6 lakh TB patients were ascertained for their HIV status (67% of TB patients registered) and about 44,000 HIV-infected TB patients were diagnosed. Public Private Mix (PPM): RNTCP has involved over 1971 NGOs and 10,894 Private Practitioners. 150 Corporate Hospitals and 297 Medical Collages are implementing RNTCP. The programme is having successful partnership with IMA, CBCI, PATH, The Union and World Vision India. Advocacy, communication & social mobilization (ACSM): An effective advocacy, communication & social mobilization (ACSM) strategy is in place. As envisaged under the Stop TB Strategy ACSM plays a major role, in order to maintain high visibility of TB and RNTCP amongst policy makers, opinion leaders and community.Four regional level ACSM capacity building workshops were held by the program, wherein key functionaries in the field (STO, DTO, and implementing NGOs).National and Regional ACSM capacity building workshops were held in year 2011 to streamline the efforts. Operational research (OR): Second round of zonal ARTI surveys were completed in 2011 and 7 Prevalence Surveys were also completed and the results were discussed and shared in a series of workshops at national level in 2011. These results were used for the TB burden estimation and impact assessment. 72 thesis proposals and 14 OR proposals were approved by various Zonal OR committees in 2011.In addition seven OR studies were approved by National OR Committee of which 2 have been completed and five are ongoing. Impact of the programme: TB mortality in the country has reduced from over 39 per hundred thousandpopulation in 1990 to 29 hundred thousand population in 2010 as per the WHO Global TB Report 2011. The prevalence of TB in the country has reduced
TB INDIA 2012
from 459 per hundred thousandpopulation in 1990 to 256per hundred thousand population by the year 2010 as per the WHO Global TB Report, 2011. The studies on ARTI, suggests estimated decline in the annual risk of infection was estimated at 3.7% per year. 12th Five Year Plan: RNTCP has developed National Strategic Plan to be implemented during 2012-2017, the national 12th Five Year plan period, with following Vision and objectives for RNTCP: Vision: "TB-free India" Goal: Universal Access to quality TB diagnosis & treatment for all pulmonary & extra pulmonary TB patients including drug resistant and HIV associated TB.
Objectives: To achieve 90% notification rate for all types of TB cases To achieve 90% success rate for all new and 85% for re-treatment cases To significantly improve the successful outcomes of treatment of Drug Resistant TB To achieve decreased morbidity and mortality of HIV associated TB To improve outcomes of TB care in the private sector
Central TB Division - Activities in 2011

1. The ninth National Task Force Meeting for the involvement of medical colleges in RNTCP, for the year 2010, was held from 18th to 20th January 2011 in Hyderabad. 2. The 19th National Laboratory Committee Meeting under RNTCP was held on 19th January 2011 in Hyderabad. 3. A preliminary workshop for discussions on the results of the ARTI and the prevalence surveys undertaken in the country and to arrive at estimates for TB prevalence and incidence was held at LRS Institute, New Delhi on 5th-6th April 2011. 4. The meeting of National Technical Working Group on HIV/TB Collaborative Activities was held at New Delhi, on 21st April 2011. 5. The 'TB Epidemiology Course' was held at LRS Institute, New Delhi from 25th April 2011 to 13th May 2011 wherein the STOs, DTOs, STDC Director, RNTCP Consultants etc had participated. 6. Central Internal Evaluation of the programme performance and implementation status was held in the state of Megahalaya from 25th to 29th April 2011. The districts of East Khasi Hills and Ri Bhoi and the state level activities were evaluated. 7. The Biannual National Review Meeting of State Tuberculosis Officers and RNTCP Consultants was held from 18th to 20th May 2011 in Surajkund, Delhi NCR with the theme of 'National scale up of DOTS plus (PMDT) services under RNTCP in India' and the objectives of 'To review the performance and quality of RNTCP services; To review the progress and challenges in the expansion of DOTS Plus (PMDT) services in the country and To update the STOs and Consultants on newer initiatives, policy changes etc' 8. The Joint Donor Review Mission was conducted from 31st May to 9th June 2011 coordinated by the Central TB Division (CTD) of the Ministry of Health and Family Welfare (MOHFW) and the World Bank, and included the following development partners: WHO, the Global Fund, DFID, USAID, the Bill and Melinda Gates Foundation and the Clinton Foundation.The major objective of the Review Mission was to provide feedback on the "National Strategic Plan for TB Control in India, 2012-2017.", with a focus on the important challenges to achieving the new more ambitious objectives of RNTCP and also to follow-up on the findings and recommendations of previous missions.
Executive Summary
9. The Zonal Task Force Workshop for involvement of Medical Colleges in RNTCP for the medical colleges of four zones - East, South, North and West were held during July to September 2011. 10. Fourteen states were reviewed for their performance in RNTCP on a one to one basis along with their activity plans to improve programme performance in the respective states during July-September 2011. 11. Workshop on TB disease burden estimation for India, 2010 was organized by Central TB Division at LRS Institute of TB and Respiratory Diseases, New Delhi, from 7thJuly 2011 to 8th July 2011. 12. Central Internal Evaluation of the programme performance and implementation status was held in the state of Tamil Nadu from 13th July to 18th July 2011. The districts of Kancheepuram and Tiruchirapalli and the state level activities were evaluated. 13. The 20th National Laboratory Committee Meeting under RNTCP was held on 13th July 2011 in Hyderabad. 14. The 7th meeting of the National DOTS Plus Committee was held on 11th - 12th July 2011 at the LRS Institute, New Delhi. 15. The status of DOTS Plus services for Multi-Drug Resistant TB was reviewed in Guwahati in July 2011 for all the North-Eastern states. 16. The National Co-ordination Committee meeting for reviewing Global Fund Round 9 projects in Tuberculosis in India was held on 22nd and 23rd July 2011. 17. Regional ACSM workshop for the state and district level RNTCP staff was held from 8th to 10th September 2011. 18. The 'Leadership and Management Course' for STOs, Deputy STOs and DTOs involved in management of RNTCP was held from 5th to 9th September 2011 at LRS Institute, New Delhi 19. Central Internal Evaluation of the programme performance and implementation status was held in the state of Goa from 21st September to 24th September 2011. The districts of North and South Goa along with the state level activities were evaluated. 20. The meeting of Independent Expert Committee for Review of Estimation of TB Burden was held on 16th September 2011 at New Delhi. 21. The training of trainers in Intensified TB-HIV package for the four UTs of Puducherry, Andaman & Nicobar Islands, Dadar & Nagar Haveli and Daman & Diu was held on 3rd to 4th October 2011. 22. National Stakeholders Meeting for Tuberculosis and Diabetes Mellitus Collaborative activities was held on 11th& 12th October 2011 at Delhi which was attended by Programme Officials from RNTCP & the NonCommunicable Disease Control Programme and State TB Officers. 23. The Biannual National State TB Officers and RNTCP Consultants Review Meeting was held from 3rd to 4th November 2011 and the RNTCP Consultants National Review Meeting was held from 31st October 2011 to 2nd November 2011 at Hotel Emporio Resorts, Dwarka, New Delhi.The theme for the meeting was 'Quality services for universal access under RNTCP' and the objectives were 'To review the performance and quality of RNTCP services (DOTS, DOTS-Plus, TB-HIV, PPM, ACSM); To prepare focused action plan for underperforming areas and To update the STOs and Consultants on newer initiatives, policy changes etc" 24. The review meeting for all the states implementing DOTS-Plus services for Multi-Drug Resistant TB patients was held on 17th-18th November 2011 at Pune, Maharashtra. 25. The National Advocacy Communication and Social Mobilization (ACSM) Workshop for strengthening ACSM activities in the programme was held from 21st to 23rd November 2011 at New Delhi. The workshop involved all the State TB Officers, State IEC Officers, State RNTCP Consultants and other stakeholders as
TB INDIA 2012
participants. 26. An 'Intermediate Reference Laboratories Experience Sharing Workshop' was held on 1st and 2nd December 2011 for State TB Officers, Microbiologists and RNTCP Consultants. 27. Meeting of Human Resource Development Technical Working Group to finalize protocol for study on the Human Resource aspect for Health and TB management Integration was held on 1st December 2011. 28. The tenth National Task Force Meeting for the involvement of medical colleges in RNTCP, for the year 2011, was held on 21st& 22nd December 2011. 29. The National Technical Working Group for TB-HIV collaborative activities was held on 23rd December 2011. 30. The National Standing Committee for Operational Research in RNTCP was held at LRS Institute, New Delhi on 22nd Dec 2011.
Tuberculosis Epidemiology - India

Estimation and regular measurement of TB disease burden is important for reviewing the progress towards the Millennium Development Goals related to TB. STOP TB Partnership targets also are measurable in terms of TB disease burden and its Public health importance.
Global TB disease burden:

As per the WHO Global TB Report 2011, there were an estimated 8.8 million incident cases of TB (range, 8.5 million-9.2 million) globally in 2010, 1.1 million deaths (range, 0.9 million-1.2 million) among HIV-negative cases of TB and an additional 0.35 million deaths (range, 0.32 million-0.39 million) among people who were HIVpositive. In 2009, there were an estimated 9.7 million (range, 8.5-11 million) children who were orphans as a result of parental deaths caused by Tuberculosis. Globally, the absolute number of incident TB cases per year has been falling since 2006 and the incidence rate (per 100 000 population) has been falling by 1.3% per year since 2002. If these trends are sustained, the MDG target that TB incidence should be falling by 2015 will be achieved.
Global Goals, targets and indicators for TB control Millennium Development Goals set for 2015 Goal 6: Combat HIV/AIDS, malaria and other diseases Target 6c: Halt and begin to reverse the incidence of malaria and other major diseases Indicator 6.9: Incidence, prevalence and death rates associated with TB Indicator 6.10: Proportion of TB cases detected and cured under DOTS Stop TB Partnership targets set for 2015 and 2050 By 2015: Reduce prevalence and death rates by 50%, compared with their levels in 1990 By 2050: Reduce the global incidence of active TB cases to <1 case per 1 million population per year
Estimated tb incidence rates, 2010
TB INDIA 2012
TB mortality is falling globally and the Stop TB Partnership target of a 50% reduction by 2015 compared with 1990 will be met if the current trend is sustained. The target could also be achieved in all WHO regions with the exception of the African Region. Although TB prevalence is falling globally and in all regions, it is unlikely that the Stop TB Partnership target of a 50% reduction by 2015 compared with 1990 will be reached. However, the target has already been achieved in the Region of the Americas and the Western Pacific Region is very close to reaching the target. Dramatic reductions in TB cases and deaths have been achieved in China. Between 1990 and 2010, prevalence rates were halved, mortality rates were cut by almost 80% and incidence rates fell by 3.4% per year. In addition, methods for measuring trends in disease burden in China provide a model for many other countries. Between 2009 and 2011, consultations with 96 countries that account for 89% of the world's TB cases have led to a major updating of estimates of TB incidence, mortality and prevalence, particularly for countries in the African Region. Estimates of TB mortality have substantially improved in the past three years, following increased availability and use of direct measurements from vital registration systems and mortality surveys. In this report, direct measurements of mortality are used for 91 countries (including China and India for the first time).
about 40% of Indian population is infected with TB bacillus. The incidence of TB in India is estimated based on findings of the nationwide annual risk of tuberculosis infection (ARTI) study conducted in 2000-2003. The national ARTI being 1.5%, the incidence of new smear positive TB cases in the country is estimated as 75 new smear positive cases per 100,000 population. The prevalence of TB has been estimated at 3.8 million bacillary cases for the year 2000, by an expert group of Govt. of India. However the recent estimate by WHO gives a prevalence of 3 million. On a national scale, the high burden of TB in India is illustrated by the estimate that TB accounts for 17.6% of deaths from communicable disease and for 3.5% of all causes of mortality (WHO, 2004). More than 80% of the burden of tuberculosis is due to premature death, as measured in terms of disability-adjusted life years (DALYs) lost. WHO estimated TB mortality in India as 280,000 (23/100,000 population) in 2009. With RNTCP implementation, death due to TB has come down to half in the country. It was estimated that the TB mortality was over 5 million annually at the beginning of the revised national TB control programme (RNTCP). Data from specific surveys, however, suggest that case fatality rates prior to RNTCP were generally greater than 25%. In RNTCP era, case fatality has remained less than 5% for new cases registered under programme. India's Progress towards Millennium Development Goals (MDGs) with respect to reduction in prevalence and mortality rate The indicator 23 of the MDGs mentions that between 1990 and 2015 to halve prevalence of TB disease and deaths due to TB. With respect to the progress towards indicator 23, as per the recent WHO estimates, in the year 1990, the prevalence rate of TB in India was 338 per 100,000 populations (best estimates) and the mortality due to TB was 42 per 100,000 populations. In comparison,
TB Burden in India
Though India is the second-most populous country in the world, India has more new TB cases annually than any other country. In 2009, out of the estimated global annual incidence of 9.4 million TB cases, 2 million were estimated to have occurred in India, thus contributing to a fifth of the global burden of TB. It is estimated that Tab le 1: Estimated burden of tuberculosis in India
Number (Millions) (95%CI) Incidence All cases (2009 WHO estimate) Period Prevalence (2000 GoI estimate) AFB positive Bacillary* Prevalence, all cases (2009 WHO estimate)
Rate Per 100,000 Persons (95% CI) 168 165 (126-204) 369 (272-457) 249
2.0 (1.6-2.4) 1.7 (1.3-2.1) 3.8 (2.8-4.7) 3.0 (1.3-5.0)
* Defined as a person with at least one AFB smear positive by sputum microscopy, or at least one sputum culture positive for M. tuberculosis. Prevalence rate calculated from estimated number of persons with disease in 2000, divided by 2000 population estimate.
in the year 2009, the prevalence of TB in India was estimated to be 249 per 100,000 populations, and the mortality due to TB is 23 per 100,000 populations [WHO Global TB Report, 2010]. These estimate are derived based on mathematical and have its own inherent limitations. Government of India has undertaken nationally representative Annual Risk of TB Infection survey and TB Prevalence surveys in 7 sites of the country. The results of these surveys will be available during the mid 2011 and are expected to provide more realistic population based estimates. As far as the progress towards indicator 24 is concerned, the country has achieved the targets on case detection and treatment outcomes, in the year 2007 onwards (after whole country coverage).
they have DM. Most recent estimates from the International Diabetes Federation put the number of persons with diabetes mellitus at 61.3 million (10% of the adult population), with a further 77 million having impaired glucose tolerance. While the HIV epidemic in India appears to have peaked, the total number of persons living with HIV/ AIDS remains high, and with time the level of immune deficiency and TB vulnerability may increase. Malnutrition remains highly prevalent in India, and will remain a significant factor for years to come. India is urbanizing at a fantastic pace, bringing larger numbers of persons into urban areas with documented higher rates of TB transmission. Tobacco use is highly prevalent in India, and has been suggested to be a potent contributor to TB-related mortality. The confluence of these and other risk factors could well influence the TB epidemiology in India. Some of the factors are described below.
Population Attributable Fraction -risk factors for progression to disease: Relative risk for active TB disease HIV infection Malnutrition Diabetes Alcohol use (>40g / d) Active smoking Indoor Air Pollution 20.6/26.7* 3.2** 3.1 2.9 2.0 1.4 Weighted prevalence (adults 22 HBCs) 0.8% 16.7% 5.4% 8.1% 26% 71.2% Population Attributable Fraction (adults) 16% 27% 10% 13% 21% 22%
Impact of Other Determinants of TB Burden:

WHO has suggested that the expected effect of improved diagnostic and treatment services may be negated by an increase in the prevalence of risk factors for the progression of latent TB to active disease in segments of the population which may tend to increase incidence despite reductions in transmission achieved under the Stop TB strategy. Broadly described, these risk factors may be biomedical (such as HIV infection, diabetes, tobacco, malnutrition, silicosis, malignancy), environmental (indoor air pollution, ventilation) or socioeconomic (crowding, urbanization, migration, poverty). The impact of these other determinants on TB epidemiology in India has yet to be fully understood. The most recent estimates of the global burden of diabetes mellitus (DM) come from the 2011 Diabetes Atlas of the International Diabetes Federation. Diabetes has been shown to be an independent risk factor for tuberculosis in community based study from South India and multiple studies globally. Modeling has suggested that diabetes accounts for 14.8% of all tuberculosis and 20.8% of smear-positive TB. In 2011, there were an estimated 366 million cases of DM globally, and by 2030 it is expected that this number will have risen to 552 million. 80% of people with DM live in low- and middle-income countries and 50% of all people with DM (183 million) are undiagnosed. It is estimated that DM caused 4.6 million deaths in 2011. As a consequence of urbanization as well as social and economic development, there has been a rapidly growing epidemic of diabetes mellitus (DM) in India. Available data suggest that an estimated 11% of urban people and 3% of rural people above the age of 15 years have DM. Among them about half in rural areas and one third in urban areas are unaware that
PAF = [P*(RR-1)] / [P*(RR-1)+1]
Sources: Lnnroth K, Castro K, Chakaya JM, Chauhan LS, Floyd K, Glaziou P, Raviglione M. Tuberculosis control 2010 -2050: cure, care and social change. Lancet 2010 DOI:10.1016/s0140-6736(10)60483-7.
Drug Resistant Tuberculosis:

Multidrug Drug Resistant Tuberculosis (MDR-TB): The Global Project on anti-tuberculosis drug resistance surveillance was launched in 1994 with two key objectives: (i) to estimate the magnitude of drug resistance; and (ii) to monitor trends in drug resistance. Since 1994, significant efforts to promote the monitoring of drug resistance through national surveys and continuous surveillance based on diagnostic testing have been made,
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with coordination at the global level by WHO. The coverage of data has improved considerably, and about 60% of countries now have at least one direct and representative measurement of the level of drug resistance among their TB patients. For some of these countries, data reported for successive years have allowed the analysis of trends. Globally there is annual decrease of 0.3% in the best estimate and 14% in the lower estimate of MDR-TB. However, the upper estimate has annual increase of 14.1%, suggesting increasing uncertainties. Global estimation of proportion of New TB cases with MDRTB is 3.4% (1.9% - 5%) & estimation of proportion of Re-treatment cases with MDR-TB is 20% (14%25%) Prevalence of drug resistant TB in India: The emergence Mycobacteria which are resistant to drugs used to treat tuberculosis has become a significant public health problem world over creating an obstacle to effective TB control. Its presence has been known virtually from the time anti-tuberculosis drugs were introduced for the treatment of TB but Drug resistant tuberculosis is being encountered more frequently in most countries including India. There have been a number of reports on drug resistance TB in India, but most studies were undertaken using non-standardized methodologies with bias and small samples usually from tertiary level care facilities. Drug Resistance Surveillance (DRS) surveys: To obtain a more precise estimate of Multi-Drug Resistant TB (MDR-TB) burden in the country, RNTCP carried out drug resistance surveillance (DRS) surveys in accordance with global guidelines in selected states, Gujarat (56 million population) and Maharashtra (107 million) in 2005-2006 and Andhra Pradesh (81 million) in 2007-2008. The results of these surveys indicate prevalence of MDR-TB to be low i.e. less than 3% amongst new cases and 12-17% in re-treatment cases. These surveys also indicate that the prevalence of MDR-TB is stable in the country as the previous studies conducted by TRC, Chennai and NTI, Bangalore have shown a similar prevalence figures. To substantiate the findings of the earlier surveys, two more DRS surveys are presently ongoing in Western UP (85 million) and Tamil Nadu and it is planned in Rajasthan and Madhya Pradesh in the near future. These surveys will be undertaken periodically to monitor and study the trend of prevalence of MDR in the community. Based on the results of Gujarat, Maharashtra and Andhra Pradesh DRS Survey, Estimated proportion of MDRTB is 2.1% (1.5% - 2.7%)in New TB cases and 15% (13%-
17%) in previously treated cases. As compared to global rates, the proportions of MDR-TB is lesser in India. As per WHO Global TB Report 2010 and Multidrug and extensively drug-resistant TB (M/XDR-TB) - 2010 Global Report on Surveillance and Response, the estimated MDR TB cases emerging annually in India are reported to be 99,000 among incident total TB cases in India in 2008 (range 79,000 - 1,20,000). As per the WHO Global TB Report 2011, Estimated number of MDR-TB cases out of notified Pulmonary TB cases in India is 64,000 (range 44,000 to 84,000) emerge annually. Extensively Drug Resistant Tuberculosis (XDR- TB): Extensively drug resistant TB (XDR-TB), subset of MDR-TB with resistance to second line drugs i.e. any fluoroquinolone and to at least 1 of the 3 second line injectable drugs (capreomycin, kanamycin and amikacin),
has been reported in India. However, the extent and magnitude of this problem is yet to be determined. Results of the second line DST on MDR isolates from Gujarat DRS survey have shown that there is no XDR amongst new cases and the prevalence amongst retreatment cases is 0.5%. . The extent of fluoroquinolone resistance observed is of great concern, and may compromise MDR TB treatment outcomes. Efforts to expand surveillance to second-line anti-TB drugs are underway. No separate DRS surveys have been undertaken to estimate the burden of XDR-TB in the country. However, DRS surveys to estimate burden of MDRTB conducted in Gujarat and Andhra Pradesh reported 14 XDR-TB cases. 112 XDR-TB patients have been diagnosed at National Reference Laboratories as reported by the states from 2008 till Sept 2011. Programme have formulated guidelines for treatment of XDR-TB patients with category V regimen.
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Burden of TB-HIV: TB and HIV act in deadly synergy. HIV infection increases the risk of TB infection on exposure, progression from latent infection to active TB, risk of death if not timely treated for both TB and HIV and risk of recurrence even if successfully treated. Correspondingly, TB is the most common opportunistic infection and cause of mortality among people living with HIV (PLHIV), difficult to diagnose and treat owing to challenges related to co-morbidity, pill burden, co-toxicity and drug interactions. Though only 5% of TB patients are HIVinfected, in absolute terms it ranks 2nd in the world and accounts for about 10% of the global burden of HIVassociated TB. This coupled with heterogenous distribution within country is a challenge for joint delivery of integrated services. National and international studies indicate that an integrated approach to TB and HIV services can be extremely effective in managing the epidemic. A modelling study by Williams et al predicts that that RNTCP should be able to reverse the increase in TB burden due to HIV, but to reduce mortality by 50% or more by 2015, universal access to coordinated TB and HIV care is essential. Studies also indicate that emphasis needs to be on early diagnosis linked to TB and HIV treatment. Global estimation of burden of HIV positive incident TB cases is 10,00,000 (11,00,000-12,00,000) while the estimates of HIV positive incident TB cases in India is 75,000 (1,10,000 - 1,60,000). As per WHO's Global TB Report of 2011, HIV prevalence amongst incident TB cases is estimated to be 3.3% (5%-7.1%). Burden of paediatric TB in the country: The actual burden of pediatric TB is not known due to diagnostic difficulties but has been assumed that 10% of total TB load is found in children. Globally, about 1 million cases of pediatric TB are estimated to occur every year accounting for 10-15% of all TB; with more than 100,000 estimated deaths every year, it is one of the top 10 causes of childhood mortality. Though MDR-TB and XDRTB is documented among pediatric age group, there are no estimates of overall burden, chiefly because of diagnostic difficulties and exclusion of children in most
of the drug resistance surveys. Socio-economic impact: Besides the disease burden, TB also causes an enormous socio-economic burden to India. TB primarily affects people in their most productive years of life with important socio-economic consequences for the household and the disease is even more common among the poorest and marginalized sections of the community. Almost 70% of TB patients are aged between the ages of 15 and 54 years of age. While two thirds of the cases are male, TB takes a disproportionately larger toll among young females, with more than 50% of female cases occurring before 34 years of age. The direct and indirect cost of TB to India amounts to an estimated $23.7 billion annually. Studies suggest that on an average 3 to 4 months of work time is lost as result of TB, resulting in an average lost potential earning of 2030% of the annual household income. This leads to increased debt burden, particularly for the poor and marginalized sections of the population. The vast majority (more than 90%) of the economic burden of TB in India is caused by the loss of life rather than by morbidity. This is due to the fact that TB mortality incurs a greater loss in the number of life-years per event than does TB morbidity - despite the fact that there are many more prevalent cases than deaths. A study on the economic impact of scaling up of RNTCP in India in 2008 shows that on average each TB case incurs an economic burden of around US$ 12,235 and a health burden of around 4.1 DALYs. Similarly, a death from TB in India incurs an average burden of around US$ 67,305 and around 21.3 DALYs. A total of 6.3 million patients have been treated under the RNTCP from 1997-2006. This has led to a total health benefit of 29.2 million DALYs gained including a total of 1.3 million deaths averted. In 2006, the health burden of TB in India would have risen to around 14.4 million DALYs or have been 1.8 times higher in the absence of the programme. The RNTCP has also led to a gain of US$ 88.1 billion in economic wellbeing over the scale-up period. In 2006, the gain in economic wellbeing is estimated at US$ 19.7 billion per annum - equivalent on a population basis to US$ 17.1 per capita. In terms of TB patients, each case treated under DOTS in India results in an average gain to patients of 4.6 DALYs and US$ 13,935 in economic wellbeing.
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Evolving strategies of TB Control in India:

India has had a National Tuberculosis Programme (NTP) in place since 1962. However, the treatment success rates were unacceptably low and the death & default rates remained high. Further the HIV-AIDS epidemic and the spread of multi-drug resistance TB were threatening to further worsen the situation. In view of this, in 1992, GOI, with WHO and SIDA reviewed the TB situation and the following were concluded: NTP, though technically sound, suffered from managerial weaknesses Inadequate funding, Over-reliance on x-ray for diagnosis Frequent interrupted supplies of drugs Low rates of treatment completion In order to overcome these lacunae, the Government decided to give a new thrust to TB control activities by revitalising the NTP, with assistance from international agencies, in 1993. The Revised National TB Control Programme (RNTCP) thus formulated, adopted the internationally recommended Directly Observed Treatment Short-course (DOTS) strategy, as the most systematic and cost-effective approach to revitalise the TB control programme in India. Political and administrative commitment, to ensure the provision of organised and comprehensive TB control services was obtained. Adoption of smear microscopy for reliable and early diagnosis was introduced in a decentralized manner in the general health services. DOTS was adopted as a strategy for provision of treatment to increase the treatment completion rates. Supply of drugs was also strengthened to provide assured supply of drugs to meet the requirements of the system. Pilots were conducted between 1993- 1995 to test the operational feasibility in a population of 2.35 million in 5 pilot sites in the states of Delhi, Kerala, Gujarat, Maharashtra and West Bengal. Following on from the success of these pilot sites, the programme was expanded to a population of 13.85 million in 1995 and 20 million in 1996. Large-scale implementation of the RNTCP began in 1997, following the successful negotiation of a World Bank credit of US$ 142 million. Expansion of the Programme was undertaken in a phased manner with rigid appraisals of the districts prior to starting service delivery. The initial 5-year project plan was to implement the RNTCP in 102 districts of the country and strengthen another 203 Short Course Chemotherapy (SCC) districts for introduction of the revised strategy at a later stage. In early 2002, the World Bank assisted TB control project was extended for another 2 years, within the same budgetary provision, to cover a population of 700 million. A further one-year no-cost extension of the project was approved to cover the period from October 2004 to September 2005 before the next phase of the project. The Government of India took up the massive challenge of nation-wide expansion of the RNTCP and covering the whole country under RNTCP by the year 2005, and to reach the global targets for TB control on case detection and treatment success. The structural arrangements for funds transfer and to account for the resources deployed were developed and thus the formation of the State and District TB Control Societies was undertaken. The systems were further strengthened and the programme was scaled up for national coverage in 2005. This was followed up with RNTCP phase II, developed based on the lessons learnt from the implementation of the programme over a 12 year period. The design of the RNTCP II remained almost the same as that of RNTCP I but additional requirements of quality assured diagnosis and treatment were built in through schemes to increase the participation of private sector providers and also inclusion of DOTS+ for MDR TB and also offering treatment for XDR TB. Systematic research and evidence building to inform the programme for better design was also included as an important component. The Advocacy, Communication and Social Mobilization were also addressed in the design. The challenges imposed by the structures under NRHM were also taken into account. India achieved country wide coverage under RNTCP in March 2006. The RNTCP was built on the infrastructure and systems built through the NTP. Major additions to the RNTCP, over and above the structures established under the NTP, was the establishment of a sub-district supervisory unit, known as a TB Unit, with dedicated RNTCP supervisors posted, and decentralization of both diagnostic and treatment services, with treatment given under the support of DOT (directly observed treatment) providers.
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The quality of diagnosis of TB patients under RNTCP has improved by giving the highest priority to the provision of quality assured sputum smear microscopy services. One of the unique innovations under RNTCP has been the development of Patient-Wise Boxes, which contain the full course of treatment for one individual patient, ensuring that treatment of that patient cannot be interrupted due to a lack of drugs. RNTCP has effectively decentralized supervision via the sub-district TB Units, with in-built systems for monitoring and evaluation. DOTS strategy adopted by Revised National TB Control Programme initially had following five main components: 1. Political will and administrative commitment 2. Diagnosis by quality assured sputum smear microscopy 3. Adequate supply of quality assured Short Course chemotherapy drugs 4. Directly Observed Treatment 5. Systematic monitoring and Accountability In 2006, STOP TB strategy was announced by WHO and adopted by RNTCP, whose components are as follows Pursuing quality DOTS expansion and enhancement Addressing TB/HIV and MDR-TB Contributing to health system strengthening Engaging all care providers Empowering patients and communities Enabling and promoting research (diagnosis, treatment, vaccine, OR) Many of the initiatives like developing and piloting the feasibility of National Airborne Infection Control guidelines, developing and piloting strategy for 'Practical Approach to Lung Health' are the examples of initiatives taken by RNTCP under the comprehensive strategy of STOP TB. 'Universal Access to TB Care': RNTCP has been achieving the global targets of 70% case detection rates and >85% success rates amongst the New Smear Positive TB patients since 2007 onwards and then moving ahead on the path of TB control in India, RNTCP defined newer objectives of 'Universal Access to TB Care' for TB control in India in 2010. Many new areas were addressed with reviewing and creating evidences (e.g. Diabetes Mellitus), greater understanding of these areas was
developed amongst the Programme managers at various levels and strategies were piloted for feasibility e.g. offering HIV counseling and voluntary testing to all TB suspects and its impact and feasibility in implementation.
National Strategic Plan (2012-2017):

With progress in achieving objectives in the 11th Five year Plan and defining newer targets of Universal Access to TB care, newer strategies have been developed as a comprehensive National Strategic Plan under the 12th Five Year Plan of Government of India. The following thrust areas were identified: Strengthening and improving the quality of basic DOTS services Further strengthen and align with health system under NRHM Deploying improved rapid diagnosis at the field level Expand efforts to engage all care providers Strengthen urban TB Control Expand diagnosis and treatment of drug resistant TB Improve communication and outreach Promote research for development and implementation of improved tools and strategies. The "National Strategic Plan (2012-2017) was prepared through a consultative process involving a wide cross section of the stakeholders and experts in the programme. More than 150 experts from various disciplines and organizations were invited for the deliberations for developing the plan. Innovation and consensus were the highlights of the process adopted for development of the National Strategic Plan. Strategic vision to move towards universal access: The vision of the Government of India is for a "TB-free India" with reduction of the burden of the disease until it is no longer a major public health problem. To achieve this vision, the programme has now adopted the new objective of Universal Access for quality diagnosis and treatment for all TB patients in the community. This entails sustaining the achievements of the programme to date, and extending the reach and quality of services to all persons diagnosed with TB. The objectives of the programme proposed in the plan are: 1. To achieve 90% notification rate for all cases 2. To achieve 90% success rate for all new and 85% for re-treatment cases 3. To significantly improve the successful outcomes of treatment of Drug Resistant TB Cases 4. To achieve decreased morbidity and mortality
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of HIV associated TB 5. To improve outcomes TB care in the private sector
Proposed strategies in the "National Strategic Plan 2012-2017":

Case finding and Diagnostics: Early identification of all infectious TB cases. Improved integration with the general health system, and leverage field staff for home-based case finding. Improve communication and outreach Screening clinically & socially vulnerable risk groups for TB. Develop improved sputum collection and transportation systems. Deployment of higher-sensitivity diagnostic tests for TB suspects (and incorporate new tests) & decentralized DST services Catch patients already diagnosed through notification from all sources, improved referral for treatment mechanisms, and deployment of Laboratory & Private Provider notification Patient friendly treatment services: Promptly and appropriately treating TB, increasingly guided by DST. Making DOTS more patient friendly through increased communitization of DOT; pilot incentives/offsets for patient costs to help patients complete treatment and better monitoring through Information Technology. Improving partnerships between public and private sector -- Establish 'Indian Standards for TB Care' which can be used to engage providers using existing private treatment and improve care with some public sector support and supervision. Research will guide improvements in regimens and delivery systems. National Treatment Committee/TWG for regular review of regimens, all treatment related technical guidance Scale-up of Programmatic Management of Drug Resistance -TB: Developing network of C&DST Laboratories & Strengthening of Reference Laboratories Decentralized DST at district level for early MDR detection Improved information system for PMDT Manpower support for additional workload by
aligning with NRHM health blocks & rationalization of number of patients per STS Improved Drug Management of second-line anti-TB drugs (22% of budget, even at low GOI procurement cost) Scale -up of Joint TB-HIV Collaborative Activities: Activities will aim at early, rapid TB diagnosis with high sensitivity tests for HIV-infected TB suspects & ART for all HIV-infected TB patients, with transport support. Integration with Health Systems: Integrating the RNTCP with the overall health system will increase effectiveness and efficiencies of TB care and control which has been depicted in the picture. In rural areas the RNTCP can focus integration through the National Rural Health Mission. In urban areas the RNTCP can integrate through the private sector and the evolving National Urban Health Mission. Engagement of Private Sector: Private sector engagement essential for universal access and early detection RNTCP set norms and conduct surveillance while maintaining some flexibility Move from sensitization model today to output-based contracting of services through interface/aggregators States need to experiment with innovation and scale-up of those models that are successful Inclusion of private laboratories and pharmacists to detect patients at earliest points of care Technical working group (for guidance, policy advice) Technical support unit (for assistance to States for contracting) Accreditation and innovative financing Human Resource Development: The goal of RNTCP's HRD strategy is to optimally utilize available health system staff to deliver quality TB services, and to strengthen the super visory and managerial capacity of programme staffs overseeing these services. RNTCP will align more effectively with health system under NRHM to leverage field supervisory staff more effectively, and increase capacity building of staffs to equip them to handle multiple tasks of DOTS, MDR-TB, TB/HIV Support cells at States and District levels will be
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strengthened to increase administrative and managerial capacity, creating space for local programme managers to focus on supervision and quality of services. Web based application will be developed for creating dynamic HRD database to assist better planning and facilitate faster communication Advocacy, Communication and Social Mobilization: Generating demand for earlier diagnosis and treatment. Community ownership, participation and involvement are essential for universal access. Enhancing the ACSM capacity of service providers to improve the quality of service delivery. ACSM can reduce stigma which is critical for universal access. Increased coverage can be achieved by focusing on at risk and clinically, socially and occupationally vulnerable populations. Monitoring and Evaluation, Surveillance and Impact Assessment: Case Based Web Based application will be de-
veloped for real time data entry to enhance programme management and better decision making. Relevant, timely and accurate data collection at each level of programme and the healthcare system. Analysis of these data is critical for ensuring continual programmatic improvement. Research to inform TB Control policy and practice: OperationalResearch will be promoted to optimize TB control Priority research agenda to be developed. Conduct or commission priority research Rapidly translate lessons into innovative policy and practice Web based application for faster feedback to the Principal Investigators and facilitate monitoring of the process of proposal submission and the decisions of respective committees Key Interventions: Strengthening and improving the quality of basic DOTS services Further strengthen and align with health system
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under NRHM Deploying improved rapid diagnosis at the field level Expand efforts to engage all care providers Strengthen urban TB Control Expand diagnosis and treatment of drug resistant TB Improve communication and outreach Promote research for development and implementation of improved tools and strategies. What will NSP achieve? Control TB: compared to today's activities, success will :
Accelerate decline in incidence & prevent 22 lakh TB cases Reduce TB deaths by 75%, and save 17 lakh lives from TB Contain MDR TB: avert 1 lakh MDR cases and reduce incidence by 50% Return on investment: For each additional $1 1$ buys quicker diagnosis of more TB patients, more effective treatment ~14$ gained [ongoing analysis being done here] in future direct economic expenditure on TB cases prevented and Leadership for India: Sustain India's global leadership in TB treatment and control.
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RNTCP: Implementation status and activities in 2011
RNTCP planning and budgeting for States/UTs and districts

The RNTCP has been implemented in all states and union territories as a Centrally Sponsored Scheme (CSS) whereby the Central Government undertakes to ensure funding for all activities of the programme. Prior to the creation of the NRHM, the RNTCP utilized a system of specially created "societies" whereby the states received CSS funds for TB control via their respective State TB Control Society (STCS). In turn, the STCSs would allocate and disburse funds to districts through District TB Control Societies (DTCS). Under the NRHM, which functions as an umbrella society, the societies for most Centrally Sponsored Schemes including TB control have been merged into integrated "State Health Societies". At present, funds for the RNTCP are maintained in a separate account within these Societies and existing Annual Action Plans have been incorporated into the NRHM framework. As per the current arrangements, the Programme Implementation Plan (PIP) of the RNTCP has been approved by the Government of India over a period of five years from 2006 to 2011. In terms of the annual planning process, each State submits an "Annual Action Plan" to CTD in the month of October. These plans relate to the State's funding requirements for the next financial year (April-March) and are based on the consolidation of district level Annual Action Plans. The CTD oversees the planning and budgeting of TB control activities for the entire country. The CTD determines a maximum budget for each State based on a review of the Annual Action Plan, previous trends in state expenditure and unutilized funds available. The final budget provision is then allotcated according to the MoHFW's approved annual budget for TB control and on this basis the Finance Division of the MoHFW makes bi-annual fund disbursements to each state.
Financial reporting by districts and states is through a system of quarterly Statement of Expenditure (SoE) in standard format.. The states consolidate the District SoEs and send a consolidated SoE to CTD after including the expenditure incurred at the level of the State TB Cell. The CTD consolidates all these SoEs to account for the expenditure in the country as a whole. Donor-wise expenditure reports are also sent to the Controller of Aid Accounts and Audit (CAAA) - a division of the Department of Economic Affairs, Ministry of Finance - that monitors such reports and funding by external agencies based on which the donor agencies make reimbursements/further fund disbursements. The financial reporting has been linked to the funds release in minimum two installments, to ensure efficiency in submission and timeliness of the reports. The release of the first installment (April-May) is based on the consolidated SoEs of the state for the January-March quarter. The second installment (October-November) is similarly released on the receipt of consolidated audit report and Utilization certificate for the previous financial year and also the SoE of the latest quarter. The financial management system of the RNTCP has been decentralized with full powers of allocation and reallocation of disbursements between programme Budget Heads being delegated to the STCs, within the guidelines of the programme. Districts have also been delegated some powers of reallocation between sub-Heads. Generally speaking, this delegation of authority has facilitated better fund flow and optimum utilization of available financial resources.
World Bank support:

World Bank financing has supported RNTCP since it started expending the coverage of DOTS over a decade ago, with first credit of US$ 142 million in between 19972005 and second credit of US$ 170 million in between
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2006-2012. The closing date of the second credit is March 2012 which is likely to get an extension upto September 2012. Additional financing of US$ 100 million extension for the two years up to March 2014 with the additional financing would support the programme in meeting its ambitious new Universal Access goals, adequately addressing the challenges on drug resistant TB, and introducing and scaling -up innovations and new approaches.
Andhra Pradesh (8 states). Moreover, the project has been also supporting the engagement of private healthcare providers and Catholic healthcare facilities with RNTCP through Sub-Recipients like Indian Medical Association (IMA) and Catholic Bishops Confederation of India (CBCI-CARD) respectively in selected number of states. Round 9 TB Project: This project has been supporting the scaling up of diagnostic and treatment services of Drug Resistant TB cases in India. Title of the project: Scale up diagnosis, care and management of DR-TB (Drug Resistant TB) across India Principal Recipient: Central TB Division Sub Recipients: WHO, FIND (Foundation for In novative New Diagnostics) Consolidated Grant: The program division has recently consolidated the above two projects into one single stream funding (SSF) which has been already reviewed and approved by the Country Coordination Mechanism (CCM) of India. The consolidated grant proposal has been sent to Global Fund for their review, consideration and approval.
Year Wise Budget for the 11th Five Year Plan for RNTCP: (Rs. in crore) Sl. No. 1 2 3 4 5 Year 2007-08 2008-09 2009-10 2010-11 2011-12 Allocation as per Planning Commission 267.00 275.00 285.00 300.00 320.00 1447.00 Actual Allocation by the MoHFW 267.00 275.00 312.25 350.00 400.00 1604.25
Global Fund support:

Revised National Tuberculosis Control Program (RNTCP), Central TB Division, Ministry of Health & Family Welfare, Govt. of India has been currently implementing two projects as below which are supported by Global Fund, Rolling Continuation Channel (RCC) TB Project: RCC is the consolidation of the three grants (two existing GFATM grants R6, R4 TB grants and expiring R2 TB grant). This project has been supporting implementation of Revised National Tuberculosis Control Program (RNTCP) in the states of Haryana, UttaraKhand, Uttar Pradesh (27 districts only), Bihar, Jharkhand, Chhattisgarh, Orissa,
Principal Recipient: Central TB Division Sub-Recipients States being covered of RCC Indian Medical Bihar, Chhattisgarh, Gujarat, Jharkhand, Association (IMA) Kerala, Orissa, Rajasthan, Tamil Nadu, Uttaranchal, and West Bengal, Uttar Pradesh, Punjab, Haryana, Maharashtra, Andhra Pradesh and Chandigarh Catholic Bishops Andhra Pradesh, Assam, Bihar, Conference of Chhattisgarh, Jharkhand, Karnataka, India (CBCIMadhya Pradesh, Orissa, Rajasthan, CARD) Uttar Pradesh, and West Bengal, Kerala, Tamil Nadu, Gujarat, Maharashtra, Goa, Meghalaya, Manipur, Nagaland
For the finacial year 2012-13 GOI has approved approximately INR 710.15 crores for the RNTCP.
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Case detection through Quality Assured Bacteriology:

A nationwide network of RNTCP quality assured designated sputum smear microscopy laboratories has been established, which provides appropriate, affordable and accessible quality assured diagnostic services for TB suspects and cases. To meet the standards of internationally recommended diagnostic practices for TB, the programme provides the supply of quality reagents and equipment to the laboratory network. An in-built routine system has been designed for sputum microscopy External Quality Assessment (EQA) and for supervision and monitoring of the diagnostic systems by the RNTCP Senior TB Laboratory Supervisor (STLS) locally and by the Intermediate (State level) and National Reference Laboratory network for RNTCP at higher levels. Introduction of LED Fluorescent Microscopy is being phased in at high load centres and will be scaled up as per requirements at all levels.
Quality Assured Laboratory services: RNTCP has established a nationwide laboratory network, encompassing over 13,000 designated sputum Microscopy Centres (DMCs), which are being supervised by Intermediate Reference Laboratories (IRL) at State level, and National Reference Laboratories (NRL) & Central TB division at the National level. RNTCP aims to consolidate the laboratory network into a well-organized one, with a defined hierarchy for carrying out sputum microscopy with external quality assessment (EQA), in line with the new guidance of WHO. RNTCP is gradually phasing in routine surveillance among the previously treated cases in states where PMDT has been initiated. Drug resistance Surveillance (DRS), mycobacterium culture and Drug susceptibility testing (DST) are undertaken only among new cases in specific selected settings. National Reference Laboratories (NRL): The four NRLs under the programme are Tuberculosis Research Centre [TRC], Chennai, National Tuberculosis Institute [NTI], Bangalore, Lala Ram Swarup Institute of Tuberculosis and Respiratory diseases [LRS], Delhi and JALMA Institute, Agra. The NRLs work closely with the IRLs, monitor and supervise the IRL's activities and also undertake periodic training for the IRL staff in EQA, Cul-
ture & DST activities. Three microbiologists and four laboratory technicians have been provided by the RNTCP on a contractual basis to each NRL for supervision and monitoring of laboratory activities. The NRL microbiologist and laboratory supervisor / technician visits each assigned state at least once a year for 2 to 3 days as a part of on-site evaluation under the RNTCP EQA protocol. Regular supervisory visits are undertaken by the NRL microbiologists to the IRLs to provide technical support for establishing quality assured C&DST services, including facility design for the introduction of newer diagnostic tools (liquid culture and molecular tests) for the rapid diagnosis of MDR TB in consultation with other technical agencies like FIND. NRLs also undertake periodic proficiency testing of the IRLs as part of the accreditation process under RNTCP. The National RNTCP Laboratory Committee, constituted with microbiologists of the NRLs, CTD and WHO India representatives as members, works as a task force to guide laboratory related activities of the programme. This technical body advice the RNTCP on key policy issues with regard to the laboratory services of the TB Control Programme.
Table 1: States assigned to NRLs for monitoring of laboratory activities (2011)

NRL States and UnionTerritories (UTs) assigned for EQA Andhra Pradesh, Chattisgarh, Goa, Gujarat, Dadra Nagar Haveli, Daman & Diu, Kerala, Lakshadweep, Sikkim, Tamil Nadu, Punjab, Chandigarh Puducherry, Andaman & Nicobar Delhi, Arunachal Pradesh, Haryana, Manipur, Nagaland, Mizoram, Meghalaya, Tripura Total nos. of IRLs assigned Total nos. of states/ UTs assigned
TRC
10
14
LRS
20
TB INDIA 2012
NRL
States and UnionTerritories (UTs) assigned for EQA Maharashtra, Orissa, West Bengal, Rajasthan, Karnataka, Bihar, Madhya Pradesh, Jharkhand, Jammu and Kashmir Uttar Pradesh, Uttarakhand, Himachal Pradesh, Assam
Total nos. of IRLs assigned 12
Total nos. of states/ UTs assigned 9
NTI
JALMA
Intermediate Reference Laboratory (IRL): One IRL has been designated in the STDC / Public Health Laboratory / Medical College of the respective state. The functions of IRL are supervision and monitoring of EQA activities, mycobacterial culture and DST and also drug resistance surveillance (DRS) in selected states. The IRL ensures the proficiency of staff in performing smear microscopy activities by providing technical training to district and sub-district laboratory technicians and STLSs. The IRLs undertake on-site evaluation and panel testing to each district in the state, at least once a year. Designated Microscopy Centre (DMC): The most peripheral laboratory under the RNTCP network is the DMC which serves a population of around 100,000 (50,000 in tribal and hilly areas). At present, more than 13,000 DMCs are available for conducting quality assured sputum smear microscopy. External Quality Assessment for smear microscopy: A process has been established under RNTCP to assess the laboratory performance utilizing the RNTCP ExterFigure 1:
nal Quality Assessment (EQA) guidelines and currently > 95% of the districts in the country are implementing quality assurance protocol. (Fig 1) Recommendations of the annual supervisory visits to the states by the NRLs have focused on operational and technical problems of the laboratories and staff in conducting effective OSE visits to districts/diagnostic centres, panel testing of STLSs, operationalization of RBRC procedures and identifying and correcting DMCs with errors. For capacity building of state level programme managers (STOs and STDC /IRL directors) in EQA, training is imparted to make them aware of their roles and responsibilities with regard to issues such as setting up of IRLs, human resources, conducting effective on site evaluations by the IRL staff to DMC level, bio-medical waste disposal, infection control measures and other operational and technical issues. A separate training, which focuses mainly on technical aspects of EQA protocol, also provided to the microbiologists and lab technicians of IRLs by the NRLs.
External quality assessment activities of RNTCP
21
Establishment of accredited C&DST labs: RNTCP has adopted a rigorous C & DST Laboratory accreditation procedure (see Figure 3) to provide accurate and reliable services for MDRTB diagnosis and follow-up of treatment. In order to meet demands of the programme, accreditation of C&DST laboratories both in Public and Private sectors is being pursued vigorously. Overall supervision is entrusted with the NRLs, to maintain uniformity in testing procedures NRLs are conducting 2-4 week Culture and DST trainings to the Microbiologists and Laboratory technicians of laboratories undergoing accreditation. The accreditation process has three main stages. Stage 1. A pre-assessment visit of 1-2 days to the laboratories by the NRL/CTD team during which a laboratory is assessed for infrastructure facilities, qualified trained personnel, work-load requirements, SOPs (Standard Operating Procedures), technical procedures, bio-safety and infection control measures. Corrective actions recFig 3: The C&DST laboratory accreditation process
ommended in case of deficiencies. Stage 2. Laboratories are assessed for performance based on first 100 patient samples processed for Culture and DST. The indicators are mainly (a) rate of smear positive and culture negatives, and (b) rate of contamination (c) proficiency for setting-up correctly interpretable DST tests. Stage 3. NRLs provide external blinded proficiency testing panel of 20 cultures for susceptibility testing for antiTB drugs namely Isoniazid, Rifampicin, Ethambutol and Streptomycin. NRLs, would also retest 10 selected cultures provided by the IRLs. Accuracy of results is assessed based on sensitivity, specificity, and positive and negative predictive values for resistance and susceptibility. Accreditation is done on obtaining a proficiency of >90% for Isoniazid and Rifampicin. Regular annual proficiency testing is done to maintain the quality standards for DST. Separate proficiency schedule has also been developed for molecular based DST.
fig 11.tif 10.tif
22
TB INDIA 2012
There are 37 accredited Culture and DST laboratories in the country which includes Public, Private and NGO laboratories. Eighteen IRLs [Gujarat, Maharashtra (Pune, Nagpur), Kerala, Andhra Pradesh, Tamil Nadu, Delhi, Rajasthan, Orissa, West Bengal, Jharkhand, Haryana, Madhya Pradesh (BMHRC Bhopal, IRL Indore), Uttar Pradesh (CSMMU Lucknow), Uttarakhand, Puducherry and Chattisgarh] are accredited for first line DST as per the RNTCP accreditation protocol until 2011. The IRL of Assam is in the advanced stages of proficiency testing (Table 3). The rest of the IRLs will be starting the accreditation process and are likely to get accredited by end 2012. The procurement of C&DST equipment for another 11 IRLs (Bihar, Sikkim, Karnataka, Manipur, Arunachal Pradesh, Uttar Pradesh (Agra), Punjab, Himachal Pradesh, Srinagar, Jammu & Goa) has been completed as per World Bank guidelines through UNOPS and installation of the equipments has been completed in most of the IRLs . Private Medical Colleges, NGOs and Private laboratories are also increasingly providing C & DST services to enhance the programmes capacity for MDR-TB diag-
nosis which includes Christian Medical College (CMC) Vellore, PD Hinduja Mumbai, Blue Peter Health and Research Centre (BPHRC) Hyderabad, SawaiMaan Singh (SMS) Medical College Jaipur, Regional Medical Research Centre for Tribals (RMRCT ICMR) Choitram hospital (Indore), DFIT Nellore and Super Religare laboratory, Mumbai. The private laboratories of MicrocareSurat, Super Religare, Gurgaon and Kolkata are in advanced stages of accreditation. Newer and Rapid technologies being introduced globally would enhance the diagnostic capacity for MDRTB and cut short the turnaround times. Some of these technologies are now endorsed by WHO Strategic and technical advisory group for TB. RNTCP has initiated projects to validate & demonstrate large scale studies of newer TB diagnostic technologies in collaboration with Foundation for Innovative New Diagnostics (FIND), India. Molecular Line probe assay (LPA), Automated Liquid culture systems for C & DST, Capilia TB and LED Fluorescence microscopy are being validated in selected IRLs and NRLs. The results of these projects, specially the rapid MDR-TB test-LPA will guide the na-
23
tion wide roll out of these technologies for MDR-TB diagnosis. By 2012, the programme aims to provide universal access to laboratory based quality assured MDR diagnosis for all re-treatment TB cases on entry and new cases who have failed treatment and by 2015, the universal access to MDR diagnosis and treatment will be made available for all smear positive TB cases under RNTCP. Table 2: National Laboratory Scale up plan
Lab unit Enhanced capacity for solid culture and sputum processing Establish Molecular unit-LPA Establish liquid culture systems 2010-11 12 12 13
Introduction of Newer Tools: Line probe Assay: The Line probe Assay is a molecular diagnostic test which can provide the DST results within one day. Line probe Assay has been implemented in the IRLs of Ahmadabad (Gujarat), Hyderabad (Andhra Pradesh), IRL Nagpur (Maharashtra) IRL Trivandrum (Kerala), NDTB centre (Delhi), IRL Kolkata (West Bengal), IRL Cuttack (Orissa), IRL Ajmer (Rajasthan), IRL
2011-12 13 13 9 2012-13 18 18 11 Total 43 43 33
accreditation. Liquid Culture DST is available to the RNTCP through some of the private and corporate providers (NGO PP scheme for C& DST) like Hinduja hospital and SRL Mumbai that is providing services for the State of Maharashtra. LED FM Microscopy:The Programme is introducing
Microbiologist performing LPA procedure Raipur (Chattisgarh), IRL Ranchi (Jharkhand), IRL Pune (Maharashtra), IRL Chennai (Tamil Nadu), IRL (Orrissa) and IRL Indore (Madhya Pradesh) for diagnosis of MDR-TB. The other C&DST laboratories with accredited LPA technologies are AMC Vizag (Andhra Pradesh), DFIT Nellore (Andhra Pradesh), SMS Jaipur (Rajasthan), AIIMS (Delhi), Jamnagar (Gujarat) and JJ Hospital (Mumbai). The National Training Centre, "International Centre for Excellence in Laboratory Training" is established in the premises of the National Tuberculosis Institute, one of the premier National Reference Laboratories of India. The training centre will cater to the recurrent training needs of the laboratory staff that will man the 43 LPA and 33 liquid culture units to be established by 2014. Liquid culture: Liquid culture (MGIT 960) technology can diagnose DR-TB within 60 days. The IRL at Hyderabad and Gujarat are accredited for first line liquid culture DST and the other IRLs are in the process of
Liquid culture (MGIT 960) the LED FM Microscopy services in 200 medical colleges of the country. The services will be made available in these colleges by 2012 after training the LTs and STLS of these Medical Colleges. Cartridge Based Nucleic Acid Amplification test (Genexpert): The 2nd generation NAAT-based TB diagnostics offer the prospect of very high sensitivity, approaching that of liquid culture - the current gold standard for TB diagnosis. In addition, some versions of the NAAT also provide information on drug susceptibility to rifampicin, which is a surrogate marker in most coun-
24
TB INDIA 2012
tries for identification of patients who are most likely to have MDR-TB, thus allowing the early initiation of standardized 2nd line TB treatment in these patients. At least one 2nd-generation NAAT-based TB diagnostic is now commercially available, the automated Xpert MTB/RIF by Cepheid (Sunnyvale, CA, USA). These tests are based on technology platforms that offer the future prospect for multiple uses (e.g. malaria detection, HIV viral load testing), with minimal operator skill requirements and bio-safety risks, allowing for the first time use of advanced diagnostics outside the reference laboratory environment. The Drug resistance of the suspect can be known in one hour. RNTCP has expanded programme targets to achieving 'early and complete' detection of all TB cases, with universal access to drug-resistant TB diagnostic and treatment services. The availability of highly-accurate rapid TB diagnostics suitable for sub-district implementation offers the opportunity to make major progress towards these new and more challenging programme targets. The early initiation of treatment and provision of appropriate TB treatment should lead to decreased transmission and spread of both drug-sensitive and drug-resistant TB. The RNTCP has initiated the evaluation of the Cartridge Based Nucleic Acid Amplification test (GeneXpert TB/ RIF) in line with the global consultation guidelines to gather evidence for use within the country in various settings. S. No 1 2 Name of the States Andaman & Nicobar Andhra Pradesh S.No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 Microbiologist performing tests on GeneXpert machine Loop mediated isothermal amplification (LAMP): Lamp is a manual NAAT that can be performed at microscopy level and is being validated by FIND in IGMS Wardha. The introduction of all newer diagnostic tools is being supported by the EXPAND TB project (WHO GLI, UNITAID and FIND) and Global Fund Round 9, which is supporting the National Laboratory Scale up plan for 43 LPA and 33 Liquid Culture units to provide an incremental capacity by 2014 of approximately more than 160000 DSTs and more than 220000 follow-up cultures. Type of DST Technology Solid LPA Liquid A A A A P A P A P A A P P P P P P P P P P P P A A P P A P A A A A A P A A P P A P P P
Name of the Laboratories RMRC Port Blair IRL Hyderabad Govt Medical College, Vishakapatnam BPHRC, Hyderabad DFIT Lab, Nellore SVIMS Medical College, Tirupati IRL Naharlagun IRL Guwahati (Guwahati Medical College) RMRC Dibrugarh IRL Patna RMRI Patna DFIT Lab, Darbhanga Central Diagnostics, Patna PGI Chandigarh IRL Raipur LRS, Delhi IRL Delhi (New Delhi TB Centre) AIIMS (Department of Medicine), Delhi AIIMS (Department of Laboratory Medicine), Delhi AIIMS (Department of Microbiology), Delhi IRL Goa (GMC, Bambolim)
3 4 5
Arunachal Pradesh Assam Bihar
6 7 8
Chandigarh Chhattisgarh Delhi
Goa
25
S. No 10
Name of the States Gujarat
S.No 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72
11
Haryana
12 13 14 15
Himachal Pradesh Jammu & Kashmir Jharkhand Karnataka
16 17
Kerala Madhya Pradesh
18
Maharashtra
19 20 21 22 23 24 25
Manipur Meghalaya Nagaland Orissa Puducherry Punjab Rajasthan
26 27
Sikkim Tamil Nadu
Type of DST Technology Solid LPA Liquid IRL Ahmedabad A A A Govt Medical College, Jamnagar P A Govt Medical College, Surat P Microcare, Surat P IRL Karnal A P P Quest Diagnostics, Gurgaon P SRL, Gurgaon P IRL Dharampur P P Govt Medical College, Tanda P P P IRL Jammu (Jammu Medical College) P IRL Srinagar P P IRL Ranchi (Itki TB sanatorium) A A P NTI, Bangalore A A A IRL Bangalore P P P KIMS, Hubli P P Manipal Medical College, Mangalore P SRL, Bangalore P JSS Medical college, Mysore P SDM Medical college, Hubli P P IRL Thiruvananthapuram A A P Calicut Medical College,Calicut P IRL Indore P A P BMHRC (IRL) Bhopal A P Choitram Hospital Indore A RMRCT, Jabalpur A IRL Nagpur A A P IRL Pune P A P PD Hinduja Hospital, Mumbai A A Government Medical College, Aurangabad P P SRL, Mumbai A JJ hospital Mumbai A A P KJ Soumiya Medical college, Mumbai P IRL Imphal, Manipur P P Nazreth Hospital, Shillong P IRL Nagaland P IRL Cuttack A A P RMRC Bhubaneswar P IRL Pondicherry A P P IRL Patiala (Patiala Government Medical College) P P P IRL Ajmer A A P SMS Jaipur A A P SN Medical college, Jodhpur P DMRC Jodhpur P RNT Medical College, Udaipur P Kota Medical College, Kota P IRL Gangtok, Sikkim P P NIRT (TRC) Chennai A A A IRL Chennai (Institute of Thoracic Medicine) A P P CMC Vellore A Madurai Medical College, Madurai P PSG Medical College, Coimbatore P
Name of the Laboratories
26
TB INDIA 2012
S. No 28
Name of the States
S.No 73 74 75 76 77 78 79 80 81 82 83 84
Name of the Laboratories Trichy Medical Colleges, Trichy JALMA, Agra IRL Lucknow (CSMMU, earlier KGMU) IRL Agra Sri Ram Murti Medical College, Bareilly IMS,Banaras Health University, Varanasi MLN Medical College, Allahabad JN Medical College, Aligarh IRL Dehradun IRL Kolkata SRL Kolkata North Bengal Medical college, Siliguri
Type of DST Technology Solid LPA Liquid P A A P P P P P A A P A A P A P
Uttar Pradesh
29 30
Uttarakhand West Bengal
P P P
P P P
(The UT's of D&N Haveli, Daman & Diu,Lakshwadeep and the States of Mizoram and Tripura are linked to their nearest CDST laboratories) A Accredited Laboratories P Accreditation in process
27
Procurement & Drug Logistics:
Central Procurement:Procurement, Supply & Logistics Unit at Central TB Division (CTD) is functioning under the supervision of Additional Deputy Director General (TB) who is supported by a Procurement & Supply Management Consultant and an agency outsourced with the assistance from WHO for drug logistics management. The procurement agency (M/s RITES Ltd.) undertakes procurement of drugs under various Programme Divisions of the MoHFW including RNTCP. The Procurement of 1st Line Anti TB Drugs (through World Bank funding) and procurement of 2nd line Anti-TB Drugs (through World Bank and GLC), Laboratory Equipment and Purified Protein Derivative (PPD) is presently being undertaken at the Central level.
Ltd.for World Bank funded states (Assam, Delhi, Goa, H.P, Jammu & Kashmir, Maharashtra, Puducherry, Chandigarh, Punjab) through International Competitive Bidding (ICB). Procurement of 2nd Line Anti TB Drugs for 11,550 pts. i.e.(GF-RCC-1200 pt.courses,GF-Rd-95350 pt. courses & UNITAID-5000 pt.courses) patients for GFATM funded states (Andhra Pradesh, Bihar, Uttar Pradesh, Rajasthan, Tamil Nadu, West Bengal, Karnataka, Madhya Pradesh, Gujarat, Kerala, Chhattisgarh, Haryana, Jharkhand, Orissa and Uttrakhand) and 4,850 patients funded by UNITAID was also done through Green Light Committee (GLC) and Global Drug Facility (GDF) which are part of Stop TB Partnership. The supply of drugs procured during the year through GDF is in process. The procurement of 2nd Line Anti-TB Drugs for 4550 patients under World Bank and for 20,450 for GFATM funded states for the year 2011-12 has been initiated. Quality Assurance of 1st& 2nd Line Anti-TB Drugs: Quality Assurance (QA) of Anti-TB Drugs has been accorded special importance by RNTCP and measures are taken to ensure both pre and post-dispatch inspection of the Anti-TB Drugs. (a) QA measures at the time of Procurement : 1st line Anti-TB Drugs - Since 2008-09, procurement of 1st Line Anti-TB Oral Drugs has been limited to 'WHO Pre-Qualified suppliers' and pre-dispatch inspection and testing of all batches is mandatorily done. Injection Streptomycin is procured through International Competitive Bidding (ICB) from WHO-GMP suppliers only, Joint Inspection for verification of WHO-GMP Certificates by a team under DCG(I) is ensured and predispatch inspection of all batches is done. 2nd line Anti-TB Drugs: - Procurement for the World
(i) Anti TB Drugs: - An uninterrupted supply of good quality Anti TB Drugs is an essential component of DOTS strategy under RNTCP. Supplies of Procurement for the Year 2010-11 have been completed, except for Inj. Streptomycin supplies which was delayed due to delay in testing of distilled water.
(a) First Line Anti TB Drugs:-With the financial support of DFID coming to an end in 2011, procurement of Drugs for the entire population of the country for both the World Bank and GFATM funded states shall now be done through International Bidding from 'WHO Pre-Qualified suppliers' only by RITES, the procurement agency of MoHFW (Govt. of India), following the World Bank procurement guidelines. As no WHO pre-qualified supplier is available for Injection Streptomycin, the same is continued to be procured through International Competitive Bidding. (b) Second Line Anti TB Drugs:- The 2nd Line Anti TB Drugs for 3450 patients under DOTS Plus is being procured during the year 2010-11 by M/s RITES
28
TB INDIA 2012
Bank funded States is done through ICB by the Procurement Agency of Ministry of Health & Family Welfare. For this procurement, WHO-GMP Certification is required, As in case of 1st line Anti-TB Drugs, Joint Inspection for verification of WHO-GMP Certificates by a team under DCG(I) is ensured and pre-dispatch inspection of all batches is done. For GFATM funded states, procurement is done through Green Light Committee (GLC) and Global Drug Facility (GDF) of Stop TB Partnership from "WHO Pre-Qualified suppliers" only. (b) QA Measures Post Procurement: Drugs procured (both 1st & 2nd Line) are tested at an ISO Certified, Independent Quality Assurance Laboratory selected from the list of DCG (I) Accredited testing Laboratories. Every quarter, random samples of AntiTB Drugs are drawn from one GMSD, one State Drug Store & 5 District Drug Stores and sent for testing to the independent QA Lab. The test reports are presented to a Committee headed by Drug Controller General (India). In addition to this, samples are also picked up randomly from the GMSDs, State Drug Stores & District Drug Stores by various Central and State Drug Inspection Authorities and sent for testing. Based on the test reports, further necessary action is taken by the Programme.
TB for technical assistance, supply of equipment & consumables for setting up of 40 identified LPA labs and 30 Liquid Culture labs. Out of the 40 LPA labs 17 have been accredited, 8 are in the process of accreditation and the remaining yet to initiate process. Out of 30 Liquid Culture labs, 6 LC technologies have been established and the remaining is in process. Based on this MoU and to facilitate training of the laboratory personnel from the identified sites, Foundation for Innovative New Diagnostics (FIND) in coordination with CTD established International Centre for Excellence in Laboratory Training (ICELT) at NTI, Bangalore and supplied equipment & reagents to nine seventeen laboratories and the process of supply of these equipments& consumable items to seven eight more laboratories is underway during the year 2011-12.
(iii)
Purified Protein Derivative
Government of India is procuring PPD vials for diagnosis of tuberculosis in pediatric patients in the country through International Competitive Bidding. For use of PPDs in the programme, a cold chain shall be required to be maintained. As relatively larger quantities of PPDs will require to be maintained primarily at the State and district levels, the States/STOs will need to strengthen the implementation of State / District Cold Chain programme in their respective states/districts. The State Drug Stores (SDS) shall take care of the entire State's Cold Chain programme relating to PPDs in their respective regional areas. Detailed guidelines on the supply chain for PPDs is under finalization at CTD. The procurement of PPDs has been done centrally by the Procurement Division of the MoHFW, based on requirement calculations and Technical specifications formulated by CTD and the Technical Committee.
(ii) Laboratory Equipment for Culture & DST for IRLs:RNTCP is in the process of establishing 10 more IRLs at Bihar, Goa, Himachal Pradesh, J&K (Jammu), J&K (Srinagar), Manipur, Punjab, Sikkim, Uttar Pradesh and Arunachal Pradesh. The Contracts for all the remaining items of Lab. equipment for solid Culture & Drug Sensitivity Testing (DST) for establishing these IRLs in the country were awarded during the year, delivery of all the equipment has been completed and the installation of most of the equipments has been done. New Initiatives for Diagnosis of TB RNTCP is linking development of MDR-TB diagnostic capacity to the expansion of MDR-TB treatment services under DOTS-Plus. During the year, the Programme has utilized the support provided by EXPANDx TB Project funded by UNITAID to accelerate the availability of rapid diagnosis of MDR-TB nationwide. Among the newer TB diagnostics approved by WHO, molecular Line Probe Assay (LPA) and Liquid Culture have already been implemented in STDC, Ahmedabad and STDC, Nagpur. According to the Memorandum of Understanding (MoU) between Ministry of Health & Family Welfare (GoI) and EXPANDx
(iv) BMs / LED Fluorescence Microscopes

Central TB Division is planning to replace the Binocular Microscopes with LED Microscopes in a phased manner over the next 5 years especially in the high work load settings. 200 LED Microscopes have already been procured by UNION for use in Projects in Medical Colleges. Though LEDs are more expensive than the ordinary BMs, studies have confirmed that the use of LEDs provide much faster diagnosis & more comfortable resulting ultimately in a better yield. Thus, it has been decided to procure LEDs also by CTD. CTD plans to procure 2500 LEDs during the year 2012-13 for high work load settings. Additionally 1500 BMs are also proposed to be procured for low work load settings..
29
Decentralized procurement:
As part of strengthening decentralized procurement, states have been repeatedly communicated to follow World Bank procurement guidelines strictly and the revised threshold limits for state/district level procurement of Goods / Works have been communicated to them. States are sending information about state/ district level procurement through "Procurement Reporting Format" circulated to them earlier by CTD, at the end of every quarter through the email ID i.e. distprocurement@rntcp.org. Capacity building for Decentralized Procurement :The Bi-annual National STO-RNTCP Consultants Review Meet was held at Surajkund, Faridabad, Haryana in May, 2011 and at Dwarka, Delhi in November 2011. The May Review Meet had a session on "Decentralized Procurement in TB II" which was conducted by the Chief Medical Officer dealing with RNTCP Procurements in CTD. During this Meet, a session on the Roles and Responsibilities of the STOs and the Medical Consultants in drug management was also highlighted. All the participants were also apprised of the general bottlenecks in this area. During the November Review Meet, the topic of procurement and supply chain were covered through a quiz which generated a very good response. During the year 2010, trainings on "Decentralized Procurement in TB II" were also conducted for State level officials in Punjab, Chandigarh, Maharashtra, Tamil Nadu by concerned officials from Central TB Division. Training on "Decentralized Procurement in TB II" was also conducted by Consultant (Procurement), CTD for the Accountants of all the States in February, 2010 at New Delhi.
software include Forecasting, Planning, Bid Processing, Bid Evaluation, Supply Orders, Quality Assurance, Stocks, Inter warehouse transfers, Bills & Invoices etc. Live data entry by RNTCP for the procurement details of 1st line and 2nd line anti TB drugs for the year 2010-11 has been completed. Drug Logistics Management: Drug requirements, consumption and stock positions, both at State and district levels are monitored at the Central TB Division (CTD) through the Quarterly Reports submitted by the districts. The 1st Line Anti-TB Drugs procured are stored at the six Government Medical Store Depots (GMSDs) across the country and issued to the States based on the Quarterly District Programme Management Reports and the monthly State Drug Stores (SDS) Reports. The States are required to maintain defined buffer stocks at each levels i.e., at the PHIs, TUs, DTCs & the SDS. The District Quarterly Reports are analyzed in detail at CTD and any discrepancies arising are notified to the concerned districts & States for necessary corrections. For long-term sustainability of the programme, decentralization of inventory management practices is very important. To ensure that the States are able to manage their drug logistics as per RNTCP guidelines, regular trainings & re-trainings on Drug Logistics Management were conducted by Central TB Division for the State & district level staff during the year. These trainings were imparted to State level officials, District TB Officers (DTOs), State and District level pharmacists alongwith respective RNTCP Medical Consultants. Such trainings were conducted for the officials in Uttar Pradesh, Meghalaya, Mizoram, Manipur, Nagaland, Himachal Pradesh, Chhattisgarh, Bihar, Assam, Arunachal Pradesh, Sikkim and Tripura. About 350 RNTCP officials/ Consultants have been trained during the year on Drug Logistics Management. The DTOs are expected to further train their sub-district level staff involved in drug logistics in their respective districts. Suggested- place for insertion of 2-3 photos on Drug Stores and Drug Logistics Training To study the impact of such trainings, CTD is also regularly re-visiting and doing field visits to some of the States already trained. Gujarat, Jharkhand, Andhra Pradesh, Uttar Pradesh, Meghalaya, Chhattisgarh and Assam were visited during the year by teams from CTD. Some improvements have been noticed but the lack of commitment by concerned officials at State and District levels is still seen as a major drawback. Some of the common observations noticed are:-
Post Procurement Reviews:Four Post Procurement Reviews of the Contracts in the States have been undertaken by CTD. Based on the reports of the Post Reviews, follow-up corrective actions are being taken by the concerned States. Post Procurement Review of State/ District level procurements are also being done during Central Internal Evaluation, Annual Financial Audit and visit to the States by officials from Central TB Division. Procurement Management Information System (ProMIS) Software:The web based software (ProMIS) to streamline procurement systems, developed by Empowered Procurement Wing (EPW) of the MOHFW has addressed all the key components of International best practices in procurement and logistics. The various modules of the
30
TB INDIA 2012
1) Poor drug storage conditions & lack of infrastructure at the drug store 2) Lack of contracted transportation arrangements from SDS to district drug stores 3) No full time pharmacist / store-keeper at the SDS and no designated officer to monitor drug logistics activities in the states visited. 4) No system of trainings / re-trainings conducted by the states visited for Drug Logistics Management. Logistics management of 2nd Line drugs is still a challenge under DOTS-Plus in RNTCP. Cycloserine and Ethionamide with a short- shelf life require continuous monitoring & regular Inter-State transfers to ensure maximum utilization and minimum expiry of these drugs. Currently, all 35 States have already implemented the DOTS-Plus programme in their respective States. Training on 2nd line drug logistics is also being imparted during the regular trainings on Drug Logistics Management
to State & district level staff. The same has been included in the Standard Operating Procedures (SOP) Manual for both State & District Drug Stores. New Initiatives undertaken during 2011 1. Government of India is procuring PPD vials for diagnosis of tuberculosis in pediatric patients in the country through International Competitive Bidding. PPD vials are to be stored and transported under cold chain ie.2-8o C. The detailed guideline for storage, transportation, recording and reporting has been finalized at CTD. 2. Revised Guidelines for storage of 2nd line Anti-TB Drugs at SDS, DTC & TU levels were finalized during the year and have been circulated to all the States for their implementation. 3. CTD is in the process of procuring LED Fluorescence Microscopes for high work load settings.
31
Human Resource Development
The ultimate goal of HRD for comprehensive TB control is to have the right number of people, with the right skills, in the right place, at the right time, who are motivated and supported to provide the right services to the right people. Vision: A world where every person, everywhere has access to a motivated and supported health worker, who is skilled in TB control. Goal: Health workers at different levels of the health system have the skills, knowledge, and attitudes (professional competence) necessary to successfully implement and sustain comprehensive TB control services based on the Stop TB Strategy. A sufficient number of health workers of all categories involved in comprehensive TB control is available at all levels of the health system with the needed support systems to motivate staff to use their competencies to provide quality preventive and curative TB services for the entire population according to their needs. Committed, qualified and trained health care providers equitably distributed at all levels are the foundation of an effective health system specifically in the context of TB since DOTS is human resource intensive and requires a strong patient-provider bond and extensive supervision and monitoring. The main thrust of the RNTCP was the provision of diagnostic and treatment facilities at the peripheries of the district and the creation of a sub-district level supervisory unit, which would also provide diagnostic and treatment services. Accordingly, and based on the TB epidemiology of the country, Designated Microscopy Centres (DMC) were set-up for every 100,000 population (for every 50,000 population in tribal and hilly areas) and TB units were set up at every 500,000 population (at every 250,000 population for hilly and tribal areas).
Unprecedented programme expansion in the last five years has outpaced capacity at central, state and district level to ensure quality of services. A workload analysis done by CTD, PATH & Initiatives Inc, highlighted the human resource gaps in many cadres. Members of the staff at state and district levels have to perform multiple functions leading to increased workload and being overburdened. Rapid turnover of officials and staff also necessitates frequent trainings, which is neglected at times. In addition, enhanced case finding, treatment, MDR, TBHIV, PPM, and ASCM activities required to achieve Universal Access over the next 5 years necessarily need a better approach to human resource development. Hence, there is an urgent need for national HRD planning that strategically and comprehensively addresses the overall staffing issues related to recruitment, capacity development, performance and retention. Key strategies for HR for TB control: HR needs assessment HR policy revisions Organize on going in-service training Initial training in all aspects of basic DOTS, TBHIV, MDR-TB, accounts, procurement, ACSM, etc. for existing staff and new hires including private providers in TB control Retraining for major performance problems On the job training for small performance problems Continued education Advanced training on management aspects such as health financing, leadership/governance, business planning, organizational development.
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Engage in strategic partnerships for health workforce development with other Training divisions/institutions, in-service training for programmes, Ministry of Education and other relevant ministries, Professional associations, Private sector including NGOs and Bilateral and international organizations Monitor and supervise health worker performance to detect performance deficiencies; identify new staff in need of training; identify additional staff needs for current interventions and for new interventions/strategies. Quality assessment of Training. Achievements The RNTCP structure for capacity building for DOTS implementation has allowed the programme to expand to full coverage and improved programme performance. This structure includes a HRD policy that envisages all times adequate number of staff at different levels of the health system, who have the skills, knowledge and attitude necessary to successfully implement and sustain TB control activities based on the DOTS strategy, including the implementation of new and revised strategies and tools. HR Approach: HR for DOTS implementation is well reflected in the RNTCP guidelines. The EHR (Epidemiology, Human Resources and Research) division, in the Central TB Division under the charge of an Additional DDG looks after HRD along with a National HR Consultant. Functions of the State TB Cell, State TB Demonstration Centre, and TB Unit team, national and intermediate reference laboratories, the Medical College Task Forces and core committees are well spelled out. The responsibilities of State TB Cell staff, district-level staff and PHI staff are clearly defined. Over years many initiatives has been taken to ensure adequate contractual manpower to support the general health system in managing TB control activities. Remunerations have been revised from time to time and increment policies are implemented. Other incentives like awards on World TB Day, achievements related incentives etc. have created a motivated workforce. Preference for candidates with experience of working in TB Control for recruitment at higher positions has further motivated the peripheral staff giving them progressive career pathways. Service delivery for TB care has been integrated with General Health System from the beginning. However due to certain aspects of programme like independent financial and supervisory structure of RNTCP has resulted in
perception of vertical programme by some. The general health system staffs at times do not take ownership of TB service responsibilities,which results in the burdening of the responsibilities to the insufficient number of contractual supervisory staff.Shifting of the existing TU structure to the block level would ensure effective integration with the general health system. The Block Medical Officer today has the responsibility for effective local implementation of all national disease control programmes and would include TB with the implementation of the proposed shifting of the TU structures. Alignment with NRHM Block Programme Management Units (BPMU) and its supervisory structures has the potential of leading to greater ownership and review of RNTCP by the general health system, and this is the aim of the programme in coming years.
Training
Levels / institutes of training:
1. International: Some of the highly specialized trainings like International trainings on TB epidemiology and operational Research in TB are attended by the RNTCP officials / Consultants at international level from time to time. This aids in keeping pace with the global developments and developing innovative and newer concepts in TB Programme Management. 2. National: Most of the trainings of the national and state master trainers as well as programme managers at state & districts level are conducted by highly experienced and qualified pool of national trainers and facilitators. These trainings are conducted mainly at NTI, Bangalore and LRS Institute of TB & Chest diseases, New Delhi. STDC Ahmedabad, Gujarat has been doing the national level master trainers training in PMDT since last four years. In addition, STDCs of Hyderabad, Andhra Pradesh and Thiruvanantapuram, Kerala also are conducting the national level master trainers training in PMDT since last two years. 3. State level: All 24 STDCs in the country are conducting the state level trainings of MO-TCs, STS, STLS, DTC-LT etc. This includes basic modular trainings, retrainings & update trainings on TB-HIV collaboration, PMDT etc. A pool of trainers trained at the national level including the officials of STDCs, STCs, medical college faculties has been developed over last one decade for this purpose, though this is an ongoing process considering the turnover. 4. Districts level: Medical Officers, LTs, Pharmacists throughout the country in the general health system are trained at the district level. District TB Officers and MO-
33
TCs are conducting these trainings with the assistance from the state level training teams. 5. Block level: Huge health workforce in the country including the Multi-purpose Workers (ANM/MPWs) and Health Supervisors and ASHAs are trained at the block level by the already trained MO-TCs, Block level Medical Officers etc with assistance from the District Training teams. 6. PHC/institutional level: Most of the community volunteers working as DOT Providers, ASHAs, AWWs and NGO workers are usually trained at the PHC / institutional level by the pool of trainers in the districts. Training Material: Standardized materials and schedules for initial training in DOTS in RNTCP, EQA, TB/ HIV, Culture and DST, and initial training for medical college staff, as well as schedules for retraining, have been developed. Skill development appropriate for the task responsibilities of different cadres of staff has been the central theme while developing training curriculums. There is on-going work to develop training materials for new initiatives including MDR, TBHIV, PPM, and ASCM modules. These training modules have undergone periodic revision based on need to reflect revised policies and recommended practices. RNTCP has been appreciated by several joint-monitoring missions for its attention to creating standardized training modules for each programme component and customized for each category of staff. It's to the credit of RNTCP that several lakh of health care providers in the general health system have been trained in various initiatives. Training methodology under RNTCP encourages participatory approach, includes reading of Modules, Interactions among participants & facilitators, Exposure to field situations, Module based Presentations, Problem based learning, Group exercises, Individual exercises, Role plays, Practical demonstrations and Presentations Training Activities: There are three types of training which address as different needs of the staff providing RNTCP services: 1.Initial RNTCP training: This includes all induction trainings in RNTCP of newly placed staff or replacement staff following staff turnover. In addition to the basic modular trainings for Medical Officers, STS, STLS, LTs and MPW, initial training for NGO and private practitioners is also included. 2.Re-training: These trainings would be mainly for individuals who have already received initial RNTCP training, but during supervision have been identified as requiring re-training on basic RNTCP activities.
3. Updates on new activities and initiatives: As the RNTCP introduces new activities and initiatives, it is imperative that the field staff is updated on these areas. These updates are given mainly by utilizing time under routine activities like regular programme review meetings such as the monthly district level meeting of the DTO, MO-TCs, STSs and STLSs and the quarterly state level review meetings. Details of training is given in Annexure Training Target Training needs are assessed on an ongoing basis based on the MIS data, reports from field visits, training requests received etc. Based on this annual calendar is prepared by the national, state, district and TU/Block level officials. The overall training plan includes number of batches, participants per batch, names and number so of trainers. Training Objectives 1. To impart necessary knowledge to the officials and staff working for TB Control 2. To develop necessary skills required for each cadre of staff 3. To develop huge Human resources required to ensure quality services across the country 4. To update knowledge and improve levels of skills for incremental quality and value addition to the services Quality assessment of Training Training quality is assessed before, during and after training. Pre-Test and Post-Test conducted gives the immediate understanding of the knowledge levels before and after the training amongst the participants. It also indirectly measures the effectiveness of the trainers to transfer knowledge to the participants. Anonymous Satisfaction surveys after the trainings help in improving the training environments, methodology, content etc which is conducted routinely after the national and state level trainings. Competency Framework Based on the requirements of the jobs and activities to be performed by each of the cadre of officials and staff at all levels in the health system throughout the country, RNTCP has devised the competency framework. Job responsibilities of all cadres of staff have been well defined in the technical and Operational guidelines of RNTCP. Based on the newer initiatives and time to time assessments these Job responsibilities are revised and circulated from time to time through out the country. Training materials and schedule and training methodology for each cadre is standardised with the aim to develop the
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TB INDIA 2012
necessary knowledge and skills for each staff. This Competency Framework is comprehensive and has aided systematic Human Resource Development under RNTCP. Trainer Development Cascade of trainings as mentioned previously ensures the development of trainers starting from the national level trainer till the PHC / institutional level trainers. Training institutions at all levels develops plans in coordination with different levels and this is synchronised annually and reflected in annual PIP. For developing trainers RNTCP
has developed partnerships with various agencies. 25 batches of National PMDT trainings were organized in 2011 by CTD whereapproximatly 800 key officials from state and district level, DOTS Plus site committee members, microbiologists of C-DST labs and RNTCP Consultants were trained in various batches held at the 4 National training Centers at New Delhi, Gujarat, Andhra Pradesh and Kerala. Partnerships for Health Workforce development: RNTCP conducted four specialized training in 2011 in collaboration with 'The Union' on TB Epidemiology, Leadership and Management in MDR-TB services, Operational Research & Integrated Management Development & Planning (IMDP). RNTCP conducted Trainings / workshops in collaboration with PATH India TB Project during 2011 including ACSM training for civil society partners, Engineers / Architects training on 'Building Design and Engineering Approaches to Airborne Infection Control', 2 IRL Experience Sharing Workshop, ACSM dissemination workshop, Innovative capacity building: In addition to routine / special trainings in batches, a lot of capacity and skill development actually happened through experience sharing between peers amongst the Programme Managers, RNTCP Consultants & partners during the workshops, national and regional meetings as well as state and central appraisals for PMDT scale-up. Way ahead: To facilitate process of Human Resource development under RNTCP, Central TB Division is in process of developing a web based application for HRD. This will enable better planning, coordination, real-time sharing of information, automated reporting by districts and states etc.
Training activities in 2011:

Officials & staff trained / Numbers re-trained in 2011 District TB Officer 319 Second Medical Officer of the DTC 95 Designated Medical Officer 517 (MO-TC) of the TB Unit DOTS Plus & TB-HIV Supervisor 111 Senior Treatment supervisor(STS) 604 Senior Tuberculosis Laboratory 715 Supervisor(STLS) TB Health Visitor 464 Data Entry Operator 164 DMC LT/Microscopist 2747 Medical Officer at BPHC/PHC/ 12732 CHC/ District Hospital/other Paramedical staff including health workers 30506 DOT providers/ Community Volunteers, 64542 including ASHAs Training and re-training in TB-HIV intensified package ICTC Counselors 665 District Supervisors 33 ART Medical Officers 58 Medical Officers 957 Paramedical Staff including LT and 15890 DOT Providers
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Monitoring and Evaluation System:
Successful implementation of even a perfectly designed programme entirely depends on a well laid out supervision and monitoring mechanism. The RNTCP, at the outset itself, had ensured that supervision and monitoring is an integral part of the programme and is well defined. Over the years, it can be correctly said, that a major reason for the success of the programme has been the effective supervision and monitoring of each programme activity and aspect. The RNTCP has a comprehensive system for regular supervision and monitoring at all levels - national, state, district and sub district. A robust surveillance structure through a well-defined recording and reporting system forms the lifeline of the RNTCP supervision and monitoring mechanism. The protocols for supervision through supervisory visits, review meetings and other means are clearly laid out in the 'Supervision and Monitoring Strategy'. Various tools to aid supervision and monitoring have also been developed and have been widely circulated for use which include checklists for supervisory visits, checklists for review meetings, and other means are clearly laid out in the 'Supervision and Monitoring Strategy'. Various tools to aid supervision and monitoring have also been developed and have been widely circulated for use which include checklists for supervisory visits, checklists for review meetings, job aids etc The various activities and implementation aspects extensively monitored under RNTCP are Political & Administrative commitment; Human Resources including trainings; Physical Infrastructure; Drugs & Logistics; Quality of services; TB-HIV collaborative activities; Involvement of NGOs & Private Practitioners; Advocacy, Communication and Social Mobilization activities; Annual Action Plans for the Districts and the States including the Financial management; Involvement of various institutions; Involvement of Community; Multi-Drug Resistant TB etc
The main indicators to monitor RNTCP implementation broadly revolve around the number of cases diagnosed and notified, and the percentage of patients who are successfully treated among those notified. However, the programme has further clearly defined indicators for each activity under the programme, defined further for each level of service delivery focusing on just not the outputs but also the inputs and the processes. Regular feedbacks, supervisory visits, series of review meetings and internal evaluations ensure early corrections in the implementation of the programme. The process of monitoring broadly covers supervisory visits, review meetings at various levels and programme evaluation by different levels of health personnel. Measurable indicators for quality control, programme outcomes and operational effectiveness are the basis for programme monitoring. Collection, Analysis and Feedback on Routine Surveillance Data: Surveillance data are received through the monthly (till sub-district levels) and quarterly reports (from sub-district levels and upwards). The reporting till district level is paper based and from district onwards the reports are electronically transmitted to the state as well as central levels. An accurately compiled quarterly report provides base level information about the performance of the programme. Central TB Division and the States analyze these quarterly reports received from the States/Districts and feedback is provided to the districts for further analyses and corrective actions. All the states were provided feedback on the quarterly reports in 2011 while more than 60% of the states have provided feedback to the districts for all the quarters in 2011. RNTCP presently uses 'EPICENTRE' for its data management which includes collection, validation, transmission, analysis and feedback of programme performance electronically. This is presently being used successfully for
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TB INDIA 2012
reporting of programme data from all the districts in the country. Data for all programme activities including TB-HIV activities is reported through the Epicentre, Figure 1: RNTCP Surveillance System
however, data for Programmatic Management of Drug Resistant TB (PMDT) is not reported through the Epicentre presently.
Supervisory visits and feedback: supervisory visits are the most powerful tools for programme monitoring and ensuring immediate corrective actions. It helps in validation of programme data and provides an opportunity to provide immediate feedback thus increasing the efficiency & motivation of the staff through updation of their knowledge, perfection of their skills and improving their attitudes towards work. RNTCP lays out clear responsibilities to the respective staff at all levels in relation to supervisory visits. The schedules of supervisory visits at different levels are depicted in Table 1. The supervisory visits made from the National level in the year 2011 are detailed as below: More than 90 visits were made to States/UTs
from CTD for various purposes. More than 60 districts were visited from CTD from wherein visits were made uptoperipheral level till patient's homes. For PIP appraisals for the FY 2011-12, fifteen visits were made to states. Seven visits were made in various missions such as the World Bank Mission etc More than 20 visits were made to states for various workshops, conferences etc More than 10 visits were made to attend various review meetings and committee meetings. More than 10 visits were made for laboratory accreditation and DOTS-plus appraisals.
37
anch isiting p er, R v . Offic ervisor isits TB trict ent Sup rvisory v Dis atm upe o1e Phot enior Tr during s S e the hom
Central and State level Internal Evaluations, through a well laid out protocol, serve as important tool for indepth qualitative & quantitative evaluation of the programme; validation of programme data; platform for sharing experiences on implementation practices; garnering political and administrative support etc The States conduct internal evaluation of 2 districts per quarter. In addition, internal evaluations are conducted by the central level with active participation of the States. The Medical Colleges, NGOs & other partners, NRHM and all other stakeholders are active participants in these nd a and arkh tients evaluations. i, Jh a
During 2011, the states have evaluated an approximately 90 districts using a standardized format which covers the entire gamut of RNTCP services. The reports are disseminated amongst the DTOs to enable corrective actions to issues in their districts. Actions taken on the recommendations are regularly reviewed by the state and the central level. The central level has visited and intensively evaluated 3 states - evaluated 6 districts in addition to reviewing state level issues.
ing t dur atien p -HIV a TB ting ry visits visi o - DTO supervis oto 2 Ph
Photo 3 - The Central Internal Evaluation team briefing the Deputy Commissioner, District Dharwad, Karnataka on the findings of the evaluation conducted from 13th to 15th February 2012.
Photo 4 - Additional DDG (TB), CTD, Dte GHS, MOHFW, GOI visiting the DOTS-plus site at Bangalore, Karantaka during the Central Internal Evaluation of Karnataka.
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TB INDIA 2012
ing ict nt be Distr Patie ation of o5lu Phot rnal Eva Inte
External Evaluation: the World Bank Mission to review the Revised National Tuberculosis Control Program (RNTCP) was undertaken between May 30 and June 9, 2011. The Joint Review Mission, coordinated by the Central Tuberculosis Division (CTD) of the Ministry of Health and Family Welfare (MOHFW) and the World Bank, included representatives of the World Health Organization (WHO), the United States Agency for International Development (USAID), the United States National Institutes of Health (NIH), the United Kingdom Department for International Development (DFID), the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Bill and Melinda Gates Foundation, and the Clinton Health Access Initiative tral en he C (CHAI). The mission included field visits to Bihar, ing t ataka. ur arn ed d view mkur, K Madhya Pradesh, Karnataka and Maharashtra. inter Tu
Review Meetings: a well laid out protocol for conducting review meetings at all levels ensures continuous interaction with the staff involved in service delivery and provide directions for improvement in programme. This also provides an opportunity to update the staff on various developments in the programme. The protocol for conducting review meetings at various levels and their frequency is detailed in Table 2. The various review meetings conducted by CTD in 2011 have been listed in the Box 'CTD - Activities in 2011'. Revision of the Supervision and Monitoring Strategy - with continuous evolution, widening priorities and
TB trict e Dis ng with h ing t Meeti visit sion . Review nderway Mis esh Bank e is u ad orld dhya Pr B Centr T 6 - W e, Ma o trict Phot , Indor e Dis ntre taff of th Ce the s
Photo 7 - Dr. Jagdish Prasad, DGHS, Dte.GHS, MOHFW, GOI addressing the Biannual National STO-RNTCP Consultant Review Meeting, 3rd - 4th November 2011.
developing challenges such as the Multi-Drug Resistant TB (MDR-TB), Universal Access, TB-HIV co-infection etc it is necessary that the supervision and monitoring strategy also undergoes revisions appropriately. The focus is now on integrating the supervision mechanisms of the programme with the general health systems and also bringing within its forte the use of newer technologies and addressing issues of MDR-TB and TBHIV co-infection. Accordingly the new supervision and monitoring strategy has been rolled out addressing these issues with a futuristic vision to also include electronic reporting of individual patient data from the most peripheral levels and also notification of TB from all health care providers. RNTCP policy on maintenance of various records has also been defined. The list of indicators have also been appropriately revised and grouped for different levels of users and purposes.
39
Newer Initiatives
Case Based Web Based Reporting: the
programme is in the process of developing mechanisms for case based electronic reporting of data and tracking of all cases, including drug resistant and HIV associated TB, in field. It is also envisaged that the mechanism would be extended to support reporting of individual patientwise data for all TB patients from the most peripheral levels to have information in real time, to the extent possible, thus paving ways for immediate corrective actions even at the patient level.
matic area affecting the composite score will be available for further necessary action for improving the programme performance. The composite score would henceforth be used for monitoring of performance along with the present objectives of the programme. The detailed guidelines on the composite score to identify programme performance are available on the website (www.tbcindia.nic.in). To ensure its effective use it is essential that the districts and the states should analyse the scores at the end of each quarter and identify gaps for corrective actions; the scores be presented to higher officials for garnering support for corrective actions required and ensure its use in all review meetings.
Composite Indicator: the performance of the Revised National Tuberculosis Control Programme is presently being monitored on the basis of New Smear Positive Treatment Success Rate and New Smear Positive Case Detection Rates. These are purely output indicators and do not measure the overall management processes which are more crucial for the success of the programme. In order to assess the performance comprehensively various input and process indicators are equally important as the output indicators. Accordingly the programme has devised a composite indicator scored on the basis of a set of indicators covering all aspects of programme management, the input and the output to measure the performance of programme over all thematic areas. The composite score would be generated for each district in an automated manner through the Epicenter and will be accessible to district at the end of a quarter after uploading of its quarterly reports. It is expected to roll out the scores through Epicenter by April 2012. However, the scores have been manually calculated for the 4th quarter 2011 and included in the Annual Performance Report for 2011. To encourage broad based analyses of the programme implementation and performance, as a policy matter, it has been decided that the scoring rules for each indicator would not be shared. However the scores for each the-
Focused Action Plan for Under-performing districts:

RNTCP is achieving the Global Target of 85% Treatment Success rate and 70% Case detection rate among New Smear Positive cases since 2007 however; there are wide variations across the states and the districts. As per the RNTCP annual data (2010) there are 35 districts with both NSP CDR <50% and NSP TSR <85%; 78 districts with NSP CDR < 50% and 120 districts with NSP TSR <85%. The programme has developed a strategy for all under performing districts with the 35 districts wherein both NSP CDR and TSR are low have being specifically chosen as High focus districts for intensified monitoring & supervision by CTD. The core strategy to improve programme performance in these districts would revolve around broadly four activities District specific situational analysis. Development of district specific microplan,Intensified support to the districts by the concerned state and district authorities Capacity Building, Resource Mobilization and Empowerment Intensified Monitoring and Supervision for efficient implementation & timely corrective measures.
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Programmatic Management of Drug Resistant TB (PMDT):
RNTCP Response to the challenge of drug resistant TB: The programme has developed a multi-faceted response plan to combat the challenge of drug resistant TB. The key focus of RNTCP is to prevent the emergence of drug resistance by providing quality DOTS diagnostic and treatment services, increasing the visibility and reach of the programme services and promoting adherence to International Standards of TB care by all healthcare providers. Indiscriminate and injudicious use of anti-TB drugs, especially outside the programme, is a significant contributor to the emergence of drug resistance TB. The programme has taken concrete steps to promote rational use of anti-TB drugs, these include the development of a guidance document, popularly called "The Chennai Consensus Statement", for healthcare providers on the
prevention and management of drug resistance TB outside the programme settings. The programme through the aegis of professional medical associations and Medical Council of India is sensitizing, educating and urging healthcare providers on judicious use of anti-TB drugs. The intervention of drug regulatory authority of the country is being sought to strictly enforce sale of antiTBdrugs against valid prescription through a special directive. Besides initiating and strengthening measures forprevention of drug resistance, the programme hassimultaneouslyinitiated diagnostic and treatment services for the managementof MDR TB. These services are considered "Standard of Care" and are an integral component of RNTCP to manage M/XDR-TB through the existing programme.
GoI commitment at Beijing Ministerial Meeting 2009

Plan for patients to be tested and treated for MDR-TB
*Based on RNTCP 2012 goal of MDR diagnosis for all S+ retreatment patients,
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The PMDT services for quality diagnosis and treatment of drug resistant TB cases were initiated in 2007 in Gujarat and Maharashtra. Despite the modest progress from 2007 - 2009, the programme has ambitious plans to rapidly scale up the DOTS Plus services in the country. In 2009, it was envisioned that by the end of 2011 the MDR TB services will be introduced in all the states across the country in a phased manner. By 2012 it is aimed to extend drug susceptibility testing to all smear positive retreatment cases upon diagnosis, and all new cases who are smear-positive after first-line anti-TB treatment. By 2015 drug susceptibility testing will be made available to all smear positive cases registered under the programme. It is intended to be initiating MDR TB treatment at a rate of 30,000 MDR cases annually by the end of 2012. This plan was part of the commitment made by Government of India at the Beijing Ministerial Meeting "Call for Action" of 27 High Burden Countries in 2009. This is further complemented by a nation wide laboratory scale up plan developed by the programme with an ambition to have 43 culture & DST laboratories (Solid & LPA techniques including Liquid Culture in 33 labs) in the public health sectors by 2015 The next five year National Strategic Plan (2012-17) for RNTCP is being developed at the Central TB Division with the objective to provide universal access to quality diagnosis and treatment to all TB cases in the community including TB HIV and Drug Resistance TB cases. As part of this strategic plan, the following key interventions are being proposed for further scaling up towards universal access of PMDT services: 1. Procurement of rapid automated NAAT i.e. the cartridge based rapid molecular test (GenXpert) 2. Procurement of second line anti-TB drugs for management of MDR TB cases scaled up to 38,000 courses annually by 2017 including drugs for management of Extensively Drug Resistant TB (XDR TB) 3. Additional HR - Counsellor at all DR-TB Centres to promote treatment adherence 4. Further enhancement of honorarium to the DOT Providers of M/XDR TB cases RNTCP services for MDR-TB and plans for scale-up have been the subject of extensive national and international review, including a joint mission of the WHO Green Light Committee (GLC) and Global Lab Initiative (GLI) in April 2010, and the RNTCP joint donor and partner mission of May 2010.
and treatment services. Diagnosis is based on clinical indication to offer DST to initially all failures of first line regimen, contacts of known MDR TB case. Subsequently, additionally, All Sm +ve re-treatment cases at diagnosis, any Sm+ve follow up case and finally extended to include All Sm -ve re-treatment cases at diagnosis and HIV associated TB cases at diagnosis. For diagnosis of XDRTB, DST for second-line drugs is extended to patients on MDR TB regimen if Culture +ve at 6 months. For drug susceptibility testing sputum specimen is transported to accredited reference laboratory. Line Probe Assay (LPA), if available is the preferred DST method for first line drugs. DST for 2nd line drugs is done at 3 National Reference Labs (TRC, NTI, LRS). Capacity building of RNTCP certified labs to conduct 2nd line DST proposed in 2012.
Treatment of M/XDR TB: Treatment of Drug

Resistant TB is based on Rifampicin DST results (RIF mono-resistance rare). Initial Hospitalization at DOTS Plus Sites is followed by ambulatory care. Standardized treatment Regimen for MDR TB under daily DOT includes (6-9m) Km Lfx Cs Eto Z Emb / (18m) Lfx Cs EtoEmb. PAS is used as a substitute drug in case of intolerance. Drug supply using 1 monthly patient wise box of different weight bands is in place. Standardized treatment Regimen for XDR TB under daily DOT includes (6-12m) Cm, PAS, Mfx, High dose?H, Cfz, Lzd, Amx-Clv / (18m) PAS, Mfx, High dose?H, Cfz, Lzd, Amx-Clv. Clr and Thz used as a substitute drug in case of intolerance.
Accomplishments during 2011: The key activities

undertaken for enhancements of programmatic management of drug resistant TB under RNTCP in India are summarized below: National PMDT scale-up plan 2011-12 documented (by consolidating and analyzing the plans of 35 states/UTs) and hosted on www.tbcindia.nic.in as endorsed and recommended at the 7th National PMDT Committee meeting held in July 2011. This plan was presented at various international forums listed below: WHO SEARO Meeting of WHO country offices' focal points on Regional Response Plan for PMDT - March '11 Indo-US International Workshop on Facing the reality of MDR TB: Challenges and Potential Solutions in India - Mar '11 WHO - GDF meeting with Indian Drug Manufacturers - April '11 & Aug '11 Joint Donor Review Mission of RNTCP in India
Diagnosis of M/XDR TB:

PMDT under RNTCP follows decentralized diagnostic
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TB INDIA 2012
through World Bank in May '11 The UNION World Lung Conference at Lille, France - Oct '11 WHO National Tuberculosis Programme Manager's Meeting at Bangkok - Dec'11 The systematic participatory approach in planning to align national resources like second line drugs, lab capacity, national training and appraisal needs with the timelines of phase wise scale up plans of the state by 2012 was highly appreciated by the international experts and experts from WHO. The Chair of UNION Expert Committee on DR TB commented at the Lille Conference that India has set out an example for other countries of SEAR region and other high burden countries to develop ambitious PMDT rapid scale up plans. Guidelines for Programmatic Management of Drug Resistant TB in India revised and hosted on www.tbcindia.nic.in as endorsed and recommended at the 7th & 8th National PMDT Committee meeting held in 2011-12. This revision have lead to a paradigm shift in the guidelines from a clinically oriented to a public health oriented one delineating the pathway for the country to move towards universal access of M/XDR TB diagnosis and management. The revisions broadly include updated RNTCP PMDT Vision & Scale up Plan, decentralized diagnostic approach with newer rapid diagnostics with access to pediatric, EP TB and HIV TB cases, updated mechanisms for lab certification and sample collection transport system, optimized regimen for MDR TB with High Dose Levofloxacin, scope for regimen alteration in MDR TB cases with baseline resistance to Ofloxacin and/or Kanamycin, services for HIV MDR TB co-infection management, revised drug supply management system to monthly PWBs, revised R&R, reconsideration of HR and PPM strategies and introduction of supervision, monitoring and evaluation strategy for PMDT. Strategy for Supervision, monitoring, evaluation and job aides for PMDT developed and introduced for states in preparatory as well as implementation stage. Standard monitoring indicators as per international guidelines on access to services, case finding, 6 and 12 months interim reports and treatment outcome on quarterly and annual cohorts evolved and published in RNTCP Annual report (TB India 2011) and Quarterly
RNTCP Performance reports since 1st Quarter 2011. These indicators are used for review on PMDT coverage and performance at national and state level meetings. This SME strategy for PMDT is slated to be integrated in the RNTCP Strategy for SME being updated at CTD. Focused and periodic intensive PMDT review meetings at regional levels with key state officials introduced to closely monitor the progress made by every state against their respective state PMDT scale up plans to get the momentum of scale up of PMDT services further accelerated as well as organize timely intervention from central and state level, rope in assistance from NRLs and partners like FIND and PATH, to support the states complete pending preparatory activities as per the state plans. The technical review material is based on standard PMDT monitoring indicators analyzed from quarterly reports, appraisal report findings and standard template of key preparatory and quality parameters for every state. Six regional PMDT review meetings were conducted in 2011-12. The states have made significant progress in scale of services within their respective states as witnessed during the series of meeting held in February 2012. 25 batches of National PMDT trainings organized in 2011 by CTD where ~ 800 key officials from state and district level, DOTS Plus site committee members, microbiologists of CDST labs and RNTCP Consultants were trained in various batches held at the 4 national training centers at New Delhi, Gujarat, Andhra Pradesh and Kerala. Central PMDT Appraisals were conducted in 138 districts across 31 states in 2011 and their action taken reports were reviewed before issuing official approval on behalf of CTD to roll out services. A team of ~ 150 experts to conduct central appraisals through a mentoring approach cascading over every subsequent central appraisal to systematically build capacity of selected experienced officials from state and district level and RNTCP Consultant's network to conduct central appraisals. Central Procurement of second Line Anti-TB Drugs: 15,000 MDR TB drug courses have been procured in the year 2011 through support from multiple sources i.e. World Bank, Global Fund,
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UNIT AID through Green Light Committee and Global Drug Facility. The drugs have started arriving at the state drug stores in tranches. Systematic public health response to the Mumbai XDR TB Episode in January 2012: The media in Mumbai published an article on 7th January 2012, on emergence of an incurable form of TB termed as "Totally Drug Resistant" (TDR) TB that created a panic situation in the community. This report was based on a letter to Clinical Infectious Disease Journal in December 2011 described 4 patients from Mumbai, India with extensively drug resistant tuberculosis (XDR TB), erroneously labeled as "TDR-TB" by the authors. Later, 8 more cases were reported by Hinduja Hospital, subsequent to the publication in the journal. Immediate cluster investigations were undertaken and a team of experts and senior officials from the Central TB Division (CTD) visited Mumbai from 16th - 19th January 2012, to guide the local team, administrators and political leaders to develop a response plan and initiate actions. Actions taken and under way to
date are as follows: Respond to the specific cases by re-testing of isolates reported as 'TDR' and cluster investigation, contact tracing, screening and addressing Public fear by Communications through press releases and IEC campaigns. Quickly establishing Laboratory surveillance and infection control measures in major private hospitals Further strengthening of basic DOTS services by adequate decentralization Accelerate the scale-up of DR TB diagnostic and treatment services in Mumbai by increasing the C&DST laboratory capacity and promoting public private partnership Extending RNTCP treatment services to patients diagnosed in private laboratories after confirmation. Achievements and Status of RNTCP in enhancements of PMDT services till 2011: India proudly announces the accomplishment of RNTCP PMDT Vision for 2011 by
services in all 35 states by 2011 was achieved on 10th Jan 2012. All 35 States/ UTs have introduced PMDT services in some districts with variable access and scaling up. 508 million (43%) population have access to services that varies from states to state as depicted in the figure below. 11 /35 (31%) States-UTs have achieved 100% complete geographical coverage and are progressing towards achieving universal access.
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At the end of the 4th quarter of 2011, the PMDT services have been scaled up to 260/662 (40%) districts. Further 65/ 662 (10%) districts have advanced to offer DST to all smearpositive ret r e a t m e n t pulmonary TB cases and to cases with any follow up smear positive during first line treatment. M o r e o v e r , treatment initiation and monitoring of cases is undertaken through 50 DOTS Plus Sites across the country.
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Indicator C-DST Labs Accredited Number of States implementing DOTS Plus Number of Districts implementing DOTS Plus (All failures as MDR TB suspects) Number of Districts implementing DOTS Plus (All S+ve RT cases as MDR TB suspects) Population with access to DOTS Plus services Number of DOTS Plus Site functional Number of MDR TB suspects Number of MDR TB cases diagnoses Number of MDR TB cases put on treatment
Upto Dec 2010 19 (4 LPA) 12 138 0 288 million 20 20965 6046 3610
Upto Dec 2011 35 (18 LPA) 35 260 60 508 million 50 38187 10267 6994
Achievement in 2011 16 (14 LPA) 23 122 60 220 million 30 17222 4221 3384
Since the inception of PMDT services in India, a cumulative total of 38155 MDR TB Suspects have been examined for diagnosis; 10263 MDR TB cases have been confirmed and 6994 MDR TB cases have been initiated on regimen for MDR TB. Over the last four decades, there has been a gradual and exponential increase in the number of cases tested for MDR TB and initiated on treatment and the momentum gained in the programme sets the stage for accelerating scale up of services across the country in 2012-13. The following table summarizes the achievements of PMDT scale up in the year 2011 asompared to 2010: Regular reporting and analysis of TB treatment outcomes for programme improvement is an ongoing activity in
RNTCP, and MDR TB treatment services are no different. The treatment outcomes of MDR TB for the initial states have been reported and presented in the data tables later in the document. These are the first MDR TB treatment outcomes under RNTCP. These patients were generally heavily treatment experienced, chronic cases, and so expectations on treatment outcomes were limited. Substantial improvements in policies and procedures have been implemented to reduce treatment default, affective 1 in 5 registered MDR TB case. Explanatory research is underway to understand the unacceptable failure rates, but early results suggest poor outcomes have been strongly associated with baseline pre-treatment Ofloxacin resistance in this patient cohort. This analysis is being expanded to subsequent sites and cohorts to inform
The challenges faced in implementation of PMDT services and solutions deployed by the programme are summarized in the adjoining table:
Challenges in PMDT & Solutions Deployed

Challenges Meeting timelines of scale up plan ~ 30% attrition from Dx to Rx : Diagnostic delay with Solid DST (TAT - 3-4 m), Tracing patients for treatment initiation (deaths, refusals, migration while waiting for diagnosis) Low treatment outcomes Solutions M&E strategy developed Aggressive & regular monitoring by RNTCP 5 large experienced states to shift to Criteria B with LPA (TAT - 48-72 hrs) in Dec '11 Demonstrate feasibility of automated NAAT to offer decentralized same day diagnosis ( TAT - 2 hrs ) Advance diagnosis early during first line Rx Optimized regimen with Levofloxacin Altered regimen for baseline mono-resistance to Ofx and KM with MDR TB developed Build capacity of all labs for SL DRS Research for better regimen Develop integrated national on-line electronic recording and reporting system GoI committed for greater part of financing in the next 5Y National Strategic Plan 2012-17
Information management Future Financing
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ongoing revision of programme policies and procedures. Initiatives proposed for 2012-13: More aggressive monitoring of PMDT Scale up by various states from CTD to achieve nationwide coverage by 2012-13. CTD team visits proposed to states. Lab capacity deficit being addressed Linkage with NRLs and MoU with SRL reference labs x 4 GeneXpert (18 TU project + 12 Expandx TB project) and GT Blot machines National Consultation to finalize modalities for
"Lab and provider Notification of TB" and "Restricting over the counter sale of anti-TB drugs" Strengthening Urban TB Control initiatives and further decentralization of TB units Revision of PPM Strategy with innovations to partnerships and engagement with major corporate hospitals and laboratories. Capacity building of accredited labs to conduct DST on 2nd line anti-TB drugs Central procurement of drugs for XDR TB, to be available from 2013 onwards. States to continue local procurements till then
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TB/HIV collaboration:
Since the advent of the collaborative efforts in 2001, TB-HIV activities have evolved to cover most of the recommendations as per the latest WHO policy statement issued in 2012. In 2007, the first National Framework for joint TB-HIV collaborative activities was developed which endorsed a differential strategy reflective of the heterogeneity of TB-HIV epidemic. Coordinated TB-HIV interventions were implemented including establishment of a coordinating body at national and state level, dedicated human resources, integration of surveillance, joint monitoring and evaluation, capacity building and operational research. Interventions have focused on improving services for HIV-infected patients, with intensified TB case finding at HIV care settings and linking with TB treatment; and for TB patients with provider initiated HIV testing and counseling, provision of ART and decentralized CPT and nationwide coverage is expected by 2011-12.
Progress
Tremendous progress has been made in the implementation of collaborative TB/HIV activities. 1. Intensified TB case finding has been implemented nationwide at all HIV testing centers (known as integrated counseling and testing centres, or ICTCs) and has now been extended to all ART centres, with better reporting coming from States implementing the intensified TB-HIV package. During 2010, in just the 7 highest-HIV burden States implementing the Intensified TB-HIV package, more than 393,000 TB suspects were referred from ICTCs to RNTCP and of them 35,500 were diagnosed as having TB. This has improved tremendously in 2011 with close to 7 lakh TB suspects identified and tested for TB in HIV care settings; of them, close to 84,000 TB cases were diagnosed and linked to TB treatment services. (Table 1.)
2. HIV testing of TB patients is now routine through provider initiated testing and counselling (PITC), implemented in all states with the intensified TB-HIV package. In these settings, the density of HIV counselling and testing services is adequate for PITC for TB patients to be effectively implemented. In 2010; 480,752 TB patients (59% of total TB patients registered in the 19 States implementing the intensified TBHIV package for at least 2 quarters) were tested for HIV; 41,476 (9% of those tested) were diagnosed as HIV positive and were offered access to HIV care. This continues to improve in 2011. Among the 23 states reported in 2011, close to 6 lakh TB patients were ascertained for their HIV status (67% of TB patients registered) and about 44,000 HIV-infected TB patients were diagnosed. Persons found to be HIV-positive are eligible for free HIV care at a network of antiretroviral treatment (ART) centres. ART centres are located in medical colleges, mainly staffed and operated by the State AIDS Control Societies, and a few are situated within the facilities of private or NGO partners. As of December 2011, more than 300 ART centres were operating in the country, and 550 linkART centres. Ten Regional Centres of Excellence provide second-line ART services for PLHIV. The number of centres providing second line ART (ART-plus centres) is expected to increase in 2012-13. HIV-infected TB patients who are on protease inhibitor based second line ART are getting rifabutin-based TB treatment in place of
Table (1): Intensified TB Case Finding at ICTC and ART centres, 2011 HIV care facility ICTC ART centre TOTAL Number of clients / patients screened for TB diagnosis 580150 111509 691659 Number of TB patients detected 55456 28431 83887
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have been developed, including special recommendations for airborne infection control activities in ART centres. Ten ART centres are included in a pilot project for airborne infection control currently underway in three States. Challenges However, several challenges remain. Only about 50% of TB patients know their HIV status and of those identified as HIV positive, only about 60% are linked to ART as the majority are poor and unable to reach centralized ART centres. As compared to TB services, which are mostly decentralized and integrated into the general health system, HIV services remain largely centralized. Thus, this gap between RNTCP and NACP infrastructure results in suboptimal linkages. Sputum smear microscopy is not a sensitive tool to diagnose TB among PLHIV, and access to a culture based diagnosis (or equivalent technology) is lacking. Implementation of airborne infection control measures in health care settings is also limited. The INH preventive therapy is not yet a policy; but is being tested for operational feasibility for further decision. Despite the achievements, the mortality among HIV-infected TB patients continues to be unacceptably high. Vision: Universal access to TB/HIV care (2012-17) There may be several reasons for the high mortality among HIV-infected TB patients: these include undiagnosed or late diagnosis of HIV, delayed or missed TB diagnosis among PLHIV, provision of inadequate chemotherapy to drug-resistant TB cases in the context of unavailability of decentralized culture and DST facilities, late presentation by HIV/TB patients (indicated by low CD4 counts at the time of diagnosis), and operational issues like long distances to travel for patients and lack of finances resulting in suboptimal linkages to centralized ART services. Available evidence suggests mortality reduction may be most effectively driven by efficient, early and improved HIV diagnosis, improved
Rifampicin. Among HIV-infected TB patients diagnosed, nearly 91% were started on cotrimoxazole prophylaxis and nearly 60% were started on ART. Though this is an improvement over past performance, this is not sufficient and both programmes are making substantial efforts in 2011 to improve early initiation of ART in HIV-infected TB patients 3. ART guidelines have been revised and ART is now to be initiated among all HIV-infected TB patients irrespective of CD4 count and all PLHIV with CD4 count less than 350/mm3. 4. The TB/HIV scheme under RNTCP has been revised to increase the involvement of community care centers in collaborative activities. 5. Airborne infection control at ART centres and associated HIV care settings (community care centres and "Link" ART centres) has been identified as an area of increasing importance. Studies have shown high rates of exogenous reinfection among HIV-infected persons with recurrent TB, suggesting that these patients have been re-exposed to TB after being cured. National Airborne Infection Control guidelines
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diagnosis of TB among PLHIV and prompt initiation of ART and TB treatment among HIV-infected TB patients. Results from the SAPIT (Starting ART at three points in TB treatment), CAMELIA (Cambodian early versus late initiation of ART) and STRIDE (Strategy immediate) trials have all demonstrated the mortality benefit of early compared to deferred initiation of ART during TB treatment, especially in the subgroup of patients with advanced immunodeficiency. The National AIDS Control Organization's adoption of recent WHO recommendations to treat all HIV-infected TB patients with ART, irrespective of CD4 count, and other measures being put in place to enhance access of HIV-infected TB patients to ART should help enhance survival. Hence, RNTCP and NACP (National AIDS Control Programme) have jointly planned the following interventions in their next strategic plans (2012-17): 1. Given the need to strengthen collaborative efforts, the next five-years would focus on reinforcing mechanisms for ensuring effective implementation and improving service delivery for TB and HIV infected patients. 2. Decentralization of HIV testing facilities and colocation in all TB microscopy centres has been planned to ensure universal coverage of HIV testing among TB patients. 3. Early and improved diagnosis of TB and Rifampicin resistance, through rapid diagnostic technology for PLHIV is envisaged. Field-testing and deployment of improved TB diagnostic tools, such as high-sensitivity cartridge-based nucleic acid amplification tests, for more effective diagnosis of TB and drug-resistant TB among PLHIV is expected to reduce morbidity and mortality. 4. Measures to improve access of HIV-infected TB patients to ART centres by provision of travel support and engagement with the affected community have been planned. 5. Early initiation of ART for all PLHIV with CD4 counts of <350, and for all HIV-infected TB patients irrespective of CD4 count. Early initiation of ART is expected to improve immune competency and prevent the development of TB. 6. Recording and reporting formats have been modified to optimize supervision and monitoring of implementation of TB/HVI collaborative activities. 7. More than half of PLHIV globally and in India do not know their HIV status and are diagnosed late. Initial results of research into the feasibility of "PITC among TB suspects" as a method of
achieving early and improved diagnosis of HIV has been promising, and broader surveillance is planned to drive policy decisions. Again, earlier HIV diagnosis can broaden opportunities for HIV care and treatment, including TB prevention. 8. The National Technical Working Group for TB/ HIV has approved an operational feasibility cum efficacy study for Isoniazid Preventive treatment among PLHIV. The study will be led by National Institute for research in TB (earlier TRC, Chennai) and conducted in 12 ART centres in the country. The results of this study will guide nationwide scale-up. Operational Research for TB-HIV: RNTCP conducted an operational research on provider initiated HIV testing and counseling (PITC) among TB suspects based on recommendation of National Technical Working Group (NTWG). The study was conducted in one district each of Andhra Pradesh and Karnataka (Vizianagaram and Mandya), with an objective to assess if PITC was feasible and effective in finding out "new" HIV cases given that all TB suspects were offered HIV testing. This study showed that HIV prevalence among TB suspects can be as high as that among TB patients ranging between 7%-10%, and also that PITC can be feasibly implemented in settings with decentralized HIV testing facilities. Acknowledging the strong evidence, NTWG recommended the national programmes to implement PITC among TB suspects in high HIV settings; the same would be piloted in 1-2 high prevalence states at all DMC with co-located HIV testing facility for a period of 3-6 months with mechanisms for recording and reporting to finalize the operational guidance before scale-up to other high HIV settings. The NTWG also recommended national programmes to implement similar surveillance activities in moderate and low HIV settings. Accordingly, protocols have been developed and surveillance has been initiated in 10 districts of the country. Evidence generated from these studies will guide scaleup across the country. Global guidelines for treatment of TB among persons living with HIV: unresolved issues Revised National TB Control Programme (RNTCP) in India uses a fully intermittent thrice-weekly rifampicincontaining regimen for all TB patients including those who are HIV-infected; whereas, WHO recommends daily TB treatment at least during the intensive phase. The WHO recommendation was based on the results of a meta-analysis demonstrating increased risk of recurrence and failure among HIV-infected TB patients receiving intermittent TB treatment, compared to a daily regimen.
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Review of the primary evidence indicates limited, lowquality information on intermittency, mostly from observational studies in the pre-antiretroviral treatment (ART) era. Molecular epidemiology in India indicates that most of the recurrences and many of the failures resulted from exogenous re-infection, suggesting poor infection control and high transmission rather than poor regimen efficacy. Subsequently published studies have shown acceptable TB treatment outcomes among HIVinfected TB patients receiving intermittent anti-TB regimens with concomitant ART. Treatment outcomes
among HIV-infected TB patients treated under programmatic conditions show low failure rates but high case-fatality; death has been associated with lack of ART. Hence, the highest priority is to reduce mortality by linking all HIV-infected TB patients to ART. While urgently seeking to reduce death rates among HIVinfected TB patients, given the poor evidence for change and operational advantages of an intermittent regimen, RNTCP intends to collect the necessary evidence to inform national policy decisions through randomized clinical trials.
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Childhood Tuberculosis
Background The actual burden of pediatric TB is not known due to diagnostic difficulties but has been assumed that 10% of total TB load is found in children. Globally, about 1 million cases of pediatric TB are estimated to occur every year accounting for 10-15% of all TB; with more than 100,000 estimated deaths every year, it is one of the top 10 causes of childhood mortality. Though MDR-TB and XDRTB is documented among pediatric age group, there are no estimates of overall burden, chiefly because of diagnostic difficulties and exclusion of children in most of the drug resistance surveys. Contrary to traditional national TB programmes pediatric tuberculosis (i.e., TB among the population aged less than 15 years) has always been accorded high priority by RNTCP since the inception of the programme. In order to simplify the management of pediatric TB, RNTCP in association with Indian Academy of Pediatrics (IAP) has described criteria for suspecting TB among children, has separate algorithms for diagnosing pulmonary TB and peripheral TB lymphadenitis and a strategy for treatment and monitoring patients who are on treatment. In brief, TB diagnosis is based on clinical features, smear examination of sputum where this is available, positive family history, tuberculin skin testing, chest radiography and histopathological examination as appropriate. The treatment strategy comprises three key components. First, as in adults, children with TB are classified, categorised, registered and treated with intermittent short-course chemotherapy (thrice-weekly therapy from treatment initiation to completion), given under direct observation of a treatment provider (DOT provider) and the disease status is monitored during the course of treatment. Second, based on their pre- treatment weight, children
are assigned to one of pre-treatment weight bands and are treated with good quality anti-TB drugs through ''ready-to-use'' patient wise boxes containing the patients' complete course of anti-TB drugs are made available to every registered TB patient according to programme guidelines. To be noted that India was the first country to introduce pediatric patient wise boxes. Progress 1. The number of pediatric TB cases registered under RNTCP has shown an increasing trend in the past five years and for 2011, about 90,000 cases were notified accounting for 7% of all cases. Expectedly, smear negative and EP cases predominate. 2. Treatment for MDR-TB for children is now available under the program and a new weight band (<16kg) has been created. 3. The treatment outcomes of pediatric TB cases, though not reported routinely under the programme, have been studied in operational research settings. Operational research conducted in the states of Delhi, Karnataka and Gujarat reported very high treatment success rates (about 95% among new TB cases) among pediatric TB patients indicating the effectiveness of RNTCP regimens and management guidelines. Challenges However, these guidelines were developed in 2004 and since then there have been changes in global and national guidelines in management of pediatric TB. Specifically, novel evidence has become available regarding the correct dosages, schedule of treatment and formulations
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of medicines for treating pediatric TB. Following this concerns have been raised over the adequacy of the RNTCP-recommended drug doses, which for some children on a milligrams per kg basis fall below that recommended in 2009, especially those at the higher end of the individual RNTCP pre-treatment weight bands (eg, 9-10 kgs, 16-17 kgs, 24-25 kgs, 29-30 kgs). World Health Organization updated its guidelines in 2009-10, through a series of coordinated efforts to review and synthesize evidence on correct dosages of anti-tuberculosis medicines in children based on systematic reviews, pharmacokinetic simulations and preparation of evidence summaries using GRADE profiles and analysis. WHO has issued a rapid advice in 2010 detailing the key recommendations. The guidelines of the International Union against TB and lung disease have also been revised in 2010. The Indian Academy of pediatrics has also revised its recommendations in 2010. Owing to these changes, there are differences between current RNTCP recommendations and that recommended globally and nationally which need to be reconciled in consensus with the national experts in
managing tuberculosis in children. National consultation on management of childhood tuberculosis in 2012 In order to reconcile between global and national guidelines, to review the evidence base and update the RNTCP guidelines in consensus with Indian academy of paediatrics, a national consultation was organized in January 2012. The above mentioned issues were extensively deliberated and several changes have been recommended in the diagnosis, treatment and prevention of childhood TB. Once approved by the ministry, these will be widely disseminated in 2012. National Technical Working Group on Pediatric TB, a mechanism for continuing consultation: It has been decided that a national technical working group of 10-12 experts on pediatric TB would be constituted with clearly defined terms of reference. This would provide a forum for continuing consultations with experts and an opportunity to evolve the guidelines based on evolving evidence.
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Research
Impact assessment :
Estimating Tuberculosis disease burden is important for planning, monitoring and evaluation of TB control programme. Progress towards Millenium Development Goals is measured especially with three indicators of TB disease burden viz: prevalence, incidence and mortality with current status in comparison to level in 1990. In India, TB surveillance especially in private sector is inadequate as TB notification is not mandatory and the incidence rates were estimated based on Annual Risk of TB Infection (ARTI) surveys done in 2002-03. These surveys were repeated between 2008 - 2011 as Nationwide (zonal) ARTI Survey coordinated by NTI, Bangalore in association with New Delhi TB center (North Zone) MGIMS, Wardha (West Zone) LRS Institute, new Delhi (East zone) CMC, Vellaore (South Zone) For estimation of TB Prevalence in the country TB Prevalence Surveys were undertaken between 2007-2011 by the programme at following seven sites: TRC Chennai - MDP Project NTI, Bangalore MGIMS, Wardha PGI, Chandigarh AIIMS, New Delhi JALMA, Agra RMRCT, Jabalpur Also TB mortality surveys were conducted by TRC, Chennai in 2005.
TB burden estimation in India were Based on the results of these surveys and the analysis of the TB notification data being collected under the Revised National TB Control Programme.
Estimation of TB Prevalence:
Data after pooling was exposed to higher statistical analysis including data mining (for missing data) & multiple imputations using R software before applying more sophisticated and appropriate analysis for prevalence estimation for reducing the uncertainty. Various adjustments were made to finally estimate the TB prevalence using the known proportions of children, EP TB cases etc. The point estimate of the year 2008 for the TB Prevalence in India was thus made from this pooled analysis. For estimating the trend between 1990 and 2012 the baseline was taken as 1956 National TB Prevalence survey conducted by NTI with assumptions of no significant change till 1990 level. Trend of TB Notification data under the TB Control Programme in the country was used from year 2000 to 2010.
Estimation of TB Mortality:
Both Direct and Indirect method were considered using
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the differential TB mortality under DOTS strategy under the Revised National TB Control Programme and outside the programme for the total estimated TB patients separately for HIV positive and HIV negative for estimating the TB Mortality.
risk of TB infection. 4. Indirect estimation using studies of the prevalence of TB disease. 5. Indirect estimation using mortality data recorded in vital registration systems. 6. Indirect estimation based on an assessment of
The TB mortality for the year 2005 was estimated based on the TB mortality surveys conducted in year 2005. Forward and backward calculation was based on the estimated TB prevalence trend. Estimation of TB Incidence: The Annual Risk of TB Infection (ARTI) has decreased from 1.5 in 2002-03 to 1.1% nationally in 2008-10 with the estimated decline of 3.7% per year (95% confidence interval, 2.4-5.1% per year). As an independent marker of trends in TB transmission, it definitely indicates possibility of decreasing TB Incidence in the country. ARTI has limited value in direct estimation of TB Incidence due to various factors challenging the use of fixed Styblo's calculation for this purpose. Internationally following methods are recommended by WHO for estimation of TB incidence: 1. Direct measurement from TB notification data 2. Direct measurement from prospective cohort studies. 3. Indirect estimation using surveys of the annual the completeness of TB notification data. Incidence for 2010 was estimated according to the method of Estimating TB incidence from estimates of the proportion of cases detected, including use of results from two sub-national inventory studies. The level of underreporting for 2010 was estimated at 34% within the same uncertainty bounds of 24% - 44%. For estimation of the trends in TB estimation, trend of notification of incident TB cases under the Programme between year 1990 and 2010 was used similar to the estimation of Prevalence Based on RNTCP's notification data from the programme's own notifications, limited prevalence surveys and limited mortality surveys, estimated disease burden of TB in terms of Incidence, Mortality and Prevalence per 1,00,000 in India as below:
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Table 1.
Year Best 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 216 216 216 216 216 216 216 216 216 216 216 216 215 214 212 209 205 201 196 190 184 Incidence * High 255 254 252 250 248 247 245 244 243 241 240 240 239 237 235 232 228 223 217 211 204 Low 181 182 184 185 187 188 189 191 192 193 194 194 193 192 190 187 184 180 176 171 165 Best 39 39 40 40 41 41 42 42 42 43 43 43 43 43 42 40 38 36 34 32 29
Prevalence
Low 56 56 57 57 57 58 58 59 59 60 60 60 61 61 59 52 54 51 48 45 42 High 25 26 26 26 27 27 28 28 28 29 29 28 29 28 28 29 26 24 22 21 20 Best 459 460 460 461 462 462 463 464 464 465 466 456 436 409 383 358 335 314 294 275 256
Mortality
High 515 516 516 517 518 519 519 520 521 521 522 510 498 475 454 436 419 405 393 382 373 low 407 407 408 408 409 409 410 411 411 412 412 400 379 347 317 288 261 234 209 185 161
However it may be noted that these are 'best' point estimates that are highly transparent in their uncertainty. The trends of estimated TB prevalence, mortality and incidence in India shows decline in TB burden The RNTCP is based on global scientific and operational guidelines and evidence, and that evidence has continued to evolve with time. As new evidence became available, RNTCP has made necessary changes in its policies and programme management practices. In addition, with the changing global scenario, RNTCP is incorporating newer and more comprehensive approaches to TB control. To generate the evidence needed to guide policy makers and programme managers, the programme implemented measures to encourage operational research (OR). Efforts of RNTCP to promote OR yielded success and most of the studies has are linked to the main priorities of TB control. The programme requires more knowledge and evidence of the effectiveness of interventions to optimize policies, improve service quality, and increase operational efficiency. This has led to the realization of the need for a more proactive approach to promoting OR for the benefit of the TB control efforts. Furthermore, the programme seeks to better leverage the enormous technical expertise and resources existing within India both within the Programme, and across the many medical colleges, institutions, and agencies. Operational research aims to improve the quality, effectiveness, efficiency and accessibility (coverage) of the control efforts. Operational studies promoted are generally: of low cost and limited staff time, because they should not deviate excessive resources from service delivery and disease reduction, of short duration, because the results should be available rapidly to decide on programme changes if necessary,
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Name of the zone
No. of thesis proposals approved (3Q10-2Q11) 21 14 5 28 4 72
No. of OR proposals submitted to Zonal OR committee (3Q10-2Q11 15 15 3 27 2 62
No. of OR proposals approved by the Zonal OR committee (3Q10-2Q11) 2 7 2 2 1 14
North South East West North East Total
based on simple standard protocols, to be repeated in different environments, and giving priority to test solutions to identified problems and to develop new implementation methods to improve the programme. Following is the summary of number of Operational Research proposals and status of approval by the mechanism of State OR Committees, Zonal OR Committees and National Standing OR Committee. At the national level 6 OR proposals were received in 2011, of which three were considered and none was approved. At the national level currently five research studies are ongoing: Evaluation of the efficacy of trice weekly DOTS regimen in TB Pleural effusion at 6 months Assessment of RNTCP Strategy of FNAC diagnosis and duration of treatment for peripheral Lymphadenitis Study on the treatment of abdominal Tuberculosis: A randomized controlled trial to compare the 6 months of cat-I treatment with 9 months of Cat-I treatment (extension for 3 months) in abdominal TB under RNTCP ARTI Survey in urban slum of Delhi Sputum smear conversion and treatment outcomes of New Smear Positive tuberculosis patients with co-existing diabetes mellitus put on Category I RNTCP treatment Following two research studies are completed: Socioeconomic implications and incidence of default amongst patients on DOTS, Himachal
Pradesh 2008-2010 Treatment of Genital Tuberculosis: A Randomized controlled trial of either Discontinuation at 6 months or continuation till 9 months after initial response to RNTCP Category I treatment. OR Capacity Development under RNTCP: Central TB Division conducted first round of Operational Research course in collaboration with The Union, WHO, CDC and NTI in 2011. In this series of three workshops, the participants identified 16 important research questions, developed protocols and in between did the review of literature, sought Ethics Committee and administrative approvals, collected data &analysed data and ultimately came up with international quality research papers. The facilitators from the partnering agencies / institutions and the Programme built the capacity of the participants to conduct fruitful, relevant operational research under RNTCP. Following important research questions were answered in this process of capacity development. What proportion of TB patients would have been additionally diagnosed to have DM, if all TB patients are actively screened for DM? What is the HIV Sero-prevalence among TB suspects (aged 18 years or more) examined for diagnostic smear microscopy at Designated Microscopy Centres (DMCs) in two districts of South India? Does watching a video of a narrative of cured tuberculosis patients (photo-voice) increase adherence to TB medications among new tuberculosis patients? Among pulmonary TB suspects examined for smear microscopy in a DMC, is there an increase
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in yield of sputum positive cases when the sputum is concentrated by 'overnight bleach sedimentation' technique as compared to direct microscopy? What is the additional yield of TB suspects and s+TB cases by ICF among household contacts of TB cases? Among all smear positive patients registered in 3Q10 what are the factors for delay in initiation of RNTCP treatment after diagnosis in 1 district (Bardhaman) of W.Bengal and 1 district (Nalgonda) of AP? What is the impact of single sputum sample examination during follow ups on management of pulmonary TB patients in RNTCP? Do private practitioners (PP) who are exposed to RNTCP involvement efforts report better diagnostic and treatment practices for TB than practitioners who are not exposed with regards to International Standards of TB Care? Are there any differences in TB management practices by PP in VSK as compared to ISTC Among TB patients registered under RNTCP
what are the patient and provider related factors associated with non-testing for HIV? What is the duration between onset of symptoms and diagnosis in a cohort of smear positive TB patients diagnosed in the district of Patna by Revised National Tuberculosis Control Programme (RNTCP) and what factors are associated with delay in diagnosis? Wat are KAP among providers of alt systems of medicine regarding diagnosis, treatment and management of patients with cough as well as chest symptomatic What is the prevalence of Ofloxacin resistance among MDR TB samples detected during antiTB drug resistance surveillance in Andhra Pradesh? What are the risk factors for death and default among NSP cases in Karnataka? What proportion of the diagnosed TB patients in Medical Colleges of West Bengal and Meghalaya, are availing RNTCP treatment services? What is the usefulness of the result of mid CP
Over years, RNTCP has made progress in not only promoting Operational Research in TB control but has also created environment to support the research initiatives by collaborations and use the scientific evidences created for policy changes. Examples of research studies conducted under RNTCP in India that led to impact on Programme policy and practice. Study title HIV sero-prevalence among tuberculosis patients in India, 20062007. Impact This study was conducted by Central TB Division. This study showed that The burden of HIV among tuberculosis patients varies widely in India ranging from 1% to 13%. Programme efforts to implement comprehensive TB-HIV services should be targeted to areas with the highest HIV burden. The study highlighted the need for surveillance through routine reporting or special surveys are necessary to detect areas requiring intensification of TB-HIV collaborative activities. This research study was conducted by the State TB Cell of Andhra Pradesh. The study showed that the reported initial default rates are very high and actual rates are nearly half of what is reported due to problems with recording and reporting patient treatment initiation status. The study also showed that pre-diagnostic counseling of patients, and better address recording in laboratory registers of DMCs may help in patient tracing. Reference # PLoSOne. 2008 Aug 20; 3(8):e2970.
Initial default among diagnosed sputum smearpositive pulmonary tuberculosis patients in Andhra Pradesh, India.
International Journal of Tuberculosis and Lung Disease (2008) 12: 1055-1058.
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Study title Linking HIV-infected TB patients to cotrimoxazole prophylaxis and antiretroviral treatment in India
Impact This study undertaken from Central TB Division showed that among HIV-infected TB patients in India death was common despite the availability of free cotrimoxazole locally and ART from referral centres. Death was strongly associated with the absence of ART during TB treatment. To minimize death, programmes should promote high levels of ART uptake and closely monitor progress in implementation. This study was commissioned by Central TB Division to assess the prevalence of MDR TB amongst TB Cases. The study showed that the prevalence of MDR-TB among new cases is 2.4% (95%CI 1.6-3.1) and among re-treatment cases it is 17.4% (95%CI 15.0-19.7%). MDR-TB prevalence remains low among new TB patients in Gujarat, but is more common among previously treated patients. Among MDR-TB isolates, the alarmingly high prevalence of OFX resistance may threaten the success of the expanding efforts to treat and control MDR-TB. This operations research study was conducted by Central TB Division. This study showed that amongst the large number of re-treatment patients in India, default occurs early and often. Improved pretreatmentcounseling and community-based treatment provision may reduce default rates. Efforts to retrieve treatment interrupters prior to default require strengthening. This operations research study was conducted by Central TB Division. The study showed that the RNTCP strategy of treating children using pediatric patient wise boxes is effective in achieving programme defined treatment success rate. In response to the raising notification rates of retreatment TB cases across the country, particularly that of the 'retreatment others', this operations research study was conducted by Central TB Division in co-ordination with the State TB Cell of Andhra Pradesh. The notification of 'Retreatment others'. 'Retreatment others' were predominantly sputum smear-negative TB, with significantly better treatment outcomes than among smear-positive retreatment patients.
Reference # PLoS One. 2009 Jun 22;4(6):e5999
Surveillance of drugresistant tuberculosis in the state of Gujarat, India.
International Journal of Tubercculosis Lung Diseases. 2009 Sep;13(9):1154-60.
Risk factors for treatment default among retreatment tuberculosis patients in India, 2006.
PLoS One (2010) 5: e8873. 10.1371/journal.pone.0008873 [doi].
Characteristics and programme-defined treatment outcomes among childhood tuberculosis (TB) patients under the national TB programme in Delhi. Tuberculosis 'retreatment others': profile and treatment outcomes in the state of Andhra Pradesh, India.
PLoS One (2010) 5: e13338 10.1371/journal.pone.0013338 [doi].
INT J TUBERC LUNG DIS (2011) 15(1):105-109
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Study title Source of Previous Treatment for ReTreatment TB Cases Registered under the National TB Control Programme, India, 2010.
Impact This operations research study was conducted by Central TB Division, to understand the implications of rising numbers of re-treatment tuberculosis cases across the country. The study showed that nearly half of the re-treatment cases registered with the national programme were most recently treated outside the programme setting. Enhanced efforts towards extending treatment support and supervision to patients treated by private sector treatment providers are needed to improve the quality of treatment and reduce the numbers of patients with recurrent disease. In addition, the study recommended that reasons for the large number of recurrent TB cases from those already treated by the national programme require urgent detailed investigation. This operations research study was undertaken from Central TB Division, to understand the resource implications of adopting the 2010 WHO ART guidelines. This study showed that in Karnataka, India, about nine out of ten HIVinfected TB patients were eligible for ART according to 2006 WHO ART guidelines. The efficiency of HIV case finding, ART evaluation, and ART initiation was relatively high, with 78% of eligible HIV-infected patients actually initiated on ART, and 80% within 8 weeks of diagnosis. This study recommended that ART could be extended to all HIV infected TB patients irrespective of CD4 count with relatively little additional burden on the national ART programme.
Reference # PLoS One (2011) 6: e22061. 10.1371/journal.pone.0022061 [doi];PONE-D-11-07281 [pii].
Will Adoption of the 2010 WHO ART Guidelines for HIV Infected TB Patients Increase the Demand for ART Services in India?
PLoS ONE (2011) 6(9): e24297. doi:10.1371/journal.pone.0024297
follow-up sputum smear examinations in declaring outcomes and guiding further management of smear positive TB patients under RNTCP? The second round of this OR capacity building workshops will soon start in April 2012. Similar course is organized in collaboration with MSF, in addition to the OR courses being organized in the leadership of NTI, Bangalore with support of WHO. RNTCP also has promoted participation by sites in India for international research. One of the studies on MDRTB regimen for this is being piloted internationally including sites from India under STREAM study.
and reactivation amongst the successfully treated NSP TB patients under the Programme. Operational feasibility of GeneXpert technology will be studied for consideration of this newer diagnostic tool in the programme for implementation as a policy. Programe has planned OR dissemination workshop with assistance of WHO in 2012 for ensuring better utilization of the results by the people of interest. Programme is in process to develop web-based application for streamlining Operational Research to facilitate transparent and accountable system ensuring timely feedback and decisions of the respective OR committees to the applicant Principal Investigators.
Steps ahead:
NIRT Chennai will be soon start a multi-centric study for estimating the proportion of Relapse
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Piloting Joint TB-DM collaborative activities:

Background The most recent estimates of the global burden of diabetes mellitus (DM) come from the 2011 Diabetes Atlas of the International Diabetes Federation. In 2011, there were an estimated 366 million cases of DM globally, and by 2030 it is expected that this number will have risen to 552 million. 80% of people with DM live in low- and middle-income countries and 50% of all people with DM (183 million) are undiagnosed. It is estimated that DM caused 4.6 million deaths in 2011. As a consequence of urbanization as well as social and economic development, there has been a rapidly growing epidemic of diabetes mellitus (DM) in India. Available data suggest that an estimated 11% of urban people and 3% of rural people above the age of 15 years have DM. Among them about half in rural areas and one third in urban areas are unaware that they have DM. Most recent estimates from the International Diabetes Federation put the number of persons with diabetes mellitus at 61.3 million (10% of the adult population), with a further 77 million having impaired glucose tolerance. TB-DM interactions The recent medical literature on the interactions between Tuberculosis and Diabetes has shown that:People with a weak immune system, as a result of chronic diseases such as diabetes, are at a higher risk of progressing from latent to active TB. Hence, people with diabetes have a 2-3 times higher risk of TB compared to people without diabetes About 10% of TB cases globally are linked to diabetes A large proportion of people with diabetes as well as TB is not diagnosed, or is diagnosed too late. Early detection can help improve care and control of both DM can lengthen the time to sputum culture conversion and theoretically this could lead to the development of drug resistance if a 4-drug regimen in the intensive phase of therapy is changed after 2 months to a 2-drug regimen in the presence of culture-positive TB. People with diabetes who are diagnosed with TB have a higher risk of death during TB treatment and of TB relapse after treatment. DM is complicated by the presence of infectious
diseases, including TB. It is important that proper care for diabetes is provided to patients suffering from TB/DM. It has been argued that good glycemic control in TB patients can improve treatment outcomes. However the precise mechanisms by which the interactions take place are still not clear. Epidemiological surveys and studies have been completed and published or are currently being conducted in India on the association between DM and TB. Epidemiological models using 2000 data in India have shown that DM accounts for 20% of smear-positive pulmonary TB and recent analyses have indicated that the increase in DM prevalence in India has been an important obstacle to reducing TB incidence in the country. In Tamil Nadu, crude prevalence rates of diabetes and pre-diabetes in TB patients were found to be 25% and 24% respectively with rates in the general population being 10% diabetes and 8% pre-diabetes. A comparison of different methods of screening for diabetes (fasting blood glucose, oral glucose tolerance test and HBA1C) showed the fasting blood glucose to be the more cost-efficient. In a study from the state of Kerala, 44% of the TB patients were found to have diabetes (as compared to a prevalence of 16%-20% diabetes in the general population) - 23% of the TB patients had self-reported diabetes, and 21% were newly diagnosed to have diabetes on measurement of HBA1C (> 6.5%). These works suggests high levels of DM in patients with TB in the states of Tamil Nadu and Kerala. This may have an important effect on TB treatment outcomes by lengthening the time to sputum culture conversion, increasing death rates and increasing the risk of recurrent TB after successful completion of TB treatment. This association may also theoretically lead to the development of multi-drug resistant TB (TB resistant to rifampicin and isoniazid). The epidemiological and clinical interactions between TB and DM are similar to that between TB and HIV. The impact of these interactions, though different in magnitude at individual level may even out at population level due to higher prevalence of DM in the population. The similarity of interactions provides an opportunity for application of lessons learnt in TB-HIV collaboration to TB-DM collaboration as well. Global response An important step in the fight against DM and TB has been the development of a WHO-Union Framework for Collaborative activities to guide policy makers and implementers in reducing the dual burden of DM and TB (Table). This was developed through a 2-year consultative process, with WHO giving clearance to
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develop a Framework rather than Guidelines due to lack of strong evidence to support some of the suggested interventions. The Framework was released in August 2011,and will serve as a guide to help policy makers and implementers to move forward to combat the looming epidemic. It will be important to ensure that interventions are delivered within the context of general health systems and take account of other chronic non-communicable diseases, and that engagement is sought both with and from civil society.
Specific objectives of the pilot project are:a) To actively screen TB patients for DM b) To refer those suspected or diagnosed with DM to appropriate diabetes care c) To actively screen DM patients attending specialized clinics for Tuberculosis and link those diagnosed as TB to RNTCP. d) To record and report on the screening data.
Table: Collaborative activities to reduce the dual burden of TB and DM A. Establish the mechanisms for collaboration A.1. Set up means of coordinating DM and TB activities A.2. Conduct surveillance of TB disease prevalence in DM patients in medium and high-TB burden settings A.3. Conduct surveillance of DM prevalence in TB patients in all countries A.4. Conduct monitoring and evaluation of collaborative DM and TB activities B. Detect and manage TB in patients with DM B.1. Intensify detection of TB disease among DM patients B.2. Ensure TB infection control in health care settings where DM is managed B.3. Ensure high quality TB treatment and management in people with DM C. Detect and manage DM in patients with TB C.1. Screen TB patients for DM C.2. Ensure high quality DM management among TB patients TB = tuberculosis; DM = diabetes mellitus One of the important activities of the Collaborative Framework is the routine implementation of bidirectional screening of the two diseases. The ways of screening, recording and reporting for the two diseases in routine health care settings are not well determined, and these knowledge gaps need to be addressed. National response - Applying lessons from TBHIV collaborative activities A national stakeholders meeting was held in Delhi, India, (October 2011) between The Union, WHO, World Diabetes Foundation (WDF), RNTCP and NPCDCS (National programme for prevention and control of Cardiovascular diseases, Diabetes mellitus, Cancer and Stroke) authorities to review and discuss linkages between diabetes mellitus (DM) and tuberculosis (TB), the need for bi-directional screening and the WHOUnion Collaborative Framework. At the national stakeholders' meeting it was agreed that the feasibility of bi-directional screening should be assessed as pilot projects within routine health care services. The aim of the pilot project is to assess the feasibility and results of screening tuberculosis (TB) patients for diabetes mellitus (DM) and vice versa within the routine health care settings. A training module has been developed by Central TB Division to assist in capacity building of the field staffs implementing the project. The pilot is being conducted in 14 sites across the country and the results will be available by the end of October 2012. The results will be presented to all the stakeholders including the national programme authorities for decisions on nationwide scale-up. Synergies and convergence with NRHM: The National Rural Health Mission (NRHM) is providing accessible, affordable and accountable quality Health services even to the poorest households in the remotest rural regions. NRHM aims to carry out the necessary architectural correction in the basic health care delivery system of the country by increasing public expenditure on health, reducing regional imbalances in health infrastructure, pooling resources, integration of organizational structures, optimization of health manpower, decentralization of district management of health programmes, community participation and ownership of assets, and the induction of management and financial personnel into district health system. These large scale initiatives to strengthen the health system as a whole, shifting the focus from sector wide approach to much more integrated approach, resulted in positive impact in health indicators including Tuberculosis.
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RNTCP, is an integral part of the NRHM and would continue to deliver its services through State/District Health society created under the umbrella of NRHM. As RNTCP is being implemented through the general health system, NRHM would further help in strengthening delivery of DOTS services and increasing accountability of general health system. NRHM is providing persistent super vision and monitoring in addition to the administrative, financial, operational support to the programme. A quarterly review meeting at state and District level, with greater focus and priority to RNTCP during the review of National Disease Control Programs, might be an option to strengthen implementation at the block level. To further decentralize to improve accessibility of services, the sputum collection centres have been established at the identified Primary Health Centres (PHCs), sub-centres, private practitioners, private hospitals, anganwadis, schools, pharmacies and any other location as decided by the programme. Trained ASHA workers can facilitate sputum collection and transportation from the community. TB/MDR-TB patients below poverty line may be linked to social welfare scheme available with the Block Development Officer on regular basis. This will enable these patients to receive additional nutrition through
additional ration above the basic eligibilities. Similarly linkages may be developed with the IDSP where IT enabled services are available at the PHI level. In the rural areas, this will be focused on convergence with NRHM and leveraging on the structures and systems that have been established but In the urban areas the programme will focus on linking of appropriate field level structures for Implementation of the programme with flexibility to integrate with the urban health systems both in public and private sector. The vision of the TB programme for the next five years is to strengthen the decentralized programme structure and ensure integration with mainstream public health systems. To address the issues at sub-district level, the programme has planned to align the TU to the block level administrative structure of NRHM. The existing TU for a population of 500,000 is planned to cover a reduced population of 200,000 when aligned with the block administrative structure of NRHM. The block level medical officer will function as medical officer -TB control supported by a STS. However, the STLS will cover a population of 500,000. A project under "Practical Approach to Lung Health (PAL)" is being piloted with the General Health System for management of chest symptomatic patients who are found to be symptomatic even after the antibiotic trial.
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Partnership
The programme achieved an engagement of all relevant health-care providers in tuberculosis (TB) care and control through public-private and public-public mix approaches (PPM). However despite various successful PPM models, it has been estimated through various studies that 30-40% of all TB cases are still not notified under the programme. To achieve the objective of "Universal access" it is mandated that these missing cases are brought under the umbrella of RNTCP. The central government departments like railways, steel,
ports, coal and mines have their own health care facilities spread across the country. Usually these facilities cater to a "captive population" who receive subsidized or free services from said facilities. The health facilities outside Ministry of Health (Other sectors), like Employees' State Insurance (ESI), Railways and Central Government Health Services (CGHS), as well as the Ministries of Defence, Steel, Coal, Mines, Petroleum and Natural Gas, Shipping, Power, Chemicals and Fertilizers, have been roped in the programme and directives have been issued to their respective health facilities to adopt the 'DOTS Strat-
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egy'. The Central TB Division (CTD) published guidelines for the participation of the NGOs (2001) and private practitioners (2002). The schemes were made more flexible and new schemes like Culture and DST in private labs, sputum collection and pick-up, slum scheme and TB HIV scheme were introduced, as recommended by a National Consultation in January 2008 . The schemes were rolled out in October 2008. Till date over 1900 NGOs and over 10,000 Private practitioners are involved in the revised schemes. Intensified PPM project The Central TB Division runs the Intensified PPM Project in fourteen urban areas in the country to systematically
undertake intensified PPM activities and to document the contribution of major categories of health providers to case detection and treatment under RNTCP. The 14 sites are large urban areas in 14 different states: Thiruvananthapuram (Kerala), Chennai (Tamilnadu), Bangalore (Karnataka), Bhopal (Madhya Pradesh), Bhubaneswar (Orissa), Ranchi (Jharkhand), Patna (Bihar), Kolkata (West Bengal), Pune-Mumbai (Maharashtra), Ahmedabad (Gujarat), Jaipur (Rajasthan), Lucknow (Uttar Pradesh), Chandigarh and New Delhi. The reporting focuses on the following four areas: 1. 2. 3. 4. Referral of TB suspects New smear positive case detection DOT provision to TB patients and, Their treatment outcome.
Involvement of Medical Colleges in RNTCP

Involvement of medical colleges in the RNTCP is a high priority. Under RNTCP Medical Colleges play important roles in service delivery, advocacy, training and operational research. Systematic involvement of medical colleges under RNTCP has been a huge success story.RNTCP is supporting Medical Colleges with additional human resources, logistics for microscopy, funds
to conduct sensitizations, trainings and research in RNTCP priority areas. Medical colleges have contributed in a major way in finding more TB cases, especially smear negative and extra - pulmonary cases. The involvement of Medical Colleges in RNTCP completed 10 years. Evolution of Medical College involvement in RNTCP Keeping in view of increasing participation of Medical colleges in the Programme as tuberculosis units,
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microscopy centers, treatment observation centres, etc., medical colleges were divided in five zones North, East, West, South and North-East which is being increased to seven zones this year to ensure maximum representation and proper involvement of Medical Colleges. Medical College Core Committee: A Medical College Core committee is formed in each Medical college including least 4 members, with representatives from department of medicine, chest medicine, microbiology and community medicine. The Core Committee functions to establish quality assured sputum smear microscopy facility in the medical college as well as treatment and referral services to all kind of TB patients. Furthermore it Organize sensitization / workshops / trainings for faculty members / PGs / UGs / Interns / paramedical staff, etc and also undertake Operational Research for RNTCP. Each Medical College is provided with a Medical Officer, Lab technician and a TB Health Visitor to facilitate the RNTCP activities through the respective District Health Societies. The logistics for the laboratory and all the reporting formats are provided by RNTCP. State Task Force (STF): Composed of a Chairman who is an elected representative from the medical college in the State, STO of the State is the member secre-
tary. Members of STF include representatives of each of the Medical colleges of the State, on rotation basis if required. The main task of STF is to provide leadership and advocacy, coordination, undertake monitoring, lead operational research and support policy development on issues related to effective involvement of medical colleges in RNTCP at State level and to Ensure establishment of DMC cum DOT centers in all Medical Colleges. Zonal Task Force (ZTF): Composed of a Chairman who is an elected representative from STF chairpersons in the respective Zone with two years tenure. Member secretary of ZTF will be the STO of the State where Medical College of ZTF Chairman is situated. Members of ZTF are representatives of the State Task forces within the zone. . In addition to Ensuring constitution of State Task Force (STF) in all States under the Zone, the main task of ZTF is to provide leadership and advocacy, coordination, undertake monitoring, lead operational research and support policy development on issues related to effective involvement of medical colleges in RNTCP at Zonal level. The annual Zonal Task Force (ZTF) CMEs cum Workshops are held every year. The Medical college Zonal task force workshop is an opportunity for reviewing the performance of medical colleges and advocating the guidelines of RNTCP.
ZTF workshops were held as follows during 2011:
ZTF workshops East Zone 2011
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ZTF workshops 2011 Sr No 1 2 3 4 5 Zone East South North-East North West Venue and STF Ranchi, Jharkhand Hyderabad, Andhra Pradesh Sikkim New Delhi Ahmedabad,Gujarat Dates 4th-5th Aug '11 11th -12th Aug '11 19th - 20th Sep '11 14th- 15th September'11 29th - 30th Sep '11
National Task Force (NTF): The NTF comprises of representatives from seven nodal medical colleges, CTD, TRC, NTI, LRS and WHO. It has a Chairman who is selected on rotational basis from amongst the 7 nodal medical colleges. DDG (TB) is the member-secretary of the NTF. The main task of NTF is to provide leadership and advocacy, coordination, undertake monitoring, lead operational research and support policy development on issues related to effective involvement of medical colleges in RNTCP at National level. Some of the major contributions of National Task Force Workshop in the past are under: RNTCP strategy for DRS/DOTS-plus, role of medical colleges in the management of MDR TB patients (2004, 2006) Strategy for TB-HIV co-ordination at medical colleges (2004, 2006) Recommendations for generation of evidence on effectiveness of RNTCP regimens in extrapulmonary TB by developing generic operational research protocols on pleural effusion, lymphnode(2005, 2006) Statement on rational use of second line antiTB drugs ( 2006) Adoption and endorsement of "International Standards for Tuberculosis care" (2006) Contribution to the development of RNTCP DOTS Plus guidelines (2008) Contribution to the development of National Airborne Infection Control Guidelines (2008) Revision of the RNTCP Operational Research Agenda and Guidelines (2008) Endorsed and contributed to implementation of revised diagnostic criteria of 2 weeks cough to suspect TB and 2 samples examination for diagnosis
Endorsement of proposed revision of RNTCP treatment regimen and nomenclature (2009) Rolling out pilot of National Guidelines on Airborne Infection Control in health care and other settings in India (2009) Promoting involvement of Medical Colleges for implementing MDR TB diagnostic and treatment services under RNTCP (2009) Streamlining reporting from Medical Colleges (2009) Endorsing the RNTCP response to WHO treatment guidelines (2010)
National Task Force Workshop 2011 was held at LRS Institute New Delhi in December 2011, under the Chairmanship of Prof Dr D Behera. The Summary of decisions of National Task force 2011 is as follows: 1. Constitution of a separate cell with a full time dedicated Nodal Person in CTD. 2. Representation of CTD during State Task Force meeting, 3. Constitution of one more Zone, by redistributing the number of Medical Colleges. 4. STF Vice Chair in States with large number of Medical Colleges 5. Inclusion of DNB Institutions under the umbrella task force 6. Establish Task Force review missions for Evaluation of Zonal Task Force Mechanisms. 7. Medical College should devise mechanisms to notify all forms of diagnosed in all departments to the Medical College RNTCP single window 8. Proposal to MCI for incorporating RNTCP in Curriculum and MCI recognition norm.
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Status of Medical college involvement: Contributions made by 291 out of 321 medical colleges In India, is as under: 2009-10 Total Number of Medical Colleges involved TB suspects examined for diagnosis Smear positive TB cases were diagnosed Sputum Smear+ ve TB cases (put on treatment and refereed) Initial Defaulters Sputum Smear -ve TB cases (put on treatment and refereed) 282/307 611683 92071 84015 8056 (9%) 49788 2010-11 291/321 689342 95272 87271 8001 (8%) 49031
Above 600 Medical College faculties are trained as trainers, these trained human resource available in the medical colleges are supporting program beyond the academics and participating in the National as well as local training as facilitators and also participating in Internal Evaluations and appraisals.
Pharmacists fight against Tuberculosis

Indian Pharmaceutical Association (IPA) slowly started engaging pharmacies in DOTS services since year 2006. After small successful pilots during 2006-09, a scaled up collaborative public-private programme "DOTS TB Pharmacists Project" was launched. It is International Pharmaceutical Federation (FIP, SEAR Pharm Forum& IPA project with Maharashtra State Chemist and Druggists Association (MSCDA) & District/City TB authorities. This project is supported by the Lilly MDR TB Partnership. Pharmacists are trained for following role: Detecting chest symptomatic cases & referral to ,nearby Designated Microscopy centres Patient counselling & education, Community awareness about TB & Drug Resistant TB DOT medicine administration Attempt to convert private sector patient to DOTS Rational use of antibiotics IPA sought the State TB officer's permission for the project, and the Food and Drug Administration was informed and necessary permission was obtained for DOT provision in pharmacies. The District/City TB Officer, WHO RNTCP Consultants along with IPA trained pharmacists, and IPA is currently working with Navi Mumbai, Mumbai, Bhivandi and Kalyan- Dombivli corporations. Local chemist association selects the willing pharmacists for participation. Project Progress at a glance: Presently, 70 pharmacists are delivering DOT services and more than 224 patients have got benefits of these services. Pharmacists are
actively referring the TB suspects to nearby designated microscopy centres. Case detection rate among the referred cases is about 16% to 30%. RNTCP field staff regularly visits the DOTS pharmacies & pharmacists have developed excellent working relationship with them. Pharmacists have expressed a high level of socioprofessional satisfaction. All pharmacists are distributing the TB literature to the patients. Patient feedback also indicates the convenience of treatment & comfort of
Pharmacist with patient DOT at pharmacies due to friendly relations with pharmacy & proximity to the house. In the last 2 months, 120 more pharmacists from Ulhasnagar, Badlapur, Ambernath and Nagpur have been trained for DOTS, and are about to start their activity. Appropriately trained community pharmacists can contribute to TB control in India. Considering the fact that there are approximately 500,000 pharmacists in India, this initiative, if scaled up nationally has huge potential to make significant impact on TB Control. Organizers have
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been working towards this national scale up of the work and pursuing the matter with Ministry of Health, Government of India. Partnership of Civil Society Organizations in RNTCP CSOs are operationally defined as non-profit organizations that do not belong to the state or the "private for profit sector" This includes nongovernmental faithbased organisation, community-based non-profit NGO, patient-based organizations, professional associations like IMA. If well planned, Civil Societies will expand TB prevention, care and control beyond health facilities and in settings that cannot be easily reached by any national programmes. Key activities of CSOs are Provision and demand generation for TB prevention, Quality diagnosis and treatment services; Improve TB case notification; Improve treatment adherence and outcomes; Health promotion; Research; Advocacy; Empowerment ,Social welfare & support and help to the most vulnerable and underprivileged. Civil Society Partnership for Tuberculosis Control and Care in India: "Partnership for Tuberculosis Care and Control in India" (the Partnership) brings together civil society across the country on a common platform to support and strengthen India's national TB control efforts. It seeks to harness the strengths and expertise of partners in various technical and implementation areas, and to empower affected communities, in TB care and control. The Partnership consists of technical agencies, nongovernmental organizations, community-based organizations, affected communities, the corporate sector, professional bodies and academia
In 2011-12, the partnership held 2 steering committee meetings, 3 regional meetings, 1 working group meeting. 40 new organizations have joined the partnership in its fight against TB making the list to 95.The Partnership has published and circulated 3 issues of the "Partners speak" quarterly newsletter in 2011. The website of the Partnership (www.tbpartnershipindia.org) is being regularly upgraded. The Partnership has been extended to social network sites of 'Facebook' and 'Twitter'. The Partnership was also represented in the Lille World Lung Conference'11
(CSO consultation on RNTCP III planning process)
(Training of traditional healers of Theni, TN on RNTCP) Project Axshya: Project Axshya is a initiative to Strengthen Civil Society Involvement in TB Care and Control in India under the GFATM round 9. Project Axshya aims to improve access to quality TB care and control through a partnership between government and civil society. It will support India's Revised National TB Control Programme (RNTCP) to expand its reach, visibility and effectiveness, and engage community-based providers to improve TB services, especially for women, children, marginalized, vulnerable and TB-HIV co-infected populations. Advocacy, Communication and Social Mobilization (ACSM) is the major focus under this project. The project
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is being implemented in 374 Districts across 23 States covering almost 750 million populations of which 300district are with The Union and remaining 74 are with World Vision. Goal : To decrease morbidity and mortality due to drug resistant TB (DR-TB) in India and improve access to quality TB care and control services through enhanced civil society participation
slums. Achievement of The Union: The collective achievements of The Union and its partners against targets are summarized below: Training: The project supported building technical capacity in Operations Research, Clinical Management of MDR-TB, TB Epidemiology and Leadership and Management for TB control. Trainings were coordinated with CTD for state and district programme managers and nodal officers. Annual Maintenance Contract (AMC) of microscopes: Microscope maintenance in Uttar Pradesh, Bihar and Rajasthan was supported. The AMC covered 3600 microscopes, and guidelines on minimum standard care of microscopes were developed and displayed in RNTCP labs.
Objectives for the Civil Society: Improve the reach, visibility and effectiveness of RNTCP through civil society support in 374 districts across 23 states by 2015. Engage communities and community-based care providers in 374 districts across 23 states by 2015 to improve TB care and control, especially for marginalized and vulnerable populations including TB-HIV patients.
The Union is implementing the Project Akhya in 300 districts across 21 States covering a total population of 570 million, including 174 million women and 199 million children and consist of around 250 million Population living in poor & backward districts, 50 million Tribal population and 40 million Population living in Urban
Technical Assistance Mission: An external mission during 12-20 April 2011 reviewed project activities, analysed plan effectiveness and estimated synergies across interventions. AxReal: This real-time web-based software with a dashboard feature was developed by USEA, and is now fully functional. Website: The Project Axshya website www.axshya-theunion.org was set up and launched. It is fully operational. Advocacy meetings were held with the Indian Medical Parliamentarian Forum on 23 March 2011 and with eight medical colleges and secondary/tertiary level non-government hospitals in Maharashtra and Bihar. The illustrated version of the Patient Charter for TB Care was developed by The Union with inputs from all partners. This is available in 19
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languages and is being disseminated through TB forums and community meetings. Union consultants provided expert support to RNTCP in Monitoring and Evaluation, Operational Research, ACSM and Public-Private Mix. The Union Consultants at the state level are providing technical assistance on ACSM to the NTP in six large states- Maharashtra, Madhya Pradesh, Punjab, Uttar Pradesh, Karnataka and Uttarakhand since August 2011. The 42nd World Union Conference on Lung Health at Lille, France, was attended where a separate Project Axshya booth showcased the project and disseminated information. The Union also facilitated participation of project partners and key RNTCP officials at the national and state levels. A baseline Knowledge, Attitudes and Practices (KAP) survey on TB, covering communities, healthcare providers, patients and opinion leaders, across a sample of 30 project districts was completed. A Monitoring and Evaluation plan was developed in consultation with WVI and CTD as a reference document to monitor implementation and effectiveness of reaching targets, and for all partners to monitor their activities. The Second National Coordination Committee Meeting was organised by The Union in Chennai, 22-23 July 2011. So far, NCC met in Delhi, Chennai, Bhopal and Kolkata to review the progress of R9 TB projects. Recently NCC has constituted an independent group of experts in the name of MEGA (Monitoring & Evaluation Group of Axshya) with the following
objectives: To conduct monitoring and evaluation of Project Axshya to know the impact of the project To report to Central TB Division and NCC about their observation of monitoring and evaluation of Project Axshya with recommendation To help to improve coordination between RNTCP and Project Axshya World Vision, the other Civil Society PR, has been implementing Project Axshya in 74 districts of 7 states with 6 Sub Recipients (SRs). Achievement of World vision Around 8611 health workers have been trained till date on Soft skills across Madhya Pradesh, Odisha, Andhra Pradesh, Bihar, West Bengal, Chhattisgarh and Jharkhand. Most Participants realized that TB patients require special attention,
ya) Axsh ing by train (RHP
National Coordination Committee Meeting
to (Visit
e) 's hom atient TB p
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Indian Red Cross Society Indian Red Cross Society (IRCS), an international humanitarian organization spread over 700 branches with strength of 12 million volunteers across the country carried out the pilot TB project funded by USAID in 8 districts of three states, Punjab, Uttar Pradesh, gujarat and Karnataka. Through this pilot project, IRCS, through its network of volunteers has reached more than 400 retreatment category-II TB patients during the year 201011 to provide care and support services in the form of assistance to the patients to access the treatment (Travel support and some small refreshment), monitoring the adherence to treatment through supportive supervision and motivation, educating and informing the family members of the patient regarding the importance of treatment adherence PATH PATH is an international nonprofit organization which specializes in several key health areas in India including: tuberculosis, immunization, HIV/AIDS, injection safety and Operation Research. Some key achievements of PATH in 2011-12: Advocacy, Communication, and Social Mobilization (ACSM): PATH, with USAID support, continued providing technical assistance on ACSM in five states: Andhra Pradesh, Madhya Pradesh, Maharashtra, Uttarakhand and Uttar Pradesh. PATH's approach towards developing comprehensive ACSM interventions is focused on a targeted approach at district level. PATH, in consultation with State TB Offices, will provide technical assistance for targeted intervention for two districts in each of the five states. During 2011, capacity of 262 RNTCP staff was built through a series of ACSM workshops. The 'Cough to Cure Pathway' planning tool was adopted during the ACSM workshops to identify barriers and challenges in RNTCP. The identified challenges were used to develop a draft micro plan. PATH organized an ACSM workshop in September 2011 where representatives from five states and civil society partners working in TB participated to share their experience and future plans in ACSM. The workshop identified the key challenges in ACSM and discussed possible solutions. Laboratory strengthening: PATH, with USAID support, undertook a variety of laboratory strengthening activities, which included upgrades to Biosafety Level 3 (BSL-3), upgrades for Line Probe Assay (LPA), procurement and/or installation of essential diagnostic equipments, and training for laboratory staff. PATH has
ya) Axsh g of etin ty me muni (Com
a noticeable change is now, and they talk more often and much closer to TB patients. As of September 2011, a total of 6,289 RHCPs were trained under the Axshya India Project. Indeed, RHCPs have been instrumental in limiting the financial toll of TB and TB care, especially to poor populations, by reaching to them as early as possible, referring them to the appropriate public health facility, providing free TB treatment, and even becoming their treatment partners. To increase political commitment and resources for TB, WV India had been engaging state politicians and members of legislative assemblies (MLAs) through sensitizing activities, wherein they were updated with TB information and shown the TB situation of their respective areas. To date, a total of 420 MLAs are sensitized on TB in Odisha, Madhya Pradesh and West Bengal. 74 District level TB forums (support groups in the community) have been formed comprising of former TB patients, health workers and key persons in the community. TB forums have been actively involved in improving social support for patients, and female patients in particular, who seemed to receive less social support from their families than men did. In some districts in the state of Odisha, Chhattisgarh and Jharkhand the TB Forum made an agreement to conduct regular house-to-house visits to TB patients who have not completed their treatment. 856 community based organizations (CBOs) have been trained on various aspects of TB in 74 Districts of India during this phase. They were trained on how to correctly identify, screen, and refer TB patients for diagnosis and treatment, and how to act as treatment partners.
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also provided technical assistance to laboratories to support accreditation. These laboratories with upgraded LPA facilities can now diagnose multidrug-resistant TB (MDR-TB) in two days instead of three to four months. USAID supported 'IRL experience sharing workshop by PATH: As per the recommendations of the National Laboratory committee, two IRL experience sharing workshops for microbiologists and RNTCP consultants were held on 30 June - 1 July, 2011 and 1-2 December, 2011 in New Delhi. Participants from across the country shared their experience and challenges in the presence of NRLs, CTD, WHO, FIND and PATH. The workshop helped the participants to discuss the challenges and solutions for several important issues such as the supply of reagents and chemicals, external quality assessment, human resources and training, maintenance of equipment (AMC), recording & reporting and the process of accreditation. Airborne Infection Control: CTD has developed provisional 'National guidelines on airborne infection control in healthcare and other settings'. Three states Andhra Pradesh, Gujarat and West Bengal - were identified to conduct pilot testing of the operational feasibility and effectiveness of the guidelines. USAID has provided technical support through WHO and PATH to support the implementation of the pilot in the three states
workshops: PATH organized two back-to-back oneday MDR-TB experience-sharing workshops on February 17-18, 2011, to share lessons learned in DOTS-Plus implementing sites. A total of 66 participants from Gujarat, Haryana, Jharkhand, Kerala, Maharashtra, Orissa, Andhra Pradesh, Daman and Diu, New Delhi, Rajasthan, Tamil Nadu, and West Bengal, as well as participants from CTD, FIND, SAMS, PATH and USAID, met to exchange ideas and stimulate group problem-solving around challenges pertaining to PMDT scale-up. The experiences shared during the workshop were used by the states and DOTS Plus sites that plan to expand PMDT services.
BSL-3 upgrades at BPHRC, Hyderabad. CATHOLIC BISHOP'S CONFERENCE OF INDIA (CBCI) Under Global Fund RCC Project, CBCI CARD as sub recipient of Central TB Division is implementing RNTCP through the Catholic Health Facilities (CHF) in 19 states by reaching out to the community. Out of 5000 CHFs spread over across the country, NGO/PP Schemes under RNTCP are operational in selected 109 (CHFs). The CHFs are mostly located in rural India which are hard to reach and caring to tribal and vulnerable population groups. State TB Project Coordinators are present in all 19 states and they are participating in various state and central level meeting, workshops and evaluation under RNTCP. Presently, CHFs have signed more than 200 MOUs under 11 NGO schemes of which 88 are DMCs. In 2011, 86 sensitization workshops covering 6853 personnel were undertaken. CBCI CARD has referred 65,602 patients to DMCs for treatment and care. In addition, CBCI CARD supported various state level activities like Observing World TD Day, signature campaigns, messages at railway stations, exhibitions and competitions for school
Gujarat state AIC review meeting USAID supported lab up gradation at Blue Peter Public Health & Research Center (BPHRC) by PATH: With USAID support PATH upgraded the Blue Peter Public Health and Research Center (BPHRC) laboratory to biosafety level-3(BSL-3), and also equipped the facility for Line Probe Assay (LPA). The laboratory has the distinction of being the first private sector accredited TB laboratory in the country with a BSL-3 facility. Currently, this laboratory is providing diagnostic services for programmatic management of multidrugresistant tuberculosis (PMDT) to four districts of Andhra Pradesh. USAID supported MDR-experience sharing
73
children and teachers, review meetings, State level workshop on RNTCP, NGO-PP Schemes Success stories of CBCI-CARD: Rajasthan (DOTSthe health booster & contributing factor in match-making for Nilofer) Nilofer is a young & vivacious girl living in a slum area in Ajmer, Rajasthan. When the project team of CBCICARD visited her at her home to get information regarding the quality of treatment received by her at the DOT Centre of St. Francis Hospital, the team members were pleasantly surprised to find a hale & hearty, rather plump girl. She happily shared that she used to be a skinny
getting engaged quickly to a handsome boy whom she will be marrying soon. RNTCP PPM IMA Project RNTCP PPM IMA project started as a sub-recipient to the Central TB Division's Global Fund Round-six in Apr'08 in five states and one Union Territory of India, namely, Uttar Pradesh, Punjab, Haryana, Maharashtra, Andhra Pradesh and Chandigarh overing 167 districts. Later on, Ten more States viz Bihar, Chhattisgarh, Gujarat, Jharkhand, Kerala, Orissa, Rajasthan, Tamil Nadu, Uttaranchal, and West Bengal were added to promote RNTCP and PPM-DOTS under GFATM RCC. The objective of this project was to improve access to the diagnostic and treatment services of DOTS and thereby improve the quality of care for patients suffering from Tuberculosis in through involvement of IMA leaders and members in RNTCP. Key activities of the project includes state/district level workshops, publication of quarterly TB/RNTCP newsletter, publication in JIMA, conduct district level CMEs of all IMA branches in the target states, produce IEC materials, assist DTOs in training of private providersetc.
(MoU signed for NGO Scheme by CHFs, Kollam District) & sickly person at the time when she was diagnosed with tuberculosis. During the course of her treatment she regained her health as well as put on some weight. The
During 2011-12: Two new DMCs were established through IMA branches in Andhra Pradesh at Amalapuram in East Godavri district and Tanuku,West Godavari district. 24 sputum positive TB cases were reported by these two DMCs. Achievement of RNTCP PPM IMA Project Number of Review cum workshop held at National and state Level: 41 Number Private Medical Practitioners reached through CME: 20672 No. of Private providers trained in DOTS using RNTCP Module and International Standard of
staff at the St Francis DOT Centre supported her & motivated her to complete the treatment. The weight gain was also a motivational factor for her. She is completely cured now & staunchly believes that DOT has not only cured her but also improved her looks. According to her, DOT has been instrumental in her
Amalapuram DMC
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Care Guidelines: 5569 No. of DOTs centers created:- 3396 No. of DMCs created:- 64 Number of Review cum workshop held at National and state Level:23: The way forward:Involving DNB Training and PG Institutes in RNTCP: The success of involving Medical Colleges in the form of task force mechanism encourages the program to extend the task force mechanism to Institutes offering Diplomat of National Board (DNB) training and also exclusive PG institutes both in Public and Private. Involving Corporate Hospitals in RNTCP: There has been a steady growth in the corporate hospitals throughout the country to meet the rising demand for healthcare from domestic and international patients along with economic growth of India especially in urban healthcare industry where already public health infrastructure is suboptimal. RNTCP will constitute a National task force for involvement of corporate sector & Private sector, which will be the highest policy making body in RNTCP for engaging corporate Hospitals. National Technical Working Group (NTWG)-PPM: RNTCP would establish a National Technical Working Group on fostering engagement with the private sector. The purpose of this group would be to provide a forum for dialogue, to ensure sustained attention on the issue, and guide innovation and learning. The group will provide guidance on technical aspects such as the inclusion of all internationally accepted regimens, guidance on the scope and geographic distribution of initial projects, and policy requirements for improved PPM. PPM Technical Support Group (PPM-TSG) at the state Level: A state level entity with the requisite skills and mandate to systematically improve and scale-up contracting of intermediaries to engage the private sector will be created. This PPM-TSG will be outsourced to a suitable qualified agency but designed to report and work on behalf of RNTCP. Private Sector Agglomerating Agencies (PSAA): These agencies will comprise of state-level entities designed and monitored by the PPM-TSG. The responsibilities of the aggregating agencies will focus on notification of TB cases by the private sector, verification
of adherence to ISTC-compliant regimens, and deployment of innovative mechanisms to realign provider incentives. ACSM in TB control The key objective of ACSM in RNTCP is to generate demand for quality diagnosis and treatment for TB including Multi Drug Resistant and HIV co-infected TB in the community, this increases the case detection rate and ensures treatment adherence and completion of all diagnosed TB cases in the program. Within the context of RNTCP, ACSM refers to health communication in TB care and control. The goal of ACSM is to support TB control efforts for: Improving case detection and treatment adherence Widening the reach of services Combating stigma and discrimination Empowering people affected by TB and the community at large. Mobilizing political commitment and resources for TB. ACSM activities aim at: 1. Creating awareness among people about the disease (signs and symptoms), diagnosis, and treatment in order to increase accessibility and utilization of services 2. Motivating all care providers to provide standardized diagnostic and treatment services to all TB patients in a patient-friendly environment as per their convenience. 3. Mobilize communities to engage in TB care, and to increase the ownership of the program by the community 4. Advocacy to influence policy changes and sustain political and financial commitment RNTCP has well defined communication strategy which clearly defines communication needs (objectives), communication players (target audiences) and communication channels, and activities (communication tools), roles and responsibilities at each level, i.e. Centre, State and District level. The program encourages need based ACSM strategy planning and implementation. The program will be taking a paradigm shift in the next five years' strategic plan in the form of reaching the targets of universal access, that is to detect at least 90% of
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estimated all type of the TB cases of the community and ensuring successful treatment of at least 90% new cases and at least 85% previously treated cases. The primary target of ACSM activities is to prevent the emergence of MDR TB by ensuring good adherence to the DOTS regime through effective and motivational communication with TB patients. Advocacy with the care providers for promoting rational use of first and second line anti TB drugs is also an important area of the programme The program has also felt the growing need of strengthening the monitoring and supervision of the ACSM activities with measurement of its impact in terms of improving the case detection and case holding in the program. The program has also identified the need of strengthening communication skill development of the RNTCP staff that is key to implement ACSM activities effectively to achieve the desired result. ACSM in newer initiatives like MDR-TB; TB/HIV and TB/Diabetes: Role of ACSM is more challenging in newer initiatives in the programme such as MDR TB and TB HIV. These patients have to undergo treatment for a longer duration with more toxic drugs including injectable. Moreover, most of these patients have a previous history of default which can result in lack of motivation to complete treatment. Added to these is the stigma and discrimination by the family and society. MDR-TB: ACSM activities for MDR TB are based on the fact that The communication initiatives, additionally, aim to increase awareness on availability and utilization of DOTS Plus services of RNTCP. Motivational counseling of the patients and family members and education on cough hygiene and disposal of sputum are equally crucial to ensure treatment adherence and further prevention of airborne transmission. HIV co-infected TB: The revised National TB/HIV frame work envisages RNTCP and NACP IEC materials, specifically, pictorial IEC on symptoms of TB and cough hygiene are displayed at all the HIV and TB care settings for providing education, care and support to PLHIV and TB patients. The scope for strengthening this collaboration has been identified in the ACSM strategy. Important ACSM activities during the year National ACSM Capacity Building Workshop: The State TB Officers, State IEC Officers of RNTCP, RNTCP WHO ACSM Consultants & ACSM Consultants of the states and Communication Facilitators of 35 states and UTs participated in this residential workshop. The
other notable participants were CMO (NFSG) from CHEB, MO (TB) and NPO (TB) of WHO and Civil Society Partners of RNTCP like PATH, The Union, World Vision and PSI. Chief Media of IEC Division, MoH& FW also participated and shared his thoughts and experiences in ACSM in this workshop on day 1. The facilitators for the workshop were drawn from academic institutions (IIMC), civil society ACSM experts from PSI, The Union, World Vision & PATH. The workshop was also facilitated by DDG (TB), Sr CMO (TB), CTD Consultants and officials of the media agency of CTD. The workshop focussed chiefly on strengthening the programmatic aspects of ACSM in the perspective of achieving the targets of Universal Access that has been planned in the next 5 years strategy (2012 - 2017) of RNTCP. Through participatory methodologies and technical plenary sessions the workshop gave the participants a clear idea about identifying the barriers and their feasible solutions in ACSM, developing strategic situation-specific and need based ACSM action plan for the districts, roles and responsibilities of the state and district level RNTCP officials in ACSM and monitoring, supervision and impact measurement of the ACSM activities.
National ACSM Capacity Building Workshop As the key next steps the program will concentrate on intensifying technical and operational assistance in ACSM at the state level with a mechanism in place to know the impact of the ACSM activities to reach the targets of the RNTCP. The report of the workshop is under preparation and would be submitted in a few days. Regional ACSM Capacity Building Workshops: Central TB Division conducted two regional ACSM training workshops: The participants of the workshops were State TB Officers, District TB Officers, IEC Officers, Communication
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Dates of the workshop 12th May to 14th May, 2011 8th Sept - 10th Sept, 2011
Venue of the workshop Jaipur, Rajasthan Nalagarh, Himachal Pradesh
States covered Rajasthan, Gujarat, Goa, Daman & Diu, Haryana Himachal Pradesh, Uttarakhand, Punjab, Chandigarh, Jammu & Kashmir, Delhi.
Facilitators, WHO RNTCP Consultants and representative of CSO partners. The workshops were conducted through lectures, group exercises, role plays and games. etc. for the team-building exercise. Selected feature films that have good lessons for advocacy and social mobilization were screened followed by Question Answers sessions with an objective to relate Advocacy and Social Mobilization and provide them with clues to translate the communication into the work methodologies. The teams used video-documentation, digital photography and a de-briefing session to document the learning from the workshop. ACSM workshop of PATH in collaboration with CTD: PATH in collaboration with Central TB Division conducted ACSM capacity building workshop in Delhi (16th Sept - 17th Sept'11) for the STOs, selected DTOs, State IEC Officers, Communication Facilitators and RNTCP and ACSM Consultants for the states of Andhra Pradesh, Maharashtra, Uttarkhand, Uttar Pradesh, Karnataka, and Madhya Pradesh. PATH provides technical assistance to support these selected states in implementing ACSM activities as part of the RNTCP strategy. World TB Day observation (24th Mar'2011) For the World TB Dayevent 2011, CTD conceptualised the Theme "TB Mukti Mashaal" in conjunction with the World Health Organisation's Global plan to STOP TB theme "On the move against Tuberculosis; transforming the fight towards elimination". The mass-movement approach is to inspire and motivate everyone to come to together for the elimination of TB. It also tells that we must come together for a common cause despite any religious or cultural differences. CTD, with the assistance of its media agency M/s RK
Swamy BBDO developed a rolled-out plan for the World TB Day into the three stages Pre-Event, Event & PostEvent. The World TB Day event had van activity for 4 days and used print ad to build the momentum. The Mashaal was picked up from different TB Clinics in Delhi. The 5 Clinics from each zone represented pan India (North, South, East, West and North-East). The torch was collected from all the 5 TB Clinics (which was lighted by the various stake holders from that zone) symbolizing the unity of the torches 'TB Mukti Mashaal'. Development of TV and radio spots: CTD has launched two small films as TV spots thatcan be telecasted as mass media campaign and can be also screened in the outreach activities and seminars and workshops. The first film (named Atoot Dor) is based on a factory worker with prolong and distressing cough, who, after being diagnosed with TB in the government hospital, went back to his village, received TB treatment from a local private doctor for some time but after much economic constrains was registered again under RNTCP for treatment. He received treatment and felt much better, went back to his workplace, stopped medication in the mid way and his cough and fever relapsed. He went to the government hospital with the suspicion of MDRTB, put under treatment and vowed not the stop the medicines in the mid-way.
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The second film (named Chaar Kahaniya) is actually combination of four stories of four TB patients (a school-going boy, office-going women, an old man, and a young girl) who faced stigma and discrimination under different circumstances and how the stigma factor was subsequently removed to make their life easy and smooth. Besides, CTD has developed short TV and Radio spots named Nayi Bahub, Do Kahaniyan, Adhoori Hajaamatd and Adhoori Mehndi TV and radio spots have been also developed on the imaginary comical character of Balgam Bhai, through collaboration between CTD, Project Axshya and BBC Trust and Population Service International (PSI). The character will ask any individual who is coughing in a funny way if the cough is for more than two weeks. At the end he will advise people with cough for more than 2 weeks to visit Designated Microscopy Centres (DMCs) of RNTCP for sputum microscopy. Development of RNTCP exhibit materials: CTD has developed 23 exhibit materials on TB and all the program components of RNTCP like DOTS, DR-TB, TB/HIV, TB-Diabetes andothers which can utilized to disseminate key messages on TB and the program among the general population.
RNTCP exhibit material
ACSM in states
Andhra Pradesh
(Hon'ble Minister for Labor Administering Oath on World TB Day 2011)
(Letter of Hon'ble Health Minister requesting elected and community leaders to promote DOTS)
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(Signature campaign on TB Principal Secretary penning down his commitment and support for TB control during the Signature Campaign on World Health Day, 7th Apr'11)
(Aarogya Padha Yatra: Ralley of cured TB patients)
Assam
(Documentary film on DOTS: Joint Director (Kamrup Metro) inaugurating the DOTS documentary at District TB Centre, Kamrup Assam in presence of Superident of LGB Chest Hospital, DTO Kamrup, WHO Consultant, State IEC Officer, Assam and other Medical Officer and staff of DTC)
(ASHADEEP, a Data Base Management system (ASHADEEP) has been developed by the District TB Centre, Jorhat to record all necessary information related to TB patients and DOT Providers of the district)
CG r the B ng fo aini SM tr el AC hnicians) lev tec (State
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Gujarat
School Based IEC Activity at Bandibar TU Limkheda (Dist. Dahod)
Patient Provider meeting at phc Ved TU. Dhanpur (Dist. Dahod)
Community Meeting at sub centre Umaria (PHI Agaswani) TU Dhanpur Dist. Dahod
Patient Visit By DTO Dahod in Remote Area of VillageVagela TU Jhalod (Dist. Dahod)
Jharkhand
(Felicitation of a community DOT Provider by H'ble Health Minister-Govt. Of Jharkhand)
(Felicitation of DOT Provider-Rickshaw Puller)
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Maharashtra
(Pharmacist's training in Nagpur, Maharashtra)
Meghalay
(Street play on TB)
(After street play suspected person came to interact with the MOTC)
Mizorum
(Participation in the 2012 Republic Day Parade with RNTCP tableau)
(TV show on DOTS Plus services of RNTCP)
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Punjab
(School students creating awareness on TB in a Rally)
Tamil Nadu
(Medical health camps in Upper Kodaikanal hills)
(TB awareness meeting with cement factory workers of Dindigul district)
(TB awareness in Gram Sabha on the Independence Day 2011 in N.Panjampatty village)
(TB motorbike rally on World TB Day 2011)
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Annexure-1
Training guidelines under RNTCP

Initial RNTCP training Duration Batch (working days) Size 14 20 STO/STDC staff/District TB Officer/ TB-HIV coordinator/ DR-TB coordinator/ PPM co-ordinator 20 12 MO-TC or BPMU programme officer 5 MO 20 8 STS (2+6) 12 15 STLS (10+5) 6 10 LT 8 2 State Drug Store Staff / 25 Pharmacist in RNTCP Category MPHS TB Health Visitor etc. MPW/HA etc. Anganwadi Worker/ Midwives/ Community Volunteers, etc. Community based DOT providers, ASHA Private/NGO/ other sector Medical Practitioners TO / SA IEC Officer Data entry operator Accountants for district Accountant - state level Initial Training on EQA Category EQA (Master Trainers / Microbiologist) EQA IRL LTs EQA STDC Dir/ STO EQA DTO/MOTC EQA STLS EQA LTs Duration (days) 5 5 2 2 2 1 Batch Size 10 6 15 25 6 25 Training Material EQA Manual EQA Manual EQA Manual Sections from EQA Manual Sections from EQA Manual Sections from EQA Manual Venue Central Institute Central Institute Central Institute State Level District Level District Level 3 2 2 2 25 25 25 25 Training Material RNTCP MO Modules 1-9, STCS/ DTCS guidelines, Financial Management manual, Procurement + SDS Manual, Monitoring strategy RNTCP MO Modules 1-9 RNTCP MO Modules 1-4 MPW Module, then STS Module LT Module, then STLS Module LT Module MPW Module/ Manual on Std. Operating Procedures for State Drug Store MPW Module, sections of STS Module MPW Module MPW Module DOT Provider Module Venue C e n t r a l Institute
STDC District STDC STDC District District/TU District/TU TU/PHI TU/PHI TU/PHI
1 6 hrs 6 6 2+2 1 3
25 20 12 Need based 12 Need based Need based
DOT Provider Module Training Module for Medical Practitioners STS Module IEC Module + MPW module MPW module, then Epicentre training Manual on Financial Management and Guidelines Manual on Financial Management and Guidelines, DTCS/ STCS guidelines
TU/PHI DTC/IMA STDC/District Central level MPW module & Epicentre at state level State level Central Division TB
Training guidelines under RNTCP
83
Initial RNTCP training on TB/HIV Category TB-HIV Master Trainers STO/ DTO/ MO-DTC/ MOTC MO STS/STLS DOT Provider Duration (days) 5 2 1 2 1 Batch Size 10 10 30 10 30 Training Material TB HIV Modules Module for MOs on TB/HIV Module for MOs on TB/HIV Module for STS STLS on TB/HIV Module for Health Workers on TB/HIV Venue State level State level District District TU/PHI
Initial RNTCP training on DOTS Plus Category Duration (days) 5 Batch Training Material Size 25 DOTS Plus guidelines/ Module 20 10 30 Module for MOs on DOTS Plus Module for Paramedical workers on DOTS Plus Module for DOT Providers on DOTS Plus Venue Central level State level District TU/PHI
STO/ DTO/ DOTS Plus site faculty/ STDC/ IRL MO-DTC/ MOTC/MO 3 STS/STLS/ Paramedical staff 3 DOT Provider 1
Initial RNTCP training for Medical College staff Category of staff Type of training Place of training Trainers to be trained Medical Staff Training material Duration (in days)
STF Chairperson Faculty in charge of RNTCP TOT's HODs and Senior staff Other faculty members (interested) PG students/ Residents/ Interns /UG's
Paramedical staff
Concise National modular institute MO-TC modular State-level
Central institute RNTCP -Key facts staff and concepts STC/STDC staff 1-9 modules
1* 12 12 1 5
MO-TC modular National/ State Central Institute/ 1-9 modules -level STC/STDC staff Concise modular State-level STC/STDC staff RNTCP -Key facts and concepts MO modules Medical college Faculty in charge 1-4 modules of RNTCP Part of Curriculum Medical College Faculty in charge Curriculum + Sensitization of RNTCP
2-3 hrs**
Nurses Pharmacists Other paramedical staff
MPW training MPW training MPW training
Medical College Medical College Medical College
Faculty in charge MPW module of RNTCP Faculty in charge MPW module of RNTCP Faculty in charge MPW module of RNTCP
2 2 2
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Category of staff Type of training Place of training Trainers to be trained Paramedical staff
Training material
Duration (in days)
Other paramedical staff
MPW training
Medical College
Faculty in charge MPW module of RNTCP
* 5 days or 12 days modular training for those interested ** Consists of theory classes. Practical training will be imparted during posting to the Chest or Medicine Departments and the DOTS Cell. Retraining schedules Category STO/STDC DTO/ MO-TC STS STLS LT MO/TO/ SA/ IEC Officer Pharmacist/ Staff Drug Management (State/ District/ TU) MPHS TB Health Visitor etc. MPW/HA etc. Anganwadi Worker/ Midwives/ Community Volunteers, etc Community based DOT providers Accountant EQA (Master Trs./ Microbiologist) EQA-IRL LT EQA (STDC Dir/ STO) EQA (DTO/MOTC) EQA (STLS) TB-HIV(DTO/ MOTC) TB-HIV (MO) TB-HIV (STS/STLS) DOTS Plus (STO/STDC) DOTS Plus (DTO/MO-TC) DOTS Plus (STS/STLS/Paramedical staff) Maximum duration (days) 5 3 2 3 2 2 1 1 1 1 1 1 1 2 2 1 1 1 1 1 1 2 1 1 Venue Central Institute STDC STDC STDC District District District/TU District/TU TU/PHI TU/PHI TU/PHI TU/PHI State/District Central Institute Central Institute Central Institute STDC District STDC District District Central level STDC District
Supervision, Monitoring, and Evaluation activities under RNTCP
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Annexure-2
S.No. Levels 1. National
Category of Supervisor Officials from Ministry of Health and Family Welfare, GoI.
Field visits (No. of days/month) RNTCP inclusive as a supervisory agenda in their routine field visits for supervision.
Objective Supervision of Programme.
Facilities to be visited
2.
National
DDG (TB) and 10 days/month (1-2 other officials days per visit) from Central TB Division.
3.
National
Central Internal One per month Evaluation
4.
National
National Reference Laboratory
All states assigned to be visited at least once in a year.
5.
National
NACO and CTD One state per quarter
State TB Cell, DTC, TUs, DMCs, PHIs, DOT Centre, Drug Store, DOTS Plus Site, ICTC Centre, CCC, ART Centre State TB Cell, DTC, Supervision of TUs, DMCs, PHIs, Programme. DOT Centre, Drug Store, DOTS Plus Site, ICTC Centre, CCC, ART Centre State TB Cell, DTC, Evaluation of TUs, DMCs, PHIs, Programme DOT Centre, Drug Performance including all aspects Store, DOTS Plus Site, ICTC Centre, such as data CCC, ART Centre validation etc IRL, One district and Supervision and Evaluation of a few DMCs. External Quality Assurance activities State TB Cell, SACS Office, DTC, TUs, Supervision of TB-HIV DMCs, PHIs, DOT collaborative Centre, Drug Store, activities DOTS Plus Site, ICTC Centre, CCC, ART Centre
Patients visits * As required.
As required.
As per protocol
As required.
At least 3 patients per visit
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S.No. Levels 6. State
7.
State
Category of Supervisor Officials from Ministry of Health and Family Welfare, State and State Health Society. STO (Including visits by STC/STDC officers)
Field visits (No. of days/month) RNTCP inclusive as a supervisory agenda in their routine field visits for supervision.
Objective Supervision of Programme.
Facilities to be visited
12-16 days/month (1-2 days per visit)
8.
State
State Internal Evaluation
9.
State
Intermediate Reference Laboratory Joint visit by SACS and STC officials
Upto 30 million - 2 districts per quarter; 30-100 million - 3 districts per quarter; >100 million - 3-4 districts per quarter. Aim to cover all districts at least once in 3-4 years. All districts to be visited at least once a year One district quarter per
DTC, TUs, DMCs, PHIs, DOT Centre, Drug Store, DOTS Plus Site, ICTC Centre, CCC, ART Centre Supervision of DTC, TUs, DMCs, Programme PHIs, DOT Centre, Performance. Drug Store, DOTS Cover all districts Plus Site, ICTC in the state every 6 Centre, CCC, ART month Centre Evaluation of DTC, TUs, DMCs, Programme PHIs, DOT Centre, Performance Drug Store, DOTS including all aspects Plus Site, ICTC such as data Centre, CCC, ART validation etc Centre
Patients visits * As required.
As per protocol
10. State
Supervision and Evaluation of External Quality Assurance activities Supervision of TB-HIV collaborative activities
DTC and a few DMCs.
Not applicable.
11. District
12. District
District Health Society Members (District Magistrate, CMHO and other District Officials). DTO (including visits by MODTC)
RNTCP inclusive as a supervisory agenda in their routine field visits for supervision.
Supervision of Programme.
District AIDS Control office, DTC, TUs, DMCs, PHIs, DOT Centre, Drug Store, DOTS Plus Site, ICTC Centre, CCC, ART Centre DTC, TUs, DMCs, PHIs, DOT Centre, Drug Store, DOTS Plus Site, ICTC Centre, CCC, ART Centre
As required.
20 days
Supervision of Programme, Cover all TU every month and all DMC every Quarter.
13. Subdistrict
Block Medical Officer/MOTC
RNTCP inclusive as a supervisory agenda in their routine field visits for supervision; at least 7 days per month
DOT Centre, DMC, PHI, Drug Store, DOTS Plus Site, ICTC Centre, CCC, ART Centre, NGO and PP health facilities Supervision of DOT Centre, DMC, Programme, Cover Drug Store, DOTS all DMC every Plus Site, ICTC month all PHI Centre, CCC, ART every quarter Centre
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S.No. Levels 14. PHC level
Category of Supervisor MO-PHI
15. District
Senior DOTS Plus- TB HIV Coordinator
Field visits (No. of days/month) RNTCP inclusive as a supervisory agenda in their routine field visits for supervision. 18-20 days per month
Objective Supervision of Programme, Cover all sub-centre every month Supervision of Programme, Visit DOTS Plus site in the district every week (if present) Cover all MDR treatment centres / providers every quarterpreferable monthly. Cover all ICTC in a quarters, cover all ART centres and link ART centres every month, Cover all CCC/ DIC / NGO facilities every quarter Supervision of Programme, Cover all PHI at least every month, all DOT centres every quarter
Facilities to be visited DMC, DOT Centre
Patients visits * At least 3 patients per visit 2-3 patients every visits (coinfected or MDRTB patient)
DOTS Plus Centre, ICTC Centre, CCC / DIC/NGO
16. SubDistrict
STS
18-20 days per month
DMC, Non-DMC PHI, ART centre (if present in TU) ICTC, DOT Centres, NGO and PP
17. SubDistrict
STLS
18-20 days per month 5-7 days
Supervision of DMC; All sputum Programme, Cover collection centres; all
All patients to be visited within one month of initiation of treatment; all patients interrupting treatment; all Category IV patients every month in IP and every quarter in CP All patients
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S.No. Levels
Category of Supervisor
Field visits (No. of days/month)
Objective all DMC at least twice a month
Facilities to be visited diagnostic centres
18. PHC level
PHI level supervisors (MPHS) MPW/ANM
5-7 days
19. PHC level
DOT Centre Supervision of Programme, Cover all sub-centre every month DOT Centre Supervision of Programme, Cover all DOT providers every month
Patients visits * with contaminated samples or invalid results. 2-3 patients per visit All patients on treatment during themonth.
* MDR, paediatric, co-infected patients should be prioritized for interview Table 8: Schedule of Review Meetings in RNTCP Level Type of Review National RNTCP performance review Medical College performance review TB-HIV collaborative activities Laboratory Committee National DOTS-Plus Committee National Technical Working Group (NTWG) for PPM Activities National Operational Research Committee National Airborne Infection Control (AIC) Committee Members Medical College performance review RNTCP Performance Review including one day exclusively for PMDT activities State Health Society Review (RNTCP included as an agenda item) RNTCP performance review Chairperson DDG (TB) DDG (TB) DDG-TB Participants STOs ZTF members Members of National Working Group for TB-HIV collaborative activities Members of Laboratory Committee Members of National DOTS-Plus Committee NTWG for PPM Activities members National OR Committee members National AIC Committee members STF members Regional Directors, STOs, DTOs of selected districts Director Health Services, CMHO , All programme heads in state, DTO Frequency Biannual Annual Quarterly
Chairperson Laboratory Committee / DDG (TB) Chairperson National DOTS- Plus Committee/ DDG (TB) Chairperson NTWG for PPM Activities / DDG (TB) Chairperson National OR Committee / DDG (TB) National AIC Committee Chairperson / DDG (TB) ZTF Chairperson DDG (TB)
Biannual Biannual
Biannual
Biannual Biannual
Zonal
Annual Annual
State
PS (Health), MD-NRHM
Quarterly
STO
Quarterly
89
Level
Type of Review Performance review of Under-performing districts Medical college performance review State Operational Research Committee Meeting State TB-HIV Co-ordination committee meeting State Working Group Meeting for HIV/TB collaborative activities State DOTS-Plus Committee meeting Review of RNTCP Accounting Review of Drug management Review of data management Workshop for Other Sector Health Facilities such as Railways, ESI, CGHS, Mines, etc Review Meeting of Partners District Health Society Review (RNTCP included as an agenda item) CMHO Monthly Meeting with Block Medical Officers and MO-In charge PHCs (RNTCP included as an agenda item) RNTCP performance review Medical college performance review TB-HIV District Coordination Committee meeting Review of Drugs and Logistics DOTS-Plus site committee meeting
Chairperson STO STO/ STF Chairperson STO/ STF Chairperson PS (Health)
Participants DTO Nodal Officers from all medical colleges State OR Committee Members Members of State TB-HIV Cordination Committee Members of State Working Group for HIV/TB collaborative activities State DOTS-Plus Committee members District level Accountant
Frequency Biannual Quarterly Quarterly Biannual
PD-SACS / STO
Quarterly
PS (Health) State Accountant
Quarterly Biannual Review and One for PIP Biannual Biannual Annual
State Drug Store Manager State epidemiologist and state Statistical Assistant STO
District Drug Storekeepers District DEO/Statistical assistant Representatives from Other sector Health facilities
District
STO District Magistrate / Chairman District Health Society. CMHO
All Partners CMHO, All programme heads in district, Block Medical Officers, MO-PHIs (infrequently) All Block Medical Officers, MO-In-charge PHC, and Superintendent CHC.
Biannual Quarterly
Monthly
DTO Core Committee Chairman of the respective Medical College Chairperson of TB-HIV District Coordination Committee DTO and DTC Pharmacist
MOTC, STS and STLS Core Committee Members of the respective Medical College and DTO Members of District TB-HIV Coordination Committee Pharmacists/Incharge Storekeeper of all TUs and PHIs DOTS-Plus site committee members, DTOs / Sr.DOTS-Plus-TB-HIV Coordinator Representative from Partners
Monthly Quarterly
Quarterly
Quarterly
Chairperson/Coordinator DOTS-Plus site
Monthly
Workshop with Partners and other sector hospitals
CMHO/DTO
Biannual
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Level
Block
PHI
Type of Review Chairperson such as Railways, ESI, CGHS, IMA, AYUSH, NGOs, External funded projects etc Review of TB-HIV DAPCU/DTO collaborative activities along with RNTCP monthly meeting Block Level Meeting with Block Medical Officer MO-In-charge PHI and other staff. (RNTCP included as an agenda item) Monthly Meetings with MOIC, PHC Staff (RNTCP included as an agenda item) Type of Review RNTCP performance review Medical College performance review TB-HIV collaborative activities Chairperson DDG (TB) DDG (TB) DDG-TB
Participants
Frequency
ICTC/CCC Counsellors, STS, DOT-Plus-TB-HIV Coordinator MO-I/C-PHC and other staff.
Monthly
Monthly
MPHS/ANM/MPW/ ASHA
Monthly
Level National
Participants STOs ZTF members
Frequency Biannual Annual Quarterly
Zonal
State
Members of National Working Group for TB-HIV collaborative activities Laboratory Committee Chairperson Laboratory Members of Laboratory Committee / DDG (TB) Committee National DOTS-Plus Chairperson National Members of National Committee DOTS- Plus Committee / DOTS-Plus Committee DDG (TB) National Technical Working Chairperson NTWG for NTWG for PPM Activities Group (NTWG) for PPM PPM Activities / DDG (TB) members Activities National Operational Chairperson National OR National OR Committee Research Committee members Committee / DDG (TB) National Airborne Infection National AIC Committee National AIC Committee Control (AIC) Committee Chairperson / DDG (TB) members Members Medical College ZTF Chairperson STF members performance review RNTCP Performance DDG (TB) Regional Directors, STOs, Review including one day DTOs of selected districts exclusively for PMDT activities State Health Society Review PS (Health), MD-NRHM Director Health Services, (RNTCP included as an CMHO , All programme agenda item) heads in state, RNTCP performance STO DTO review Performance review of STO DTO Under-performing districts Medical college STO/ STF Chairperson Nodal Officers from all performance review medical colleges
Biannual Biannual
Biannual
Biannual Biannual
Annual Annual
Quarterly
Quarterly Biannual Quarterly
91
Level
Type of Review State Operational Research Committee Meeting State TB-HIV Coordination committee meeting State Working Group Meeting for HIV/TB collaborative activities State DOTS-Plus Committee meeting Review of RNTCP Accounting Review of Drug management Review of data management Workshop for Other Sector Health Facilities such as Railways, ESI, CGHS, Mines, etc Review Meeting of Partners District Health Society Review (RNTCP included as an agenda item) CMHO Monthly Meeting with Block Medical Officers and MO-In charge PHCs (RNTCP included as an agenda item) RNTCP performance review Medical college performance review TB-HIV District Coordination Committee meeting Review of Drugs and Logistics
Chairperson STO/ STF Chairperson PS (Health)
Participants State OR Committee Members Members of State TB-HIV Cordination Committee Members of State Working Group for HIV/TB collaborative activities State DOTS-Plus Committee members District level Accountant
Frequency Quarterly Biannual
PD-SACS / STO
Quarterly
PS (Health) State Accountant
Quarterly Biannual Review and One for PIP Biannual Biannual Annual
State Drug Store Manager
District Drug Storekeepers
State epidemiologist and state District DEO/Statistical Statistical Assistant assistant STO Representatives from Other sector Health facilities
District
STO District Magistrate / Chairman District Health Society. CMHO
All Partners CMHO, All programme heads in district, Block Medical Officers, MO-PHIs (infrequently) All Block Medical Officers, MO-In-charge PHC, and Superintendent CHC.
Biannual Quarterly
Monthly
MOTC, STS and STLS Core Committee Members of the respective Medical College and DTO Members of District TBHIV Coordination Committee Phar macists/Incharge Storekeeper of all TUs and PHIs DOTS-Plus site committee Chairperson/Coordinator DOTS-Plus site committee meeting DOTS-Plus site members, DTOs / Sr.DOTSPlus-TB-HIV Coordinator Workshop with Partners CMHO/DTO Representative from Partners and other sector hospitals such as Railways, ESI, CGHS, IMA, AYUSH, NGOs, External funded projects etc Review of TB-HIV DAPCU/DTO ICTC/CCC Counsellors, collaborative activities along STS,DOT-Plus-TB-HIV
DTO Core Committee Chairman of the respective Medical College Chairperson of TB-HIV District Coordination Committee DTO and DTC Pharmacist
Monthly Quarterly Quarterly
Quarterly
Monthly
Biannual
Monthly
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Level
Block
PHI
Type of Review Chairperson with RNTCP monthly meeting Block Level Meeting with Block Medical Officer MO-In-charge PHI and other staff. (RNTCP included as an agenda item) Monthly Meetings with MOIC, PHC Staff (RNTCP included as an agenda item)
Participants Coordinator MO-I/C-PHC and other staff.
Frequency
Monthly
MPHS/ANM/MPW/ ASHA
Monthly
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Success Stories
Andaman & Nicobor Islands:

INTERMEDIATE REFERENCE LABORATORY, A&N ISLANDS - A SUCCESS STORY The DOTS Plus State Committee had been constituted in Andaman & Nicobor islands under the Chairmanship of Secretary (Health), A&N Administration. The upgradation of the DOTS Plus site at G.B. Pant Hospital, Port Blair was also commenced with a view to hasten the rolling out of DOTS PLUS in the A & N Islands. Special training for DOTS Plus was provided to the RNTCP staff. Having met all the requirements, ICMR, Port Blair earned Accreditation in April, 2011 to be the Intermediate Reference Laboratory of the Andaman & Nicobar group of Islands (Lab Accreditation No. 24/RNTCP/2011) under the Designated NRL at TRC, Chennai - a milestone achievement in A &N Islands' RNTCP Unit's struggle against Tuberculosis. Regular EQAs keep the proficiency of the IRL at par with the standards set by the Central TB Division. Since then, till Dec 2011, a total of 10 MDR-TB suspect cases have been cultured in the IRL, Port Blair, out of which 02 cases have been confirmed as MDR-TB. It takes around 56 days to confirm a negative culture whereas a positive culture with a heavy bacterial load can be confirmed in as little a time as 3 weeks. The identification of MDR-TB cases within the infrastructure and facilities of the A&N Islands makes the dream of an MDR-TB-free Islands seem closer to reality. With the availability of Falcon tubes and other transport material, all the distant islands will be equipped to send culture specimens directly to the IRL, Port Blair without having to refer each patient to the capital town. The culture
in IRL, Port Blair will also save, substantially, the resources of the government and also enable the treatment for MDR-TB through the DOTS Plus regimen commence quickly. This will, in turn, reduce the number of people being exposed to MDR-TB infection and also significantly reduce the mortality caused by MDR-TB. The initiation of DOTS Plus and plans for setting up of a separate MDR-TB ward at G.B. Pant Hospital are only the beginning of the long yet attainable journey to see an MDR-TB-free Islands 'in our lifetime'. This success story of the constitution of an IRL for the A&N Islands- and thus enabling speedier and more convenient treatment to the Islanders- would always be our inspiration, and drive us to reach greater heights and overcoming all hurdles in our war against Tuberculosis.
Andhra Pradesh:
INVOLVING PHARMACIES IN TB CONTROL - ANDHRA PRADESH EXPERIENCE State TB cell, Andhra Pradesh is involving private chemists in Ongole, Prakasam district in identification and referral of TB suspects to DMC. PATH with USAID support has provided technical assistance for this project. In addition to referring suspects to designated microscopy Centers (DMC), private chemists also play role in reducing over the counter (OTC) sale of anti TB drugs. The project sensitized and trained key stakeholders including private chemists on the role of PPM in TB care and control, referral mechanism, availability of free TB services under RNTCP. To facilitate referral process appropriate job aids (referral slips and drop box, DMC referral map, pamphlets etc.) were developed. Self carbonized color coded referral slips were designed in quadruplicate (A-D). Slip D (green) is to be retained at the medical shop, the remaining three to be provided to
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the chest symptomatic who is instructed to drop slip A (pink) in the designated drop box at the DMC, hand over slip B (yellow) to the laboratory technician, and keep slip C (blue) for patient's records.In order to integrate the above activities of project with district RNTCP, supportive supervision, joint review meetings and SMS feedback mechanism were developed. This project contributed to 5% of the chest symptomatics examined and 2% of the smear positive TB patients diagnosed in the project area. The report of this project was released during 71st conference of International Pharmaceutical Federation (FIP) held at Hyderabad India and was also shared with all the stakeholders in the state and district. Further,
motivation to other T.B. patients currently under treatment.
Bihar:
Jaiprabha - Substantial contribution by an unknown silent operator to RNTCP In a remote area of Banka District in Bihar, inhabited by the Santhal tribals and infested with naxalites, an NGO named Jaiprabha silently and effortlessly participates under DMC Scheme since 2008. The area is greatly underserved as there is no Govt. health facility in a 30 km radius. Thus the participation of Jaiprabha is a boon to the inhabitants as its DMC has examined over 800 suspects and detected 140 sputum positive patients. More than 250 patients have been treated with DOTS by its vast network of SHGs in its area of work. Such silent operating NGOs working tirelessly are a beacon to the PP model. Using mobiles to reach people MuzaffarpurCBCI-CARD, a Union partner in Project Axshya, took the novel initiative of reaching large numbers of people through a text message on TB sent
experiences from the pilot were shared by State TB office with the Director General, Drugs and Copy Rights, Drug Control Administration (DG, DCA), Andhra Pradesh during a state level convention of pharmacies. The DG DCA made an emphasis of involving private chemists to expand accessibility to TB control services. He also directed the drug inspectors to keep a watch on the sale of anti TB drugs without valid prescription by the registered medical practitioners and Pharmacists. A circular to this effect has been issued on 31st October 2011. With the learning's from Ongole project state TB office has expanded this to another district Rangareddy with a vision to expand this intervention to entire state of Andhra Pradesh with the technical assistance from key partners.
Assam:
Cured Re-treatment patient as trained DOTS Provider in Missionaries of Charity DOTS Centre, Bongaigaon district Sisters of Missionaries of Charity DOTS Centre, Bongaigaon district have engaged one cured re-treatment patient as DOTS Provider which gives tremendous
(DMC - Jaiprabha hospital)
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95
(Doctor examining TB suspects)
crowding of living areas in prisons. Central Jail Raipur was engaged in RNTCP way back in 2009 with establishment of a DMC and a DOTS Centre. DMC is managed by a MO & LT and DOTS Centre by few selected jail inmates, acting as DOT providers. Out of (Training of SHG DOT Providers) on mobile networks in Muzaffarpur district, Bihar. The message was sent to 10000 people, as a result of which 53 chest symptomatics reached the designated microscopy centre for sputum examination. Of those tested, two were sputum-positive cases and are now on DOTS. The target is to send messages to 1 lakh mobile numbers within four months in a phased manner so that effective tracking can be done. A definite impact is anticipated through this innovative communication technique
Chhattisgarh:
Reaching the un-reached - RNTCP in the Central Jail Raipur Central Jail Raipur is the largest Central Jail in Chhattisgarh with capacity of 1130 prisoners. Current lock up statistics shows 2247 (as of 31st March 2011) prisoners, which is 2 times more than the actual intake capacity. Prisoners are vulnerable to TB as they may enter the prison with high risk of prior TB disease with potential to spread the disease to the jail inmates due to confinement and over80 Registered TB cases in Raipur jail, 18 are cured, 14 have completed their treatment and 11 are currently on DOTS. Patients do not default their treatment in the Jail Hospital and fully comply with the DOTS and follow up sputum schedules. However, the feedback mechanism of the patients who are transferred out and released from the Jail needs to be strengthened with support from the
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DTO - District Raipur. Credit for ensuring good quality of DOTS in the Central Jail Raipur goes to the RNTCP dedicated team in this Jail Hospital - Dr Roy Chowdhary, MO in-charge of DMC and especially, to Mr Sanjay Yadav, a jail inmate and a committed TB worker, who has been providing quality DOTS to the TB patients here since 2009. Sanjay is also instrumental in building capacity of his fellow inmates to act as DOT Providers and has already created small group of DOT Providers in the hospital.
Gujarat:
Private Practitioner - front runner for TB referral and Treatment (Surat Municipal CorporationGujarat) Dr. Manoj Pansuria is practicing physician at Navagam Dindoli -textile and Diamond workers population area since last 3 Years. He was sensitized by RNTCP staff following which he took interest in the program and started referring TB suspects to local DMCs. He also started providing DOTS to the TB patients at his clinic.
Kadana TU resides in village Chhani of Khanpur Taluka (Tribal TU). He had TB in 2007 and completed his
Presently he is providing DOTS to 23 TB patients. His contribution to RNTCP has been highly appreciated by the Surat Municipal Corporation. ASHA - successful DOTS Provider: Smt. KUMUDBEN M. PARMAR, ASHA (Accredited Social Health Activist) worker of Sathrota village resides in TU Halol district Panchmahal. She works as DOT Provider. She has cured 5 patients of CAT - I in year 2010 and currentlygiving DOTS to CAT - IV Patient Vitthal Shankar Rathod of her village. Vitthal Shankar has already completed 1 year of DOTS Plus treatment. Story of a MDR TB case currently under the treatment of RNTCP: ABHESINH KALUBHAI RAVAL, Male, 16, a physically handicapped patient of
(During DOTS Plus treatment initiation)
(Currently)
treatment. Again he had a relapse of TB in 2009 and diagnosed as MDR TB in August 2010. He was put on on CAT - IV on 24/11/10. At the time of treatment initiation his weight was 40 kg. He was so frustrated due to his illness he dropped his school and stopped his studies. After starting DOTS Plus treatment, he started
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feeling better and re-joined his school. He took 4 months for culture conversion. Now he is 45 kg of weight and feels healthy. He expresses his gratitude to his family members and health staff of RNTCP for his wellbeing and health. He is currently preparing for the Higher Secondary Board Exam in 2012.
Jammu & Kashmir:

A poet in RNTCP
Doun dohan doulate karnav jaanch Get sputum tested on day one and day two DOT center ghas wael kar sanz Prepare to go to DOT centre Dawaa tate khov mooftas mannz Take medicine free of coast Dade nishe sapdakh wael aazad You will be TB free In reply to a survey question approximately 40% people said they know signs, symptoms and cure of TB because they have heard these from Ayoub Saber on Radio Kashmir Srinagar.Jharkhand: Impact of School based IEC activities Muni Lal Murmu, resident of a tribal and hard to reach village of Bhataundha in Godda district developed cough. Having cough for 20 days, he also started feeling weak, hampering his daily work. He visited a local quack many times and took herbal medicines. Although costly, the medicines did not help in improving his health, instead it led to further deterioration of his health and made him bedridden. One day his neighbor's son saw him cough & cry in the bed. The boy after listening to his complain of cough for more than two weeks, weakness and presence of blood in s p u t u m , remembered of the school visit by some health workers who, by describing about the TB and DOTS, made them aware about TB symptoms. He advised Muni lal to get his sputum examined. On the boy's advice he visited DMC and had his sputum examined. He was diagnosed to have sputum positive pulmonary TB. Sahiya of his village visited and sensitized him about precautions to prevent spread of TB and started giving DOTS treatment regularly under her supervision. With regular treatment & timely follow up sputum examinations, he was declared cured after the full course of treatment. Now he is free from all the symptoms and is performing his daily chores effectively. He is now a regular part of community meetings in the village & spreads awareness about symptoms of TB and free of cost availability of diagnosis and treatment for TB under DOTS Programme.
(Poet Ayoub Saber at TU Pattan during patientprovider meeting) A man in his seventies decided to get involved with TB cure and control programme in Kashmir division 5 years ago not knowing that this activity will give a charismatic influence to his own character and elevate the programme to a more conspicuous level. White haired, clean shaved and shoulders slightly dropping down Ayoub Sabir- poet and social worker has now become face of the Revised National Tuberculosis Control Programme in Kashmir division. Ayoub Sabir- nick named as" DOTS ON AND TB GONE" within his literary circles and RNTCP in Kashmir division are complementing to each other, one increasing the visibility of other. He came up with the following poetic piece in local language; Mushkil hall gov pani deri I swear that difficulty is over Yane aov RNTCP Since the inception of RNTCP TB zaniv akh kath khaas About TB particularly note Doun haftan ya ami hur chaas Cough for two weeks or more TB nish haa sapdakh free You will be TB free Wael ghas DMC labatery Go at once to DMC laboratory Thok nee seeti yeye ma aanch Take sputum along
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Impact of Community meeting Bengali Ram, a 45 years old farmer resident of Bihari Champadih village of Hazaribagh district of Jharkhand.
He was suffering from cough for a few months and weakness for more than 15 days, due to which his daily work was suffering leading to economical loss, as he was the sole bread winner in the family. One day a community
meeting was held in the village on TB issue. Sahiya Punam Devi was also present there. Bengali Ram heard about TB symptoms and consulted the Sahiya. She advised him to go to DMC and get sputum examined. He was diagnosed as sputum positive pulmonary TB. The sahiya herself provided DOT services to Bengali Ram. The patient could complete the treatment only due to free of cost medicines and care provided by Punam devi under the DOTS Programme. He completed full course of treatment with timely follow-up sputum examinations and was cured of TB. Now his life is back to normalcy with a renewed confidence in himself. He now is an active member of VHND (Village Health & Sanitation Committee) and "TB Forums" in his village & spreads awareness about the availability of free of cost TB care services under RNTCP.
Karnataka
My favorite 2's in RNTCP DTO and RNTCP staff of Ramanagara district greeted all the private practitioners 2012 new year with an innovative greeting card with the title My favorite 2's in RNTCP.
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Madhya Pradesh:
A family saved: Khamaria village, Jabalpur
Mr Shivdas Tiwari and his two daughters, Mausmi on the left and Neha on his right, make up a TB-infected family of village Khamaria in Jabalpur, Madhya Pradesh
- his wife and son died of TB years back. Mr Shivdas (55 years) and Mausmi (22 years) too are TB patients and their treatments are on. An NGO partner, Norbetine Social Society, met them during Project Axshya activities. Mausmi was the first victim of TB and the family was searching for treatment but, they say, could not get good treatment and guidance even at the government hospitals. Finally, she was diagnosed as a TB patient with the help of a RNTCP DOTS centre in a medical college and treatment was started. Before treatment, she lacked appetite, had loss of eyesight, and was so feeble that she could not move from one place to another. Now she can do all her activities on her own. She has been taking paediatric anti-TB drugs as per her bodyweight. Her weight has now increased and she is responding to the treatment. Meanwhile, Mr Shivdas too developed a cough and was also diagnosed as a TB patient after sputum examination. He was advised to take treatment and was also started on DOTS. They are now hopeful that their lives will be saved - and we are happy we could save a family.
Meghalaya
The Students from Martin Luther Christian University, Tura Campus had come to District Tuberculosis Centre, Tura for the project work for 3 months. During their project work they had conducted poster campaign on Tuberculosis in Local language (Garo) and English. The following Posters had been displayed by the students of the said University at District TB Hospital Compound, Tura, West Garo Hills, Meghalaya.
Mizoram:
Sputum collection centre & DOT provider at Kolasib District Mr. Thangkhuma, Church Elder, Zanlawn, Kolasib District had volunteered to be sputum collection centre. He was trained on correct techniques of sputum collection and transportation and provided with sputum cups. He has collected and transferred 11 sputum samples so far since October 2011.
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Retrieval of drug addict TB patients: Mrs.B. Lalhmangaihsangi of Luangmual, Lunglei is a dedicated Community Volunteer of CMAI. She had undergone TB and ACSM training at district level. She successfully brought the a drug addict TB patient back to RNTCP for treatment who had defaulted number of times previously. Now the patient is taking the treatment regularly and never misses a dose. The 'impossible' has been possible due to Mrs.B. Lalhmangaihsangi's hard work and dedication to RNTCP.
Orissa:
Initiative of Ganjam district, Odisha to encourage key staff of RNTCP for better performance
Nagaland:
Dedication of District TB Officer: Dr Chubatemsu , DTO of Mokokchung District in Nagaland has been serving the TB Programme ever since its inception. He is one of the most sincere and efficient Program Managers in the State. Not only does he treat patients but he takes an extra effort to visit each and every patient at their homes and interacts with them and their family members and provides them necessary health education on TB, cough hygiene, drug adherence and infection control. In his own words, Dr. Chubatemsu states that" in their own homes, the patient is a king and hence feels confident enough to put forward various queries, thereby addressing issues of stigma and discrimination" Being a Christian, he ends the visit with a simple word of prayer for speedy recovery and general well-being of the patient and their family. This is also one of the main reasons why Mokokchung has been able to check the problem of Defaulters and also Case finding has been consistent. He is well known in the District for his service rendered towards the people and on several occasions he has been lauded even by the State Officials. RNTCP has its own 'Supervision and Monitoring Strategy' with specific indicators to monitor and evaluate the programme at different levels with the specific objective to further improve the performance of programme. For better performance of RNTCP, Ganjam district team has decided to give some rewards to TU level RNTCP supervisory staff. This reward will be rotatory trophy to the winner who will achieve the performance above RNTCP norm. The indicators are Case detection (> 70%), Sputum Conversion rate (>90%), Cure rate (> 85%), and Default rate (< 5%).Trophy will be given to STS, STLS and a appreciation letter with sign of CDMO will be given to Mo-TU. On the basis of 3q 2011RNTCP reports of Ganjam district, Aska TU, got 3 trophies for performing above the norms as best performing TU. We hope that this initiative will enhance enthusiasm of the Supervisory Team at the TU and healthy competition among them which will be helpful to improve performance of RNTCP.
Punjab:
Flower Vendor outside Temple works as DOT Provider of RNTCP Jagdish Tiwari, a 45 year old man who belongs to Gaunda District, U.P. is owner of a flower stall outside Bizli Pehalwan Mandir on famous Lawrence Road, ASR. He takes personal
(Dr Dr Chubatemsu , DTO of Mokokchung District visiting a TB patient at his home)
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101
interest in RNTCP and a trained DOT provider. He had successfully given treatment to 4 TB patients. He is regularly accompanying the chest symptomatics to the local DMCs for their sputum examination. His contribution helps in high compliance of patients specially migrants and ultimately contributing to the success of RNTCP. A flag bearer of RNTCP as a DOT Provider in Slum
Local RMP Dr Simarjeet Singh has been practicing in slum area around Sultan Wind Road, Amritsar is a DOT Provider since last 1 year. He joined the RNTCP as a DOT Provider inspired by the cure of his son who suffered from Tuberculosis and still on DOTS. Dr Singh never allows his patient to default. He has given treatment to 40 TB patients in his area and 8 TB patients still under DOTS from him. "He is my best DOT Provider working in my area." says T.B. Health Visitor Jasveer Kaur.
Tamil Nadu:
Screening for TB and HIV In Tiruchirappalli District Aniyapur PHC is an additional PHC and also DOT Centre. During routine visit to the centre in August 2011 DTO reviewed TB Cards of two TB patient who were also co-infected by HIV and both belong to a small village V. Poosaripatti. The village has a population of about 200. Then after discussion with DDHS it was decided to screen the whole village for both HIV and TB. The VHN of the village was given the responsibility of meeting the village Panchayat President to arrange an awareness and screening campaign.
TB and HIV and offered the services available at the Village itself for screening of both diseases. The STLS and LT of the nearby DMC collected the sputum samples and ICTC Technician collected the blood sample for HIV. Tribal Patient turned DOT Provider
The villagers were asked to assemble at 6PM. The MO, VHN and local Panchayat President also attended. A famous Tamil Film with Mr. Rajiniganth as Hero "Shivaji" was screened. About 170 villagers attended the meeting. Medical Officer in the middle of the film spoke about
(DOT Provider Rajamani (Rt) with patient)
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Selvi Rajamani, 31, is a resident of the tribal village of Anaikatty. She had TB and got cured after receiving treatment from RNTCP. Since then, Rajamani started to refer TB suspects to the District TB Center for sputum examination. She has so far referred around 15 suspects of which 6 of them have been diagnosed as Sputum Positive Pulmonary Tuberculosis including a small boy aged 5 years. Rajamani has also volunteered to treat the patients she has helped to diagnose by acting as a DOT Provider and has successfully cured 2 patients and is currently delivering treatment to 3 more.
Tripura:
DOTS Plus treatment first serve in North East
Under the aegis of State Health and Family Welfare Society (TB), Uttarakhand the Himalayan Institute of Medical Sciences (HIMS) Dehradun has become the first private medical college in the country to start DOTS Plus site in PPM mode. The State Govt. and the Society decided to establish the State DOTS Plus site in HIMS. This was necessitated by the fact that there was no Govt medical college in Dehradun and the District hospital had a severe space deficit. The HIMS College administration agreed to provide space for a 10 beded ward for DOTS Plus site. On 6th April 2011 the Society signed a Memorandum of Understanding with HIMS College after due approvals. The civil work was done as per the RNTCP norms and AIC guidelines and funds for this was provided by State TB Cell from the budget of DOTS Plus site. Further the State got approval of Rs 2 lac from NRHM additionalities for the recurring cost of patient management in the NRHM PIP of FY 2011-12. Central TB Division DOTS Plus appraisal team visited this site on 9th Aug 2011 for DOTS Plus appraisal. The first MDR TB patient was admitted on 19th October 2011. A total of 16 MDR TB patients have been admitted in this site in 2011. The refreshment to the patients are provided by Rotary Club of Dehradun .This site will cater to the MDR TB patients of 7 districts of Uttarakhand.
RNTCP, Tripura has taken the first initiative to introduce DOTS Plus treatment and facilities for patients in the North East Region. The first dose of 2nd line anti TB Drugs was given to the patients namely Anil Debnath & Sajal Deb who are the residents of Agartala. These two patients are suffering from Drug resistance TB, which was detected by LRS Institute , New Delhi after sputum culture, and recommended for starting of DOTS Plus treatment under Category-IV. Patients are very much cooperative to accept the injections and medicines. They have also committed to undergo regular treatment with medicines till the course is completed.
Uttaranchal:
The first Private medical college in the country to start DOTS Plus site in PPM mode
West Bengal:
Success story from Burdwan district Supriya Nandi of Gram Panchayet office of Raina II block, is a highly motivated and dedicated DOT provider of IMPACT project of CARE India in West Bengal. Supriya works diligently to ensure her TB patients adher to DOTS. As part of the initiative of the IMPACT program to link TB patients with support from the Government welfare schemes Supriya brings midday meal
Success Stories
103
to each of TB patient in the village. Supriya is very particular about preventing the slightest chance of defaulters. Once she noticed some of her TB patients were experiencing problems of non-adherence. She immediately alerted the local panchayet, health staff and field workers of IMPACT project of CARE about the growing problems. They quickly formed a team and
were successful in redirecting the patients into their treatment regimens. Supriya reports increased awareness and reducing stigma in the community members on TB that resulted from the gallant efforts of health volunteers like her. She says she loves her job and enjoys bringing hope and awareness to her community.
RNTCPPerformance 104
RNTCP Case Finding and Treatment Outcome Performance, 1999 2011

Every quarter, Central TB Division receives aggregate case-finding, programme management, sputum conversion, and treatment outcome information for patients registered under the programme from over 2,600 tuberculosis units nationwide. RNTCP follows the global method of cohort analysis for describing case finding and treatment outcomes. Timely data collection and dissemination are hallmarks of the RNTCP surveillance and data management systems. The data from the quarterly reports are analyzed and disseminated in the public domain as quarterly performance reports before the end of the subsequent quarter and as an annual report. For the purpose of describing the notification in this section, the data from the reports of the 4 quarters in a calendar year have been added and is presented in the form of annual data. Though the programme was formally initiated in the year 1997 and the quarterly reporting mechanism was in place since inception, the data presented below extend from the year 1999, when approximately about 10% of the countrys population was covered onwards. The rapid pace of DOTS expansion over the past decade complicates longitudinal data analysis in a number of ways. District-bydistrict scale-up of RNTCP services over several years changes the denominator of population covered every quarter. Basic demographic characteristics of implementing districts differed over the expansion years, as well as the expected evolution of services and TB epidemiology in areas implementing RNTCP over longer time periods. For the purposes of this analysis, districts implementing RNTCP less than one year during the initial year of implementation were attributed to cover a population proportionate to the number of days in the first year that services were available in each district. The rates presented in this section are all per 100,000 populations after adjusting for the number of days of implementation by individual districts till year 2006. Also the population of the districts is based on 2001 census and 2011 Census India for these two years and estimated for the rest of the years based on these two Censuses. Though the population in the tables is complete population of services covered as on 31st December of that year. Sputum Microscopy Services and TB Suspect Examination Over the 11 year analysis period, the population covered increased from 139 million to 1.21 billion populations (Table 1). Smear microscopy services are reported independently of case notification results. As expected from service expansion, the absolute number of TB suspects examined by smear microscopy annually has increased manifold, from 0.96 million to 7.8 million. Over the same time period, the rate of TB suspect examination also increased by 50%, from 421 per 100,000 population covered by RNTCP services to 651 per 100,000 population covered. Similarly, the rate of sputum smear positive cases diagnosed by microscopy has increased by 20%, from 62 to 79 per 100,000 population [Figure 1]. The average number of suspects examined for every sputum smear positive case diagnosed has gradually increased about 1.3% per year, from 2001 to 2011, the number of suspects examined per smear positive case diagnosed has increased by 28% from 6.4 to 8.3 suspects (Figure 2). Total and sputum smear positive case notification is also shown in Table 1. An average difference of 11.3% [Range 8 15%] was observed between the rate of sputum-positive cases diagnosed and the sputum-positive case notification rate.
Table1:TBCasefindingactivitiesandnotificationrates(19992011)
Total populationof Indiacovered under RNTCP (millions) 139 241 441 528 761 920 1058 1105 1,138 1,156 1,174 1,192 1,210 SputumMicroscopyServices Suspectsexamined Sputumsmear positive casesdiagnosed Number n/a 148,610 286,789 356,409 555,250 711,661 762,619 834,628 879,741 911,821 930,453 939062 953032 Rate 65 73 75 81 83 76 76 77 79 79 79 79 CaseNotification TotalTBcases notified Number 133,918 240,835 468,360 619,259 906,638 1,188,545 1,294,550 1,400,340 1,474,605 1,517,363 1,533,309 1,522,147 1,515,872 Rate 101 106 118 129 132 139 129 127 130 131 131 128 125 Totalsputumsmear positive casesnotified Number 61,103 131,100 252,878 327,519 473,378 615,343 676,542 746,149 790,463 815,254 825,397 831,429 844,920 Rate 46 58 64 68 69 72 68 68 69 71 70 70 70
Year
Number n/a 956,113 2,046,039 2,507,455 3,955,395 5,128,852 5,684,860 6,216,509 6,483,312 6,817,390 7,247,895 7,550,522 7,875,158
Rate 421 517 524 576 599 569 566 570 590 617 633 651
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Populationistotalcoveredattheyearendofeachyeartill2006 Estimatedpopulationbasedon2001&2011Census Ratesareadjustedforthenumberofdaysofimplementationtill2006
Figure 1: rate of TB suspect examined and smear positive TB cases diagnosed per 100,000 population 700 90 600 500
Per100,000
80 70 Per100,000 60 50 40 30
Suspectsexaminedper100,000 Smearpositivecasesdiagnosedper100,000
400 300 200 100 0

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
20 10 0
Year
Figure 2: Trends in suspects examined per smear positive TB case diagnosed (199-2011) 8.5 8.0 7.5 7.0 6.5 6.0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
y=0.13x+6.6 R=0.87
Year
Notification Rates of TB Cases
Overall, case notification has increased over the 12 year analysis period, and the notification rates of most types of TB cases has steadily increased or remained stable, with the exceptions of new smear-negative (Table 2 and Figure 3) and treatment after default (Table 2 and Figure 4). The total case notification rate has increased from 101 cases per 100,000 population in 1999 to 125 per 100,000 population in 2011 (Table 1), though the last 4 years case notification has been effectively flat or rather decreasing. The NSP case notification rate has increased from 39 cases per 100,000 population in 1999 to 53 per 100,000 population in the year 2008, and has remained at 53/100,000 for the past 4 years. The NSN notification rates have shown a decreasing trend from 45 per 100,000 population in 2004 to 28 per 100,000 population in 2011 (Table 2 and Figure 3), and continues to fall without clear explanation. Some of the arguments for this are increased efforts to get the sputum examined and bacilli demonstrated with increasing availability and application of quality sputum smear microscopy services expanded under the programme. The notification rate of re-treatment cases has increased by 40% over the past 12 years, from 18 per 100,000 population in 1999 to 25 per 100,000 population in 2011. The increase in retreatment notification rates appears to be driven largely by increases in the notification rates of the relapse and others types of re-treatment cases. The re-treatment others notification rate has almost doubled from 4 per 100,000 population in 1999 to 8 per 100,000 population in 2011. The notification rate of failure-type re-treatment cases has remained almost stable from 2002 onwards at the rate of 2 cases per 100,000 population. The Treatment after default notification rates have declined from 10/100,000 population in 2001 to 6/100,000 population in 2011 (Table 2 and Figure 4).
Table2:NotificationratesofdifferenttypesofTBunderRNTCP,1999:2011(Numbers&notificationratesper100,000population)
Population covered (millions) 139 241 441 528 761 920 1058 1105 1,138 1,156 1,174 1,192 1,210 Newsmear positive Newsmear negative Rate 32 32 37 41 42 45 39 37 35 34 33 31 28 Newextra pulmonary Number 16,015 28,004 52,373 72,288 109,777 144,182 170,783 183,719 206,701 220,185 233,026 231,121 226,965 Retreatment Relapse Rate 6 6 6 7 7 7 8 8 9 9 9 9 9 Retreatement Treatment afterdefault Number Rate 9,326 20,288 38,400 40,767 54,353 67,657 72,021 76,699 77,397 76,583 73,549 72,110 72,787 7 9 10 9 8 8 7 7 7 7 6 6 6 Retreatment Failure Number 1,401 3,183 6,195 8,684 11,560 16,296 17,710 19,496 19,012 18,434 18,870 18,463 17,304 Rate 1 1 2 2 2 2 2 2 2 2 2 2 1 Retreatment Others Number 5,541 9,115 18,450 24,578 35,983 51,929 59,845 74,270 83,746 89,995 88,976 91,708 101832 Rate 4 4 5 5 5 6 6 7 7 8 8 8 8 Totalcase notification Number 133,918 240,835 468,360 619,259 906,638 1,188,545 1,294,550 1,400,340 1,474,605 1,517,363 1,533,309 1,522,147 1,515,872 Rate 101 106 118 129 132 139 129 127 130 131 131 128 125
Year
Number Rate Number 51,627 93,359 183,970 243,529 358,490 465,616 507,089 554,914 592,262 616,027 624,617 630,165 642,321 39 41 47 51 52 54 51 51 52 53 53 53 53 42,180 73,714 146,145 195,798 291,062 381,656 392,679 401,384 398,707 390,260 384,113 366,381 340,203
Rate Number 12 12 13 15 16 17 17 17 18 19 20 19 19 7,334 12,511 23,122 34,143 46,577 62,251 75,054 90,153 96,781 104,210 108,361 110,691 112,508
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Populationistotalcoveredattheyearendofeachyeartill2006 Estimatedpopulationbasedon2001&2011Census Ratesareadjustedforthenumberofdaysofimplementationtill2006
Figure 3: Trends in type of TB case notification rate (199-2011)

160 Retreatment(all) 140 120 Newsmearnegative Newextrapulmonary Newsmearpositive
Casesper100,000
100 80 60 40 20 0 1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
Year
Figure 4: Trends in type of re-treatment TB case notification rate (199-2011) 30 Others 25 Casesper100,000 20 15 10 5 0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Failure
TAD
Relapse
Year
All New (incident) TB Case Notification

The number and rate of all new (incident) cases notified in the country has steadily increased at the rate of 7% annually for several years initially in the implementation of the programme starting from 83 per 100,000 population in 1999 to 116 per 100,000 population in 2004, with almost 40% increase in half a decade (Figure 5). The decline began after complete coverage in the country, and the all new (incident) TB case notification rate has decreased from 116 per 100,000 population in 2004 to 100 per 100,000 population in year 2011 showing a decline of 14%, almost 2% annually. Figure 5: Trend in incident TB case notification rate (199-2011) 180 160 140 120 100 80 60 40 20 0 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
y=7x+75 R=0.97 y= 1.5x+120 R=0.624
Year
Treatment Outcomes of Notified TB Cases Treatment outcomes of pulmonary sputum-positive cases notified under RNTCP is summarized in Table 3 Among NSP cases, the treatment success rate has been > 85% since the year 2001. The death rate and failure rate has been about 5% and 2% respectively. The default rates has decreased from 9% for the cohort of TB patients registered in 1999 to 6% for the cohort of patients registered in 2010. Among smear positive re-treatment cases the treatment success rate has been > 68% since implementation. The death rate has shown increase from 7% to 8%, failure rate about 6%. High default rates > 15% has been an area of concern among the re-treatment cases. The treatment success rate has been relatively less favorable among re-treatment TAD cases and failure cases (Table 4) when compared to the treatment success rate among other smear positive TB cases (NSP and relapse). Death rates among re-treatment cases have been higher when compared to the death rates among new smear positive TB cases (Table 3 and Table 4). Among re-treatment cases, the death rates
among failure cases has been consistently higher by about 1-2% when compared to the death rates among other types of re-treatment cases. Table3:TreatmentoutcomesamongnotifiednewTBcases,19992010
Year 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Newsmearpositive Newsmearnegative NewExtraPulmonary Success Death Failure Default Success Death Failure Default Success Death Failure Default 82% 5% 3% 9% 85% 4% 1% 9% 91% 2% 0% 6% 84% 4% 3% 8% 86% 3% 1% 9% 91% 2% 0% 7% 85% 5% 3% 7% 86% 4% 1% 8% 91% 2% 0% 6% 87% 4% 3% 6% 87% 4% 1% 7% 92% 2% 0% 5% 86% 5% 2% 6% 87% 4% 1% 7% 92% 2% 0% 5% 86% 4% 2% 7% 87% 4% 1% 8% 92% 2% 0% 5% 86% 5% 2% 7% 87% 4% 1% 8% 91% 2% 0% 6% 86% 5% 2% 6% 87% 4% 1% 8% 90% 3% 0% 5% 87% 5% 2% 6% 87% 3% 1% 8% 91% 2% 0% 5% 87% 4% 2% 6% 88% 3% 1% 7% 92% 3% 0% 4% 87% 4% 2% 6% 88% 3% 1% 7% 92% 2% 0% 4% 88% 4% 2% 6% 89% 3% 1% 7% 93% 3% 0% 4%
Theyearshownistheyearofregistration
Table4:TreatmentoutcomesamongnotifiedsmearpositiveretreatmentTBcases,19992010
Year Success 1999 73% 2000 73% 2001 74% 2002 75% 2003 75% 2004 74% 2005 73% 2006 73% 2007 74% 2008 75% 2009 75% 2010 75% Relapse Failure TreatmentAfterDefault TotalSmearpositiveRetreatment Death Failure Default Success Death Failure Default Success Death Failure Default Success Death Failure Default 7% 6% 13% 61% 7% 13% 17% 65% 7% 6% 21% 68% 7% 6% 18% 7% 6% 14% 57% 9% 14% 19% 69% 7% 5% 17% 69% 7% 6% 16% 7% 6% 12% 59% 9% 15% 16% 71% 7% 5% 16% 71% 7% 6% 15% 7% 6% 12% 60% 8% 15% 16% 71% 7% 5% 16% 72% 7% 6% 14% 7% 5% 12% 60% 9% 14% 16% 69% 8% 5% 18% 70% 8% 6% 15% 7% 5% 13% 62% 8% 13% 16% 69% 7% 4% 18% 71% 7% 6% 16% 7% 5% 14% 59% 8% 14% 18% 67% 8% 4% 20% 69% 7% 6% 17% 7% 5% 14% 58% 9% 14% 18% 66% 8% 4% 19% 69% 8% 6% 16% 7% 4% 12% 60% 9% 13% 16% 68% 8% 4% 18% 70% 8% 5% 15% 7% 5% 12% 59% 9% 14% 16% 68% 8% 4% 17% 71% 8% 5% 14% 7% 5% 12% 58% 10% 16% 15% 68% 8% 4% 17% 71% 8% 6% 14% 7% 5% 12% 57% 10% 15% 16% 68% 8% 4% 18% 71% 8% 5% 14%
Theyearshownistheyearofregistration
TB Suspects Examined per 100,000 Population per Quarter, by Districts, India 2011
>= 150 100 - 149.9 < 100
Annual Smear Positive Case Notification Rate (from CFR) by District, India, 2010
< 50 50 - 69.9 70 - 89.9 >= 90
Annual Total Case Notification Rate, India, 2010
< 100 100 - 149.9 150 - 199.9 >= 200
Cure Rate of New Smear Positive Cases by Districts, India 2010
>= 85% 80% - 84.9% < 80%
Performance of RNTCP Case Detection (2011), Smear Conversion (Fourth quarter 2010 to Third quarter 2011), and Treatment Outcomes (2010)
State
Suspects Population No. of examined (in lakh) per lakh covered by suspects examined population 1 RNTCP per quarter
Rate of change in No of Smear suspects positive examined per patients lakh 2 population diagnosed (compared to previous year) 48% 0% -8% -5% 1% 45% -5% 20% 28% 11% 22% -4% 11% 1% 4% -3% 3% 4% 180% 10% 1% -13% -5% -7% 9% -2% 16% 1% 2% -7% -8% -4% 8% -4% 0% 1% 367 77732 1409 22304 46382 2351 13063 298 216 24065 1298 59584 25161 7748 9017 23051 46196 14662 10 54677 75319 1360 2610 740 1894 28833 2695 23689 73378 706 45404 1925 190446 10307 64135 953032
Suspects examined per smear positive case diagnosed
Annual smear Rate of Annual smear positive case change in Total positive case notification suspects patients rate [from examined per notification registered rate (reported CFR: sm + s+ case for by RNTCP cases (NSP + diagnosed 4 treatment 3 Rel + TAD) / (compared to DMCs) Pop] previous year) 26% 1% -19% 2% 7% 8% 3% 19% 33% 3% 2% 2% 7% 10% 9% 2% 3% 3% 117% 8% 5% 3% 9% -8% 1% 5% 1% 9% 2% 2% 0% -1% 0% 2% 6% 3% 97 92 102 72 45 223 51 87 89 144 89 99 99 113 72 70 76 44 16 75 67 50 88 68 96 69 217 86 107 116 63 52 95 102 70 79 91 77 84 62 39 116 46 64 45 119 66 83 81 97 67 64 61 37 20 64 60 46 71 61 85 61 69 78 91 106 57 48 86 78 62 68 908 111915 2311 37841 76484 2537 27118 419 313 51645 1982 74867 37913 13501 13473 38574 70595 26126 17 90764 135281 3080 5079 2304 3722 48970 1568 39206 112504 1631 79830 2798 285884 14883 99829 1515872
Annual Annual Annual new Annual new previously Annual Annual new smear smear extra treated previously total case positive negative pulmonary smear treated case notificatio case case case positive notification n rate notificatio notification notification case rate n rate rate rate notification rate 239 132 167 121 74 241 106 122 129 308 136 124 150 197 107 117 115 78 26 125 120 113 171 211 188 117 126 142 164 268 111 76 143 147 109 125 71 60 62 51 32 85 41 49 36 82 49 59 54 69 54 55 47 32 12 50 47 39 56 45 65 51 52 56 63 78 44 42 69 54 51 53 65 30 33 31 21 24 39 23 45 54 20 13 27 32 14 33 24 18 0 38 26 30 38 55 40 28 23 25 41 57 28 13 32 32 20 28 70 16 28 17 5 83 14 24 19 101 38 16 27 48 21 8 21 18 6 13 21 25 41 70 42 21 29 30 22 72 21 12 16 24 18 19 34 27 43 23 15 49 13 26 30 71 29 36 41 47 18 20 23 10 8 24 26 20 35 41 42 17 22 31 38 62 17 9 26 37 21 25 25 19 25 12 8 35 6 17 11 41 19 25 30 31 15 10 16 7 8 16 14 9 20 18 24 10 19 23 29 38 13 7 19 25 14 17
Andaman & Nicobar Andhra Pradesh Arunachal Pradesh Assam Bihar Chandigarh Chhattisgarh D & N Haveli Daman & Diu Delhi Goa Gujarat Haryana Himachal Pradesh Jammu & Kashmir Jharkhand Karnataka Kerala Lakshadweep Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Orissa Puducherry Punjab Rajasthan Sikkim Tamil Nadu Tripura Uttar Pradesh Uttarakhand West Bengal Grand Total
4 847 14 312 1038 11 255 3 2 168 15 604 254 69 125 330 611 334 1 726 1124 27 30 11 20 419 12 277 686 6 721 37 1996 101 913 12102
4568 563463 10706 144567 400173 17560 109636 2654 3043 164392 14948 428419 181414 70916 98304 155736 525613 345053 951 392329 710985 13083 22586 8499 14506 212366 22618 182348 421609 6874 676634 20486 1268669 71805 587645 7875158
301 166 194 116 96 416 107 194 313 245 256 177 179 259 196 118 215 258 369 135 158 120 191 195 183 127 454 165 154 283 234 140 159 177 161 163
12 7 8 6 9 7 8 9 14 7 12 7 7 9 11 7 11 24 95 7 9 10 9 11 8 7 8 8 6 10 15 11 7 7 9 8
Estimated New Smear Positive cases / lakh population based on ARTI data for North Zone (Chandigarh, Delhi, Haryana, Himachal Pradesh, Jammu & Kashmir, Punjab, Uttar Pradesh, Uttarakhand) is 95; East Zone (Andaman & Nicobar, Arunachal Pradesh, Assam, Bihar, Jharkhand, Manipur, Meghalaya, Mizoram, Nagaland, Sikkim, Tripura, West Bengal) is 75; South Zone (Andhra Pradesh, Karnataka, Lakshdweep, Puducherry, Tamil Nadu ) is 75 and West Zone (Chhattisgarh, Dadra & Nagar Haveli, Daman & Diu, Goa, Gujarat, Madhya Pradesh, Maharashtra, Rajasthan) is 80; Orissa is 85, Kerala is 50 1 Projected population based on census population of 2011 is used for calculation of case-detection rate. 1 lakh = 100,000 population 2 Smear positive patients diagnosed include new smear positive cases and smear positive retreatment cases reported from DMCs in the PMR 3 Smear positive patients reported by RNTCP DMCs in the PMR 4 Total patients registered for treatment includes new sputum smear positive cases, new smear negative cases, new extra-pulmonary cases, new others, relapse, failure, TAD and retreatment others
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State
No (%) of pediatric cases out of all New cases
3 month conversion rate of new smear positive patients
No (%) of all Smear 3 month No (%) of all Smear Positive cases registered conversion Positive cases started within one month of rate of RNTCP DOTS within 7 days starting RNTCP DOTS retreatment of diagnosis treatment patients
Proportion Proportion No (%) of all cured Smear of TB No (%) of cases (all forms of all Positive cases having end patients of TB) registered receiving registered of treatment follow- up known to be DOT through a community TB cases sputum done within 7 days HIV infected volunteer with known of last dose among status tested 265 45597 801 11620 24357 1090 7458 137 98 15361 754 38248 12958 5604 6750 12080 21920 8236 8 27943 43619 951 1393 426 1211 14761 598 17136 42263 533 27296 1186 112386 4965 38613 548622
Proportion Proportion of TB Proportion of HIV patients of HIV infected TB known to infected TB patients be HIV patients put put on infected on ART( RT CPT( RT among report) report) registered 0.1% 10% 0.2% 0% 0% 1% 0.4% 0.2% 4% 1% 5% 4% 1% 1% 0.1% 1% 13% 2% 0.3% 8% 5% 0% 7% 4% 0.4% 1% 1% 0.2% 0.1% 7% 1% 0.2% 0.4% 1% 3% 86% 57% 25% 50% 68% 91% 59% 57% 37% 36% 64% 59% 47% 18% 69% 0% 50% 25% 77% 99% 95% 41% 52% 9% 2% 99% 42% 21% 94% 53% 100% 95% 86% 7% 100% 64% 47% 96% 48% 62% 100% 50% 8% 73% 69% 71% 36% 57% 73% 62% 72% 52% 64% 60% 43% 0% 52% 54% 18% 48% 61% 42% 90% 44%
57 4368 199 1507 4343 221 1264 19 13 5539 118 3219 1639 601 737 1794 4315 3434 0 8472 7382 170 663 345 417 2310 128 1994 4586 119 5020 49 14165 885 3972 84064
7% 5% 12% 5% 7% 11% 5% 6% 5% 14% 8% 6% 6% 6% 7% 6% 8% 15% 0% 12% 7% 7% 16% 19% 14% 6% 10% 6% 5% 40% 7% 2% 6% 8% 5% 7%
93% 92% 91% 87% 88% 91% 89% 90% 86% 89% 87% 92% 90% 92% 92% 92% 88% 84% 100% 91% 90% 90% 85% 91% 93% 88% 90% 90% 92% 87% 90% 89% 92% 90% 88% 90%
77% 75% 79% 66% 73% 74% 72% 68% 75% 72% 67% 69% 75% 81% 80% 80% 63% 69% 100% 71% 68% 75% 62% 74% 82% 67% 74% 75% 77% 68% 70% 73% 78% 74% 65% 73%
345 59982 1055 16970 35843 1131 10469 209 100 18454 880 46616 18990 6650 8400 18356 32703 11489 13 42171 59791 1237 2016 681 1317 21502 708 20506 51823 659 34508 1430 157175 7068 47301 738548
95% 90% 88% 86% 87% 89% 87% 93% 88% 89% 89% 92% 89% 96% 98% 85% 85% 87% 100% 89% 87% 96% 90% 98% 75% 83% 80% 93% 81% 93% 83% 79% 90% 88% 80% 87%
316 64915 1152 18365 40270 1222 11673 221 113 20187 935 49895 19953 6694 8527 21289 36657 11906 13 45943 66364 1232 2144 677 1447 25220 745 21574 59224 641 40268 1755 172831 7824 54594 816786
87% 97% 96% 93% 97% 97% 97% 98% 100% 98% 94% 98% 93% 97% 99% 99% 96% 91% 100% 97% 97% 95% 95% 98% 83% 98% 84% 98% 93% 91% 97% 97% 99% 98% 93% 97%
89% 83% 91% 75% 77% 95% 78% 94% 100% 94% 94% 90% 82% 92% 95% 69% 81% 78% 73% 77% 81% 85% 85% 84% 76% 72% 95% 91% 81% 97% 83% 78% 86% 79% 82% 83%
190 92986 713 12598 50505 498 13829 79 79 4297 264 41964 10368 1749 1447 24052 35258 16466 3 54816 42372 1626 2921 459 1548 34864 0 10407 15698 620 21092 1319 204085 8681 26041 733894
21% 83% 31% 33% 66% 20% 51% 19% 25% 8% 13% 56% 27% 13% 11% 62% 50% 63% 18% 60% 31% 53% 58% 20% 42% 71% 0% 27% 14% 38% 26% 47% 71% 58% 26% 48%
15% 85% 60% 28% 10% 96% 11% 29% 80% 62% 95% 89% 67% 31% 10% 18% 91% 57% 0% 17% 79% 48% 12% 65% 51% 17% 69% 64% 24% 3% 89% 30% 13% 39% 46% 45%
1% 11% 0.3% 1% 4% 1% 4% 1% 4% 2% 5% 5% 1% 2% 1% 3% 14% 3% 2% 10% 10% 1% 11% 8% 3% 2% 2% 1% 2% 8% 2% 1% 1% 2% 6%
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State
Human Resource Management Score (%)
Financial Management Score (%)
Drugs & Logistics Management Score (%)
Case Finding Efforts Score (%)
Quality of Services Score (%)
Composite Score for Performance Assessment (%)
56 46 33 43 38 62 44 52 53 45 63 56 49 42 50 47 55 54 24 48 53 42 47 39 36 44 61 51 44 48 52 51 43 47 46 47
85% 71% 51% 66% 59% 95% 68% 81% 82% 69% 96% 86% 75% 65% 77% 72% 85% 84% 37% 74% 81% 64% 73% 60% 55% 67% 94% 79% 68% 75% 80% 78% 66% 73% 70% 72%
20 11 19 17 8 20 9 10 20 19 10 18 17 19 16 3 17 18 20 14 14 18 19 19 18 15 20 15 16 15 12 18 3 12 18 13
100% 56% 96% 83% 42% 100% 47% 50% 100% 94% 50% 92% 83% 96% 82% 13% 87% 89% 100% 72% 68% 89% 93% 94% 91% 76% 100% 73% 82% 75% 60% 88% 15% 58% 89% 67%
20 14 17 14 15 20 14 20 20 13 16 16 15 17 16 17 14 13 20 15 15 16 17 9 14 13 20 18 18 19 15 19 16 13 14 15
100% 69% 86% 70% 76% 100% 70% 100% 100% 63% 80% 80% 76% 85% 79% 85% 69% 63% 100% 73% 74% 78% 83% 43% 71% 65% 100% 91% 89% 95% 74% 95% 79% 66% 71% 75%
15 11 13 7 12 10 13 11 14 16 8 13 13 11 12 10 10 15 25 12 11 8 11 12 10 15 19 9 14 11 12 9 12 11 14 12
51% 37% 43% 25% 40% 33% 44% 37% 46% 53% 25% 42% 43% 35% 40% 32% 33% 50% 83% 41% 35% 27% 35% 39% 33% 51% 62% 31% 45% 35% 41% 31% 41% 35% 47% 40%
74 81 66 56 66 95 60 55 73 72 62 78 65 70 71 69 70 70 41 69 80 64 64 65 71 63 68 73 66 80 67 54 70 58 59 69
64% 70% 58% 49% 58% 83% 53% 48% 64% 63% 54% 68% 57% 61% 61% 60% 61% 61% 36% 60% 69% 56% 56% 56% 62% 55% 59% 63% 57% 69% 58% 47% 61% 51% 52% 60%
185 163 149 137 141 207 141 149 181 164 158 181 159 160 165 145 167 170 130 158 171 147 157 143 150 150 188 166 158 173 158 151 144 141 151 156
74% 65% 60% 55% 56% 83% 56% 60% 72% 66% 63% 72% 64% 64% 66% 58% 67% 68% 52% 63% 69% 59% 63% 57% 60% 60% 75% 66% 63% 69% 63% 60% 58% 56% 60% 62%
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Outcome of Smear Positive Retreatment cases for India 2010 (excluding "Others")
Type of retreatment case Relapse Failure Treatment after default Total Cured 68.7% 50.1% 59.8% 63.8% Success 75.0% 56.7% 67.8% 70.8% Died 7.2% 9.6% 8.2% 7.8% Failure 4.8% 15.5% 3.9% 5.5% Defaulted 11.8% 16.3% 17.6% 14.3% Transferr ed out 1.1% 1.4% 2.6% 1.7% No. registered 110590 18439 72074 201103
State-wise outcome of Smear Positive Retreatment cases 2010 (excluding "Others")

Relapse
Implementing states Andaman & Nicobar Andhra Pradesh Arunachal Pradesh Assam Bihar Chandigarh Chhattisgarh D & N Haveli Daman & Diu Delhi Goa Gujarat Haryana Himachal Pradesh Jammu & Kashmir Jharkhand Karnataka Kerala Lakshadweep Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Orissa Puducherry Punjab Rajasthan Sikkim Tamil Nadu Tripura Uttar Pradesh Uttarakhand West Bengal Grand Total No. registere d 56 8304 197 2153 2928 237 917 28 25 4162 153 9460 4103 1804 1283 1481 4485 1124 1 5668 9616 141 307 127 229 2070 122 4604 11151 150 5016 205 19510 1685 7088 110590 Cured 76.8% 72.0% 77.2% 55.4% 65.0% 73.8% 59.8% 60.7% 60.0% 73.3% 65.4% 68.5% 68.7% 74.4% 74.6% 71.8% 61.4% 73.0% 100.0% 64.2% 62.1% 68.1% 56.4% 72.4% 82.5% 57.5% 73.0% 69.5% 73.1% 68.0% 63.4% 74.6% 73.6% 70.4% 67.2% 68.7% Success 76.8% 76.2% 79.2% 65.4% 80.4% 74.3% 76.8% 60.7% 72.0% 73.9% 66.7% 69.5% 74.9% 81.3% 81.0% 80.5% 66.0% 77.1% 100.0% 76.4% 67.4% 71.6% 64.2% 82.7% 87.8% 72.0% 76.2% 77.4% 80.5% 68.0% 70.0% 78.5% 81.0% 75.4% 71.2% 75.0% Died 10.7% 9.2% 4.1% 8.5% 5.2% 5.5% 5.6% 3.6% 8.0% 6.3% 8.5% 8.8% 6.1% 6.4% 5.7% 5.7% 9.8% 7.4% 0.0% 6.0% 9.7% 2.1% 6.5% 6.3% 4.4% 8.3% 10.7% 7.1% 6.1% 4.0% 8.7% 3.9% 5.5% 5.3% 7.7% 7.2% Failure 7.1% 5.7% 10.2% 5.7% 3.4% 9.7% 2.3% 3.6% 0.0% 7.4% 10.5% 7.4% 4.8% 5.9% 3.7% 2.8% 7.0% 6.3% 0.0% 3.6% 5.6% 12.1% 11.7% 10.2% 7.4% 3.6% 6.6% 3.3% 3.8% 20.7% 5.3% 4.4% 2.2% 3.9% 6.9% 4.8% No. Transferred Defaulted registere out d 5.4% 0.0% 6 8.2% 0.5% 1849 6.6% 0.0% 41 19.5% 0.8% 506 9.8% 1.1% 558 6.8% 3.8% 58 15.0% 0.3% 164 28.6% 3.6% 4 16.0% 4.0% 6 9.4% 2.3% 731 13.7% 0.7% 34 13.1% 0.9% 942 13.8% 0.4% 736 5.9% 0.5% 241 6.1% 3.6% 115 9.2% 1.9% 244 15.5% 1.6% 1089 8.1% 1.0% 650 0.0% 0.0% 0 11.6% 2.5% 1029 15.6% 1.5% 1598 13.5% 0.7% 42 16.3% 1.3% 174 11.0% 0.0% 30 3.5% 0.9% 66 15.2% 0.9% 445 6.6% 0.0% 21 9.5% 2.9% 519 10.4% 0.2% 1497 4.7% 2.7% 62 15.5% 0.6% 788 13.2% 0.0% 28 10.4% 0.8% 1980 11.9% 3.4% 185 12.7% 1.4% 2001 11.8% 1.1% 18439 Cured 83.3% 51.7% 65.9% 43.7% 44.3% 69.0% 50.6% 25.0% 50.0% 50.6% 52.9% 44.3% 53.9% 52.3% 53.9% 51.6% 43.3% 66.8% 47.2% 40.8% 69.0% 33.9% 66.7% 63.6% 44.9% 52.4% 58.4% 58.5% 33.9% 41.6% 67.9% 57.4% 56.2% 47.4% 50.1% Success 83.3% 56.9% 65.9% 53.6% 59.5% 69.0% 65.2% 25.0% 50.0% 51.3% 52.9% 45.9% 61.4% 55.2% 60.9% 59.8% 47.6% 71.5% 15.5% 4.6% 2.4% 7.5% 6.7% 4.5% 11.0% 0.0% 8.1% 9.2% 0.0% 4.2% 0.0% 8.6% 8.6% 3.4% 6.6%
Failure
Died 0.0% 12.9% 4.9% 10.1% 9.7% 8.6% 9.1% 25.0% 0.0% 8.8% 14.7% 11.0% 6.1% 10.0% 8.7% 8.6% 10.0% 3.5% 9.1% 12.5% 7.1% 8.0% 6.7% 4.5% 7.9% 9.5% 10.6% 7.5% 11.3% 13.8% 7.1% 7.6% 6.5% 9.5% 9.6% Failure 0.0% 17.7% 22.0% 12.6% 15.1% 15.5% 5.5% 50.0% 33.3% 19.7% 17.6% 19.1% 14.3% 23.2% 9.6% 8.2% 20.5% 12.2% 11.0% 17.2% 16.7% 23.6% 30.0% 25.8% 11.5% 23.8% 9.6% 11.2% 50.0% 17.9% 7.1% 8.7% 9.7% 21.0% 15.5% No. Transferr Defaulted registere ed out d 16.7% 0.0% 29 11.0% 0.8% 6375 7.3% 0.0% 78 23.1% 0.6% 1243 14.0% 1.8% 4171 5.2% 1.7% 63 20.1% 0.0% 616 0.0% 0.0% 29 0.0% 16.7% 12 11.2% 4.4% 2029 14.7% 0.0% 65 21.9% 1.0% 6060 17.9% 0.3% 2480 10.0% 0.8% 248 12.2% 7.8% 290 15.2% 7.8% 1420 20.0% 1.7% 3957 11.7% 0.3% 600 0 15.9% 1.2% 4485 20.1% 2.1% 4666 4.8% 0.0% 92 22.4% 4.6% 162 10.0% 0.0% 9 6.1% 0.0% 121 22.2% 1.6% 1733 14.3% 0.0% 61 11.4% 1.7% 1264 13.8% 0.2% 7623 3.2% 1.6% 35 21.1% 0.8% 3280 17.9% 0.0% 41 16.8% 0.8% 14422 16.2% 2.7% 753 16.4% 2.0% 3562 16.3% 1.4% 72074 Cured 48.3% 65.3% 60.3% 49.3% 62.3% 58.7% 46.3% 34.5% 50.0% 65.6% 50.8% 62.0% 55.8% 56.0% 60.3% 66.8% 45.0% 41.8% 52.8% 54.8% 66.3% 39.5% 55.6% 84.3% 44.1% 65.6% 58.1% 68.7% 57.1% 52.2% 61.0% 66.4% 60.8% 50.0% 59.8% Success 62.1% 72.0% 75.6% 59.1% 77.8% 58.7% 63.5% 34.5% 66.7% 66.5% 53.8% 63.0% 66.8% 64.1% 67.6% 77.0% 50.3% 48.7% 15.2% 4.9% 5.4% 11.1% 0.0% 5.8% 14.5% 3.3% 8.5% 8.4% 0.0% 7.7% 4.9% 8.8% 5.2% 5.5% 8.1%
TAD
Died 10.3% 9.9% 1.3% 7.7% 4.9% 12.7% 9.4% 20.7% 0.0% 8.3% 4.6% 8.6% 7.4% 10.9% 5.9% 6.8% 12.6% 9.2% 8.3% 11.2% 5.4% 11.1% 33.3% 3.3% 8.9% 11.5% 9.3% 6.9% 8.6% 10.4% 2.4% 5.9% 5.8% 9.5% 8.2% Failure 6.9% 5.2% 6.4% 4.1% 2.3% 6.3% 1.6% 6.9% 16.7% 7.1% 9.2% 5.8% 4.4% 7.7% 3.1% 2.3% 6.1% 6.3% 3.3% 3.8% 7.6% 5.6% 0.0% 3.3% 2.8% 6.6% 4.3% 3.4% 22.9% 3.7% 9.8% 2.1% 2.8% 6.0% 3.9% Defaulted 6.9% 11.6% 15.4% 27.9% 13.5% 19.0% 24.8% 37.9% 8.3% 14.7% 29.2% 19.6% 21.0% 16.1% 14.8% 10.8% 25.6% 32.0% 16.7% 22.5% 15.2% 28.4% 44.4% 2.5% 23.9% 11.5% 14.3% 13.5% 5.7% 24.8% 22.0% 13.5% 18.5% 26.1% 17.6% Transferr ed out 13.8% 1.2% 1.3% 1.2% 1.5% 3.2% 0.6% 0.0% 8.3% 2.6% 1.5% 2.6% 0.3% 1.2% 8.6% 3.2% 5.4% 3.5% 3.7% 2.6% 0.0% 4.3% 0.0% 1.7% 5.7% 1.6% 5.5% 0.3% 5.7% 1.1% 0.0% 3.3% 6.9% 2.9% 2.6%
Treatment success includes 'Cured' and 'Treatment completed'
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Treatment Outcome of New cases for 2010
Implementing states
New Smear Positive 1

Registered 285 50120 741 16819 33636 1008 10722 145 84 13527 773 36419 13387 5132 6604 17841 27324 10952 10 34368 52661 1057 1640 398 1347 22355 589 16960 42522 508 32805 1538 122334 5511 47556 629678 Cure 82.5% 87.1% 88.4% 79.8% 80.4% 88.8% 80.2% 80.7% 88.1% 85.3% 83.8% 87.8% 84.3% 87.6% 89.6% 85.7% 81.2% 82.3% 100.0% 86.1% 84.6% 88.4% 81.5% 98.7% 93.2% 82.6% 82.7% 86.1% 88.6% 80.5% 84.9% 86.7% 86.3% 83.0% 83.9% 85.1% Completed 0.4% 1.9% 0.5% 3.8% 8.3% 0.0% 6.4% 0.0% 1.2% 0.2% 0.5% 0.2% 1.5% 1.6% 1.7% 4.4% 1.3% 1.8% 0.0% 3.4% 1.2% 1.5% 2.1% 3.5% 0.8% 4.0% 2.5% 2.0% 2.0% 0.0% 1.5% 0.8% 3.3% 2.9% 1.4% 2.6% Died 2.5% 4.7% 2.4% 3.9% 2.8% 2.4% 4.1% 4.8% 3.6% 3.0% 4.4% 4.4% 4.4% 3.6% 2.7% 3.5% 6.9% 4.8% 0.0% 3.7% 6.0% 3.1% 3.4% 3.3% 1.8% 5.0% 5.4% 4.4% 3.6% 3.7% 5.3% 4.6% 3.2% 3.9% 3.9% 4.2% Failure 6.0% 2.2% 3.6% 2.1% 1.1% 2.9% 0.9% 0.7% 3.6% 4.2% 3.6% 2.4% 3.0% 2.8% 1.3% 1.2% 2.7% 4.9% 0.0% 1.4% 2.1% 2.1% 5.2% 4.5% 3.9% 1.2% 3.6% 1.8% 1.7% 12.6% 1.5% 3.1% 0.9% 1.7% 3.0% 1.9% Defaulted 6.3% 3.5% 3.9% 9.8% 6.8% 3.3% 8.0% 12.4% 3.6% 5.3% 6.5% 4.4% 6.2% 3.9% 2.5% 4.7% 6.9% 5.5% 0.0% 4.6% 5.2% 4.7% 6.5% 5.3% 3.3% 6.2% 5.4% 4.0% 4.8% 2.2% 6.5% 4.6% 5.6% 6.7% 6.9% 5.5% Trans out 2.5% 0.4% 1.1% 0.6% 0.6% 2.4% 0.4% 1.4% 0.0% 1.9% 0.9% 0.8% 0.4% 0.4% 2.3% 0.4% 1.0% 0.6% 0.0% 0.8% 1.0% 0.2% 1.2% 0.0% 0.2% 0.9% 0.3% 1.8% 0.3% 1.0% 0.3% 0.4% 0.7% 1.9% 0.9% 0.7% Registered 195 28529 589 10603 24750 381 10443 94 71 8453 407 8599 7046 2443 1908 12345 14699 6074 2 26734 30279 1181 1042 486 905 11714 301 7132 30268 349 21967 494 73215 3248 18900 365846
New Smear Negative 2

Completed 85.1% 90.3% 90.2% 82.2% 89.9% 93.7% 86.3% 85.1% 85.9% 92.3% 89.4% 89.3% 86.4% 90.5% 87.6% 89.8% 83.5% 91.8% 100.0% 88.6% 87.0% 91.4% 86.9% 109.1% 94.5% 85.5% 92.0% 88.1% 90.8% 92.6% 92.3% 88.7% 89.9% 86.4% 85.0% 88.8% Died 4.1% 4.1% 2.4% 3.4% 1.9% 0.8% 2.3% 2.1% 4.2% 1.9% 5.2% 4.3% 3.4% 3.4% 4.8% 2.0% 6.6% 2.9% 0.0% 2.2% 4.5% 2.9% 3.6% 5.1% 2.1% 5.2% 4.0% 4.3% 3.1% 2.3% 3.6% 6.5% 1.9% 2.3% 5.5% 3.3% Failure Defaulted 0.5% 0.5% 0.8% 0.6% 0.3% 1.8% 0.3% 2.1% 0.0% 1.2% 1.2% 0.8% 1.4% 1.4% 0.5% 0.3% 0.6% 0.2% 0.0% 0.4% 0.7% 0.0% 0.5% 0.2% 1.0% 0.5% 0.3% 0.6% 0.8% 4.0% 0.3% 0.4% 0.3% 0.7% 0.7% 0.5% 8.2% 4.6% 6.1% 13.4% 7.2% 1.6% 10.6% 8.5% 8.5% 3.7% 2.9% 5.0% 8.4% 4.3% 4.5% 6.8% 7.4% 4.5% 0.0% 7.7% 6.7% 5.7% 7.6% 4.9% 5.9% 7.4% 2.7% 4.7% 6.0% 1.1% 3.5% 4.3% 7.0% 8.6% 8.1% 6.7%
New Extra Pulmonary2

Trans Regist- Compout ered leted 2.1% 219 88.6% 0.5% 12966 92.6% 0.5% 437 92.4% 0.4% 5421 88.5% 0.7% 5109 90.7% 2.1% 856 96.4% 0.5% 3701 93.0% 2.1% 65 90.8% 1.4% 57 91.2% 0.9% 16397 96.2% 0.2% 560 94.5% 0.6% 10077 92.6% 0.3% 6460 93.9% 0.4% 3360 94.4% 2.5% 2877 90.6% 1.1% 2840 93.0% 1.8% 12836 87.9% 0.5% 6023 90.3% 0.0% 0 1.1% 9915 91.6% 1.2% 25052 90.5% 0.0% 738 93.0% 1.4% 1144 89.7% 0.4% 606 112.2% 0.6% 730 110.3% 1.5% 9023 91.0% 0.0% 308 94.5% 2.3% 8388 94.3% 0.1% 15362 95.3% 0.0% 410 96.6% 0.3% 15940 95.7% 0.2% 455 89.2% 0.9% 33029 94.1% 2.0% 2441 93.8% 0.9% 17066 88.4% 0.8% 230868 92.6% Died 5.9% 3.0% 0.9% 3.3% 1.6% 1.1% 1.7% 1.5% 5.3% 1.0% 2.7% 3.0% 1.3% 2.4% 2.7% 1.5% 5.0% 3.4% 1.6% 3.5% 2.8% 2.3% 5.1% 0.8% 3.2% 3.2% 2.2% 2.6% 2.2% 2.4% 4.2% 1.0% 1.1% 4.1% 2.5% Failure 0.0% 0.2% 0.2% 0.2% 0.1% 0.1% 0.1% 0.0% 0.0% 0.1% 0.2% 0.1% 0.2% 0.1% 0.2% 0.2% 0.2% 0.1% 0.1% 0.2% 0.0% 0.0% 0.3% 0.3% 0.2% 0.0% 0.1% 0.1% 0.2% 0.0% 0.0% 0.1% 0.2% 0.2% 0.1% Defaulted 4.6% 2.9% 5.7% 7.6% 4.0% 1.4% 4.5% 3.1% 3.5% 2.0% 2.0% 3.6% 4.2% 2.5% 3.1% 4.5% 4.7% 4.6% 4.2% 4.3% 4.1% 6.7% 3.8% 2.1% 4.7% 1.6% 2.0% 3.0% 0.2% 1.5% 6.2% 3.8% 4.1% 4.8% 3.7% Trans out 0.9% 1.2% 0.7% 0.4% 3.6% 1.1% 0.7% 4.6% 0.0% 0.7% 0.2% 0.7% 0.2% 0.4% 3.3% 0.7% 2.2% 1.6% 2.5% 1.5% 0.1% 1.3% 0.2% 0.1% 0.9% 0.0% 1.4% 0.1% 0.7% 0.3% 0.4% 1.1% 0.8% 2.5% 1.2%
1 Treatment success for New Smear Positive is cured and treatment completed. 2 Treatment success for New Smear Negative and New Extra Pulmonary are treatment completed.
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Programme infrastructure,Staffing and Training status in 2011
Implementing states Andaman & Nicobar Andhra Pradesh Arunachal Pradesh Assam Bihar Chandigarh Chhattisgarh D & N Haveli Daman & Diu Delhi Goa Gujarat Haryana Himachal Pradesh Jammu & Kashmir Jharkhand Karnataka Kerala Lakshadweep Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Orissa Puducherry Punjab Rajasthan Sikkim Tamil Nadu Tripura Uttar Pradesh Uttarakhand West Bengal Grand Total
Total no. of reporting units (Districts / DTC) 1 24 14 24 38 1 16 1 2 25 2 30 21 12 14 24 31 14 1 50 55 9 7 8 11 31 1 20 33 4 31 4 71 13 19 662
Implementing district details No. of TB No. of Units DMCs 3 13 178 924 14 34 69 337 177 714 3 17 67 375 1 5 2 4 36 198 4 20 138 738 49 230 41 170 42 165 70 294 125 644 79 490 1 9 150 742 276 1368 13 52 12 57 9 30 13 44 109 547 4 23 60 290 150 825 14 20 142 797 10 54 414 1831 30 144 193 834 2698 13039
Involvement of Other sectors Medical NGO PP College 0 0 0 110 138 32 13 0 0 29 0 3 28 2 7 7 76 2 72 0 3 0 9 0 0 3 0 75 62 6 2 56 1 157 3927 16 9 65 4 3 40 2 9 8 5 48 12 3 59 144 39 79 27 22 2 0 0 83 105 11 226 5378 41 133 10 1 27 0 1 1 0 0 46 15 0 146 1 5 3 0 9 71 312 8 55 250 9 3 1 1 106 102 27 3 0 2 210 138 22 17 2 4 139 11 11 1971 10894 297
Number of key staff in position DTO 1 18 14 24 26 1 16 1 2 23 2 17 18 12 15 23 26 14 1 50 54 9 6 8 11 28 1 20 31 4 25 4 69 12 19 605 2nd MO 0 21 0 9 28 0 2 0 1 10 0 13 7 3 12 12 7 10 0 11 58 6 1 2 0 8 0 7 9 0 23 1 43 4 9 317 MO-TC 3 171 6 51 157 3 53 1 1 18 4 137 46 36 35 60 123 56 0 128 240 4 7 8 3 98 4 52 125 3 113 8 371 22 181 2328 STS 3 161 14 69 140 3 62 1 2 46 4 137 46 40 40 66 124 73 1 133 270 13 12 9 13 107 4 55 136 5 136 10 377 28 190 2530 STLS 3 169 14 69 145 3 60 1 2 38 4 134 51 42 43 72 124 72 1 144 262 17 12 9 13 87 5 54 130 5 133 10 357 28 192 2505 LT 32 873 39 426 639 17 318 5 4 185 20 690 229 171 234 411 632 530 19 769 1318 62 52 29 48 502 23 287 794 22 733 63 1972 141 924 13213
In Place and trained in RNTCP Para MO Staff
89% 71% 70% 82% 70% 100% 80% 100% 66% 96% 100% 97% 80% 76% 90% 79% 85% 79% 19% 83% 74% 69% 90% 74% 77% 79% 71% 88% 85% 95% 86% 92% 66% 60% 83% 79%
94% 83% 58% 64% 82% 100% 88% 89% 100% 73% 100% 96% 69% 81% 87% 86% 78% 64% 100% 86% 86% 59% 69% 92% 68% 86% 94% 65% 83% 92% 90% 95% 58% 64% 71% 79%
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State
District
Population (in lakh) covered by RNTCP

1
No. of suspects examined
Rate of change in No of Suspects Suspects suspects Smear examined examined examined positive per smear per lakh per lakh patients positive population population diagnosed case per quarter (compared 2 diagnosed previous year)
Annual Rate of smear change in positive Annual suspects case smear examined positive notificatio per s+ n rate case case notificatio [from CFR: diagnosed sm + n rate (compared cases (from to (NSP + Rel PMR) previous + TAD) / year) Pop] 26% -1% 0% -5% -3% 4% 10% -3% -3% 1% 4% -2% -2% -10% 2% 3% 4% 34% -11% -1% 7% -5% 7% -3% 2% -32% -43% -56% 5% 6% -47% -16% -19% -17% 36% -13% -27% -33% 5% 8% -1% 4% 12% 1% 97 82 95 156 102 73 86 118 154 82 127 86 77 76 61 91 95 81 82 73 75 90 101 100 91 65 97 129 92 7 95 70 261 70 92 94 83 88 54 46 79 64 84 65 63 91 78 75 131 66 74 77 93 77 73 102 74 69 70 63 77 80 78 81 61 71 76 94 74 87 72 102 88 100 11 90 78 122 72 91 85 76 83 66 44 66 50 75 64 56
Total patients registered for treatment

3
Annual Annual Annual Annual previousl Annual new new extra previousl y treated Annual new smear smear pulmonar y treated smear total case positive negative y case case positive notificati case case notificati notificati case on rate notification notificati on rate on rate notificati rate on rate on rate
Andaman & Nicobar Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Arunachal Pradesh Arunachal Pradesh Arunachal Pradesh Arunachal Pradesh Arunachal Pradesh Arunachal Pradesh Arunachal Pradesh Arunachal Pradesh Arunachal Pradesh Arunachal Pradesh Arunachal Pradesh Arunachal Pradesh Arunachal Pradesh Arunachal Pradesh Assam Assam Assam Assam Assam Assam
Andaman & Nicobar Islands * Adilabad * Anantapur Bhadrachalam Chittoor Cuddapah East Godavari Guntur Hyderabad Karimnagar Khammam Krishna Kurnool Mahbubnagar Medak Nalgonda Nellore Nizamabad Prakasam Rangareddi Srikakulam Visakhapatnam Vizianagaram Warangal West Godavari Changlang ** Dibang Valley East Kameng * East Siang * Kurung Kumey Lohit ** Lower Subansiri * Papum Pare * Tawang * Tirap Upper Siang * Upper Subansiri * West Kameng * West Siang * Barpeta Bongaigaon Cachar Darrang Dhemaji Dhubri
4 27 41 8 42 29 52 49 40 38 20 45 40 40 30 35 30 26 34 53 27 43 23 35 39 1 1 1 1 1 2 1 2 0.5 1 0.4 1 1 1 19 10 17 9 7 19
4568 12350 27590 7172 28651 19676 45556 39115 42658 22274 13450 28617 23662 19249 12410 15474 21378 21440 20825 20839 19327 32550 19994 20601 28605 1115 456 525 818 81 1037 541 3114 353 929 383 466 470 418 6708 5966 8574 5454 2811 7227
301 113 169 214 172 171 221 200 266 146 172 158 146 119 102 111 180 210 153 98 179 190 213 146 182 188 184 167 207 23 156 163 441 177 207 271 140 135 93 88 144 123 150 102 93
48% 5% -6% 1% -3% -6% 17% -3% 1% 6% -1% 1% -7% -15% 0% 1% 0% 32% -5% -32% 11% -2% 13% -2% 13% 9% -22% -18% 1% 25% 32% -20% -14% 7% 8% -23% -2% -15% 1% -2% -10% 32% -12% -10%
367 2253 3868 1312 4242 2102 4434 5779 6174 3114 2487 3884 3100 3059 1839 3165 2826 2078 2799 3855 2024 3880 2357 3511 3590 96 60 101 91 6 158 58 461 35 103 33 69 77 61 889 820 1112 759 450 1220
12 5 7 5 7 9 10 7 7 7 5 7 8 6 7 5 8 10 7 5 10 8 8 6 8 12 8 5 9 14 7 9 7 10 9 12 7 6 7 8 7 8 7 6 6
908 3731 5345 1651 4758 4035 8058 7584 6985 4285 2957 5624 5576 4263 2819 4156 3904 2917 4261 5822 3974 5829 3823 3767 5791 178 78 179 189 21 249 129 589 71 208 43 125 115 137 1838 1167 2287 1320 690 2178
239 136 131 197 114 140 156 155 174 112 151 124 138 105 93 119 132 114 126 110 147 136 163 107 147 120 126 228 191 23 149 156 334 142 186 122 150 132 122 96 113 132 145 100 112
71 65 60 106 53 52 63 70 60 54 77 58 53 54 48 56 58 67 62 46 59 63 75 51 69 62 73 56 72 7 74 46 84 52 63 71 54 74 51 36 54 44 62 54 47
65 40 30 40 21 36 45 37 31 25 28 28 39 18 15 22 30 23 26 20 53 30 30 19 37 24 8 47 44 6 31 33 90 24 27 11 25 23 7 28 28 45 41 21 34
70 11 17 10 17 16 22 14 51 8 10 15 14 10 11 15 9 9 8 23 10 22 28 8 11 18 13 28 29 4 9 28 64 36 52 23 24 21 20 9 7 31 15 9 4
34 20 24 41 22 35 27 34 31 26 36 23 32 24 19 26 34 16 29 21 26 21 30 29 30 17 32 97 45 7 36 49 96 30 43 17 47 15 33 23 24 11 27 15 28
25 17 17 30 15 23 15 24 18 21 30 17 20 19 16 22 25 12 22 16 14 15 20 25 19 13 29 33 36 4 18 36 47 20 29 14 25 9 17 10 14 7 16 10 12
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State
District
3 month conversio 3 month No (%) of n rate of conversio pediatric cases new n rate of out of all New smear retreatmen cases positive t patients4 4 patients
Treatmen Treatmen t success t Success rate rate of among new smear smear positive positive previousl 5 patients y treated cases5 83% 90% 85% 90% 87% 90% 91% 91% 88% 90% 87% 90% 84% 86% 87% 91% 86% 89% 89% 86% 93% 92% 92% 88% 94% 91% 91% 90% 92% 86% 97% 92% 79% 83% 84% 81% 94% 87% 83% 86% 82% 85% 87% 89% 73% 71% 66% 77% 66% 75% 77% 75% 66% 74% 77% 71% 64% 72% 61% 74% 61% 76% 73% 71% 76% 79% 77% 77% 84% 70% 100% 77% 71% 68% 76% 75% 100% 84% 80% 75% 86% 63% 51% 66% 61% 58% 71% 71%
No (%) of all Smear Positive cases started RNTCP DOTS within 7 days of diagnosis
No (%) of all cured No (%) of cases No (%) of all Smear Smear Positive (all forms of TB) Positive cases cases having end registered registered within one of treatment receiving DOT month of starting follow- up sputum through a RNTCP DOTS done within 7 community treatment days of last dose volunteer
Proportio n of all registere d TB cases with known HIV status
Proportio n of TB patients known to be HIV infected among tested
Proportio n of TB patients known to be HIV infected among registere d
Proportio n of HIV infected TB patients put on CPT( RT report)
Proportio n of HIV infected TB patients put on ART( RT report)
57 113 142 18 129 87 336 171 652 65 73 200 240 162 113 149 81 89 116 349 203 338 281 61 200 7 5 23 10 4 5 18 68 6 20 6 4 11 12 48 24 102 27 20 51
7% 4% 3% 1% 3% 3% 5% 3% 11% 2% 3% 4% 6% 5% 5% 5% 3% 4% 4% 7% 6% 7% 9% 2% 4% 5% 9% 22% 7% 27% 3% 20% 16% 11% 13% 16% 5% 11% 12% 3% 3% 5% 3% 3% 3%
93% 90% 87% 87% 90% 91% 96% 94% 93% 91% 85% 92% 89% 89% 89% 91% 91% 91% 90% 91% 94% 95% 93% 91% 95% 90% 95% 97% 94% 100% 82% 76% 97% 96% 89% 81% 86% 93% 93% 81% 90% 89% 87% 89% 90%
77% 64% 69% 67% 69% 69% 87% 84% 71% 74% 74% 71% 69% 76% 64% 70% 68% 75% 68% 74% 80% 85% 81% 80% 88% 74% 100% 73% 76% 84% 66% 77% 100% 73% 67% 82% 88% 89% 56% 69% 75% 63% 75% 65%
345 2031 2780 957 2660 1887 3574 4337 3040 2542 1796 3003 2456 2746 1741 2357 2205 1888 2420 3107 1641 3099 1984 2384 3347 90 63 67 86 9 92 64 220 34 98 30 58 72 72 702 627 761 625 400 884
95% 91% 88% 84% 93% 86% 89% 94% 96% 89% 86% 88% 82% 93% 90% 87% 90% 93% 85% 94% 84% 92% 88% 89% 96% 82% 100% 96% 80% 90% 60% 94% 95% 94% 94% 100% 88% 100% 95% 80% 89% 85% 89% 90% 78%
316 2229 3058 1082 2818 2082 3913 4610 3036 2748 2082 3243 2979 2861 1825 2502 2457 1982 2824 3253 1857 3328 2171 2523 3452 104 63 70 84 10 153 68 231 35 94 30 66 72 72 869 616 857 690 443 893
87% 100% 97% 95% 99% 95% 98% 100% 96% 96% 100% 95% 100% 97% 95% 93% 100% 98% 99% 99% 95% 99% 97% 94% 100% 95% 100% 100% 79% 100% 100% 100% 100% 97% 90% 100% 100% 100% 95% 99% 87% 96% 98% 100% 79%
265 1438 2073 488 1944 1447 2967 3470 2463 1902 1349 2379 1489 2012 1101 1646 1624 1520 2067 2482 1200 2542 1607 1823 2564 56 63 24 85 0 100 38 184 25 60 25 49 42 50 392 265 488 557 335 620
89% 87% 79% 55% 80% 84% 88% 87% 94% 86% 79% 83% 64% 82% 74% 75% 86% 87% 92% 90% 76% 91% 82% 83% 84% 78% 100% 73% 88% 100% 90% 96% 93% 88% 71% 100% 82% 96% 63% 44% 63% 72% 83% 67%
190 3666 4814 1160 4147 3664 6918 5988 3054 3469 2604 2792 5375 4000 2547 3866 3904 2629 4141 4956 3513 5246 3535 3767 3231 92 8 6 58 0 25 20 353 8 97 3 15 28 0 62 216 1125 582 288 1344
21% 98% 90% 70% 87% 91% 86% 79% 44% 81% 88% 50% 96% 94% 90% 93% 100% 90% 97% 85% 88% 90% 92% 100% 56% 52% 10% 3% 31% 0% 10% 16% 60% 11% 47% 7% 12% 24% 0% 3% 19% 49% 44% 42% 62%
15% 77% 87% 59% 88% 70% 87% 84% 95% 75% 72% 83% 79% 90% 86% 92% 86% 76% 94% 88% 86% 92% 94% 82% 81% 36% 90% 35% 42% 29% 70% 30% 86% 61% 34% 35% 74% 69% 58% 34% 24% 26% 27% 36% 18%
1% 4% 10% 3% 11% 8% 19% 15% 7% 10% 7% 19% 10% 5% 8% 15% 12% 7% 14% 11% 13% 10% 7% 5% 18% 0% 0% 0% 0% 0% 0% 0% 1% 0% 0% 0% 0% 0% 0% 1% 1% 5% 0% 0% 0%
0% 3% 9% 2% 10% 5% 16% 13% 7% 7% 5% 16% 8% 4% 7% 14% 10% 6% 13% 10% 11% 9% 7% 4% 14% 0% 0% 0% 0% 0% 0% 0% 1% 0% 0% 0% 0% 0% 0% 0% 0% 1% 0% 0% 0%
100% 84% 100% 99% 98% 77% 100% 91% 100% 97% 99% 94% 93% 85% 95% 98% 99% 100% 98% 93% 94% 18% 92% 77%
33% 56% 56% 77% 49% 28% 49% 49% 43% 41% 32% 55% 41% 57% 26% 46% 55% 46% 49% 21% 62% 82% 75% 27%
100% 0%
100% 100%
0%
0%
Page123
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56 48 24 16 57 38 57 61 40 50 40 48 48 34 51 42 58 37 56 52 57 59 45 59 38 22 44 25 27 26 48 61 26 19 29 47 27 26 44 41 51 49 52 48
85% 74% 37% 24% 88% 58% 87% 94% 62% 77% 62% 73% 74% 52% 78% 64% 90% 56% 87% 80% 88% 91% 69% 90% 58% 34% 68% 39% 42% 40% 74% 95% 39% 29% 45% 73% 41% 40% 68% 64% 78% 76% 80% 73%
20 10 10 10 10 10 10 10 10 20 10 10 10 20 10 10 10 10 10 10 10 10 20 10 10 10 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 10
100% 50% 50% 50% 50% 50% 50% 50% 50% 100% 50% 50% 50% 100% 50% 50% 50% 50% 50% 50% 50% 50% 100% 50% 50% 50% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 50%
20 16 8 12 8 8 12 16 8 16 16 16 16 16 16 16 16 12 16 16 16 12 16 20 8 20 20 12 8 20 20 16 20 12 20 20 20 16 20 16 16 20 8 16
100% 80% 40% 60% 40% 40% 60% 80% 40% 80% 80% 80% 80% 80% 80% 80% 80% 60% 80% 80% 80% 60% 80% 100% 40% 100% 100% 60% 40% 100% 100% 80% 100% 60% 100% 100% 100% 80% 100% 80% 80% 100% 40% 80%
15 14 8 14 12 18 17 20 14 15 12 5 11 5 5 29 11 5 5 7 5 10 10 5 10 5 15 15 15 15 15 20 15 13 5 15 15 5 6 5 5 5 5 5
51% 46% 28% 47% 41% 62% 55% 67% 45% 50% 38% 17% 38% 17% 17% 96% 36% 17% 17% 23% 17% 33% 33% 17% 33% 17% 50% 50% 51% 50% 50% 67% 50% 43% 17% 50% 50% 17% 21% 17% 17% 17% 17% 17%
74 75 61 67 76 94 87 89 90 77 82 94 81 73 67 67 87 87 70 84 76 84 86 89 92 68 75 66 71 60 49 74 68 62 58 64 81 68 54 63 44 70 53 68
64% 65% 53% 59% 66% 81% 76% 78% 78% 67% 71% 82% 71% 63% 59% 58% 76% 76% 60% 73% 66% 73% 75% 77% 80% 59% 65% 57% 61% 53% 43% 64% 59% 54% 50% 56% 70% 59% 47% 55% 39% 61% 46% 60%
185 163 112 119 164 168 182 197 162 178 159 172 166 147 149 163 183 151 157 169 164 175 177 182 158 125 174 138 141 141 152 191 149 125 132 167 163 135 144 146 136 164 138 147
74% 65% 45% 48% 65% 67% 73% 79% 65% 71% 64% 69% 67% 59% 60% 65% 73% 60% 63% 68% 66% 70% 71% 73% 63% 50% 70% 55% 57% 57% 61% 77% 59% 50% 53% 67% 65% 54% 58% 58% 55% 66% 55% 59%
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Annual Rate of smear change in positive Annual suspects case smear examined positive notificatio per s+ n rate case case notificatio [from CFR: diagnosed sm + n rate (compared cases (from to (NSP + Rel PMR) previous + TAD) / year) Pop] 5% 16% 4% 5% 48% -7% -11% -13% -5% -19% 22% 9% 13% -7% -14% 1% -9% 5% 21% 10% 8% 11% 9% 6% 5% -2% 3% 7% 10% -2% 30% 4% 11% 2% -12% 26% 11% 13% 2% 1% 13% -9% 10% 3% -4% 113 60 62 51 75 89 69 46 87 64 52 58 48 80 81 99 122 35 40 48 37 35 55 64 30 37 56 32 39 28 54 33 68 38 48 34 46 43 59 52 37 31 48 52 33 73 80 57 56 45 67 72 61 39 82 57 46 49 51 71 76 87 96 34 33 42 33 38 52 52 25 37 47 28 35 27 51 30 59 35 47 32 42 36 56 46 34 30 44 36 29 63

3
Assam Assam Assam Assam Assam Assam Assam Assam Assam Assam Assam Assam Assam Assam Assam Assam Assam Assam Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar
Dibrugarh Goalpara Golaghat Hailakandi Jorhat Kamrup Karbi Anglong * Karimganj Kokrajhar Lakhimpur Marigaon Nagaon Nalbari North Cachar Hills * Sibsagar Sonitpur Tinsukia Udalguri Araria ** Arwal Aurangabad-BI ** Banka ** Begusarai ** Bhagalpur ** Bhojpur ** Buxar Darbhanga ** Gaya ** Gopalganj ** Jamui ** Jehanabad ** Kaimur ** Katihar ** Khagaria ** Kishanganj ** Lakhisarai ** Madhepura ** Madhubani ** Munger ** Muzaffarpur ** Nalanda ** Nawada ** Pashchim Champaran ** Patna Purba Champaran ** Purnia **
13 10 11 7 11 29 10 12 11 10 10 28 13 2 12 19 13 8 28 7 25 20 30 30 27 17 39 44 26 18 11 16 31 17 17 10 20 45 14 48 29 22 39 58 51 33
7427 4144 4450 3523 7150 15454 4044 4917 4420 3442 4284 12840 4743 1246 5065 10767 7797 2114 8916 3355 9507 7833 13496 18717 7624 6542 16816 11564 10791 4510 4816 4685 13666 6400 6309 3713 10451 16506 7335 19890 8278 5325 13116 24035 12958 20266
140 103 105 134 164 132 105 101 104 83 112 114 88 146 110 140 148 63 79 120 95 96 114 154 70 96 107 66 105 64 107 72 111 97 93 93 131 92 135 104 72 60 84 104 64 155
3% -2% -9% -12% 44% -7% -6% -22% -6% -18% -5% -4% -3% 2% -5% -8% -8% -2% 0% 13% 18% -3% 2% 3% 27% 11% -2% 16% -5% -2% 23% -1% -4% -10% -17% 20% -7% 7% 1% -10% 3% -18% -1% 11% -9%
1500 601 655 334 818 2618 669 554 925 669 498 1652 653 171 929 1908 1612 288 1113 339 918 705 1633 1951 824 636 2211 1421 989 497 611 539 2094 623 814 339 925 1920 798 2494 1062 697 1873 3016 1662 2405
5 7 7 11 9 6 6 9 5 5 9 8 7 7 5 6 5 7 8 10 10 11 8 10 9 10 8 8 11 9 8 9 7 10 8 11 11 9 9 8 8 8 7 8 8 8
2373 937 1368 571 1491 3991 1464 1086 1354 901 964 2619 1279 291 1684 2981 2408 599 1846 473 1404 1436 2921 3198 1336 1046 3102 3706 1496 1211 1114 922 2363 868 1078 637 1066 2258 1346 5016 1642 1006 2200 5853 2208 3054
179 93 129 87 137 136 152 89 127 87 101 93 95 136 146 155 183 72 66 68 56 71 99 105 49 61 79 85 58 69 99 57 77 52 64 64 53 50 99 105 57 45 56 101 43 93
66 49 48 37 54 49 55 33 70 47 37 43 42 51 60 75 79 27 29 33 26 33 41 44 18 27 38 23 26 22 39 22 50 30 40 25 35 31 44 37 31 25 39 28 25 52
31 24 42 20 33 30 60 24 30 17 32 26 25 44 30 39 26 26 25 17 13 18 34 34 11 16 14 33 12 26 35 16 9 12 8 17 8 9 26 38 19 9 7 35 10 22
59 4 22 14 28 16 13 15 3 6 5 8 10 8 29 16 51 5 2 2 4 1 4 10 3 3 12 5 3 2 5 1 4 2 4 4 1 3 10 8 3 2 2 15 2 3
23 16 17 15 21 41 24 18 24 16 27 15 18 34 28 25 27 14 9 15 13 18 20 18 17 15 15 17 17 19 21 18 14 9 11 17 9 7 19 21 5 9 8 23 6 16
16 9 8 9 13 25 8 6 13 10 10 7 10 23 17 14 18 7 4 9 7 5 12 9 8 10 10 4 9 7 13 8 10 5 6 8 7 5 13 9 2 5 5 9 4 11
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Treatmen Treatmen t success t Success rate rate of among new smear smear positive positive previousl 5 patients y treated cases5 90% 80% 80% 79% 80% 86% 79% 81% 81% 88% 74% 87% 83% 79% 79% 81% 85% 85% 95% 79% 85% 94% 89% 78% 91% 88% 93% 91% 79% 85% 80% 83% 86% 90% 87% 95% 84% 89% 89% 95% 96% 94% 89% 96% 90% 73% 51% 58% 72% 48% 63% 48% 63% 58% 61% 52% 71% 57% 57% 55% 63% 67% 64% 93% 60% 80% 88% 74% 70% 83% 71% 88% 84% 74% 75% 65% 67% 77% 82% 83% 91% 71% 74% 81% 90% 87% 88% 68% 87% 84%
226 18 64 26 83 102 38 30 25 32 25 53 23 2 99 149 229 11 158 16 73 54 197 288 57 57 256 131 64 50 58 26 133 56 44 34 54 81 83 295 104 40 66 587 62 166
11% 2% 5% 6% 7% 4% 3% 3% 2% 4% 4% 2% 2% 1% 7% 6% 11% 2% 10% 4% 7% 5% 8% 11% 6% 7% 10% 4% 6% 6% 7% 4% 7% 8% 5% 7% 6% 4% 8% 7% 7% 5% 3% 13% 3% 7%
91% 88% 88% 88% 87% 88% 82% 86% 82% 90% 82% 92% 86% 86% 85% 81% 91% 87% 89% 88% 84% 77% 91% 89% 82% 93% 92% 81% 91% 76% 89% 86% 86% 86% 90% 72% 89% 86% 87% 89% 93% 97% 95% 88% 90% 90%
75% 61% 69% 57% 56% 69% 57% 60% 55% 68% 64% 72% 72% 63% 59% 59% 76% 76% 69% 76% 74% 61% 84% 75% 66% 87% 75% 75% 82% 61% 81% 75% 68% 67% 69% 62% 82% 73% 67% 76% 78% 86% 77% 71% 70% 77%
1016 546 515 191 718 1905 545 402 748 541 370 1087 623 140 690 1557 1126 251 676 278 771 663 1447 1520 521 599 1774 917 817 434 540 450 1527 506 719 320 728 1513 682 1612 895 647 1450 1758 1296 1916
94% 93% 87% 63% 97% 87% 90% 84% 85% 90% 82% 77% 89% 89% 78% 91% 88% 88% 71% 94% 91% 86% 93% 95% 74% 95% 95% 76% 90% 88% 94% 93% 83% 87% 91% 97% 87% 93% 89% 72% 92% 98% 83% 82% 88% 92%
979 584 558 303 735 2097 582 479 794 595 406 1345 702 147 790 1686 935 280 915 295 814 683 1558 1596 590 610 1877 1159 911 489 561 481 1846 581 791 308 839 1604 770 2079 919 646 1688 1957 1475 2048
90% 100% 94% 99% 100% 96% 96% 100% 90% 99% 90% 96% 100% 94% 89% 98% 73% 99% 96% 100% 96% 89% 100% 99% 84% 97% 100% 95% 100% 99% 98% 99% 100% 100% 100% 94% 100% 99% 100% 93% 95% 97% 97% 91% 100% 99%
837 428 421 174 493 1216 216 268 532 397 275 1027 344 47 399 1031 858 0 569 193 508 243 988 1227 351 328 1131 575 682 162 368 271 1414 322 579 159 568 1012 349 942 815 537 1350 1368 815 1126
88% 92% 78% 61% 89% 78% 55% 71% 80% 83% 82% 84% 62% 51% 69% 84% 80% 78% 78% 88% 73% 70% 91% 75% 82% 90% 73% 89% 52% 85% 75% 100% 71% 86% 71% 86% 72% 58% 62% 87% 86% 82% 73% 74% 69%
691 292 417 132 490 971 592 413 541 744 170 582 509 71 658 877 600 231 229 271 973 778 2717 1384 201 956 2813 2691 1411 1094 932 413 1950 362 939 259 34 1842 1040 3508 1432 740 469 520 911 2830
29% 31% 30% 23% 33% 24% 40% 38% 40% 83% 18% 22% 40% 24% 39% 29% 25% 39% 12% 57% 69% 54% 93% 43% 15% 91% 91% 73% 94% 90% 84% 45% 83% 42% 87% 41% 3% 82% 77% 70% 87% 74% 21% 9% 41% 93%
53% 24% 68% 16% 32% 29% 11% 33% 31% 10% 27% 25% 22% 67% 13% 15% 38% 17% 8% 39% 1% 5% 17% 14% 6% 0% 36% 0% 24% 4% 3% 0% 37% 57% 45% 33% 16% 2% 11% 3% 0% 19% 7% 0% 17% 25%
0% 0% 1% 1% 1% 0% 2% 1% 1% 0% 0% 1% 1% 0% 1% 0% 0% 1% 1% 1% 5% 5% 1% 6% 7% 4% 6% 15% 3% 2% 3% 2% 2% 2% 8% 6% 5% 0% 3% 5% 2%
0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 1% 0% 0% 2% 0% 1% 1% 0% 0% 1% 1% 1% 1% 0% 0% 1% 0% 0% 0% 0% 0% 1% 0%
100% 0% 144% 0% 38% 100%
67% 100% 200% 75% 50% 100%
40% 100% 0% 0% 33% 0% 0%
100% 100% 0% 67% 67% 0% 0%
13% 0% 43% 67% 50%
75% 0% 38% 33% 50%
0% 0% 0%
100% 100% 17%
0%
100%
0%
100%
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43 52 22 29 41 40 42 47 47 53 26 44 49 45 52 28 45 54 51 29 47 41 32 29 29 44 24 20 39 52 39 51 48 41 36 29 28 39 38 38 30 29 38 36 62
67% 80% 34% 44% 63% 62% 64% 72% 73% 82% 41% 68% 76% 69% 81% 43% 69% 82% 79% 45% 73% 62% 49% 45% 44% 68% 37% 30% 59% 80% 60% 78% 74% 63% 56% 45% 43% 60% 59% 58% 46% 44% 59% 56% 96%
10 10 10 20 20 20 20 10 20 20 20 10 20 20 10 10 20 20 10 0 0 20 20 0 10 20 10 20 10 10 10 20 10 10 0 0 10 10 10 0 10 0 0 10 10
50% 50% 50% 100% 100% 100% 100% 50% 100% 100% 100% 50% 100% 100% 50% 50% 100% 100% 50% 0% 0% 100% 100% 0% 50% 100% 50% 100% 50% 50% 50% 100% 50% 50% 0% 0% 50% 50% 50% 0% 50% 0% 0% 50% 50%
12 4 4 20 16 8 20 12 20 16 8 12 16 20 12 12 16 16 16 16 16 16 12 16 16 16 12 12 8 16 8 16 20 16 16 20 16 16 16 16 16 16 8 16 16
60% 20% 20% 100% 80% 40% 100% 60% 100% 80% 40% 60% 80% 100% 60% 60% 80% 80% 80% 80% 80% 80% 60% 80% 80% 80% 60% 60% 40% 80% 40% 80% 100% 80% 80% 100% 80% 80% 80% 80% 80% 80% 40% 80% 80%
14 15 5 5 15 10 5 5 5 5 5 5 5 5 7 15 15 6 19 15 18 5 5 5 30 15 11 25 14 15 5 15 25 15 18 5 5 15 11 5 6 10 15 25 10
46% 50% 17% 17% 50% 33% 17% 17% 17% 17% 17% 17% 17% 17% 22% 50% 50% 20% 62% 50% 59% 17% 17% 17% 100% 50% 35% 83% 45% 50% 17% 50% 83% 50% 59% 17% 17% 50% 37% 17% 19% 33% 50% 83% 34%
70 63 45 55 59 67 42 62 55 55 48 49 53 60 30 58 63 55 80 50 83 75 60 42 86 75 51 88 65 60 47 61 65 54 55 70 64 64 64 72 76 63 59 80 63
61% 55% 39% 48% 51% 58% 37% 54% 47% 48% 42% 42% 46% 52% 26% 50% 55% 48% 70% 44% 72% 65% 52% 36% 74% 66% 44% 77% 57% 52% 41% 53% 56% 47% 48% 61% 55% 55% 55% 63% 66% 55% 52% 70% 55%
150 144 86 128 151 145 129 135 147 149 107 120 143 150 111 123 159 150 176 111 164 157 129 92 170 171 107 165 135 153 109 163 168 136 125 125 122 144 139 131 138 118 121 168 162
60% 58% 34% 51% 60% 58% 52% 54% 59% 60% 43% 48% 57% 60% 44% 49% 63% 60% 70% 44% 66% 63% 52% 37% 68% 68% 43% 66% 54% 61% 44% 65% 67% 54% 50% 50% 49% 58% 56% 52% 55% 47% 48% 67% 65%
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Annual Rate of smear change in positive Annual suspects case smear examined positive notificatio per s+ n rate case case notificatio [from CFR: diagnosed sm + n rate (compared cases (from to (NSP + Rel PMR) previous + TAD) / year) Pop] 9% 7% 29% 21% 26% 20% 6% 10% -5% -9% 8% -4% 0% -7% -8% 16% 14% -11% 18% -10% 5% 18% 8% 7% 0% 1% 3% 19% 38% 23% -4% -2% 1% 21% -10% -4% -2% 8% 3% -1% 12% -17% 51 37 51 27 33 36 56 42 29 40 223 58 52 87 55 38 49 38 67 31 55 33 47 54 56 64 45 87 94 69 127 92 86 125 102 209 92 114 113 141 105 143 140 45 35 45 26 23 35 52 37 28 35 116 44 48 71 48 34 50 27 64 29 50 28 46 50 50 64 43 64 48 35 119 95 60 123 96 148 77 85 105 143 101 73 137

3
Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Bihar Chandigarh Chhattisgarh Chhattisgarh Chhattisgarh Chhattisgarh Chhattisgarh Chhattisgarh Chhattisgarh Chhattisgarh Chhattisgarh Chhattisgarh Chhattisgarh Chhattisgarh Chhattisgarh Chhattisgarh Chhattisgarh Chhattisgarh D & N Haveli Daman & Diu Daman & Diu Delhi Delhi Delhi Delhi Delhi Delhi Delhi Delhi Delhi Delhi Delhi Delhi Delhi
Rohtas Saharsa ** Samastipur ** Saran ** Sheikhpura ** Sheohar Sitamarhi ** Siwan Supaul ** Vaishali ** Chandigarh Bastar * Bilaspur-CG Dantewada * Dhamtari Durg Janjgir Jashpur * Kanker * Kawardha ** Korba Koriya ** Mahasamund Raigarh-CG ** Raipur Rajnandgaon Surguja Dadra & Nagar Haveli Daman Diu BJRM Chest Clinic BSA Chest Clinic CD Chest Clinic DDU Chest Clinic DFIT Chest Clinic GTB Chest Clinic Gulabi Bagh Hedgewar Chest Clinic Jhandewalan Karawal Nagar Kingsway Camp LN Chest Clinic LRS
30 19 43 39 6 7 34 33 22 35 11 16 27 8 8 33 16 9 7 8 12 7 10 15 41 15 24 3 2 0.5 5 5 5 11 9 6 9 5 5 8 7 5 9
14482 7534 17498 10174 3378 2372 14453 12723 6570 13569 17560 6138 11612 4017 3254 14934 8156 2344 5054 2018 6408 2640 3863 4850 17670 7362 9316 2654 2300 743 4685 2935 3192 10980 5670 7449 6285 3944 4209 5658 4902 5949 7564
122 99 103 65 133 90 106 96 74 97 416 99 109 127 102 112 126 69 169 61 133 100 94 81 109 120 99 194 301 357 238 138 150 258 159 337 172 208 193 185 166 304 203
12% -6% 15% 8% 9% -10% 6% -4% -2% -7% 45% -5% -11% 11% -12% -1% -9% 61% 13% -18% 0% 7% -2% -1% -18% -5% 3% 20% 24% 43% 19% -3% 0% 67% 8% 17% 5% 11% -13% -10% 9% 20%
1497 707 2186 1081 207 239 1915 1404 637 1400 2351 904 1381 688 443 1260 792 328 501 253 665 217 489 802 2288 979 1073 298 180 36 624 490 457 1332 914 1157 842 539 616 1083 774 697 1303
10 11 8 9 16 10 8 9 10 10 7 7 8 6 7 12 10 7 10 8 10 12 8 6 8 8 9 9 13 21 8 6 7 8 6 6 7 7 7 5 6 9 6
2057 1373 3818 2214 533 772 2932 2718 1036 3225 2537 1743 2751 917 703 3602 1815 548 1000 388 1605 600 1029 1546 4347 1927 2597 419 270 43 1368 1409 1033 4100 1944 2205 1756 1078 1616 2856 1675 950 3278
69 72 90 56 84 118 86 82 46 92 241 112 103 116 88 108 112 64 134 47 133 91 100 104 107 125 110 122 141 83 278 265 194 385 218 399 192 228 296 373 227 194 352
39 33 36 20 19 24 44 27 23 27 85 36 42 63 43 30 43 24 56 24 46 24 42 44 44 55 40 49 38 27 82 68 45 83 66 101 53 66 73 105 72 48 96
16 30 28 17 32 61 21 24 12 38 24 43 32 31 29 45 47 28 51 10 52 42 39 43 33 35 48 23 51 21 51 65 47 70 34 63 33 32 61 56 37 25 55
2 2 8 4 3 6 8 1 1 5 83 15 18 8 8 23 7 3 13 5 21 9 10 6 18 18 8 24 18 21 82 81 58 153 61 134 64 82 90 135 66 73 122
13 7 18 14 12 25 13 29 11 21 49 18 12 14 8 10 15 7 14 8 13 17 10 9 12 18 15 26 34 13 63 50 33 79 57 100 42 48 71 76 50 48 78
7 2 10 6 5 11 9 11 5 9 35 8 8 8 6 5 7 4 9 5 4 6 5 6 7 10 3 17 12 8 38 29 17 43 32 54 28 23 36 44 32 26 46
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Treatmen Treatmen t success t Success rate rate of among new smear smear positive positive previousl 5 patients y treated cases5 91% 95% 92% 75% 88% 82% 82% 91% 97% 88% 89% 78% 92% 59% 79% 85% 93% 92% 90% 86% 93% 85% 83% 89% 89% 85% 91% 81% 89% 92% 86% 84% 80% 85% 83% 86% 84% 83% 89% 86% 90% 91% 80% 88% 86% 57% 68% 64% 63% 91% 98% 77% 71% 65% 83% 49% 61% 66% 86% 86% 67% 46% 73% 71% 69% 81% 69% 63% 81% 46% 65% 83% 69% 61% 71% 71% 67% 70% 67% 60% 76% 71% 85% 71%
75 71 223 100 44 40 214 91 33 162 221 71 198 32 17 181 69 7 36 22 106 21 68 53 173 79 131 19 4 9 145 139 100 438 172 233 184 109 220 361 144 115 313
4% 6% 7% 6% 10% 7% 9% 5% 4% 7% 11% 5% 8% 4% 3% 6% 4% 1% 4% 7% 7% 4% 7% 4% 4% 5% 6% 6% 2% 25% 14% 12% 12% 13% 12% 14% 13% 13% 18% 16% 11% 16% 12%
88% 97% 84% 75% 82% 86% 84% 86% 89% 85% 91% 86% 93% 62% 84% 86% 90% 85% 90% 88% 93% 85% 91% 93% 92% 90% 92% 90% 85% 100% 93% 87% 91% 89% 90% 88% 87% 89% 88% 86% 91% 92% 89%
70% 88% 71% 59% 54% 58% 67% 77% 73% 66% 74% 70% 69% 39% 64% 70% 80% 80% 66% 64% 74% 82% 78% 81% 81% 60% 80% 68% 75% 75% 79% 70% 83% 73% 76% 68% 65% 67% 65% 66% 68% 69% 67%
1276 570 1635 918 143 180 1535 1122 523 965 1131 649 1050 324 353 1019 744 199 433 192 541 178 448 718 1800 893 928 209 82 18 521 468 331 1124 796 789 649 401 534 1078 582 348 1146
94% 85% 84% 89% 93% 78% 85% 89% 85% 76% 89% 94% 80% 58% 91% 88% 91% 85% 90% 81% 89% 92% 93% 95% 87% 89% 91% 93% 86% 100% 88% 90% 100% 84% 91% 92% 88% 95% 89% 94% 76% 96% 87%
1352 667 1944 1033 153 232 1675 1257 614 1253 1222 684 1212 498 386 1139 812 201 481 237 610 194 483 753 2040 947 996 221 95 18 591 502 329 1346 874 857 738 424 598 1143 593 362 1315
100% 100% 100% 100% 100% 100% 93% 100% 100% 99% 97% 100% 93% 89% 99% 99% 100% 86% 100% 100% 100% 100% 100% 100% 98% 95% 98% 98% 100% 100% 100% 97% 99% 100% 100% 100% 100% 100% 100% 100% 77% 100% 99%
899 386 1042 487 129 137 662 791 378 494 1090 347 630 90 265 810 644 110 311 120 494 155 292 447 1487 491 765 137 82 16 450 345 218 1091 587 564 566 333 409 883 444 362 720
85% 74% 64% 75% 89% 84% 60% 71% 87% 63% 95% 99% 65% 38% 79% 79% 87% 73% 74% 70% 85% 89% 71% 72% 85% 62% 98% 94% 100% 100% 100% 93% 85% 73% 91% 100% 95% 100% 94% 78% 100% 100%
1586 712 2845 1926 502 715 2312 2384 1043 2781 498 1057 1839 216 533 1380 998 164 342 184 1068 284 910 348 1548 1095 1863 79 73 6 340 566 22 342 925 125 0 6 79 58 47 37 0
77% 52% 75% 87% 94% 93% 79% 88% 101% 86% 20% 61% 67% 24% 76% 38% 55% 30% 34% 47% 67% 47% 88% 23% 36% 57% 72% 19% 27% 14% 25% 40% 2% 8% 48% 6% 0% 1% 5% 2% 3% 4% 0%
8% 0% 0% 2% 26% 0% 1% 0% 0% 3% 96% 22% 11% 0% 21% 0% 7% 0% 34% 0% 45% 0% 0% 0% 16% 20% 0% 29% 83% 58% 58% 17% 65% 57% 84% 71% 74% 100% 60% 52% 59% 82% 48%
3% 61% 40% 0% 36% 0% 7% 1% 3% 9% 2% 2% 2% 1%
5% 7% 1% 5% 0% 3% 2% 1% 2% 1% 1% 3% 1% 2% 2% 2% 2% 2%
0% 0% 0% 1% 0% 0% 0% 0% 0% 0% 1% 1% 1% 0% 0% 0% 0% 0% 1% 0% 0% 0% 0% 0% 1% 1% 0% 0% 4% 0% 2% 0% 1% 1% 1% 1% 2% 1% 1% 1% 1% 2% 1%
0% 0%
0% 100%
0% 69% 0%
13% 62% 50%
0%
114%
50% 27% 0% 100% 0% 92% 100% 100% 0% 100% 67% 77% 100% 14%
50% 0% 100% 87% 100% 70% 90% 100% 88% 67% 50% 77% 91% 86%
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43 48 29 32 41 46 45 34 37 28 62 34 45 40 53 41 51 39 52 37 49 50 49 45 45 52 24 52 54 53 65 46 45 49 63 30 53 51 30 35 53 46
67% 74% 44% 49% 63% 70% 70% 53% 57% 43% 95% 52% 69% 61% 82% 63% 79% 59% 80% 57% 76% 76% 75% 69% 70% 79% 38% 81% 83% 81% 100% 71% 69% 76% 97% 46% 82% 78% 46% 53% 82% 71%
20 0 0 0 10 10 0 10 0 10 20 20 10 10 10 0 10 10 10 10 10 10 10 10 10 10 0 10 20 20 20 20 20 10 20 20 20 10 20 20 20 20
100% 0% 0% 0% 50% 50% 0% 50% 0% 50% 100% 100% 50% 50% 50% 0% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 0% 50% 100% 100% 100% 100% 100% 50% 100% 100% 100% 50% 100% 100% 100% 100%
20 16 16 16 12 20 12 16 16 16 20 20 4 20 12 12 16 20 12 8 16 16 12 16 12 12 16 20 20 20 16 16 0 12 20 8 20 20 20 16 16 4
100% 80% 80% 80% 60% 100% 60% 80% 80% 80% 100% 100% 20% 100% 60% 60% 80% 100% 60% 40% 80% 80% 60% 80% 60% 60% 80% 100% 100% 100% 80% 80% 0% 60% 100% 40% 100% 100% 100% 80% 80% 20%
19 5 5 10 5 15 17 5 5 5 10 8 19 5 25 15 5 5 25 25 20 6 10 20 15 5 5 11 5 23 19 25 16 10 14 25 11 17 10 26 20 15
63% 17% 17% 34% 17% 50% 57% 17% 17% 17% 33% 25% 63% 17% 83% 50% 17% 17% 83% 83% 65% 19% 33% 67% 49% 17% 17% 37% 17% 76% 64% 82% 54% 33% 47% 84% 36% 57% 33% 85% 67% 50%
63 77 84 70 59 59 91 60 70 63 95 47 79 35 60 50 54 65 68 54 85 45 70 71 68 58 57 55 79 68 89 80 68 83 74 41 87 41 82 82 82 71
55% 67% 73% 61% 52% 51% 80% 52% 61% 55% 83% 41% 69% 30% 52% 43% 47% 57% 59% 47% 74% 39% 61% 62% 59% 51% 50% 48% 69% 59% 77% 70% 59% 72% 64% 35% 75% 36% 72% 71% 71% 62%
165 146 134 128 127 150 166 125 128 122 207 129 157 109 160 118 136 139 167 134 180 126 151 161 150 137 103 149 178 183 209 187 149 164 191 124 191 138 162 178 191 156
66% 58% 54% 51% 51% 60% 66% 50% 51% 49% 83% 52% 63% 44% 64% 47% 55% 56% 67% 54% 72% 51% 60% 65% 60% 55% 41% 60% 71% 73% 84% 75% 60% 66% 76% 50% 76% 55% 65% 71% 76% 63%
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Annual Rate of smear change in positive Annual suspects case smear examined positive notificatio per s+ n rate case case notificatio [from CFR: diagnosed sm + n rate (compared cases (from to (NSP + Rel PMR) previous + TAD) / year) Pop] 1% 0% -1% 2% 0% 7% 21% 9% 0% 16% 10% 18% 6% -5% -14% 0% -5% 6% 0% -2% 15% 13% -1% -2% 3% -2% -4% 6% 1% 7% -10% 0% 18% -4% 6% -3% 3% -6% 11% 22% 13% 5% -1% -2% 14% 135 205 168 274 163 192 106 163 166 186 98 178 93 84 99 103 90 114 102 111 88 91 113 98 77 81 77 116 96 100 95 129 110 84 82 118 154 66 109 80 153 90 69 110 137 200 128 128 96 135 168 97 130 146 144 74 169 64 67 75 79 82 90 84 94 77 95 102 85 71 79 63 93 81 98 82 116 88 80 72 92 96 64 81 75 96 75 70 103 91

3
Delhi Delhi Delhi Delhi Delhi Delhi Delhi Delhi Delhi Delhi Delhi Delhi Goa Goa Gujarat Gujarat Gujarat Gujarat Gujarat Gujarat Gujarat Gujarat Gujarat Gujarat Gujarat Gujarat Gujarat Gujarat Gujarat Gujarat Gujarat Gujarat Gujarat Gujarat Gujarat Gujarat Gujarat Gujarat Gujarat Gujarat Gujarat Gujarat Gujarat Gujarat Haryana
MNCH Chest Clinic Moti Nagar Narela NDMC Nehru Nagar Patparganj R.K.Mission RTRM Chest Clinic SGM Chest Clinic Shahdra SPM Marg SPMH Chest Clinic North Goa South Goa Ahmadabad Ahmadabad MC Amreli Anand Banaskantha Bharuch Bhavnagar Chhota Udepur Dahod * Gandhinagar Jamnagar Junagadh Kachchh Kheda Mahesana Narmada Navsari Panch Mahals Patan Porbandar Rajkot Sabarkantha Surat Surat MC Surendranagar The Dangs * Vadodara Vadodara Corp Valsad * Vyara (Surat) Ambala
5 6 6 7 11 8 8 5 7 6 6 5 8 6 16 56 15 21 31 16 29 10 21 14 22 27 21 23 20 6 13 24 13 6 38 24 16 45 18 2 15 17 17 8 11
4257 9020 6907 13028 9878 9380 6136 6213 8693 7449 4113 5896 10241 4707 10217 33501 12006 15573 18058 10976 19307 6875 18141 10261 15025 18244 12636 15929 16699 5809 10097 16914 13052 3962 29301 16007 14262 26502 13600 2092 16644 9962 10629 6138 15265
216 382 292 498 233 312 195 304 321 318 171 277 313 184 156 150 198 186 145 177 168 172 213 185 174 166 151 173 206 246 190 177 243 169 193 165 220 148 194 231 279 149 156 190 336
59% 16% 10% 25% 3% -2% -15% 48% -2% -10% 6% 23% 23% 22% -20% -10% 1% 6% -8% -2% 4% 13% -15% 5% -3% -4% -13% 2% 1% 2% -7% -5% 21% 4% 2% -6% -6% -28% 6% 4% 38% -15% -13% -4% 56%
666 1212 990 1791 1724 1440 837 831 1122 1088 588 948 762 536 1616 5714 1368 2387 3180 1724 2519 914 2394 1359 1654 2234 1619 2668 1950 589 1269 3085 1471 492 3113 2869 2498 2967 1916 181 2277 1495 1173 889 1555
6 7 7 7 6 7 7 7 8 7 7 6 13 9 6 6 9 7 6 6 8 8 8 8 9 8 8 6 9 10 8 5 9 8 9 6 6 9 7 12 7 7 9 7 10
2633 1811 1751 1633 3854 2920 1784 1463 2846 2350 1005 2327 1146 836 1756 8326 1515 3023 3666 2030 3129 1214 2821 1720 2400 2871 1789 2960 2301 731 1704 3764 1665 790 3852 3799 2277 5471 2141 250 1997 1946 1670 1289 1710
535 307 297 250 364 388 226 286 420 402 168 437 140 131 107 149 100 145 118 131 109 121 133 124 111 105 86 129 113 124 128 158 124 135 101 157 141 123 122 110 134 117 98 160 150
138 83 91 64 90 112 67 85 100 104 52 110 50 48 53 50 63 61 55 71 57 67 67 61 54 61 48 63 61 74 63 77 61 68 57 60 70 44 57 60 64 55 55 80 63
102 45 52 35 71 46 61 47 109 64 20 46 22 17 7 14 5 25 13 11 10 12 16 7 7 8 5 14 9 10 17 19 13 32 8 30 16 11 14 22 13 10 6 29 23
174 99 78 93 117 138 47 78 117 142 54 166 42 32 14 36 9 15 8 17 13 7 10 14 20 8 8 9 13 8 18 9 9 10 14 10 19 32 17 7 13 19 11 15 26
121 79 75 57 83 92 52 77 93 91 42 115 25 34 33 48 23 43 43 31 28 35 40 40 30 28 24 42 30 32 30 52 40 25 22 55 36 35 33 21 44 33 26 35 39
69 47 45 35 50 60 34 48 53 44 26 66 17 22 23 31 19 29 30 24 21 28 36 25 20 20 17 32 21 26 20 42 27 14 16 33 26 20 25 16 33 22 15 25 30
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Treatmen Treatmen t success t Success rate rate of among new smear smear positive positive previousl 5 patients y treated cases5 81% 84% 80% 89% 82% 89% 88% 92% 86% 83% 80% 86% 88% 80% 87% 84% 85% 89% 88% 91% 90% 90% 91% 87% 84% 89% 87% 88% 88% 93% 88% 90% 89% 91% 88% 87% 89% 88% 88% 89% 87% 87% 87% 90% 87% 66% 69% 63% 71% 67% 68% 69% 81% 70% 70% 69% 67% 63% 60% 61% 55% 60% 73% 73% 72% 70% 73% 75% 66% 55% 63% 59% 63% 68% 77% 68% 73% 67% 67% 62% 71% 70% 60% 67% 62% 56% 53% 64% 74% 72%
294 177 192 126 374 335 214 106 316 315 92 325 65 53 73 569 63 97 107 76 123 24 145 59 163 154 52 72 73 16 74 97 51 77 238 107 76 312 102 19 47 75 57 21 38
14% 13% 15% 10% 13% 15% 16% 10% 14% 17% 12% 19% 7% 9% 6% 10% 5% 5% 5% 5% 5% 3% 7% 5% 9% 7% 4% 4% 4% 3% 6% 4% 5% 12% 8% 4% 4% 8% 7% 9% 4% 5% 5% 2% 3%
86% 89% 83% 94% 88% 92% 92% 93% 91% 88% 86% 89% 88% 85% 91% 86% 91% 94% 92% 93% 92% 92% 97% 93% 91% 92% 89% 92% 92% 97% 94% 93% 91% 91% 92% 92% 92% 91% 91% 92% 92% 90% 90% 93% 93%
68% 75% 65% 76% 67% 75% 79% 80% 76% 77% 64% 74% 70% 64% 63% 57% 62% 79% 77% 80% 73% 76% 81% 66% 61% 67% 61% 69% 75% 79% 77% 73% 68% 60% 68% 75% 70% 64% 57% 56% 60% 65% 66% 80% 82%
817 705 754 579 1328 1041 754 677 999 852 402 779 502 378 1145 4159 1173 1790 2420 1340 2115 860 2106 1097 1452 2087 1267 1950 1454 538 1049 2666 1055 456 2623 2029 1379 2614 1355 154 1368 1061 1073 781 983
80% 92% 93% 90% 89% 81% 96% 100% 96% 99% 87% 83% 92% 85% 92% 92% 94% 95% 91% 91% 94% 90% 96% 92% 91% 94% 93% 90% 88% 91% 95% 94% 89% 96% 94% 90% 88% 90% 95% 90% 94% 83% 90% 93% 93%
1019 767 657 642 1488 1293 788 680 1038 864 342 937 522 413 1237 4504 1211 1835 2562 1477 2223 949 2176 1152 1532 2189 1319 2014 1622 588 1089 2849 1173 472 2771 2215 1561 2888 1427 172 1423 1234 1189 842 1020
100% 100% 81% 100% 100% 100% 100% 100% 100% 100% 74% 100% 96% 93% 100% 99% 98% 97% 97% 100% 99% 100% 100% 97% 96% 99% 96% 93% 98% 100% 99% 100% 99% 99% 99% 98% 100% 100% 100% 100% 98% 96% 100% 100% 97%
784 523 525 495 1203 1074 699 592 794 760 281 659 448 306 909 3335 898 1556 1890 1127 1852 708 1828 958 926 1631 892 1676 1290 466 935 2304 865 356 2136 1616 1243 2225 1049 138 1001 882 875 681 603
77% 97% 99% 100% 100% 100% 100% 60% 100% 99% 77% 91% 96% 92% 88% 98% 92% 92% 84% 86% 89% 87% 95% 95% 73% 88% 85% 88% 90% 89% 97% 94% 87% 88% 93% 83% 87% 96% 90% 88% 90% 83% 85% 90% 89%
0 72 335 0 0 0 72 158 5 348 120 640 170 94 1652 1768 842 1725 2704 1216 2027 880 1954 1079 1485 1987 1169 1650 747 597 1194 2802 894 340 1628 2866 1736 1546 1367 190 1278 407 1176 1058 20
0% 4% 19% 0% 0% 0% 4% 11% 0% 15% 12% 28% 15% 11% 94% 21% 56% 57% 74% 60% 65% 72% 69% 63% 62% 69% 65% 56% 32% 82% 70% 74% 54% 43% 42% 75% 76% 28% 64% 76% 64% 21% 70% 82% 1%
43% 65% 83% 62% 54% 77% 62% 64% 88% 61% 36% 57% 96% 94% 94% 85% 68% 82% 89% 87% 90% 88% 98% 99% 76% 93% 79% 89% 97% 84% 87% 91% 93% 92% 92% 88% 89% 98% 98% 96% 89% 76% 88% 94% 48%
2% 1% 2% 2% 2% 1% 3% 3% 0% 2% 5% 2% 4% 6% 6% 7% 4% 4% 2% 3% 4% 1% 2% 5% 5% 4% 6% 3% 8% 1% 5% 2% 4% 6% 6% 3% 4% 9% 7% 1% 3% 8% 3% 2% 2%
1% 1% 2% 1% 1% 1% 2% 2% 0% 1% 2% 1% 4% 6% 6% 6% 3% 3% 2% 3% 3% 1% 2% 5% 4% 3% 5% 3% 8% 1% 5% 2% 4% 6% 6% 3% 4% 9% 7% 1% 3% 6% 3% 2% 1%
94% 79% 45% 100% 98% 95% 60% 48% 100% 52% 50% 39% 100% 99% 100% 86% 97% 100% 100% 84% 98% 85% 100% 98% 100% 95% 86% 100% 100% 100% 97% 90% 100% 83% 100% 74% 97% 100% 99% 67% 94% 98% 96% 98%
67% 64% 41% 97% 56% 76% 80% 52% 95% 48% 54% 61% 74% 64% 80% 72% 81% 73% 81% 61% 74% 77% 70% 75% 94% 91% 43% 68% 88% 60% 39% 80% 96% 68% 65% 82% 71% 65% 70% 33% 65% 76% 73% 53%
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47 57 23 51 46 44 30 33 34 53 58 30 63 62 45 63 48 64 60 49 41 58 62 65 50 45 58 52 53 57 63 49 59 50 64 63 50 64 64 53 50 63 48 64 44
72% 87% 36% 78% 71% 67% 46% 51% 53% 82% 89% 46% 97% 95% 70% 96% 73% 98% 92% 76% 63% 89% 95% 100% 76% 70% 90% 80% 82% 88% 97% 75% 90% 77% 98% 97% 77% 99% 98% 81% 76% 98% 73% 98% 68%
20 20 20 20 20 20 20 10 20 20 20 20 10 10 20 20 20 20 20 20 20 20 20 20 20 10 20 20 20 10 20 10 20 20 20 20 20 20 20 20 20 20 0 20 20
100% 100% 100% 100% 100% 100% 100% 50% 100% 100% 100% 100% 50% 50% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 50% 100% 100% 100% 50% 100% 50% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 0% 100% 100%
16 8 0 12 12 16 16 8 8 12 8 20 16 16 20 8 16 16 12 20 16 16 12 20 16 16 20 16 16 12 16 20 12 16 16 16 16 16 20 20 16 12 12 20 20
80% 40% 0% 60% 60% 80% 80% 40% 40% 60% 40% 100% 80% 80% 100% 40% 80% 80% 60% 100% 80% 80% 60% 100% 80% 80% 100% 80% 80% 60% 80% 100% 60% 80% 80% 80% 80% 80% 100% 100% 80% 60% 60% 100% 100%
7 20 17 20 16 10 20 5 20 14 7 20 5 10 12 16 13 15 12 20 8 13 10 21 8 10 26 7 10 10 5 14 23 10 18 17 13 7 20 10 17 5 5 7 15
23% 67% 57% 67% 55% 34% 68% 17% 67% 46% 23% 67% 17% 33% 39% 53% 42% 51% 39% 67% 25% 44% 33% 69% 28% 33% 86% 23% 33% 33% 17% 45% 77% 33% 60% 57% 45% 23% 67% 33% 56% 17% 17% 23% 50%
46 58 63 87 62 80 77 85 71 81 62 83 74 50 91 50 66 81 78 68 76 76 92 76 71 76 87 48 81 79 90 101 86 75 74 78 106 69 83 64 85 79 78 70 75
40% 50% 54% 76% 54% 70% 67% 74% 62% 70% 54% 73% 64% 44% 79% 44% 58% 71% 68% 59% 66% 66% 80% 66% 62% 66% 76% 42% 70% 69% 78% 88% 75% 65% 65% 68% 92% 60% 73% 56% 73% 69% 68% 61% 65%
136 162 123 189 157 170 163 141 154 180 155 173 168 148 188 156 163 196 182 177 161 183 196 202 165 158 211 143 180 168 194 194 200 171 192 194 205 176 207 167 187 179 143 181 175
54% 65% 49% 76% 63% 68% 65% 56% 61% 72% 62% 69% 67% 59% 75% 63% 65% 79% 73% 71% 64% 73% 78% 81% 66% 63% 85% 57% 72% 67% 77% 77% 80% 68% 77% 78% 82% 71% 83% 67% 75% 72% 57% 72% 70%
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Annual Rate of smear change in positive Annual suspects case smear examined positive notificatio per s+ n rate case case notificatio [from CFR: diagnosed sm + n rate (compared cases (from to (NSP + Rel PMR) previous + TAD) / year) Pop] 15% -11% 13% 9% 6% 41% 11% 3% -3% -5% -6% 2% 1% 10% -3% 7% 9% 6% 8% 8% 30% -6% 10% 10% 8% 15% -22% 7% 17% 3% 11% 4% 36% 2% -1% 12% -2% -4% 0% 9% -7% 16% -4% 7% 25% 21% 3% 3% 1% -5% 1% 90 80 80 97 109 97 90 79 107 94 87 77 77 143 82 81 233 101 94 78 95 115 107 105 113 113 92 102 145 104 153 88 52 60 45 45 135 49 99 59 50 56 68 65 67 83 69 65 66 69 90 80 72 72 73 73 116 86 75 87 80 69 73 74 93 68 73 118 84 98 66 101 122 96 84 117 103 92 109 89 102 99 90 52 63 40 44 106 47 93 70 47 56 74 61 60 84 66 64 60 65 83

3
Haryana Haryana Haryana Haryana Haryana Haryana Haryana Haryana Haryana Haryana Haryana Haryana Haryana Haryana Haryana Haryana Haryana Haryana Haryana Haryana Himachal Pradesh Himachal Pradesh Himachal Pradesh Himachal Pradesh Himachal Pradesh Himachal Pradesh Himachal Pradesh Himachal Pradesh Himachal Pradesh Himachal Pradesh Himachal Pradesh Himachal Pradesh Jammu & Kashmir Jammu & Kashmir Jammu & Kashmir Jammu & Kashmir Jammu & Kashmir Jammu & Kashmir Jammu & Kashmir Jammu & Kashmir Jammu & Kashmir Jammu & Kashmir Jammu & Kashmir Jammu & Kashmir Jammu & Kashmir Jammu & Kashmir Jharkhand Jharkhand Jharkhand Jharkhand Jharkhand
Bhiwani Faridabad Fatehabad Gurgaon Hisar Jhajjar Jind Kaithal ** Karnal Kurukshetra Mahendragarh Mewat ** Palwal Panchkula Panipat Rewari Rohtak Sirsa Sonipat Yamunanagar Bilaspur-HP Chamba Hamirpur-HP ** Kangra Kinnaur * Kullu Lahul & Spiti * Mandi Shimla Sirmaur Solan Una Anantnag Badgam Baramula Doda Jammu Kargil * Kathua Kupwara Leh (Ladakh) * Poonch Pulwama Rajouri Srinagar Udhampur Bokaro Chatra ** Deoghar ** Dhanbad Dumka **
16 18 9 15 17 10 13 11 15 10 9 11 10 6 12 9 11 13 15 12 4 5 5 15 1 4 0.3 10 8 5 6 5 15 7 14 9 18 1 6 9 1 5 8 6 16 9 21 10 15 27 13
8854 10335 6041 10069 11246 7546 8906 5968 10458 6163 6059 4034 5603 8113 7365 6940 16592 9102 9794 6961 3809 4202 5066 13904 1073 4599 478 10255 10106 4541 8747 4136 12015 5270 8086 4773 18456 1262 4258 6424 1324 3188 5864 4607 14776 8001 11842 3976 7831 12821 7255
136 144 160 166 161 197 167 139 174 160 164 93 135 363 153 194 392 176 165 143 249 202 279 231 318 263 379 256 311 214 379 198 201 179 144 129 250 220 173 183 225 167 175 186 236 230 144 95 131 119 137
21% -13% 0% -6% 9% 84% 11% 9% 6% -6% 16% -4% 16% 24% 5% 7% 10% 12% 14% 3% 1% -2% -11% 7% 14% -14% 26% 4% 9% -10% 2% -4% 18% -12% -6% -19% 12% 15% 4% -4% 0% 8% 0% 0% 8% 17% -4% 5% -9% -5% 2%
1462 1437 755 1473 1901 927 1202 847 1611 904 805 836 806 800 990 727 2471 1313 1398 941 364 596 488 1587 95 496 29 1018 1180 553 882 460 770 439 624 416 2484 70 609 519 74 267 565 403 1051 726 1417 677 986 1849 1184
6 7 8 7 6 8 7 7 6 7 8 5 7 10 7 10 7 7 7 7 10 7 10 9 11 9 16 10 9 8 10 9 16 12 13 11 7 18 7 12 18 12 10 11 14 11 8 6 8 7 6
1888 3295 1078 2209 2014 1898 1816 1287 2544 1278 1288 1308 1496 1075 2147 1469 2158 1684 2813 1458 635 1169 771 2623 225 1299 81 2051 1551 1037 1328 731 1041 567 880 890 3263 137 967 764 217 511 778 766 1487 1205 2551 1092 1163 2978 2545
116 183 114 146 116 198 136 120 169 133 140 120 144 192 178 164 204 130 190 120 166 225 170 174 267 297 257 205 191 196 230 140 70 77 63 96 177 96 157 87 148 107 93 124 95 138 124 105 78 111 193
52 47 47 51 48 82 55 52 56 57 43 45 51 64 48 48 75 56 67 50 73 79 69 60 91 70 57 70 66 71 79 70 45 60 36 30 74 41 64 64 33 48 71 47 54 57 57 58 54 57 69
15 34 22 17 18 26 21 21 42 17 33 16 35 29 60 39 31 13 40 19 23 30 15 28 27 71 67 31 26 37 50 23 6 3 5 17 28 27 31 5 21 20 9 20 11 15 31 28 11 26 77
14 57 11 42 11 38 20 12 27 26 20 14 23 51 27 30 44 20 32 24 27 45 51 46 77 83 73 49 55 37 51 21 9 10 16 31 30 15 25 11 75 25 8 34 21 34 15 3 3 8 2
36 45 35 36 39 52 41 34 44 32 44 45 35 48 43 48 55 41 52 27 42 71 34 37 66 72 60 54 43 50 50 26 9 4 6 18 44 12 37 8 18 14 5 21 8 32 22 15 10 20 44
31 27 29 24 29 41 35 26 34 26 29 31 26 31 22 27 45 34 33 19 34 50 29 26 32 35 38 43 24 34 24 21 8 4 5 16 36 6 30 7 17 8 4 16 7 29 10 7 6 9 14
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Treatmen Treatmen t success t Success rate rate of among new smear smear positive positive previousl 5 patients y treated cases5 86% 85% 87% 83% 85% 84% 85% 84% 89% 89% 83% 90% 84% 86% 86% 83% 87% 83% 88% 87% 88% 87% 91% 89% 89% 91% 100% 88% 92% 88% 88% 92% 92% 89% 96% 94% 88% 93% 91% 93% 76% 90% 97% 88% 92% 90% 87% 89% 96% 90% 91% 69% 68% 77% 65% 69% 73% 73% 74% 81% 77% 69% 54% 77% 67% 77% 68% 74% 65% 77% 66% 70% 75% 73% 78% 68% 84% 0% 77% 89% 71% 76% 64% 79% 88% 97% 83% 70% 0% 74% 87% 72% 80% 71% 89% 74% 81% 72% 74% 95% 78% 84%
65 266 35 134 55 98 48 23 104 34 59 72 126 65 99 40 115 47 76 40 18 41 21 161 12 113 10 46 73 40 51 15 110 24 55 61 114 8 26 47 3 15 78 52 109 35 128 41 40 157 43
5% 11% 5% 8% 4% 7% 4% 2% 6% 4% 7% 9% 11% 8% 6% 4% 7% 4% 4% 4% 4% 5% 3% 8% 7% 12% 16% 3% 6% 5% 5% 3% 12% 4% 7% 8% 5% 7% 4% 7% 2% 3% 11% 8% 8% 4% 6% 4% 4% 6% 2%
88% 90% 90% 86% 90% 92% 90% 88% 92% 92% 90% 91% 89% 92% 90% 90% 89% 90% 89% 90% 88% 91% 93% 92% 84% 94% 91% 92% 96% 91% 90% 91% 92% 92% 95% 92% 89% 93% 93% 92% 80% 91% 95% 91% 93% 92% 92% 94% 95% 93% 93%
66% 76% 86% 65% 78% 75% 79% 73% 76% 76% 81% 58% 79% 76% 82% 85% 74% 64% 82% 61% 67% 85% 83% 83% 50% 88% 100% 79% 89% 79% 76% 74% 82% 88% 83% 77% 78% 67% 82% 76% 65% 83% 91% 79% 85% 85% 73% 94% 93% 81% 92%
1108 1208 585 919 1204 1115 1060 776 1266 760 616 718 621 485 657 591 1112 1069 1371 766 393 665 430 1248 99 423 26 1074 695 546 582 469 790 460 542 421 1968 67 539 621 74 269 622 386 953 688 1315 597 804 1547 861
83% 90% 82% 81% 90% 95% 89% 92% 93% 95% 93% 87% 78% 91% 78% 88% 88% 92% 92% 91% 97% 99% 97% 96% 95% 92% 87% 95% 95% 98% 98% 99% 100% 99% 95% 100% 97% 100% 93% 100% 100% 100% 100% 100% 100% 93% 95% 87% 89% 88% 78%
997 1222 611 1029 1223 1177 1119 840 1351 765 591 829 641 491 842 592 1247 1089 1467 810 405 664 436 1286 103 453 26 1116 610 538 585 472 790 467 560 421 1995 67 580 621 74 269 622 386 953 722 1378 686 899 1722 1104
74% 91% 85% 91% 91% 100% 94% 100% 99% 96% 89% 100% 80% 92% 100% 88% 98% 94% 99% 96% 100% 99% 98% 99% 99% 98% 87% 99% 83% 96% 98% 99% 100% 100% 98% 100% 99% 100% 100% 100% 100% 100% 100% 100% 100% 97% 100% 100% 100% 98% 100%
566 735 526 735 939 705 743 596 880 614 351 444 469 359 519 366 667 695 798 648 377 413 422 1023 93 444 24 893 656 374 471 414 671 389 513 411 1358 39 366 514 41 180 484 292 930 562 928 430 731 1175 596
58% 86% 82% 87% 84% 89% 80% 91% 99% 93% 81% 77% 0% 94% 79% 73% 72% 82% 69% 88% 97% 87% 93% 91% 97% 86% 96% 95% 91% 83% 94% 99% 95% 88% 90% 100% 97% 93% 92% 99% 85% 85% 99% 90% 100% 90% 76% 88% 87% 79% 68%
85 216 264 1130 348 406 658 267 1114 485 364 223 0 390 1120 655 331 643 514 1135 1 72 63 679 10 61 0 214 83 238 176 152 140 101 62 0 894 20 23 43 19 0 50 0 41 54 1993 1016 779 1517 2472
5% 7% 24% 51% 17% 21% 36% 21% 44% 38% 28% 17% 0% 36% 52% 45% 15% 38% 18% 78% 0% 6% 8% 26% 4% 5% 0% 10% 5% 23% 13% 21% 13% 18% 7% 0% 27% 15% 2% 6% 9% 0% 6% 0% 3% 4% 78% 93% 67% 51% 97%
281% 63% 51% 39% 76% 39% 41% 31% 76% 49% 65% 26% 80% 66% 49% 73% 27% 43% 91% 43% 55% 46% 60% 31% 8% 11% 0% 8% 45% 21% 38% 36% 37% 6% 0% 0% 9% 0% 0% 50% 18% 0% 11% 0% 5% 1% 19% 22% 38% 19% 40%
1% 1% 1% 1% 1% 5% 1% 1% 1% 1% 1% 1% 1% 1% 2% 1% 3% 0% 1% 0% 3% 2% 4% 2% 0% 1% 1% 0% 0% 1% 2% 0% 0%
4%
0% 0% 0% 0% 11% 2% 0% 1% 1% 0%
2% 1% 1% 0% 1% 2% 0% 0% 1% 0% 0% 0% 0% 0% 1% 1% 1% 0% 1% 0% 2% 1% 3% 1% 0% 0% 0% 0% 0% 0% 1% 1% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0%
29% 100% 38% 75% 100% 0% 100% 33% 0% 100% 67% 0% 43% 0%
29% 100% 31% 25% 0% 100% 0% 33% 50% 0% 17% 0% 36% 91%
0% 86% 0%
25% 71% 100%
9%
73%
17%
17%
Page135
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District
44 60 62 39 46 65 45 52 61 58 51 50 43 46 31 41 38 50 53 49 48 42 48 28 39 43 49 47 24 48 47 47 55 51 59 37 35 38 47 53 51 50 63 48 63 51 48 38 49 56 47
68% 92% 96% 59% 71% 100% 69% 80% 95% 89% 79% 77% 67% 70% 48% 63% 59% 77% 81% 76% 73% 64% 73% 44% 60% 67% 75% 73% 37% 73% 72% 72% 84% 79% 91% 57% 54% 58% 72% 81% 79% 78% 97% 74% 97% 79% 74% 58% 76% 86% 73%
10 20 20 20 20 20 10 20 20 20 10 0 20 20 20 20 10 20 20 10 20 20 20 20 20 20 20 20 20 20 10 20 20 20 10 10 10 20 20 20 20 20 20 20 10 10 0 0 10 0 0
50% 100% 100% 100% 100% 100% 50% 100% 100% 100% 50% 0% 100% 100% 100% 100% 50% 100% 100% 50% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 50% 100% 100% 100% 50% 50% 50% 100% 100% 100% 100% 100% 100% 100% 50% 50% 0% 0% 50% 0% 0%
16 12 0 20 16 16 16 16 12 20 16 12 12 20 8 16 20 20 12 20 20 20 20 16 20 16 20 20 12 8 20 12 20 20 16 20 8 20 0 8 20 16 20 20 12 20 20 16 12 20 12
80% 60% 0% 100% 80% 80% 80% 80% 60% 100% 80% 60% 60% 100% 40% 80% 100% 100% 60% 100% 100% 100% 100% 80% 100% 80% 100% 100% 60% 40% 100% 60% 100% 100% 80% 100% 40% 100% 0% 40% 100% 80% 100% 100% 60% 100% 100% 80% 60% 100% 60%
5 15 5 15 15 10 20 15 13 5 15 15 16 15 15 15 14 12 14 5 5 15 17 10 15 5 5 5 5 5 20 20 10 5 11 19 5 21 15 20 26 5 11 5 11 5 5 7 5 17 15
17% 50% 17% 50% 50% 33% 67% 50% 43% 17% 50% 50% 55% 50% 50% 50% 45% 40% 48% 17% 17% 50% 58% 33% 50% 17% 17% 17% 17% 17% 67% 67% 33% 17% 36% 64% 17% 71% 50% 67% 85% 17% 37% 17% 37% 17% 17% 23% 17% 56% 50%
62 84 76 65 57 68 62 69 87 51 67 42 68 67 66 49 65 35 77 74 74 74 81 80 71 73 66 64 81 59 56 69 84 84 76 76 71 71 81 71 74 46 64 61 69 63 70 88 87 57 84
54% 73% 66% 57% 49% 59% 54% 60% 76% 44% 59% 36% 59% 58% 58% 43% 56% 31% 67% 65% 64% 64% 70% 70% 61% 63% 57% 55% 70% 51% 49% 60% 73% 73% 66% 66% 61% 62% 70% 62% 64% 40% 56% 53% 60% 55% 61% 77% 76% 49% 73%
137 191 163 159 154 179 153 172 194 153 159 119 159 168 141 141 146 137 176 158 167 170 186 154 165 157 160 156 142 139 153 168 189 180 172 162 129 170 162 172 191 137 178 154 165 150 144 148 163 149 158
55% 76% 65% 64% 61% 72% 61% 69% 77% 61% 64% 48% 64% 67% 56% 57% 59% 55% 71% 63% 67% 68% 74% 62% 66% 63% 64% 62% 57% 56% 61% 67% 75% 72% 69% 65% 52% 68% 65% 69% 76% 55% 71% 62% 66% 60% 57% 59% 65% 60% 63%
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1
Annual Rate of smear change in positive Annual suspects case smear examined positive notificatio per s+ n rate case case notificatio [from CFR: diagnosed sm + n rate (compared cases (from to (NSP + Rel PMR) previous + TAD) / year) Pop] -2% -1% -10% 2% 12% -1% -19% 28% 13% 10% 2% -5% 6% -1% 21% 3% 17% -7% -8% -5% 2% -12% 5% 15% 13% -6% -26% 4% -13% 12% -3% 4% 9% 10% -14% 7% 10% -16% 16% -6% 8% 15% 64 59 56 60 62 73 66 44 72 54 99 81 83 82 57 73 64 66 87 74 80 63 70 52 94 81 72 69 88 59 74 67 82 81 87 77 59 79 49 69 86 71 60 56 49 56 58 70 66 34 78 48 98 77 77 70 53 57 60 65 83 58 39 60 92 50 68 72 55 77 83 50 73 50 59 56 75 65 56 75 43 54 76 67

3
Jharkhand Jharkhand Jharkhand Jharkhand Jharkhand Jharkhand Jharkhand Jharkhand Jharkhand Jharkhand Jharkhand Jharkhand Jharkhand Jharkhand Jharkhand Jharkhand Jharkhand Jharkhand Jharkhand Karnataka Karnataka Karnataka Karnataka Karnataka Karnataka Karnataka Karnataka Karnataka Karnataka Karnataka Karnataka Karnataka Karnataka Karnataka Karnataka Karnataka Karnataka Karnataka Karnataka Karnataka Karnataka Karnataka
Garhwa Giridih ** Godda ** Gumla Hazaribagh ** Jamtara ** Khunti Kodarma ** Lathehar ** Lohardaga * Pakaur ** Palamu ** Pashchimi Singhbhum * Purbi Singhbhum Ramgarh ** Ranchi Sahibganj ** Saraikela-Kharsawan ** Simdega ** Bagalkot Bangalore City Bangalore Rural Bangalore Urban Belgaum Bellary Bidar ** Bijapur Chamarajanagar Chikkaballapur Chikmagalur Chitradurga Dakshina Kannada Davanagere Dharwad Gadag Gulbarga ** Hassan Haveri Kodagu Kolar Koppal Mandya
13 24 13 10 17 8 5 7 7 5 9 19 15 23 9 29 12 11 6 19 74 10 22 48 25 17 22 10 13 11 17 21 19 18 11 26 18 16 6 15 14 18
5305 8639 5163 3800 10109 3725 1460 2936 4716 1552 4792 11246 6203 9077 4394 14476 6288 5284 2846 14987 47264 7677 19148 32105 20040 16545 16454 9825 10510 12863 11097 22263 19582 15873 9749 21747 20365 13123 5154 11728 9157 21497
100 88 98 93 146 118 69 102 162 84 133 145 103 99 116 124 137 124 119 198 160 194 217 168 198 243 189 241 209 283 167 267 251 215 229 212 287 205 232 190 165 297
-13% -14% 7% 1% 15% -3% -13% -2% 4% -5% -3% -9% 3% -9% 21% -9% 19% -16% 7% 4% -39% -9% 28% 4% 6% 13% -3% 1% 16% 24% -4% 13% 17% 6% 4% 9% 12% 6% 19% -8% 11% 22%
842 1432 733 617 1076 577 348 313 526 248 886 1568 1242 1887 539 2139 736 706 523 1397 5880 624 1554 2482 2379 1369 1566 704 1110 669 1226 1399 1605 1493 931 1973 1055 1265 271 1066 1195 1279
6 6 7 6 9 6 4 9 9 6 5 7 5 5 8 7 9 7 5 11 8 12 12 13 8 12 11 14 9 19 9 16 12 11 10 11 19 10 19 11 8 17
1970 1815 1389 914 1741 975 496 431 863 361 1302 2860 2379 2896 1004 3313 1614 1256 666 2176 6280 1234 4136 4683 3272 2442 2215 1452 1755 1048 2396 1922 2209 1811 1242 2937 1680 2407 441 1542 1860 2048
149 74 106 89 100 123 94 60 119 78 145 148 158 126 106 114 140 118 111 115 85 125 188 98 129 144 102 142 140 92 144 92 113 98 117 115 95 151 79 100 134 113
52 47 40 49 50 60 58 30 64 40 86 64 72 58 47 47 51 60 71 45 27 47 71 43 51 53 45 60 65 40 60 38 46 43 59 47 42 57 35 44 58 52
62 11 39 18 26 25 10 13 27 16 29 48 64 32 35 31 58 38 16 36 13 21 31 27 31 43 32 24 25 13 37 14 26 13 19 20 16 46 13 17 30 13
6 3 4 6 7 2 14 3 6 9 4 11 10 10 11 14 5 5 7 13 26 35 50 13 21 13 8 29 23 22 23 17 17 23 14 13 17 18 17 23 14 26
29 12 23 13 17 36 11 14 19 13 26 24 13 26 12 22 27 15 18 21 19 22 35 15 26 35 17 28 27 17 25 23 24 19 24 35 20 30 15 16 32 23
8 9 9 7 10 10 8 5 14 9 14 13 6 13 9 11 10 6 13 14 13 16 23 7 19 23 11 21 22 13 15 14 14 14 17 22 15 19 11 11 23 16
Page137
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Treatmen Treatmen t success t Success rate rate of among new smear smear positive positive previousl 5 patients y treated cases5 94% 92% 94% 91% 83% 93% 90% 80% 93% 81% 88% 94% 90% 90% 83% 90% 91% 92% 85% 83% 83% 84% 85% 83% 79% 76% 76% 85% 85% 85% 85% 81% 82% 80% 82% 76% 85% 81% 84% 86% 79% 87% 85% 85% 89% 74% 84% 83% 77% 63% 88% 55% 73% 76% 81% 76% 77% 57% 85% 83% 63% 60% 53% 51% 58% 72% 60% 52% 58% 58% 58% 55% 60% 57% 60% 63% 61% 49% 53% 69% 61% 55% 53% 61%
147 102 56 38 102 25 20 18 43 12 20 209 68 72 57 200 145 38 13 109 454 108 233 577 212 94 112 64 76 47 67 66 59 102 45 131 51 352 18 101 103 100
9% 7% 5% 5% 7% 4% 5% 5% 6% 4% 2% 9% 3% 3% 6% 7% 11% 3% 2% 6% 9% 11% 7% 15% 8% 5% 6% 5% 5% 6% 3% 5% 3% 7% 5% 6% 4% 18% 5% 8% 7% 6%
92% 90% 87% 92% 92% 94% 88% 86% 94% 79% 91% 95% 95% 91% 88% 93% 90% 91% 87% 90% 88% 86% 89% 89% 89% 89% 91% 89% 90% 88% 89% 87% 86% 87% 90% 86% 92% 86% 86% 88% 85% 92%
85% 80% 82% 85% 81% 80% 78% 53% 89% 60% 82% 82% 81% 75% 60% 78% 85% 75% 53% 64% 57% 58% 71% 76% 64% 62% 70% 63% 50% 55% 60% 67% 69% 61% 68% 56% 71% 72% 71% 59% 61% 68%
648 1182 570 442 994 466 328 243 427 165 541 1367 908 1465 496 1452 547 581 410 931 2504 561 1791 2180 1424 1124 914 742 809 524 1084 997 1035 968 687 1401 887 965 213 730 911 1037
81% 85% 88% 77% 96% 84% 94% 97% 75% 73% 61% 91% 78% 90% 94% 86% 78% 83% 82% 83% 85% 89% 86% 91% 80% 88% 76% 90% 74% 86% 87% 92% 88% 91% 85% 80% 87% 79% 83% 86% 81% 84%
799 1385 641 575 1030 556 348 251 487 210 893 1500 1159 1633 511 1634 687 703 498 1078 2928 628 2032 2369 1625 1200 988 785 1076 600 1229 1034 1124 1019 812 1640 961 1169 256 824 1101 1194
100% 100% 99% 100% 100% 100% 100% 100% 86% 93% 100% 100% 99% 100% 97% 97% 98% 100% 99% 96% 100% 100% 98% 99% 92% 93% 82% 95% 99% 99% 99% 95% 95% 96% 100% 93% 94% 96% 100% 97% 98% 96%
393 852 243 356 546 368 187 148 276 134 246 762 487 1264 54 1144 180 401 179 684 2025 377 1286 1601 878 457 338 545 398 307 797 660 705 629 455 655 675 593 187 541 547 883
62% 75% 51% 78% 77% 78% 66% 73% 59% 71% 37% 63% 47% 87% 0% 82% 35% 69% 54% 82% 89% 88% 84% 78% 78% 69% 57% 84% 59% 68% 82% 83% 82% 78% 82% 71% 84% 78% 95% 81% 77% 90%
1633 1357 800 759 1517 612 617 302 19 361 1053 457 1819 1291 0 1223 1038 786 631 1088 1804 658 2926 1960 1471 669 1013 695 953 659 1870 965 1272 445 178 1273 824 1647 250 875 1179 1291
83% 75% 58% 83% 87% 63% 124% 70% 2% 100% 81% 16% 76% 45% 0% 37% 64% 63% 95% 50% 29% 53% 71% 42% 45% 27% 46% 48% 54% 63% 78% 50% 58% 25% 14% 43% 49% 68% 57% 57% 63% 63%
8% 17% 1% 12% 21% 33% 11% 59% 10% 0% 0% 18% 6% 15% 19% 24% 5% 16% 8% 96% 84% 93% 90% 92% 93% 85% 97% 93% 92% 94% 88% 98% 88% 95% 89% 88% 92% 82% 93% 96% 98% 89%
0% 2% 0% 2% 32% 1% 2% 2% 1%
3% 0% 4% 0% 1% 5% 0% 0% 44% 6% 6% 10% 25% 13% 8% 33% 10% 7% 10% 7% 11% 15% 15% 23% 13% 11% 8% 8% 7% 15% 12%
0% 0% 0% 0% 7% 0% 0% 1% 0% 0% 0% 1% 0% 1% 0% 0% 0% 0% 0% 43% 5% 5% 9% 23% 12% 7% 32% 9% 7% 9% 6% 11% 13% 15% 20% 11% 10% 7% 7% 7% 15% 11%
0% 0% 0%
67% 100% 57%
0% 8% 0% 0%
86% 69% 80% 100%
99% 99% 100% 100% 99% 100% 100% 96% 98% 100% 99% 98% 96% 100% 100% 100% 99% 100% 99% 96% 99% 100% 100%
78% 69% 74% 75% 67% 70% 62% 63% 68% 68% 80% 72% 83% 78% 77% 64% 73% 81% 76% 88% 72% 62% 80%
Page138
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52 58 55 45 51 55 34 24 52 29 53 52 37 47 41 65 46 46 50 55 58 61 56 49 59 59 56 50 41 61 44 55 59 57 58 57 55 60 45 63 56 58
79% 88% 84% 69% 79% 84% 53% 36% 79% 45% 82% 80% 57% 72% 63% 100% 71% 70% 76% 85% 89% 93% 86% 75% 90% 91% 87% 77% 62% 95% 68% 85% 90% 87% 90% 88% 85% 92% 70% 96% 87% 90%
0 0 0 0 0 0 10 0 0 10 0 0 0 0 20 0 0 0 10 20 20 20 20 10 20 10 20 20 10 20 20 10 20 20 20 20 20 10 20 10 20 20
0% 0% 0% 0% 0% 0% 50% 0% 0% 50% 0% 0% 0% 0% 100% 0% 0% 0% 50% 100% 100% 100% 100% 50% 100% 50% 100% 100% 50% 100% 100% 50% 100% 100% 100% 100% 100% 50% 100% 50% 100% 100%
8 16 12 20 16 12 20 20 20 20 20 12 20 20 20 12 20 20 20 12 8 16 12 16 20 16 12 8 20 12 16 16 12 12 12 16 8 16 20 16 16 12
40% 80% 60% 100% 80% 60% 100% 100% 100% 100% 100% 60% 100% 100% 100% 60% 100% 100% 100% 60% 40% 80% 60% 80% 100% 80% 60% 40% 100% 60% 80% 80% 60% 60% 60% 80% 40% 80% 100% 80% 80% 60%
15 5 15 5 5 15 10 15 6 5 7 15 11 5 5 14 11 11 5 5 10 20 5 5 7 15 15 5 8 9 5 5 5 6 8 15 5 15 20 7 19 5
50% 17% 50% 17% 18% 50% 33% 50% 20% 17% 22% 50% 37% 17% 17% 45% 37% 36% 17% 17% 33% 67% 17% 17% 24% 50% 50% 17% 26% 30% 17% 18% 17% 20% 26% 50% 17% 50% 67% 23% 64% 17%
69 80 82 73 83 59 72 68 70 42 62 65 59 77 68 67 68 49 49 72 69 86 91 79 83 64 60 91 79 63 71 59 51 59 73 73 60 57 86 66 63 76
60% 69% 71% 63% 72% 51% 62% 59% 61% 37% 54% 57% 51% 67% 59% 58% 60% 43% 43% 63% 60% 74% 79% 69% 72% 56% 52% 79% 69% 55% 62% 51% 44% 52% 64% 64% 53% 50% 74% 57% 55% 66%
143 158 163 143 155 141 146 126 147 106 142 144 127 149 154 157 146 126 134 165 165 202 184 160 189 164 163 174 157 165 156 145 146 154 172 182 148 158 191 161 175 171
57% 63% 65% 57% 62% 56% 58% 50% 59% 43% 57% 58% 51% 60% 61% 63% 58% 50% 54% 66% 66% 81% 73% 64% 76% 66% 65% 70% 63% 66% 62% 58% 59% 62% 69% 73% 59% 63% 76% 65% 70% 68%
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1
Annual Rate of smear change in positive Annual suspects case smear examined positive notificatio per s+ n rate case case notificatio [from CFR: diagnosed sm + n rate (compared cases (from to (NSP + Rel PMR) previous + TAD) / year) Pop] -2% -2% 13% 13% 7% 4% 8% 52% 9% -8% -12% -3% 4% 26% 11% -9% 0% 5% 19% 1% 2% 27% 117% 32% 2% -11% 3% -1% -4% 1% -6% 12% 14% 2% 6% -1% -10% -1% 31% 0% 9% -12% 4% 11% 31% 0% 3% 9% 3% 115 102 76 68 81 72 46 51 42 53 34 38 35 44 56 39 28 43 54 55 54 34 16 42 61 56 46 67 59 47 146 85 169 61 101 89 58 59 53 53 110 53 84 100 100 72 69 54 73 65 82 77 65 70 55 43 52 44 41 33 30 34 42 47 30 26 43 48 41 40 32 20 42 60 58 46 54 46 40 80 83 111 52 93 78 56 59 51 43 82 51 82 77 82 66 61 49 66

3
Karnataka Karnataka Karnataka Karnataka Karnataka Karnataka Karnataka Karnataka Kerala Kerala Kerala Kerala Kerala Kerala Kerala Kerala Kerala Kerala Kerala Kerala Kerala Kerala Lakshadweep Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh
Mysore Raichur Ramanagara Shimoga Tumkur Udupi Uttara Kannada Yadgiri ** Alappuzha Ernakulam Idukki Kannur Kasaragod Kollam Kottayam Kozhikode Malappuram Palakkad Pathanamthitta Thiruvananthapuram Thrissur Wayanad Lakshadweep * Alirajpur Anuppur Ashoknagar Balaghat ** Barwani Betul ** Bhind Bhopal Burhanpur ** Chhatarpur ** Chhindwara ** Damoh ** Datia Dewas Dhar Dindori Guna Gwalior Harda ** Hoshangabad ** Indore Jabalpur Jhabua Katni Khandwa ** Khargone **
30 19 11 18 27 12 14 12 21 33 11 25 13 26 20 31 41 28 12 33 31 8 0.6 7 7 8 17 14 16 17 24 8 18 21 13 8 16 22 7 12 20 6 12 33 25 10 13 13 19
35397 14824 11592 16435 25727 12301 13396 7188 24107 28393 16079 25920 9738 28070 29167 27581 34171 20931 12330 47721 32643 8202 951 1948 4001 3022 3461 7573 12072 7378 21565 5290 23400 9258 6909 3219 6672 10568 4822 4033 15947 2640 8171 30450 19033 4391 3988 4899 9921
295 193 268 234 240 261 233 153 284 216 363 257 187 267 368 223 208 186 258 361 262 251 369 67 133 89 51 137 192 108 228 175 332 111 137 102 107 121 171 81 196 116 165 233 193 107 77 94 132
2% -4% 42% 22% 11% 16% 16% 48% 13% -8% 6% 3% -3% 23% 14% -3% -11% -7% 30% 12% 3% 12% 180% 194% 547% 390% 0% -6% 49% 6% -9% 137% 37% 14% 12% 3% 1% -15% 41% -53% 2% -3% 1% 7% 44% -40% -14% -27% -5%
3432 1968 824 1195 2176 844 665 600 897 1727 379 950 456 1163 1105 1193 1167 1218 648 1810 1668 281 10 308 460 476 781 923 922 795 3454 647 2975 1282 1271 697 907 1279 374 654 2234 302 1040 3284 2468 734 887 710 1359
10 8 14 14 12 15 20 12 27 16 42 27 21 24 26 23 29 17 19 26 20 29 95 6 9 6 4 8 13 9 6 8 8 7 5 5 7 8 13 6 7 9 8 9 8 6 4 7 7
3889 2967 1484 1895 3628 1065 1252 1227 2051 2710 747 1650 893 2196 1774 2384 2560 2245 1112 2615 2498 691 17 501 778 993 1225 1158 1237 2086 4105 1138 2910 1919 2016 1284 1549 2728 647 1182 2994 705 2125 4745 3835 1379 1901 1271 2575
130 154 137 108 135 90 87 105 97 83 67 65 69 84 90 77 62 80 93 79 80 85 26 69 104 118 72 84 79 122 173 150 165 92 160 163 99 125 92 95 147 124 171 145 156 135 147 97 138
49 60 56 56 56 45 36 39 39 34 29 25 28 36 42 26 22 37 42 36 34 29 12 31 54 45 40 43 39 31 57 69 88 37 68 54 51 48 41 37 58 37 66 55 62 56 51 44 54
27 42 21 19 27 12 23 28 31 23 12 13 12 23 15 20 18 12 19 16 16 28 0 18 33 42 16 17 22 68 52 50 37 26 36 52 24 50 27 37 27 53 66 25 33 53 77 39 51
30 13 28 19 30 16 14 8 18 13 20 19 16 14 23 23 15 20 21 17 20 22 6 4 7 7 5 8 6 9 20 13 8 8 19 13 14 10 10 9 25 14 15 29 25 8 6 4 16
24 38 32 14 22 18 14 30 9 13 6 9 13 10 10 7 7 11 11 10 11 6 8 15 9 23 11 15 11 14 44 18 32 20 36 44 10 16 14 11 37 20 24 36 35 18 13 10 16
18 24 23 10 16 13 8 15 8 9 5 6 8 7 8 5 5 9 8 7 8 5 8 12 6 13 7 12 9 10 24 16 26 16 28 25 7 11 11 8 26 16 18 24 22 11 12 6 13
Page140
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District
Treatmen Treatmen t success t Success rate rate of among new smear smear positive positive previousl 5 patients y treated cases5 79% 85% 87% 86% 84% 86% 83% 73% 84% 83% 83% 85% 81% 87% 84% 83% 85% 85% 84% 81% 87% 90% 0% 100% 200% 300% 90% 89% 88% 82% 84% 88% 92% 89% 88% 87% 86% 91% 84% 90% 89% 91% 93% 93% 91% 93% 88% 88% 87% 52% 54% 55% 74% 58% 68% 62% 48% 68% 67% 67% 65% 63% 71% 67% 73% 75% 68% 65% 64% 70% 75% 100% 93% 60% 85% 73% 75% 74% 67% 54% 73% 77% 72% 69% 64% 62% 73% 76% 78% 61% 45% 84% 79% 63% 84% 76% 70% 75%
248 303 69 63 158 42 102 49 429 343 93 191 43 218 173 475 483 154 118 227 333 154 0 24 71 31 52 49 87 351 373 116 276 41 135 220 157 442 50 35 468 166 317 618 337 119 92 127 370
8% 14% 6% 4% 5% 5% 10% 6% 23% 15% 14% 13% 6% 11% 11% 22% 21% 8% 12% 10% 15% 24% 0% 6% 10% 4% 5% 5% 8% 19% 12% 12% 12% 3% 9% 23% 11% 19% 9% 3% 21% 28% 17% 17% 11% 10% 5% 11% 16%
86% 88% 92% 89% 86% 86% 86% 82% 85% 84% 84% 86% 84% 88% 82% 85% 83% 82% 86% 85% 85% 86% 100% 92% 91% 92% 90% 89% 92% 86% 93% 91% 95% 91% 86% 91% 91% 93% 91% 90% 93% 91% 94% 96% 93% 95% 87% 90% 94%
63% 60% 65% 71% 56% 69% 66% 51% 73% 67% 58% 70% 69% 76% 68% 67% 72% 66% 70% 71% 65% 73% 100% 81% 61% 66% 71% 67% 73% 66% 63% 74% 81% 72% 61% 52% 64% 76% 79% 68% 67% 47% 83% 83% 64% 88% 78% 63% 83%
1802 1345 695 1044 1732 664 559 443 943 1225 327 728 410 1072 831 826 897 978 570 1276 1150 256 13 283 376 413 650 700 680 616 1661 610 1924 1011 1140 594 808 1177 308 494 1513 271 904 2443 1842 639 642 536 1117
90% 82% 82% 90% 89% 97% 88% 70% 96% 87% 87% 92% 87% 94% 84% 84% 80% 77% 97% 89% 88% 93% 100% 90% 84% 84% 81% 91% 91% 88% 87% 95% 96% 90% 94% 95% 89% 91% 83% 88% 88% 89% 87% 95% 89% 93% 79% 82% 89%
1878 1432 817 1137 1899 671 601 550 935 1264 364 753 449 1134 818 934 1034 952 583 1326 1098 262 13 310 448 494 786 764 750 691 1911 637 2005 1084 867 602 903 1273 365 561 1705 302 1034 2570 2057 673 802 534 1255
94% 88% 96% 98% 98% 98% 95% 86% 95% 90% 97% 95% 95% 100% 83% 96% 92% 75% 99% 92% 84% 95% 100% 99% 100% 100% 98% 99% 100% 99% 100% 99% 100% 97% 72% 96% 100% 98% 99% 100% 99% 100% 100% 100% 99% 98% 99% 82% 100%
1077 908 550 711 1353 469 407 222 625 904 231 514 274 886 624 555 709 783 340 787 768 236 8 331 120 269 436 387 351 318 1360 432 1418 499 658 262 477 872 132 414 1098 86 878 2043 1140 528 550 373 961
79% 77% 87% 83% 88% 95% 83% 67% 78% 82% 83% 82% 71% 88% 77% 78% 73% 75% 72% 78% 75% 83% 0% 301% 171% 368% 62% 66% 96% 66% 93% 184% 96% 60% 80% 69% 73% 81% 50% 52% 89% 52% 94% 93% 75% 53% 76% 48% 88%
962 2304 861 820 2249 654 711 732 1639 1503 597 881 637 903 745 1577 1978 1540 629 1677 1669 491 3 170 68 567 851 685 1093 1387 2080 757 2139 1086 631 658 804 1529 512 421 1633 335 1258 2816 2555 684 1634 1093 1008
25% 78% 58% 43.3% 62% 61% 57% 60% 80% 55% 80% 53% 71% 41% 42% 66% 77% 69% 57% 64% 67% 71% 18% 34% 9% 57% 69% 59% 88% 66% 51% 67% 74% 57% 31% 51% 52% 56% 79% 36% 55% 48% 59% 59% 67% 50% 86% 86% 39%
89% 94% 94% 86% 96% 97% 93% 90% 55% 32% 75% 56% 95% 63% 69% 51% 68% 50% 56% 58% 52% 63% 0% 4% 41% 12% 27% 0% 7% 8% 4% 38% 5% 3% 6% 12% 30% 4% 23% 15% 20% 30% 34% 46% 6% 3% 9% 5% 16%
12% 14% 7% 8% 17% 15% 9% 12% 2% 4% 2% 2% 5% 2% 2% 3% 2% 3% 2% 4% 3% 1% 0% 0% 0% 2% 0% 1% 0% 4% 0% 3% 2% 0% 1% 0% 1% 1% 1% 4% 1% 4% 3% 0% 0% 1% 1%
11% 13% 6% 7% 16% 15% 8% 10% 1% 1% 2% 1% 5% 2% 1% 1% 1% 2% 1% 2% 2% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 1% 0% 0% 0% 0% 0% 0% 0% 0% 0% 1% 0% 2% 0% 0% 0% 0% 0%
100% 100% 100% 97% 100% 100% 100% 100% 80% 44% 11% 37% 95% 100% 47% 0% 86% 21% 60% 22% 38% 0%
75% 67% 82% 54% 67% 94% 71% 73% 95% 56% 78% 58% 75% 90% 59% 100% 93% 68% 80% 17% 100% 100%
0%
100%
0% 86%
0% 14%
0%
83%
Page141
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District
50 58 57 63 64 39 52 50 52 55 60 62 59 59 34 25 63 58 53 57 61 64 24 20 49 36 42 56 53 48 55 45 47 45 53 38 49 57 44 47 62 54 61 65 63 45 30 41 49
77% 89% 87% 96% 98% 60% 81% 77% 79% 85% 92% 96% 91% 90% 52% 38% 97% 89% 82% 88% 94% 98% 37% 31% 76% 56% 65% 86% 82% 74% 85% 69% 72% 69% 82% 58% 76% 88% 68% 72% 96% 83% 94% 100% 97% 70% 46% 63% 76%
10 20 20 20 20 20 20 10 10 20 20 20 10 20 20 20 20 20 20 10 20 20 20 20 10 10 10 10 20 10 20 20 10 10 20 20 20 10 20 10 20 20 10 10 20 10 20 10 10
50% 100% 100% 100% 100% 100% 100% 50% 50% 100% 100% 100% 50% 100% 100% 100% 100% 100% 100% 50% 100% 100% 100% 100% 50% 50% 50% 50% 100% 50% 100% 100% 50% 50% 100% 100% 100% 50% 100% 50% 100% 100% 50% 50% 100% 50% 100% 50% 50%
12 12 12 8 16 16 12 16 16 4 16 16 20 16 16 12 4 0 20 4 16 16 20 8 20 16 20 16 16 20 8 8 4 12 16 8 20 12 16 20 12 12 12 16 20 16 4 12 20
60% 60% 60% 40% 80% 80% 60% 80% 80% 20% 80% 80% 100% 80% 80% 60% 20% 0% 100% 20% 80% 80% 100% 40% 100% 80% 100% 80% 80% 100% 40% 40% 20% 60% 80% 40% 100% 60% 80% 100% 60% 60% 60% 80% 100% 80% 20% 60% 100%
5 18 5 14 10 15 5 17 29 9 10 10 8 18 10 10 12 25 15 22 20 10 25 5 5 5 7 15 15 15 20 15 25 15 5 15 20 20 24 5 5 15 20 20 15 5 5 25 25
17% 60% 17% 47% 33% 50% 17% 56% 97% 30% 33% 33% 26% 61% 33% 33% 41% 84% 49% 74% 67% 33% 83% 17% 17% 17% 23% 50% 50% 50% 67% 50% 83% 50% 17% 50% 67% 67% 79% 17% 17% 50% 67% 67% 50% 17% 17% 83% 85%
74 65 71 69 69 74 71 59 86 53 74 56 81 79 51 62 87 53 73 63 76 86 41 72 70 75 69 51 65 63 65 80 81 50 59 57 92 78 50 68 73 79 91 92 65 70 74 59 75
64% 57% 61% 60% 60% 64% 62% 51% 75% 46% 64% 49% 70% 69% 45% 54% 76% 46% 63% 55% 66% 75% 36% 63% 60% 66% 60% 45% 57% 55% 57% 70% 70% 43% 51% 50% 80% 68% 43% 59% 63% 69% 79% 80% 57% 61% 64% 51% 65%
151 173 164 173 179 164 160 151 193 142 180 165 178 192 131 129 186 156 181 156 193 196 130 126 154 143 149 148 169 156 168 168 166 132 153 138 201 177 153 150 172 180 194 203 183 146 133 146 180
60% 69% 66% 69% 71% 65% 64% 61% 77% 57% 72% 66% 71% 77% 53% 52% 75% 62% 72% 62% 77% 79% 52% 50% 61% 57% 59% 59% 68% 62% 67% 67% 66% 53% 61% 55% 80% 71% 61% 60% 69% 72% 78% 81% 73% 58% 53% 59% 72%
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1
Annual Rate of smear change in positive Annual suspects case smear examined positive notificatio per s+ n rate case case notificatio [from CFR: diagnosed sm + n rate (compared cases (from to (NSP + Rel PMR) previous + TAD) / year) Pop] 12% 15% -6% 3% 3% 22% -2% -1% 22% 0% 4% 64% 11% -12% 10% -4% 0% 4% -22% -10% 8% 14% 52% 5% 14% 38% 13% 31% 1% 7% 87% -47% 35% 16% 33% 6% 2% 10% -14% 4% 0% -5% -1% -6% -35% 4% -15% -7% 13% 80 87 58 49 83 77 47 50 68 78 83 70 42 50 53 81 132 87 67 41 36 99 71 63 40 55 41 132 76 62 97 36 60 104 39 76 66 55 187 78 61 51 44 135 44 79 54 40 48 72 82 50 48 81 73 50 43 56 70 74 63 39 47 44 81 107 84 64 37 33 71 67 61 41 30 48 55 50 57 51 52 54 85 35 51 54 64 81 66 51 53 54 53 42 65 49 38 42

3
Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Madhya Pradesh Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra
Mandla Mandsaur Morena Narsinghpur ** Neemuch Panna ** Raisen ** Rajgarh Ratlam Rewa Sagar ** Satna Sehore ** Seoni ** Shahdol Shajapur Sheopur Shivpuri Sidhi Singrauli Tikamgarh ** Ujjain Umaria Vidisha ** Ahmadnagar Ahmednagar MC Akola Akola MC Amravati MC Amravati Rural Aurangabad MC Aurangabad-MH ** Bhandara Bhiwandi Nizampur Bid ** Buldana ** Chandrapur Dhule Dhule MC Gadchiroli ** Gondiya Hingoli ** Jalgaon Jalgaon MC Jalna ** Kalyan Dombivli MC Kolhapur Kolhapur MC Latur **
11 13 20 11 8 10 13 15 15 24 24 22 13 14 11 15 7 17 11 12 14 20 6 15 42 4 14 4 6 22 12 25 12 7 26 26 22 17 4 11 13 12 38 5 20 12 33 5 25
4680 8810 7404 5047 5710 3195 5067 5602 6628 13592 10703 12938 5123 4686 3856 5663 3766 9946 4668 4051 3460 12427 4222 6454 23194 2596 9091 3378 6121 17219 12743 5839 10338 4822 17338 14467 15101 10222 4660 6761 8059 5014 16097 5393 5354 6739 22010 2447 16669
111 164 94 116 173 79 95 91 114 144 113 145 98 85 91 94 137 144 104 86 60 156 164 111 138 185 163 198 237 192 272 58 216 169 168 140 172 153 310 158 152 106 107 293 68 135 166 111 170
2% 22% -3% -9% 5% 21% 30% -8% 12% 24% 4% 62% 10% -6% -41% -1% 10% 15% -46% 243% 11% 28% 128% 8% 10% 9% 0% 38% -9% 21% 319% -82% 41% 93% 15% -2% 4% 1% 7% 14% -5% -4% 1% -14% -35% 22% -8% -11% 5%
844 1162 1141 539 685 784 631 772 985 1853 1971 1551 553 687 563 1226 906 1500 758 486 519 1961 457 920 1663 194 568 563 494 1399 1132 920 714 738 1016 1976 1455 919 703 840 806 602 1645 621 870 983 1787 218 1181
6 8 6 9 8 4 8 7 7 7 5 8 9 7 7 5 4 7 6 8 7 6 9 7 14 13 16 6 12 12 11 6 14 7 17 7 10 11 7 8 10 8 10 9 6 7 12 11 14
1389 2180 1778 1109 1318 1159 1383 1706 2050 3589 2790 3608 1191 1125 988 1867 1189 2416 1451 906 894 2769 738 2185 3278 350 1247 479 705 2371 1070 1815 1276 1575 1846 2424 2186 1684 540 1207 1292 1214 4148 554 1572 2027 2721 440 2032
132 163 90 102 160 114 104 110 141 152 117 162 91 82 93 123 173 140 129 77 62 139 115 150 78 100 90 112 109 106 91 72 106 221 71 94 100 101 144 113 98 103 110 120 80 163 82 80 83
61 53 32 37 62 53 36 33 36 58 57 57 32 34 37 61 85 71 51 32 27 49 58 41 37 21 38 39 35 43 40 43 41 66 29 37 45 54 66 57 42 43 43 45 30 52 42 29 32
39 54 13 27 47 22 34 38 54 45 30 68 34 18 32 21 46 45 28 21 22 37 28 62 17 36 16 18 21 21 7 9 23 58 16 22 24 20 19 24 22 28 37 40 22 38 15 15 19
16 15 14 19 17 7 6 8 14 24 10 19 7 10 7 14 7 2 17 13 4 24 9 10 13 24 18 30 25 17 25 6 15 41 14 11 13 10 24 14 17 14 12 17 10 31 12 21 13
14 41 31 19 33 32 27 31 37 24 20 18 18 20 15 27 35 22 32 11 9 29 20 38 12 19 18 25 28 25 19 14 27 53 13 23 18 17 35 18 17 18 18 20 19 42 13 15 18
11 31 20 13 20 20 15 11 21 14 18 7 7 14 7 21 23 13 16 6 7 24 11 21 5 10 13 18 16 15 12 10 15 22 6 16 11 10 16 10 10 13 11 10 13 16 7 10 12
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Treatmen Treatmen t success t Success rate rate of among new smear smear positive positive previousl 5 patients y treated cases5 91% 90% 90% 86% 88% 89% 89% 88% 84% 91% 89% 91% 88% 90% 94% 92% 89% 93% 90% 92% 86% 89% 90% 87% 89% 71% 78% 68% 82% 84% 87% 91% 80% 83% 85% 79% 88% 89% 93% 85% 82% 83% 85% 87% 90% 77% 87% 79% 83% 80% 76% 61% 65% 81% 68% 81% 75% 64% 80% 72% 76% 77% 68% 85% 91% 82% 73% 89% 78% 77% 64% 75% 77% 60% 56% 50% 43% 57% 66% 63% 80% 55% 57% 74% 62% 63% 74% 78% 64% 50% 67% 67% 53% 77% 50% 56% 44% 47%
110 197 157 101 47 106 49 103 241 266 177 216 119 65 56 178 137 163 154 68 21 368 42 207 143 10 43 33 29 82 56 63 59 144 75 60 65 49 31 41 44 36 164 29 22 149 160 22 68
9% 12% 14% 11% 5% 13% 5% 8% 16% 9% 8% 7% 13% 8% 7% 12% 14% 8% 14% 9% 3% 17% 7% 13% 5% 4% 4% 9% 6% 5% 7% 4% 6% 12% 5% 3% 4% 4% 8% 4% 4% 4% 5% 6% 2% 10% 7% 6% 4%
94% 90% 91% 89% 91% 91% 88% 89% 89% 90% 89% 89% 90% 93% 88% 94% 85% 92% 85% 81% 89% 90% 92% 84% 90% 68% 82% 79% 90% 88% 91% 93% 90% 86% 91% 86% 91% 93% 96% 85% 83% 88% 89% 88% 90% 87% 92% 82% 88%
78% 69% 58% 61% 79% 73% 81% 55% 75% 80% 67% 68% 72% 64% 79% 92% 51% 77% 60% 50% 71% 66% 76% 71% 64% 68% 62% 49% 70% 63% 71% 82% 62% 66% 65% 58% 66% 74% 81% 63% 58% 73% 68% 57% 75% 60% 68% 52% 56%
622 1005 837 379 603 658 393 654 730 1611 1543 1292 480 600 420 1194 570 1361 584 319 372 1384 400 808 1627 99 555 211 312 1056 1214 542 577 569 847 1106 1049 982 294 593 573 607 1686 228 829 755 1459 194 957
82% 90% 82% 69% 89% 88% 58% 97% 88% 95% 87% 91% 94% 89% 90% 97% 77% 94% 77% 72% 77% 95% 90% 90% 94% 92% 79% 87% 94% 81% 199% 41% 85% 91% 92% 81% 86% 91% 95% 82% 84% 92% 82% 90% 97% 89% 89% 91% 88%
745 1119 985 542 671 743 678 669 794 1268 1747 1365 508 592 466 1214 711 1402 718 441 485 1441 426 830 1740 107 701 243 330 1303 1312 609 679 623 906 1348 1208 1073 305 644 683 625 2036 254 853 847 1643 205 1081
98% 100% 96% 99% 99% 99% 100% 100% 95% 75% 98% 96% 100% 88% 100% 98% 96% 96% 94% 99% 100% 99% 96% 92% 100% 99% 99% 100% 100% 100% 215% 46% 100% 100% 99% 98% 99% 99% 99% 89% 100% 95% 99% 100% 100% 100% 100% 96% 100%
530 678 377 294 421 449 186 397 412 980 815 879 345 280 245 924 307 897 343 143 250 678 177 543 1376 56 436 105 242 633 907 453 359 346 565 682 954 741 267 394 406 420 1062 202 585 500 1019 124 716
70% 83% 59% 63% 72% 82% 48% 76% 74% 86% 61% 76% 86% 55% 34% 88% 62% 83% 50% 172% 64% 80% 76% 86% 89% 0% 83% 0% 91% 65% 178% 40% 72% 87% 69% 69% 88% 80% 0% 80% 73% 87% 70% 0% 93% 85% 80% 92% 86%
1121 1126 1529 804 790 33 139 1293 1472 2781 1659 2100 885 1002 563 1385 1045 1879 1187 437 531 1555 694 352 425 1 957 25 246 1214 683 6 663 443 688 690 977 1202 71 420 617 850 2001 32 780 93 1000 11 936
81% 52% 86% 72% 60% 3% 10% 76% 72% 77% 59% 58% 74% 89% 57% 74% 88% 78% 82% 48% 59% 56% 94% 16% 13% 0% 77% 5% 35% 51% 64% 0% 52% 28% 37% 28% 45% 71% 13% 35% 48% 70% 48% 6% 50% 5% 37% 3% 46%
18% 29% 18% 6% 13% 0% 23% 25% 26% 22% 10% 7% 7% 44% 8% 21% 58% 19% 0% 0% 0% 36% 25% 5% 80% 80% 81% 91% 86% 75% 69% 81% 94% 68% 83% 81% 87% 81% 87% 77% 78% 82% 83% 94% 92% 92% 90% 83% 79%
2% 2% 0% 2% 2% 1% 1% 1% 4% 1% 1% 2% 3% 1% 2% 0% 6%
2% 1% 0% 11% 26% 9% 14% 9% 5% 7% 6% 9% 10% 17% 4% 9% 11% 9% 2% 5% 8% 10% 11% 7% 9% 13% 24% 14%
0% 1% 0% 0% 0% 0% 0% 0% 0% 1% 0% 0% 0% 1% 0% 0% 0% 1% 0% 0% 0% 1% 0% 0% 9% 21% 7% 13% 7% 3% 5% 5% 9% 7% 14% 3% 8% 9% 8% 2% 4% 6% 8% 11% 7% 8% 12% 20% 11%
0%
100%
0%
100%
100% 0%
100% 38%
67%
67%
99% 100% 99% 97% 100% 100% 66% 90% 94% 46% 100% 98% 97% 100% 98% 75% 98% 92% 99% 100% 60% 90% 92% 100% 97%
68% 42% 76% 94% 85% 77% 64% 72% 98% 63% 42% 58% 80% 79% 71% 50% 75% 55% 46% 75% 46% 50% 64% 50% 44%
Page144
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District
58 57 40 53 63 47 47 49 53 55 48 48 38 60 41 48 56 38 16 34 50 41 57 49 54 31 48 33 55 49 64 64 63 44 60 50 52 56 27 56 61 47 61 33 55 58 46 35 47
89% 88% 61% 82% 97% 72% 72% 75% 82% 84% 74% 73% 58% 92% 63% 74% 86% 59% 25% 53% 77% 64% 87% 76% 84% 47% 74% 50% 85% 76% 98% 99% 98% 68% 92% 77% 80% 86% 41% 87% 93% 73% 94% 50% 84% 89% 71% 54% 72%
10 10 20 20 20 20 10 10 10 10 10 10 20 10 20 20 10 10 20 10 20 10 10 20 20 20 0 10 20 20 10 20 0 10 20 10 10 10 10 10 0 20 20 10 10 10 10 20 10
50% 50% 100% 100% 100% 100% 50% 50% 50% 50% 50% 50% 100% 50% 100% 100% 50% 50% 100% 50% 100% 50% 50% 100% 100% 100% 0% 50% 100% 100% 50% 100% 0% 50% 100% 50% 50% 50% 50% 50% 0% 100% 100% 50% 50% 50% 50% 100% 50%
20 16 16 20 12 12 16 16 16 16 12 16 16 20 8 12 16 16 12 16 16 12 16 16 20 8 16 12 16 16 16 20 16 16 16 16 8 16 16 20 8 20 16 16 16 16 12 12 16
100% 80% 80% 100% 60% 60% 80% 80% 80% 80% 60% 80% 80% 100% 40% 60% 80% 80% 60% 80% 80% 60% 80% 80% 100% 40% 80% 60% 80% 80% 80% 100% 80% 80% 80% 80% 40% 80% 80% 100% 40% 100% 80% 80% 80% 80% 60% 60% 80%
5 5 5 5 10 15 15 7 15 11 14 15 15 15 15 5 15 5 5 5 5 14 15 18 5 15 17 17 10 14 14 10 7 20 5 5 10 15 5 24 10 7 5 5 20 7 5 5 9
17% 17% 17% 17% 33% 50% 50% 23% 50% 38% 46% 50% 50% 50% 50% 17% 50% 17% 17% 17% 17% 46% 50% 59% 17% 50% 57% 57% 33% 45% 46% 33% 23% 67% 17% 17% 33% 50% 17% 81% 33% 23% 17% 17% 67% 23% 17% 17% 30%
70 67 64 63 72 52 65 76 80 103 65 85 51 65 65 86 68 65 74 59 36 79 68 58 67 91 85 69 79 98 88 64 80 74 74 78 96 81 95 73 46 94 73 64 106 52 91 80 90
61% 58% 56% 55% 62% 45% 56% 66% 69% 89% 57% 74% 44% 56% 56% 74% 59% 57% 64% 52% 31% 68% 59% 50% 58% 79% 74% 60% 69% 85% 77% 56% 70% 64% 65% 68% 83% 70% 82% 63% 40% 82% 64% 56% 93% 45% 79% 69% 78%
163 155 145 161 177 146 152 157 174 195 149 174 140 170 149 170 165 135 127 125 127 156 166 161 166 164 166 141 180 197 192 178 167 164 175 159 175 178 153 184 124 188 176 128 207 142 164 152 172
65% 62% 58% 65% 71% 58% 61% 63% 70% 78% 60% 70% 56% 68% 59% 68% 66% 54% 51% 50% 51% 62% 66% 64% 66% 66% 66% 56% 72% 79% 77% 71% 67% 66% 70% 64% 70% 71% 61% 73% 50% 75% 70% 51% 83% 57% 66% 61% 69%
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Annual Rate of smear change in positive Annual suspects case smear examined positive notificatio per s+ n rate case case notificatio [from CFR: diagnosed sm + n rate (compared cases (from to (NSP + Rel PMR) previous + TAD) / year) Pop] -1% -5% 15% 0% 6% -6% -14% -14% 10% 15% 5% 7% 3% 5% 2% 5% -9% 9% -9% -5% 0% 10% 17% -4% 6% -1% 5% 8% -1% -3% 20% 3% -11% 2% 11% -8% 25% 3% 4% 22% 14% -5% 3% -31% 2% 25% 113 78 108 85 75 51 70 65 48 68 125 40 42 57 52 76 80 84 77 43 62 57 44 90 53 84 118 74 44 66 50 38 56 52 79 29 39 38 40 38 149 58 74 34 89 58 88 74 103 64 66 46 43 57 48 56 85 38 43 45 59 52 76 82 66 39 57 55 44 58 56 63 79 58 45 63 54 47 57 52 53 30 39 36 43 35 92 54 79 51 75 67

3
Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Maharashtra Manipur Manipur Manipur Manipur Manipur Manipur Manipur Manipur Manipur Meghalaya Meghalaya Meghalaya Meghalaya Meghalaya Meghalaya Meghalaya
Malegoan Corporation Mira Bhayander Mumbai Nagpur MC Nagpur Rural Nanded ** Nanded Waghela MC Nandurbar * Nashik Nashik Corp Navi Mumbai Osmanabad ** Parbhani ** Pimpri Chinchwad Pune Pune Rural Raigarh-Mh Ratnagiri Sangli Sangli MC Satara Sindhudurg Solapur Solapur MC Thane Thane MC Ulhasnagar MC Wardha Washim Yavatmal ** Bishnupur Chandel * Churachandpur * Imphal East Imphal West Senapati * Tamenglong * Thoubal Ukhrul * East Garo Hills * East Khasi Hills * Jaintia Hills * Ri Bhoi * South Garo Hills * West Garo Hills * West Khasi Hills *
5 8 125 24 22 28 6 16 42 15 11 17 18 17 31 46 26 16 23 5 30 8 34 10 48 18 5 13 12 28 2 1 3 5 5 4 1 4 2 3 8 4 3 1 6 4
3917 3796 97710 14222 15209 12354 3210 7831 21462 8697 11158 7876 8068 9821 15472 32453 16284 16621 24157 2020 25700 9107 19411 5588 22136 9780 3195 10966 4932 16160 814 740 2547 2309 3419 907 485 1275 587 1257 10480 1825 1821 429 4353 2421
208 116 196 148 169 110 146 119 129 146 249 119 110 142 124 177 154 258 261 100 214 268 144 147 114 134 158 212 103 146 85 128 235 128 166 64 87 76 80 99 318 116 176 75 169 157
53% 32% 15% -9% 5% -9% -32% -7% 1% -1% -21% 2% -7% -36% 12% -10% -6% 42% 16% -29% 7% 14% 0% -3% -33% -16% 5% 12% 1% 1% -15% -23% -22% -24% -4% 8% -20% 1% -20% 143% -60% -20% -11% -45% -10% 0%
530 636 13448 2042 1677 1445 386 1065 1990 1016 1404 661 775 983 1619 3491 2118 1354 1782 218 1870 480 1493 853 2541 1521 596 953 524 1841 121 55 151 235 406 103 54 161 74 122 1226 229 191 48 569 225
7 6 7 7 9 9 8 7 11 9 8 12 10 10 10 9 8 12 14 9 14 19 13 7 9 6 5 12 9 9 7 13 17 10 8 9 9 8 8 10 9 8 10 9 8 11
923 939 30429 3224 2460 2445 504 1781 3398 1447 2144 1326 1562 1857 3649 3892 3661 2642 3033 523 3290 1050 2451 1091 5973 2893 868 1338 1060 3375 242 161 465 720 632 247 65 406 142 207 2084 744 465 110 708 761
196 115 244 134 109 87 92 108 82 97 192 80 85 107 117 85 139 164 131 104 110 124 73 115 123 159 171 103 89 122 101 112 171 159 123 70 46 97 78 65 253 189 180 77 110 197
70 55 68 52 56 39 35 46 43 49 62 31 34 34 49 44 59 68 58 30 46 43 37 44 45 45 60 45 34 49 44 37 45 45 46 24 34 32 32 28 67 44 61 46 67 52
43 9 50 18 25 21 15 29 20 26 32 24 24 16 15 13 27 47 31 24 25 36 15 25 33 33 41 15 23 30 14 33 64 52 27 10 2 32 10 17 46 80 26 12 15 51
54 20 51 35 11 14 26 13 9 8 45 12 14 33 31 14 21 13 16 23 18 22 9 22 20 41 14 23 16 22 25 13 25 37 32 22 4 19 17 6 75 35 47 8 12 57
28 31 75 28 17 13 16 20 10 15 53 13 13 24 23 15 31 36 25 14 20 22 12 24 24 41 56 20 16 21 17 28 38 25 17 14 7 13 17 14 61 30 44 11 16 38
20 20 37 13 10 8 9 12 6 7 28 8 10 12 11 9 19 16 9 10 11 12 7 15 12 20 20 14 12 15 15 10 14 8 8 8 5 5 13 7 35 13 26 5 10 20
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Treatmen Treatmen t success t Success rate rate of among new smear smear positive positive previousl 5 patients y treated cases5 84% 87% 86% 85% 88% 89% 87% 86% 91% 86% 85% 83% 89% 85% 88% 87% 83% 88% 87% 85% 84% 86% 88% 83% 86% 83% 81% 82% 85% 89% 91% 90% 90% 90% 87% 96% 91% 91% 82% 86% 74% 83% 80% 90% 93% 88% 74% 61% 64% 52% 74% 86% 62% 76% 81% 67% 47% 64% 67% 63% 56% 66% 62% 57% 63% 55% 58% 56% 64% 47% 65% 61% 58% 67% 62% 66% 79% 50% 77% 79% 68% 76% 92% 63% 64% 78% 46% 59% 61% 50% 80% 50%
87 47 1982 175 108 66 15 71 288 132 270 82 51 142 194 162 185 57 119 31 137 51 95 94 448 307 41 46 34 188 3 6 98 20 15 13 2 7 6 9 232 211 51 7 30 123
11% 7% 9% 7% 5% 3% 4% 5% 10% 11% 17% 7% 4% 10% 7% 5% 7% 3% 5% 7% 5% 6% 5% 11% 9% 14% 7% 4% 4% 7% 2% 5% 27% 3% 3% 7% 4% 2% 5% 6% 15% 34% 14% 7% 5% 20%
87% 92% 90% 91% 92% 90% 90% 90% 94% 91% 90% 88% 90% 90% 93% 92% 89% 92% 92% 90% 91% 90% 91% 88% 91% 86% 93% 90% 82% 88% 93% 86% 87% 92% 91% 93% 91% 87% 81% 90% 78% 84% 77% 96% 91% 90%
84% 71% 67% 69% 77% 63% 71% 83% 90% 70% 52% 70% 74% 70% 71% 73% 71% 68% 72% 71% 64% 69% 68% 60% 71% 58% 62% 70% 63% 65% 66% 89% 71% 77% 84% 83% 78% 77% 41% 82% 54% 49% 66% 86% 86% 66%
402 585 11378 1173 1357 1165 200 816 1826 784 940 531 687 758 1730 1991 1780 1253 1411 171 1590 434 1280 495 2236 1049 325 612 458 1453 124 62 160 224 269 112 54 152 80 102 749 172 198 52 484 259
95% 96% 86% 75% 91% 89% 83% 84% 90% 94% 94% 82% 86% 94% 93% 83% 87% 93% 90% 85% 92% 92% 86% 89% 81% 88% 81% 80% 83% 82% 89% 90% 100% 92% 96% 100% 100% 99% 98% 91% 90% 76% 88% 71% 98% 93%
424 611 12205 1262 1490 1278 225 963 1994 832 1005 648 801 791 1805 2225 2031 1341 1561 201 1726 464 1424 549 2701 1161 392 717 507 1672 139 69 160 229 241 112 49 151 82 89 800 227 203 64 494 267
100% 100% 93% 81% 100% 97% 94% 99% 99% 100% 100% 100% 100% 98% 97% 93% 99% 99% 99% 100% 100% 98% 96% 99% 98% 98% 97% 93% 92% 95% 99% 100% 100% 94% 86% 100% 91% 99% 100% 79% 96% 100% 90% 88% 100% 96%
277 439 7961 928 1221 795 144 431 1285 630 667 440 544 587 1356 1493 1190 892 940 130 1064 370 1241 396 1738 787 291 490 297 1045 116 38 120 167 193 118 47 92 60 85 400 94 152 34 450 178
0% 0% 82% 74% 90% 74% 57% 64% 64% 97% 99% 78% 83% 83% 95% 73% 82% 87% 83% 71% 77% 86% 83% 94% 81% 95% 98% 79% 81% 82% 91% 60% 98% 81% 81% 98% 80% 75% 100% 77% 84% 62% 100% 57% 94% 89%
277 512 34 275 1045 1178 250 1381 1486 154 1031 638 507 13 353 965 2263 1902 656 30 2012 666 511 22 3955 1295 41 821 701 2367 217 103 172 500 270 0 42 230 92 98 1100 744 409 73 173 324
30% 55% 0% 9% 42% 48% 50% 78% 44% 11% 48% 48% 32% 1% 10% 25% 62% 72% 22% 6% 61% 63% 21% 2% 66% 45% 5% 61% 66% 70% 90% 64% 37% 69% 43% 0% 65% 57% 65% 47% 53% 100% 88% 66% 24% 43%
76% 90% 76% 81% 88% 60% 80% 77% 74% 85% 95% 75% 79% 96% 83% 76% 61% 93% 91% 96% 89% 91% 64% 90% 58% 77% 82% 91% 68% 80% 43% 40% 63% 52% 23% 74% 69% 45% 65% 32% 0% 1% 10% 15% 56% 8%
5% 9% 7% 17% 6% 9% 12% 8% 4% 9% 12% 28% 17% 15% 19% 18% 9% 8% 13% 32% 17% 4% 23% 15% 7% 8% 9% 6% 10% 16% 1% 33% 17% 6% 10% 3% 2% 5% 28% 2% 0% 25% 4% 0% 0% 0%
4% 8% 5% 14% 6% 6% 10% 6% 3% 8% 12% 21% 13% 15% 16% 14% 5% 8% 12% 31% 15% 4% 15% 13% 4% 6% 8% 6% 7% 13% 0% 13% 11% 3% 2% 2% 2% 2% 18% 0% 0% 0% 0% 0% 0% 0%
100% 100% 100% 100% 90% 83% 100% 91% 97% 97% 100% 95% 98% 97% 97% 75% 88% 100% 99% 100% 97% 92% 77% 97% 91% 100% 100% 100% 83% 97% 0% 78% 94% 45% 0% 0% 13% 67% 100%
53% 86% 49% 53% 72% 71% 94% 45% 75% 67% 83% 49% 34% 77% 68% 35% 60% 81% 84% 67% 72% 83% 52% 58% 60% 76% 66% 60% 45% 38% 100% 22% 94% 20% 4% 11% 50% 67% 0%
100%
0%
Page147
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District
30 53 52 49 56 56 57 55 59 64 63 61 57 63 60 61 60 45 24 49 56 59 46 57 64 62 63 54 60 33 44 29 61 54 34 32 58 29 47 47 33 51 48 53 53
46% 81% 80% 76% 87% 86% 88% 84% 90% 98% 97% 93% 87% 97% 92% 94% 92% 69% 37% 76% 86% 91% 71% 87% 98% 95% 97% 83% 92% 51% 68% 45% 94% 83% 53% 49% 90% 45% 73% 72% 51% 78% 73% 81% 82%
10 20 10 20 10 20 20 10 10 20 10 10 20 20 20 10 10 20 10 20 10 10 20 10 20 20 10 10 10 20 20 20 10 20 20 20 20 10 10 20 20 20 20 20 20
50% 100% 50% 100% 50% 100% 100% 50% 50% 100% 50% 50% 100% 100% 100% 50% 50% 100% 50% 100% 50% 50% 100% 50% 100% 100% 50% 50% 50% 100% 100% 100% 50% 100% 100% 100% 100% 50% 50% 100% 100% 100% 100% 100% 100%
20 16 12 16 16 16 16 16 16 16 16 16 16 8 16 12 8 16 12 16 8 16 12 12 16 16 12 16 16 20 16 12 4 16 20 16 20 16 20 16 4 20 20 16 20
100% 80% 60% 80% 80% 80% 80% 80% 80% 80% 80% 80% 80% 40% 80% 60% 40% 80% 60% 80% 40% 80% 60% 60% 80% 80% 60% 80% 80% 100% 80% 60% 20% 80% 100% 80% 100% 80% 100% 80% 20% 100% 100% 80% 100%
24 23 10 5 5 5 15 5 10 29 15 5 5 10 5 10 5 6 8 5 15 5 15 15 23 5 11 5 5 5 10 5 10 10 5 17 5 5 5 14 15 15 5 5 15
81% 78% 33% 17% 17% 17% 50% 17% 32% 95% 50% 17% 17% 35% 17% 32% 17% 21% 27% 17% 50% 17% 50% 50% 77% 17% 38% 17% 17% 17% 33% 17% 33% 33% 17% 58% 17% 17% 17% 46% 50% 50% 17% 17% 50%
87 83 68 89 74 66 93 99 100 76 78 94 89 74 86 76 91 99 83 88 103 71 59 38 81 68 73 56 82 58 37 92 44 66 68 65 65 82 66 43 63 62 71 75 70
76% 73% 59% 77% 64% 58% 81% 86% 87% 66% 67% 82% 78% 65% 75% 66% 79% 86% 72% 77% 89% 62% 51% 33% 71% 59% 63% 49% 71% 50% 33% 80% 38% 57% 59% 57% 57% 71% 57% 37% 55% 54% 62% 66% 61%
172 195 152 180 161 163 202 185 194 205 182 186 187 176 187 168 174 186 137 178 192 161 152 132 204 171 169 141 172 136 128 158 129 166 147 150 168 142 148 139 135 167 164 169 178
69% 78% 61% 72% 65% 65% 81% 74% 78% 82% 73% 74% 75% 70% 75% 67% 70% 75% 55% 71% 77% 64% 61% 53% 82% 68% 68% 56% 69% 54% 51% 63% 52% 66% 59% 60% 67% 57% 59% 56% 54% 67% 66% 68% 71%
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Annual Rate of smear change in positive Annual suspects case smear examined positive notificatio per s+ n rate case case notificatio [from CFR: diagnosed sm + n rate (compared cases (from to (NSP + Rel PMR) previous + TAD) / year) Pop] 0% 34% 48% -15% -46% -11% -18% 5% 0% -8% 14% -5% 9% -7% 47% -1% 10% 13% -36% 1% 0% 8% 12% -10% 0% -4% 10% -3% -11% -5% 18% 29% 13% 0% 13% -10% 9% 9% 3% 8% -2% 1% 2% -1% 9% -6% 9% 83 31 70 17 119 43 75 40 176 95 81 87 92 81 27 50 93 73 71 60 63 61 51 31 71 48 50 51 60 107 77 21 37 72 69 91 34 93 37 100 110 127 52 91 91 34 109 69 29 65 32 99 37 85 39 113 100 63 85 87 114 41 45 92 73 70 49 55 51 53 30 34 58 30 50 60 98 69 21 40 70 64 82 36 82 38 84 124 119 49 73 78 33 100

3
Mizoram Mizoram Mizoram Mizoram Mizoram Mizoram Mizoram Mizoram Nagaland Nagaland Nagaland Nagaland Nagaland Nagaland Nagaland Nagaland Nagaland Nagaland Nagaland Orissa Orissa Orissa Orissa Orissa Orissa Orissa Orissa Orissa Orissa Orissa Orissa Orissa Orissa Orissa Orissa Orissa Orissa Orissa Orissa Orissa Orissa Orissa Orissa Orissa Orissa Orissa Orissa
Aizawl * Champhai * Kolasib * Lawngtlai * Lunglei * Mamit * Saiha * Serchhip * Dimapur * Kiphire * Kohima * Longleng* Mokokchung * Mon * Peren * Phek * Tuensang * Wokha * Zunheboto * Anugul Balangir ** Baleshwar Bargarh Bhadrak Bhubaneshwar MC Boudh Cuttack Debagarh Dhenkanal Gajapati Ganjam Jagatsinghpur Jajapur Jharsuguda Kalahandi ** Kandhamal Kendrapara Kendujhar Khordha Koraput Malkangiri * Mayurbhanj Nabarangapur Nayagarh Nuapada Puri Rayagada
4 1 1 1 2 1 1 1 4 1 3 1 2 3 1 2 2 2 1 13 16 23 15 15 8 4 26 3 12 6 35 11 18 6 16 7 14 18 14 14 6 25 12 10 6 17 10
3884 762 813 382 1107 536 614 401 3731 590 1506 358 1190 2682 420 563 1559 1350 557 7696 7511 10764 6806 5230 4215 1424 9594 1231 6218 3165 19233 4620 5394 3857 7465 4723 6323 11061 4342 7902 2989 17571 3941 5679 3996 6285 6606
240 152 245 81 180 156 272 155 246 199 139 177 154 267 111 86 198 203 99 151 114 116 115 87 126 81 92 99 130 137 137 102 74 166 119 161 110 153 77 143 122 175 81 148 165 93 172
-2% -8% -13% -49% -10% -17% 21% 62% -4% 38% -20% 112% 16% 11% -16% 32% 16% 20% 1% -4% -9% 11% 5% 20% -15% -12% 3% -14% -10% -13% 14% 7% -4% -21% -10% -13% 9% -7% 6% 2% -27% -9% -8% -3% 8% -9% -7%
335 39 58 20 183 37 42 26 669 70 219 44 178 202 26 82 183 121 100 762 1044 1407 749 468 597 213 1320 159 717 618 2724 237 677 420 1083 663 489 1679 526 1376 677 3183 637 872 553 583 1049
12 20 14 19 6 14 15 15 6 8 7 8 7 13 16 7 9 11 6 10 7 8 9 11 7 7 7 8 9 5 7 19 8 9 7 7 13 7 8 6 4 6 6 7 7 11 6
1223 131 158 149 290 86 205 62 989 150 419 86 280 626 84 146 642 157 143 1050 2291 2023 1724 851 768 402 1710 292 1102 1094 5427 471 1439 803 1983 1035 864 2941 1095 1722 1021 5160 979 1429 933 1215 1555
303 104 190 127 188 100 364 96 260 203 155 170 145 250 88 89 326 94 101 83 139 87 117 56 92 91 65 94 92 190 154 41 79 139 126 141 60 163 78 125 167 205 80 149 154 72 162
48 21 46 25 80 35 59 34 81 77 46 67 63 81 26 38 73 65 65 41 50 43 48 26 26 51 24 42 49 88 54 18 34 57 57 71 31 71 32 72 105 104 44 51 68 26 86
75 29 36 45 29 31 144 29 61 34 28 26 28 52 37 10 76 20 23 17 45 21 30 9 13 12 10 21 11 45 39 6 15 37 31 26 9 45 16 22 25 52 25 34 56 14 36
116 37 60 29 52 20 105 22 38 54 42 45 21 64 7 24 126 2 3 13 22 12 28 15 33 16 22 17 18 30 33 13 20 23 21 25 11 26 19 13 15 24 3 25 13 17 18
64 18 48 28 27 14 57 11 80 38 39 32 33 52 18 17 52 8 10 11 19 11 11 7 17 13 10 13 15 26 28 4 10 21 17 20 9 21 11 17 22 25 8 39 17 14 22
24 10 23 8 19 8 30 9 37 26 20 24 30 34 18 12 20 8 6 8 6 9 6 4 10 7 6 9 12 12 17 3 6 13 8 12 6 12 7 12 19 15 5 24 12 8 16
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Treatmen Treatmen t success t Success rate rate of among new smear smear positive positive previousl 5 patients y treated cases5 108% 84% 88% 100% 138% 76% 94% 81% 86% 95% 93% 90% 89% 95% 91% 93% 124% 100% 86% 90% 84% 86% 88% 91% 83% 86% 86% 82% 93% 79% 82% 93% 92% 84% 86% 88% 96% 86% 86% 88% 84% 89% 88% 66% 89% 88% 88% 74% 64% 92% 88% 100% 43% 89% 100% 78% 88% 87% 78% 80% 98% 78% 65% 109% 100% 89% 66% 73% 73% 78% 75% 64% 71% 60% 55% 69% 47% 56% 70% 77% 66% 59% 78% 76% 54% 67% 67% 74% 71% 80% 35% 75% 67% 75%
159 29 9 21 54 12 48 13 54 23 24 13 39 77 8 10 140 15 14 41 109 42 70 25 88 23 71 11 60 111 345 11 49 32 92 74 34 140 80 97 44 143 32 65 38 82 119
16% 27% 8% 18% 22% 16% 28% 24% 8% 19% 8% 19% 18% 16% 12% 8% 26% 10% 11% 5% 6% 2% 4% 3% 14% 7% 5% 4% 7% 12% 8% 3% 4% 5% 5% 8% 5% 5% 9% 7% 5% 3% 4% 6% 5% 8% 9%
92% 71% 92% 96% 95% 83% 95% 95% 92% 96% 94% 88% 95% 91% 96% 85% 92% 98% 91% 94% 88% 89% 90% 88% 86% 89% 88% 85% 92% 87% 88% 90% 94% 92% 82% 90% 97% 86% 88% 89% 81% 89% 92% 70% 91% 89% 88%
65% 90% 78% 88% 81% 67% 100% 80% 83% 95% 90% 56% 81% 79% 60% 72% 75% 100% 100% 74% 53% 76% 69% 76% 68% 71% 69% 48% 78% 45% 56% 68% 84% 77% 64% 64% 86% 62% 68% 73% 66% 75% 71% 43% 60% 68% 78%
290 38 54 35 153 35 49 27 375 72 178 45 172 2 0 70 183 120 100 495 771 1032 671 371 263 219 629 149 631 488 2045 213 652 361 845 475 480 1308 452 917 575 2477 536 640 424 538 676
100% 97% 95% 92% 100% 95% 98% 96% 83% 95% 99% 98% 97% 1% 0% 85% 100% 99% 100% 79% 83% 86% 84% 82% 89% 86% 78% 93% 87% 85% 82% 87% 88% 88% 83% 79% 91% 87% 82% 79% 76% 83% 89% 89% 88% 95% 69%
290 39 54 31 153 36 49 25 451 72 178 45 178 41 0 78 183 121 100 623 916 1143 779 448 278 255 795 159 727 528 2440 242 701 389 992 582 530 1495 546 1142 635 2971 569 681 470 569 975
100% 100% 95% 82% 100% 97% 98% 89% 100% 95% 99% 98% 100% 14% 0% 95% 100% 100% 100% 100% 99% 95% 98% 99% 94% 100% 99% 99% 100% 92% 98% 99% 95% 95% 97% 97% 100% 100% 100% 98% 84% 99% 95% 95% 97% 100% 100%
175 44 36 16 85 19 39 12 269 67 199 40 184 46 0 43 167 123 73 440 377 670 498 211 184 184 363 117 421 300 1072 224 613 325 486 246 467 1086 339 652 366 1975 368 139 265 345 610
81% 100% 62% 67% 99% 90% 95% 63% 72% 100% 100% 93% 100% 19% 0% 83% 91% 100% 96% 78% 54% 77% 74% 77% 86% 81% 62% 97% 70% 69% 64% 87% 80% 85% 57% 55% 94% 87% 78% 69% 60% 77% 74% 41% 69% 76% 69%
91 58 32 96 66 54 46 16 484 43 396 0 75 0 0 77 330 120 23 836 2143 1885 1650 851 230 383 1430 269 988 795 4115 468 1169 775 100 948 814 42 65 1430 464 4571 940 40 249 1138 1358
7% 44% 20% 64% 23% 63% 22% 26% 49% 29% 95% 0% 27% 0% 0% 53% 51% 76% 16% 80% 94% 93% 96% 100% 30% 95% 84% 92% 90% 73% 76% 99% 81% 97% 5% 92% 94% 1% 6% 83% 45% 89% 96% 3% 27% 94% 87%
67% 86% 70% 33% 82% 66% 24% 100% 61% 36% 89% 80% 35% 23% 40% 30% 54% 67% 19% 6% 12% 49% 13% 67% 31% 19% 0% 5% 8% 3% 21% 1% 16% 0% 8% 6% 5% 0% 21% 46% 0% 25% 5% 7% 15% 29% 19%
16% 17% 9% 4% 2% 4% 0% 2% 15% 0% 9% 3% 3% 1% 3% 23% 4% 0% 15% 8% 0% 2% 4% 2% 3% 1% 0% 1% 14% 8% 0% 3% 2% 3% 0% 0% 1% 1% 1% 4% 2% 0% 1% 1%
11% 15% 6% 1% 1% 2% 0% 2% 9% 0% 8% 2% 1% 0% 1% 7% 2% 0% 3% 0% 0% 1% 1% 1% 1% 0% 0% 0% 0% 0% 2% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0%
100% 36% 87% 100% 100% 100% 99% 100% 100% 0% 100% 100% 100% 14%
53% 21% 53% 63% 75% 100% 51% 100% 57% 0% 50% 100% 100% 57%
0% 0% 100%
0% 31% 100%
100%
0%
0%
0%
0%
0%
Page150
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District
63 32 34 32 61 28 34 29 59 33 35 51 34 28 30 24 32 35 34 36 47 40 43 47 41 38 34 30 59 50 38 52 39 46 40 61 47 51 49 31 39 40 44 43 45 56 31
97% 50% 53% 49% 93% 43% 52% 45% 91% 50% 54% 78% 52% 43% 46% 37% 49% 53% 53% 55% 72% 62% 66% 72% 63% 58% 52% 46% 90% 77% 58% 80% 60% 71% 61% 94% 73% 78% 76% 48% 59% 61% 68% 67% 69% 86% 47%
20 20 20 20 20 20 10 20 20 20 20 10 20 20 20 20 20 10 20 20 10 20 10 20 20 20 20 20 10 20 10 10 10 10 10 10 10 10 20 20 20 20 10 20 20 10 20
100% 100% 100% 100% 100% 100% 50% 100% 100% 100% 100% 50% 100% 100% 100% 100% 100% 50% 100% 100% 50% 100% 50% 100% 100% 100% 100% 100% 50% 100% 50% 50% 50% 50% 50% 50% 50% 50% 100% 100% 100% 100% 50% 100% 100% 50% 100%
4 0 12 12 4 12 12 12 8 16 20 20 20 12 4 12 8 16 20 16 8 4 12 12 12 16 16 20 12 16 20 16 8 12 12 16 8 20 8 16 12 20 8 12 12 12 8
20% 0% 60% 60% 20% 60% 60% 60% 40% 80% 100% 100% 100% 60% 20% 60% 40% 80% 100% 80% 40% 20% 60% 60% 60% 80% 80% 100% 60% 80% 100% 80% 40% 60% 60% 80% 40% 100% 40% 80% 60% 100% 40% 60% 60% 60% 40%
10 15 5 8 15 20 15 5 5 15 10 15 10 5 15 5 20 5 5 11 25 15 23 25 23 25 26 15 13 5 15 15 15 16 8 13 5 12 28 5 5 15 15 10 11 15 5
33% 50% 17% 27% 51% 67% 50% 17% 17% 50% 33% 50% 33% 17% 50% 17% 67% 17% 17% 38% 83% 51% 77% 83% 76% 83% 86% 50% 45% 17% 50% 50% 50% 53% 28% 42% 17% 40% 94% 17% 17% 50% 50% 33% 36% 50% 17%
53 78 77 48 58 67 61 75 69 87 95 68 81 44 64 67 67 75 69 61 67 70 80 71 72 83 61 63 68 49 66 77 60 40 52 62 85 38 76 71 63 59 58 48 65 78 38
46% 68% 67% 42% 50% 58% 53% 65% 60% 76% 82% 59% 70% 39% 56% 58% 58% 65% 60% 53% 59% 61% 69% 62% 63% 72% 53% 55% 59% 43% 58% 67% 52% 35% 45% 54% 74% 33% 66% 61% 55% 52% 51% 42% 57% 68% 33%
150 145 148 120 158 147 132 141 161 171 180 164 165 110 133 128 147 141 148 144 157 150 168 175 168 182 156 148 162 140 149 170 132 124 122 162 155 131 181 143 139 154 136 133 153 171 101
60% 58% 59% 48% 63% 59% 53% 57% 64% 68% 72% 65% 66% 44% 53% 51% 59% 56% 59% 58% 63% 60% 67% 70% 67% 73% 63% 59% 65% 56% 60% 68% 53% 50% 49% 65% 62% 52% 72% 57% 55% 62% 54% 53% 61% 69% 41%
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Annual Rate of smear change in positive Annual suspects case smear examined positive notificatio per s+ n rate case case notificatio [from CFR: diagnosed sm + n rate (compared cases (from to (NSP + Rel PMR) previous + TAD) / year) Pop] -3% 4% 3% 1% 27% 19% -1% -2% -2% 13% 1% 11% 6% 3% 11% 23% 13% 6% 1% 7% 7% 8% 12% 14% 2% -1% 4% -3% 6% -9% -6% -2% 6% 13% 0% 11% -3% -7% 10% 19% 1% 7% 4% 97 43 99 217 104 78 89 119 81 72 82 72 96 77 78 83 89 53 96 92 104 101 69 84 148 79 130 127 49 79 156 100 86 90 76 86 127 144 86 100 164 103 53 70 61 46 83 69 78 74 84 100 83 71 82 66 82 75 70 73 89 71 83 95 76 94 71 91 115 78 135 108 50 78 143 72 96 108 72 79 111 141 82 90 97 93 52 85

3
Orissa Orissa Orissa Puducherry Punjab Punjab Punjab Punjab Punjab Punjab Punjab Punjab Punjab Punjab Punjab Punjab Punjab Punjab Punjab Punjab Punjab Punjab Punjab Punjab Rajasthan Rajasthan Rajasthan Rajasthan Rajasthan Rajasthan Rajasthan Rajasthan Rajasthan Rajasthan Rajasthan Rajasthan Rajasthan Rajasthan Rajasthan Rajasthan Rajasthan Rajasthan Rajasthan Rajasthan
Sambalpur Sonapur Sundargarh Puducherry Amritsar Barnala Bathinda Faridkot Fatehgarh Sahib Firozpur Gurdaspur Hoshiarpur Jalandhar Kapurthala Ludhiana Mansa-PN Moga Mohali Muktsar Nawanshahr Patiala Rupnagar Sangrur Tarn Taran Ajmer Alwar Banswara Baran Barmer Bharatpur Bhilwara Bikaner Bundi Chittaurgarh Churu Dausa Dhaulpur Dungarpur Ganganagar Hanumangarh Jaipur Jaipur DTC II Jaisalmer Jalore
10 7 21 12 25 6 14 6 6 20 23 16 22 8 35 8 10 10 9 6 19 7 17 11 26 37 19 12 26 25 24 24 11 21 20 16 12 14 20 18 36 31 7 18
7900 2880 15745 22618 14557 4051 8482 4459 5202 11421 15473 10250 13478 5788 21052 6492 5149 5061 5831 4291 14190 6319 13161 7641 17779 17781 9401 8614 12332 11503 17933 15356 5970 13478 8797 10203 8486 6733 11689 9924 40900 23946 4454 7050
189 110 189 454 146 170 153 180 217 141 168 162 154 177 151 211 130 128 161 175 187 231 199 171 172 121 121 176 118 113 186 162 134 162 108 156 176 121 148 139 285 195 166 96
-1% 0% 5% 16% 0% 21% -13% -8% 31% -4% 4% 4% 4% 1% -8% 1% 12% -27% -2% 7% 9% 9% -3% 25% 9% -11% 4% 5% -22% 3% -3% -2% 13% 16% -5% 14% 4% -8% 9% 8% 19% -10% -17%
1008 281 2062 2695 2590 467 1243 737 483 1464 1890 1142 2098 633 2721 637 879 527 868 565 1975 691 1141 938 3818 2905 2522 1552 1265 2024 3750 2363 957 1882 1557 1401 1537 2006 1692 1783 5873 3173 359 1290
8 10 8 8 6 9 7 6 11 8 8 9 6 9 8 10 6 10 7 8 7 9 12 8 5 6 4 6 10 6 5 6 6 7 6 7 6 3 7 6 7 8 12 5
1409 613 3569 1568 3941 634 1999 1307 800 2302 2975 1797 3366 1032 5194 988 1434 1405 1181 887 2857 1047 2492 1568 5572 5660 3596 2471 2478 3607 6188 2699 1900 3752 2711 2519 2244 3031 3201 2777 7202 5436 561 2661
135 94 172 126 158 106 144 211 133 114 129 114 154 126 149 129 145 142 131 144 151 153 151 140 216 154 185 202 95 141 257 114 171 180 133 154 186 218 163 156 201 177 83 145
52 40 69 52 55 60 58 66 66 52 58 47 59 57 52 54 70 52 59 75 52 70 48 65 71 61 97 82 38 57 92 52 69 71 46 54 78 102 64 59 63 61 41 66
34 23 50 23 26 11 27 46 13 19 20 26 25 20 31 24 23 19 19 17 20 21 43 19 46 47 33 57 28 43 61 11 40 40 37 49 48 52 46 33 46 39 12 40
32 20 27 29 43 17 23 46 30 16 18 16 37 26 37 25 22 43 22 27 44 32 29 22 36 25 12 20 10 11 39 24 18 24 17 17 15 14 25 22 43 32 16 6
18 11 25 22 34 18 36 54 25 27 33 25 33 22 29 26 29 29 31 25 33 30 31 33 62 20 43 43 20 30 65 27 43 45 33 33 45 50 28 42 49 45 15 34
11 7 14 19 25 15 28 36 20 20 25 21 26 19 20 21 19 21 26 21 26 25 24 27 47 18 39 32 13 23 52 21 29 39 27 25 35 42 21 35 36 34 12 21
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55 19 108 128 283 28 74 54 38 95 118 72 177 44 419 38 60 75 48 26 125 49 114 57 292 197 112 134 53 161 305 135 60 98 151 85 139 89 103 160 446 260 11 34
4% 4% 4% 10% 9% 5% 5% 6% 6% 5% 5% 5% 7% 5% 10% 5% 5% 7% 5% 4% 6% 6% 6% 5% 7% 4% 4% 7% 3% 6% 7% 7% 4% 3% 7% 4% 8% 4% 4% 8% 8% 6% 2% 2%
91% 82% 92% 90% 88% 92% 91% 88% 92% 87% 93% 93% 91% 88% 89% 92% 96% 91% 91% 95% 83% 94% 88% 92% 91% 92% 92% 92% 91% 94% 92% 89% 91% 89% 90% 92% 92% 92% 92% 90% 94% 94% 89% 93%
68% 68% 75% 74% 70% 83% 83% 63% 64% 68% 82% 86% 76% 81% 74% 78% 93% 76% 73% 80% 66% 82% 74% 72% 66% 81% 80% 84% 74% 83% 77% 68% 67% 78% 77% 84% 78% 73% 80% 78% 80% 80% 74% 83%
576 263 1330 708 1893 405 1147 611 482 1298 1742 1012 1728 616 2256 567 849 611 722 571 1345 594 1026 1031 2635 1711 2191 1285 1123 1624 3009 1483 1016 1781 1320 1044 1060 1498 1551 1516 1771 2471 315 1457
88% 86% 77% 80% 96% 91% 96% 97% 94% 89% 91% 95% 94% 99% 90% 98% 96% 85% 94% 96% 91% 92% 86% 100% 86% 59% 83% 92% 86% 80% 87% 86% 93% 78% 89% 80% 78% 75% 93% 91% 50% 84% 89% 92%
652 305 1683 745 1976 438 1190 618 513 1363 1913 1069 1750 618 2463 578 849 714 765 594 1411 646 1075 1031 2938 1810 2480 1371 1304 2005 3391 1525 1074 2144 1403 1278 1313 2004 1655 1572 2208 2856 327 1568
100% 100% 97% 84% 100% 98% 100% 98% 100% 94% 100% 100% 95% 100% 98% 100% 96% 100% 100% 100% 95% 100% 90% 100% 96% 62% 94% 98% 99% 99% 98% 89% 98% 93% 95% 98% 96% 100% 100% 94% 62% 98% 92% 99%
341 135 942 598 1621 306 1125 444 297 1070 1386 947 1057 486 2208 570 732 574 545 511 963 596 880 818 1838 1725 1361 996 1045 995 2627 1119 682 1497 1054 751 807 1319 1429 1285 2448 2035 265 1274
61% 62% 69% 95% 100% 81% 100% 90% 94% 89% 85% 94% 70% 88% 94% 99% 94% 94% 90% 94% 90% 96% 84% 100% 85% 69% 66% 87% 82% 72% 91% 85% 85% 85% 90% 75% 74% 78% 90% 87% 58% 190% 83% 89%
1409 54 3255 0 2862 150 433 341 523 733 235 619 703 255 1419 0 514 431 262 180 291 189 193 74 510 1065 465 755 69 812 510 349 251 293 353 438 408 651 492 105 310 552 50 63
100% 9% 91% 0% 73% 24% 22% 26% 65% 32% 8% 34% 21% 25% 27% 0% 36% 31% 22% 20% 10% 18% 8% 5% 9% 19% 13% 31% 3% 23% 8% 13% 13% 8% 13% 17% 18% 21% 15% 4% 4% 10% 9% 2%
8% 10% 16% 69% 80% 61% 73% 85% 71% 53% 72% 51% 60% 92% 62% 52% 73% 78% 65% 44% 51% 77% 51% 48% 47% 12% 10% 8% 30% 6% 28% 0% 14% 43% 8% 12% 12% 7% 55% 29% 63% 71% 22% 9%
3% 0% 3% 2% 2% 2% 2% 2% 2% 2% 1% 2% 2% 2% 1% 2% 2% 2% 1% 2% 1% 1% 1% 2% 1% 0% 3% 1% 0% 1% 2% 1% 1% 0% 0% 1% 3% 0% 0% 1% 1% 1% 19%
0% 0% 0% 1% 1% 1% 2% 2% 2% 1% 1% 1% 1% 2% 1% 1% 1% 2% 1% 1% 1% 1% 0% 1% 0% 0% 0% 0% 0% 0% 1% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 2%
100% 56% 100% 60% 100% 100% 17% 100% 100% 73% 50% 50% 100% 100% 89% 100% 100% 29% 67% 100% 73%
48% 67% 100% 20% 100% 100% 67% 100% 0% 45% 64% 67% 20% 40% 89% 25% 100% 67% 47% 67% 27%
50% 0%
50% 0%
75% 0% 40%
100% 100% 43%
Page153
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47 51 46 61 59 27 45 41 53 45 56 56 62 55 58 49 55 56 56 51 33 59 50 60 32 29 38 43 20 52 50 42 48 43 44 45 48 54 50 36 59 62 48 41
72% 79% 71% 94% 90% 41% 70% 63% 82% 69% 85% 86% 95% 84% 89% 76% 84% 86% 87% 78% 50% 92% 76% 92% 49% 45% 59% 67% 31% 80% 77% 64% 74% 66% 68% 69% 73% 83% 77% 56% 90% 96% 74% 63%
20 10 10 20 20 10 20 20 20 0 10 20 10 20 20 20 20 10 10 20 10 20 0 10 10 20 10 20 20 20 20 10 20 0 20 20 20 10 20 20 20 20 20 20
100% 50% 50% 100% 100% 50% 100% 100% 100% 0% 50% 100% 50% 100% 100% 100% 100% 50% 50% 100% 50% 100% 0% 50% 50% 100% 50% 100% 100% 100% 100% 50% 100% 0% 100% 100% 100% 50% 100% 100% 100% 100% 100% 100%
12 8 16 20 20 20 16 16 12 20 20 20 16 20 20 20 20 20 16 20 20 20 16 12 12 20 20 20 16 12 20 16 20 20 20 16 20 16 20 12 20 20 16 20
60% 40% 80% 100% 100% 100% 80% 80% 60% 100% 100% 100% 80% 100% 100% 100% 100% 100% 80% 100% 100% 100% 80% 60% 60% 100% 100% 100% 80% 60% 100% 80% 100% 100% 100% 80% 100% 80% 100% 60% 100% 100% 80% 100%
15 25 15 19 7 5 5 25 20 15 13 5 5 5 5 15 15 5 5 10 10 5 8 5 20 15 5 11 13 15 24 16 15 20 8 25 10 10 5 15 15 20 10 21
50% 83% 50% 62% 23% 17% 17% 83% 67% 50% 43% 17% 17% 17% 17% 50% 50% 17% 17% 33% 33% 17% 27% 17% 67% 50% 17% 37% 43% 50% 79% 54% 50% 67% 28% 83% 32% 32% 17% 50% 51% 67% 33% 71%
54 48 72 68 76 101 95 75 82 63 59 64 66 71 67 73 61 75 77 65 60 89 66 71 63 89 72 75 77 72 68 60 58 80 58 56 67 61 87 53 78 53 70 80
47% 42% 62% 59% 67% 88% 83% 65% 71% 55% 51% 56% 58% 62% 58% 63% 53% 65% 67% 57% 52% 77% 57% 62% 55% 77% 63% 65% 67% 63% 59% 52% 50% 69% 50% 49% 58% 53% 76% 46% 67% 46% 60% 70%
148 142 159 188 182 163 182 176 187 143 158 165 159 171 170 177 170 166 165 166 133 193 139 158 137 173 146 170 147 171 182 144 161 162 150 162 164 151 182 136 192 175 163 182
59% 57% 64% 75% 73% 65% 73% 71% 75% 57% 63% 66% 64% 68% 68% 71% 68% 66% 66% 66% 53% 77% 56% 63% 55% 69% 58% 68% 59% 69% 73% 57% 64% 65% 60% 65% 66% 60% 73% 55% 77% 70% 65% 73%
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1
Annual Rate of smear change in positive Annual suspects case smear examined positive notificatio per s+ n rate case case notificatio [from CFR: diagnosed sm + n rate (compared cases (from to (NSP + Rel PMR) previous + TAD) / year) Pop] 8% 9% 6% 17% 14% 5% 12% -9% 6% -6% -11% 4% -1% 1% 2% 11% -3% 2% 6% 0% -9% 4% -4% -7% 2% 16% -3% 3% 7% -81% 8% -3% 3% 3% -12% 0% 40% -8% -11% -15% -5% -1% -5% 0% 11% 4% 104 76 78 102 107 64 78 101 118 75 108 149 259 143 85 108 80 121 59 47 45 109 111 31 67 40 38 92 50 40 52 50 47 55 61 70 27 83 39 55 69 58 29 67 69 69 84 71 62 92 82 62 77 106 106 64 104 148 128 109 111 110 95 68 47 52 45 68 62 56 50 53 42 63 52 50 52 45 58 49 50 58 27 65 57 51 58 54 47 65 62 64

3
Rajasthan Rajasthan Rajasthan Rajasthan Rajasthan Rajasthan Rajasthan Rajasthan Rajasthan Rajasthan Rajasthan Rajasthan Rajasthan Sikkim Sikkim Sikkim Sikkim Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu
Jhalawar Jhunjhunun Jodhpur Karauli Kota Nagaur Pali Rajsamand Sawai Madhopur Sikar Sirohi Tonk Udaipur East Sikkim North Sikkim * South Sikkim ** West Sikkim ** Chennai Coimbatore Cuddalore Dharmapuri Dindigul Erode Kanchipuram Kanyakumari Karur Krishnagiri Madurai Nagapattinam Namakkal Perambalur Pudukottai Ramanathapuram Salem Sivaganga Thanjavur The Nilgiris Theni Thiruvallur Thiruvarur Tiruchirappalli Tirunelveli Tiruppur Tiruvanamalai Toothukudi Vellore
14 21 37 15 20 33 20 12 13 27 10 14 33 3 0.4 1.5 1.4 47 35 26 15 22 23 40 19 11 19 30 16 17 13 16 13 35 13 24 7 12 37 13 27 31 25 25 17 39
6952 11558 20855 10298 12869 12984 9374 5163 9319 14672 6264 10572 28400 3945 347 1481 1101 66206 22591 30012 11464 23159 24431 13960 22266 5512 11257 26420 10800 9398 7637 11611 12126 18713 10459 27165 6467 12601 31475 7374 30170 23292 9225 22118 12654 72174
123 135 141 177 165 98 115 111 174 137 151 186 218 351 200 252 202 354 163 288 191 268 270 87 299 128 149 217 167 137 145 179 227 134 195 283 220 253 211 145 278 189 93 224 182 459
11% 11% -5% 6% 12% 1% 6% 4% 15% 1% -15% 5% 6% -13% 14% 2% -4% -1% -6% -12% -15% 1% -9% -19% 10% -12% -21% -11% 5% -86% 9% -3% -4% -7% -20% -7% 56% -10% -24% -3% -12% 3% -12% -9% -1% 1%
1464 1631 2871 1489 2081 2105 1580 1175 1579 2018 1124 2122 8430 401 37 159 109 5663 2038 1212 672 2349 2515 1249 1250 436 720 2795 811 697 686 806 622 1924 813 1689 200 1036 1460 702 1875 1769 708 1651 1206 2722
5 7 7 7 6 6 6 4 6 7 6 5 3 10 9 9 10 12 11 25 17 10 10 11 18 13 16 9 13 13 11 14 19 10 13 16 32 12 22 11 16 13 13 13 10 27
2030 2720 4939 2584 3164 4009 2933 1986 2513 3062 1612 3809 6877 814 143 401 273 6649 2697 3431 1344 3063 2206 4640 1411 1158 1487 3509 1568 1458 1319 1368 1265 3085 1235 2547 396 1715 4125 1429 3470 3390 2155 3006 1862 5356
144 127 134 177 162 121 144 171 188 114 155 268 211 289 330 273 200 142 78 132 89 142 98 116 76 108 79 115 97 85 100 85 95 89 92 106 54 138 111 113 128 110 87 122 107 136
57 46 46 60 58 41 55 72 75 42 76 104 91 82 72 76 73 50 37 38 31 54 47 42 41 43 33 47 43 40 42 36 48 37 42 46 23 53 44 41 52 42 37 50 50 54
40 27 36 65 49 32 46 39 41 28 26 74 46 60 76 70 29 31 11 42 24 39 17 27 13 34 19 27 30 19 24 24 21 17 27 26 11 41 23 41 35 33 24 31 27 31
10 20 27 9 21 17 14 18 27 11 12 33 27 79 97 65 56 36 15 30 14 30 14 29 10 15 15 20 13 14 22 11 11 18 12 17 13 21 26 12 31 18 11 20 15 36
37 34 25 44 34 32 29 41 45 33 41 57 47 68 85 61 43 24 14 22 20 19 19 18 11 16 12 22 12 12 12 13 14 16 12 17 6 23 18 18 10 17 15 20 16 15
30 27 17 35 25 23 23 35 35 23 29 48 39 39 44 39 32 20 11 15 14 15 16 15 10 11 10 18 11 11 10 9 12 12 8 13 5 14 14 11 6 14 11 16 14 11
Page155
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Treatmen Treatmen t success t Success rate rate of among new smear smear positive positive previousl 5 patients y treated cases5 87% 86% 92% 91% 90% 88% 89% 88% 90% 88% 90% 89% 92% 76% 71% 86% 89% 87% 85% 92% 86% 86% 84% 86% 88% 90% 87% 82% 90% 87% 80% 90% 87% 84% 88% 82% 85% 83% 87% 84% 88% 82% 85% 90% 84% 91% 73% 70% 76% 76% 82% 79% 82% 79% 78% 70% 78% 75% 86% 51% 55% 63% 81% 61% 57% 82% 63% 71% 54% 66% 62% 80% 70% 60% 57% 58% 65% 63% 59% 50% 72% 56% 56% 55% 67% 54% 76% 62% 52% 75% 59% 73%
52 129 177 72 173 175 90 58 63 125 61 163 223 54 11 31 23 468 84 379 43 331 38 311 85 43 64 309 93 48 110 54 147 154 73 162 45 91 205 174 214 155 52 175 125 141
3% 6% 4% 4% 7% 6% 4% 4% 3% 6% 5% 5% 4% 9% 10% 10% 11% 8% 4% 13% 4% 12% 2% 8% 7% 4% 5% 11% 7% 4% 9% 5% 14% 6% 7% 8% 13% 6% 6% 15% 7% 5% 3% 7% 8% 3%
90% 91% 95% 93% 91% 89% 93% 90% 91% 91% 93% 91% 92% 84% 78% 95% 88% 91% 90% 93% 87% 91% 91% 90% 92% 95% 88% 89% 92% 89% 91% 92% 91% 89% 91% 87% 82% 87% 92% 87% 90% 90% 89% 93% 87% 90%
75% 66% 75% 82% 79% 75% 81% 76% 79% 79% 81% 79% 81% 64% 80% 73% 64% 72% 67% 85% 68% 71% 60% 70% 78% 87% 77% 61% 44% 69% 72% 58% 51% 58% 81% 63% 56% 61% 79% 52% 67% 69% 69% 83% 69% 76%
1028 1288 1969 1045 1465 1837 1357 1028 1258 1457 1004 2019 3207 327 37 160 135 2729 1460 1090 484 1273 1189 1775 840 461 683 1814 661 669 561 508 672 1413 513 1401 200 637 1670 545 1460 1434 992 1178 1013 2295
84% 82% 85% 76% 90% 87% 85% 83% 85% 84% 92% 94% 76% 95% 74% 95% 94% 84% 88% 80% 71% 85% 83% 79% 89% 79% 86% 93% 76% 77% 82% 69% 83% 82% 76% 98% 97% 76% 77% 82% 92% 83% 84% 72% 92% 91%
1181 1540 2304 1373 1486 1970 1539 1201 1470 1600 1073 2150 4111 331 37 168 105 3243 1663 1320 648 1470 1412 2094 945 577 769 1661 796 868 626 610 807 1703 561 1423 206 820 2152 662 1575 1666 1184 1583 1086 2532
96% 98% 99% 100% 91% 93% 97% 97% 100% 92% 98% 100% 97% 97% 74% 99% 73% 99% 100% 97% 95% 99% 99% 93% 100% 99% 96% 85% 92% 100% 91% 83% 100% 99% 83% 100% 100% 98% 100% 100% 99% 96% 100% 97% 99% 100%
764 986 1529 923 1190 1468 1085 751 923 1141 868 1652 2431 252 33 133 115 2309 1208 1136 425 825 898 1647 518 420 494 1435 415 813 388 475 614 724 450 976 158 473 1332 385 1278 840 0 1250 736 1914
82% 82% 74% 76% 85% 85% 77% 80% 85% 86% 92% 89% 70% 96% 94% 98% 97% 87% 87% 87% 81% 78% 83% 92% 73% 76% 82% 98% 59% 94% 80% 80% 91% 54% 75% 89% 96% 80% 82% 80% 93% 69% 0% 88% 81% 92%
220 177 343 702 687 540 177 395 324 133 267 862 2370 202 56 235 127 514 822 155 54 1417 698 1132 816 105 263 268 154 482 175 495 385 886 367 639 231 206 1057 161 765 1137 164 1089 359 3297
11% 7% 7% 27% 22% 13% 6% 20% 13% 4% 17% 23% 34% 25% 39% 59% 47% 8% 30% 5% 4% 46% 32% 24% 58% 9% 18% 8% 10% 33% 13% 36% 30% 29% 30% 25% 58% 12% 26% 11% 22% 34% 8% 36% 19% 62%
1% 13% 2% 0% 0% 0% 7% 24% 27% 0% 8% 59% 35% 1% 5% 6% 1% 92% 96% 74% 96% 86% 97% 87% 83% 100% 79% 76% 64% 100% 96% 88% 95% 92% 98% 94% 95% 92% 100% 69% 73% 91% 100% 89% 99% 93%
0% 3% 5%
4% 0% 1% 5% 0% 1% 0% 0% 4% 0% 3% 7% 5% 14% 12% 8% 3% 2% 14% 11% 10% 9% 16% 11% 9% 5% 17% 9% 6% 4% 14% 4% 3% 14% 6% 11% 6% 7% 5%
0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 3% 7% 3% 14% 11% 8% 2% 2% 14% 9% 7% 5% 16% 10% 8% 5% 15% 9% 6% 4% 13% 4% 2% 10% 6% 11% 6% 7% 5%
0%
100%
100% 50%
0% 50%
99% 94% 93% 100% 63% 98% 94% 92% 60% 80% 69% 100% 100% 82% 22% 41% 96% 62% 96% 92% 100% 100% 88% 84% 67% 98% 89% 99% 67%
84% 71% 78% 35% 42% 75% 63% 83% 40% 44% 32% 47% 57% 58% 68% 55% 58% 45% 67% 92% 31% 99% 68% 53% 91% 67% 79% 53% 32%
Page156
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32 51 41 48 51 38 37 58 53 42 47 30 40 46 52 45 51 54 63 51 50 56 64 58 27 52 56 64 60 44 51 54 47 48 45 59 62 31 60 31 52 50 64 39 61 63
49% 78% 62% 75% 78% 58% 57% 89% 81% 64% 73% 46% 61% 71% 80% 69% 78% 83% 96% 79% 78% 86% 99% 89% 42% 80% 87% 98% 92% 67% 78% 84% 72% 75% 68% 91% 95% 47% 92% 48% 80% 76% 98% 60% 95% 97%
20 0 20 20 20 10 10 20 20 0 20 20 20 10 10 20 20 10 20 10 10 10 10 10 10 20 10 10 20 10 0 20 10 10 20 10 10 10 20 20 10 10 20 10 10 10
100% 0% 100% 100% 100% 50% 50% 100% 100% 0% 100% 100% 100% 50% 50% 100% 100% 50% 100% 50% 50% 50% 50% 50% 50% 100% 50% 50% 100% 50% 0% 100% 50% 50% 100% 50% 50% 50% 100% 100% 50% 50% 100% 50% 50% 50%
20 20 20 8 16 20 20 16 16 20 20 16 20 16 20 20 20 12 16 16 12 12 16 16 20 20 12 16 20 16 8 12 16 16 16 8 20 12 16 20 12 20 16 16 16 0
100% 100% 100% 40% 80% 100% 100% 80% 80% 100% 100% 80% 100% 80% 100% 100% 100% 60% 80% 80% 60% 60% 80% 80% 100% 100% 60% 80% 100% 80% 40% 60% 80% 80% 80% 40% 100% 60% 80% 100% 60% 100% 80% 80% 80% 0%
15 6 5 8 12 5 14 27 15 11 8 17 14 7 5 15 15 10 10 11 10 27 25 5 6 30 20 10 10 11 15 15 5 11 5 5 30 5 13 6 5 17 10 10 15 10
50% 21% 17% 28% 38% 17% 46% 90% 50% 36% 25% 57% 48% 23% 17% 50% 50% 32% 33% 37% 33% 90% 83% 17% 19% 100% 67% 33% 34% 37% 50% 49% 17% 35% 17% 17% 100% 17% 45% 21% 17% 57% 33% 34% 50% 33%
67 66 62 28 60 50 68 67 52 54 83 73 73 81 74 83 81 65 49 88 73 75 64 65 56 58 64 57 63 61 58 57 67 61 71 62 74 80 71 79 69 78 78 77 54 67
59% 58% 54% 25% 52% 43% 59% 58% 45% 47% 73% 63% 63% 70% 64% 72% 70% 57% 42% 77% 64% 65% 55% 56% 48% 50% 56% 50% 55% 53% 50% 49% 58% 53% 61% 54% 64% 70% 62% 68% 60% 68% 68% 67% 47% 59%
154 143 148 113 158 122 149 188 156 127 178 156 167 160 161 183 187 151 157 177 156 180 179 153 118 180 163 157 173 142 132 158 144 146 156 144 195 138 181 156 148 175 188 153 156 150
62% 57% 59% 45% 63% 49% 60% 75% 62% 51% 71% 62% 67% 64% 64% 73% 75% 60% 63% 71% 62% 72% 72% 61% 47% 72% 65% 63% 69% 57% 53% 63% 58% 59% 62% 58% 78% 55% 72% 62% 59% 70% 75% 61% 63% 60%
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Annual Rate of smear change in positive Annual suspects case smear examined positive notificatio per s+ n rate case case notificatio [from CFR: diagnosed sm + n rate (compared cases (from to (NSP + Rel PMR) previous + TAD) / year) Pop] -12% 310% 17% 21% 2% -8% 5% 2% -4% 6% -1% -4% -5% -9% 12% 0% -8% 1% 1% 4% -7% 9% -3% -7% 35% -6% -8% -9% 5% -2% 6% 14% -8% 4% -5% -2% 1% 3% -6% -7% 15% -9% 0% -3% 47 77 37 33 43 68 156 117 110 66 118 66 102 87 64 61 93 111 114 83 90 120 103 68 68 69 152 125 85 90 93 98 124 117 62 77 89 108 104 92 86 73 113 108 71 62 40 35 44 56 121 101 89 62 110 61 104 84 66 59 80 107 86 75 89 118 103 64 66 66 133 105 78 77 85 88 114 123 61 70 77 95 101 86 82 70 89 107

3
Tamil Nadu Tamil Nadu Tripura Tripura Tripura Tripura Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh
Villupuram Virudhunagar Dhalai * North Tripura South Tripura West Tripura Agra Aligarh Allahabad Ambedkar Nagar Auraiya Azamgarh Baghpat Bahraich ** Ballia Balrampur Banda ** Barabanki ** Bareilly Basti ** Bijnor ** Budaun ** Bulandshahar Chandauli Chitrakoot Deoria Etah Etawah Faizabad Farrukhabad Fatehpur ** Firozabad Gautam Budh Nagar Ghaziabad Ghazipur Gonda Gorakhpur Hamirpur-UP ** Hardoi ** Hathras Jalaun ** Jaunpur Jhansi ** Jyotiba Phule Nagar **
35 19 4 7 9 17 44 37 60 24 14 46 13 35 32 21 18 33 45 25 37 37 35 20 10 31 18 16 25 19 26 25 17 47 36 34 44 11 41 16 17 45 20 18
16263 67634 1975 2860 4473 11178 41896 32044 47112 8803 9635 20896 6960 17526 12917 9720 11557 22044 37120 12927 24674 35700 24104 7891 5807 11551 17179 11789 13210 10888 19411 13945 12813 34709 11588 14602 26147 8538 26474 8535 10448 19425 13237 16599
117 870 131 103 128 162 239 218 198 92 176 113 134 126 100 113 161 169 208 131 167 240 172 101 147 93 244 187 134 144 184 140 191 186 80 106 147 193 162 136 156 108 165 226
-9% 303% -8% 1% -1% -5% 15% 16% 9% 11% 12% 16% 17% -14% 18% -4% 3% 23% -4% 23% 6% 15% 5% -7% 25% 33% 20% -12% -10% -3% 26% 10% 3% -4% -4% 10% 26% 38% 0% 9% 24% -1% 28% 9%
1622 1506 141 230 376 1178 6825 4303 6553 1593 1614 3065 1334 3030 2066 1316 1671 3616 5106 2043 3321 4465 3592 1335 678 2144 2670 1972 2089 1695 2444 2452 2080 5445 2245 2646 3964 1191 4270 1445 1440 3283 2260 1977
10 45 14 12 12 9 6 7 7 6 6 7 5 6 6 7 7 6 7 6 7 8 7 6 9 5 6 6 6 6 8 6 6 6 5 6 7 7 6 6 7 6 6 8
4952 2534 239 450 577 1532 8997 6953 8213 2066 2068 4809 1984 5379 3508 2397 2442 5856 6618 3324 4450 6404 7538 1894 1463 2802 3395 2663 3424 2509 3437 4008 3937 11613 2982 5174 4159 1581 7615 1675 2626 6007 2774 2618
143 130 63 65 66 89 205 189 138 86 151 104 152 155 109 112 136 180 148 135 121 172 215 97 148 90 193 169 139 133 131 161 235 249 82 151 94 143 186 107 157 134 139 142
53 51 38 30 37 50 77 82 63 57 83 50 72 66 62 55 55 82 62 66 75 87 83 54 51 57 102 73 67 61 67 60 87 95 53 62 70 80 84 69 64 63 68 82
38 48 16 18 10 12 27 56 28 13 20 25 21 54 32 41 23 42 34 39 9 38 70 13 45 9 31 28 41 32 25 29 42 54 11 63 7 33 68 5 48 42 26 26
26 13 4 8 9 17 31 23 13 8 10 8 21 16 9 8 21 23 15 16 17 5 28 11 23 11 20 29 13 19 12 24 62 52 6 12 7 9 9 9 13 18 9 7
25 19 6 8 10 10 68 28 33 8 38 21 38 19 6 7 36 32 37 14 20 42 33 17 30 13 38 39 18 20 25 48 44 48 12 14 10 21 25 24 32 12 36 27
18 14 3 6 7 8 46 20 28 6 31 11 32 19 4 5 28 25 25 10 15 32 21 11 17 10 32 34 12 17 20 29 29 29 8 9 7 16 18 18 20 8 23 25
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339 308 1 12 9 27 985 367 361 36 84 185 68 203 151 99 119 425 298 166 237 258 386 93 55 203 255 114 160 129 123 606 228 675 130 327 137 59 229 100 123 192 75 47
8% 14% 0% 3% 2% 2% 16% 6% 6% 2% 5% 5% 5% 4% 5% 4% 7% 9% 6% 6% 6% 5% 6% 6% 5% 8% 9% 6% 5% 6% 4% 22% 7% 7% 5% 7% 4% 4% 3% 8% 6% 4% 4% 2%
92% 88% 97% 90% 90% 87% 91% 93% 92% 91% 91% 91% 92% 89% 94% 91% 93% 94% 90% 90% 91% 95% 95% 89% 92% 94% 93% 91% 91% 93% 90% 90% 93% 95% 89% 92% 92% 91% 92% 94% 89% 93% 90% 93%
78% 65% 87% 67% 75% 72% 64% 81% 75% 85% 77% 78% 86% 77% 89% 67% 85% 86% 69% 76% 77% 88% 83% 74% 79% 79% 89% 67% 79% 84% 81% 66% 75% 88% 78% 83% 70% 82% 81% 85% 74% 79% 64% 90%
1972 916 139 209 298 784 4731 3297 5047 1339 1401 2588 1167 2792 1986 1283 1386 2955 3344 1686 3005 4221 3399 1182 581 1837 1981 1481 1764 1202 2116 1947 1758 5639 2023 2113 2954 939 3729 1189 1264 2794 1644 1847
80% 73% 89% 83% 76% 78% 88% 88% 93% 88% 90% 91% 86% 95% 93% 100% 93% 84% 86% 89% 91% 96% 93% 93% 87% 88% 84% 87% 91% 81% 92% 88% 90% 98% 91% 87% 86% 89% 90% 88% 89% 89% 91% 94%
2351 1255 139 234 383 999 5388 3756 5405 1454 1563 2772 1356 2941 2055 1283 1496 3506 3900 1885 3306 4393 3620 1268 666 2050 2356 1682 1941 1476 2288 2165 1939 5715 2213 2424 3400 1044 4122 1351 1369 3066 1801 1971
95% 100% 89% 93% 97% 100% 100% 100% 100% 96% 100% 97% 100% 100% 96% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 98% 100% 99% 100% 100% 100% 98% 100% 99% 100% 100% 99% 99% 99% 100% 97% 97% 100% 100%
1585 470 143 175 233 635 2720 2259 2733 1027 1017 1454 718 2045 1453 931 1037 2245 3000 1099 2286 3366 2544 881 470 914 1276 1113 1364 974 1435 1321 1074 4391 1184 1275 1818 503 2762 826 944 2190 845 1286
84% 48% 92% 82% 75% 75% 80% 88% 79% 82% 86% 74% 71% 91% 85% 92% 87% 78% 100% 82% 96% 94% 88% 88% 88% 73% 78% 84% 90% 78% 87% 80% 80% 93% 77% 76% 76% 75% 85% 89% 91% 87% 77% 90%
1898 901 182 327 208 602 7670 3079 6778 1513 1811 2216 1414 4421 1846 1511 1942 4220 5282 2752 3715 4495 4103 1689 1292 2826 2902 2105 2672 1101 2696 3633 2748 8526 2889 3256 3191 735 5372 1455 1949 4047 1520 1202
38% 36% 76% 73% 36% 39% 85% 44% 83% 73% 88% 46% 71% 82% 53% 63% 80% 72% 80% 83% 83% 70% 54% 89% 88% 101% 85% 79% 78% 44% 78% 91% 70% 73% 97% 63% 77% 46% 71% 87% 74% 67% 55% 46%
84% 85% 52% 37% 16% 30% 14% 7% 50% 28% 17% 0% 36% 0% 1% 0% 58% 12% 2% 2% 22% 15% 0% 26% 5% 27% 6% 70% 17% 7% 11% 6% 38% 2% 1% 6% 2% 5% 17% 76% 11% 7% 13% 22%
9% 4% 0% 5% 1% 2% 1% 1% 1% 1% 1% 100% 1% 61% 100% 0% 1% 1% 14% 0% 0% 1% 0% 5% 0% 1% 1% 1% 1% 1% 0% 1% 44% 1% 9% 0% 0% 0% 1% 6% 0% 1%
7% 3% 0% 2% 0% 1% 0% 0% 1% 0% 0% 0% 0% 0% 1% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 1% 0% 0% 0% 0% 0% 0% 0% 0% 1% 0% 0% 0% 0% 0% 0% 0% 0% 0%
92% 75%
73% 54%
50% 60%
50% 60%
39% 0% 0% 100%
27% 100% 0% 50%
30%
80%
0%
0%
0% 9% 0% 100%
20% 0% 0% 100%
0% 20% 0%
100% 0% 17%
0% 0% 0%
100% 0% 0%
Page159
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43 62 50 51 49 54 42 50 34 46 48 46 41 42 41 48 43 46 48 45 49 50 50 45 51 47 50 37 47 36 45 33 46 52 25 44 47 26 42 45 41 46 42 44
67% 95% 77% 78% 75% 83% 64% 76% 53% 70% 73% 70% 63% 64% 63% 74% 67% 70% 73% 69% 76% 77% 77% 69% 78% 73% 77% 57% 72% 55% 69% 51% 71% 81% 39% 67% 72% 40% 64% 70% 63% 71% 65% 68%
10 0 20 20 20 10 0 20 0 0 10 0 0 0 0 10 0 0 0 0 0 0 0 0 0 0 10 10 0 0 0 0 0 10 10 0 0 10 0 0 0 0 0 0
50% 0% 100% 100% 100% 50% 0% 100% 0% 0% 50% 0% 0% 0% 0% 50% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 50% 50% 0% 0% 0% 0% 0% 50% 50% 0% 0% 50% 0% 0% 0% 0% 0% 0%
16 16 20 20 16 20 20 12 16 20 16 20 20 20 20 20 16 20 20 16 12 20 16 8 20 20 16 16 16 0 20 20 0 16 16 16 20 16 12 16 20 20 20 16
80% 80% 100% 100% 80% 100% 100% 60% 80% 100% 80% 100% 100% 100% 100% 100% 80% 100% 100% 80% 60% 100% 80% 40% 100% 100% 80% 80% 80% 0% 100% 100% 0% 80% 80% 80% 100% 80% 60% 80% 100% 100% 100% 80%
10 5 10 10 12 5 20 15 16 5 11 15 16 15 19 10 15 13 5 10 15 10 15 19 15 5 15 5 10 5 12 9 25 15 5 15 15 7 15 16 15 17 15 15
33% 17% 34% 34% 40% 17% 67% 50% 55% 17% 38% 50% 54% 50% 63% 33% 50% 43% 17% 33% 49% 33% 50% 64% 50% 17% 50% 17% 33% 17% 39% 30% 83% 50% 17% 50% 50% 23% 50% 53% 50% 56% 50% 50%
80 46 61 64 53 37 65 78 90 70 74 60 71 53 65 56 92 86 36 80 60 76 77 72 73 78 75 68 80 67 85 59 74 83 68 80 69 53 55 71 75 75 80 55
69% 40% 53% 56% 46% 32% 56% 67% 79% 61% 65% 52% 62% 46% 57% 49% 80% 75% 32% 69% 52% 66% 67% 63% 64% 68% 65% 60% 69% 58% 74% 52% 64% 72% 59% 69% 60% 46% 48% 62% 65% 65% 69% 48%
159 129 161 166 150 126 146 174 157 140 159 141 148 129 145 144 167 164 109 151 136 156 158 144 159 150 165 137 152 108 162 121 145 176 125 155 151 112 124 148 151 158 157 131
64% 52% 65% 66% 60% 50% 59% 70% 63% 56% 64% 56% 59% 52% 58% 58% 67% 66% 44% 60% 55% 62% 63% 58% 64% 60% 66% 55% 61% 43% 65% 48% 58% 71% 50% 62% 60% 45% 49% 59% 60% 63% 63% 52%
Page160
State
District

1
Annual Rate of smear change in positive Annual suspects case smear examined positive notificatio per s+ n rate case case notificatio [from CFR: diagnosed sm + n rate (compared cases (from to (NSP + Rel PMR) previous + TAD) / year) Pop] -1% -9% 1% -13% 22% -7% -7% 25% 0% -9% 24% 9% 9% -5% -1% 8% 2% -1% -2% -5% 3% 3% 1% -4% 6% 19% -7% -6% 0% -1% 1% -6% 3% -9% -2% 19% 7% 0% 7% -5% 4% -6% 9% 15% 10% -3% 13% 8% -8% 7% 0% 84 101 132 83 106 98 72 94 130 58 87 67 86 65 124 92 99 107 107 82 78 100 109 70 117 100 77 61 85 82 73 97 94 105 80 73 52 151 129 77 160 84 76 68 78 84 76 75 94 98 125 83 99 95 78 106 94 68 85 84 56 82 62 73 58 113 88 94 103 86 79 74 94 103 67 116 88 73 61 81 77 66 97 77 96 85 74 50 74 82 67 108 78 83 88 66 77 68 66 81 92 98

3
Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttar Pradesh Uttarakhand Uttarakhand Uttarakhand Uttarakhand Uttarakhand Uttarakhand Uttarakhand Uttarakhand Uttarakhand Uttarakhand Uttarakhand Uttarakhand Uttarakhand West Bengal West Bengal West Bengal West Bengal West Bengal
Kannauj Kanpur Dehat ** Kanpur Nagar Kanshiram Nagar Kaushambi Kheri Kushinagar Lalitpur ** Lucknow Maharajganj ** Mahoba ** Mainpuri Mathura Mau ** Meerut Mirzapur Moradabad ** Muzaffarnagar Pilibhit ** Pratapgarh ** Rae Bareli ** Rampur Saharanpur Sant Kabir Nagar ** Sant Ravidas Nagar Shahjahanpur Shravasti ** Siddharthnagar ** Sitapur ** Sonbhadra Sultanpur Unnao ** Varanasi Almora Bageshwar Chamoli Champawat Dehradun Garhwal Hardwar Nainital Pithoragarh Rudraprayag Tehri Garhwal Udhamsingh Nagar Uttarkashi Bankura Barddhaman Birbhum Dakshin Dinajpur Darjiling **
17 18 46 14 16 40 36 12 46 27 9 18 25 22 34 25 48 41 20 32 34 23 35 17 16 30 11 26 45 19 38 31 37 6 3 4 3 17 7 19 10 5 2 6 16 3 36 77 35 17 18
10550 10804 33665 7444 12942 24733 14571 8157 36822 9781 5267 8786 14506 11707 31916 18045 29550 33377 16461 20645 15045 18016 26087 8106 14550 21148 5221 10674 31472 8190 17343 18191 24476 5458 1773 2301 1649 16694 6139 9128 7695 3209 1447 4243 9883 2186 27314 56071 24074 12298 16094
159 150 184 129 203 154 102 167 201 92 150 119 143 133 231 181 155 202 202 163 110 193 188 118 234 176 117 105 176 110 114 146 166 219 171 147 159 246 224 118 201 165 153 172 150 166 190 181 172 184 218
-2% 19% 12% -13% 15% 18% 15% 14% -15% -8% 9% 17% 0% 21% 8% 8% 7% 9% -1% 18% 3% -1% 2% 0% 32% 21% -2% 0% 3% -2% 6% 12% 6% 31% -19% 24% -13% -12% 24% -14% -9% 0% 0% 31% -18% -5% 6% 9% -8% -4% -7%
1389 1816 6024 1200 1695 3927 2558 1141 5982 1533 762 1245 2177 1435 4283 2298 4749 4418 2177 2592 2670 2334 3792 1193 1823 3002 857 1567 3800 1526 2762 3013 3468 652 209 286 135 2568 887 1476 1526 410 181 421 1280 276 2738 5793 3300 1643 2307
8 6 6 6 8 6 6 7 6 6 7 7 7 8 7 8 6 8 8 8 6 8 7 7 8 7 6 7 8 5 6 6 7 8 8 8 12 7 7 6 5 8 8 10 8 8 10 10 7 7 7
1998 2299 7279 1628 3019 6148 3649 1403 6838 2019 910 1915 3088 2072 6916 3751 5494 6855 2694 4302 4967 3902 5435 2264 3009 3954 1102 2358 7486 1910 3705 4888 5265 848 344 584 249 2863 945 2247 1961 573 315 951 2405 598 4154 9356 4364 2400 3641
121 128 159 113 189 153 102 115 149 76 104 104 121 94 201 150 115 166 132 136 146 167 157 132 194 132 99 92 167 103 98 157 143 136 132 149 96 169 138 117 205 118 133 154 146 181 116 121 125 144 198
68 80 68 67 84 75 61 70 59 50 57 52 57 53 88 67 76 78 65 68 60 69 73 58 92 73 62 55 64 64 57 72 64 76 60 48 33 51 60 48 61 58 59 59 47 54 59 53 68 79 71
22 10 22 24 50 39 21 16 32 13 10 22 29 25 44 42 8 30 23 29 53 45 20 33 51 27 17 21 61 13 19 33 35 9 17 31 20 41 28 26 37 15 27 24 47 46 23 28 26 24 30
13 12 26 10 14 10 10 8 24 4 7 11 14 7 33 10 11 24 8 15 13 18 27 24 11 11 8 7 11 8 7 18 24 21 30 27 15 40 18 16 29 19 15 28 17 38 19 16 10 19 48
18 26 43 13 42 29 10 21 34 9 30 17 21 9 35 32 21 33 35 23 19 35 37 17 40 21 13 8 32 18 14 34 20 30 25 42 28 37 31 26 78 26 32 44 35 43 15 24 20 21 49
16 21 29 11 22 20 7 15 26 6 26 13 17 5 25 22 18 27 22 13 14 27 31 10 24 15 12 6 17 13 11 26 13 21 25 27 17 25 24 20 50 22 24 31 20 26 11 15 14 15 33
Page161
State
District
Treatmen Treatmen t success t Success rate rate of among new smear smear positive positive previousl 5 patients y treated cases5 93% 90% 82% 95% 98% 90% 93% 91% 82% 94% 92% 93% 88% 94% 91% 94% 88% 88% 86% 94% 86% 89% 90% 93% 94% 88% 89% 93% 93% 93% 93% 89% 88% 90% 87% 92% 87% 85% 85% 87% 76% 87% 88% 93% 86% 90% 91% 86% 82% 82% 84% 86% 83% 65% 100% 97% 84% 84% 84% 60% 84% 80% 84% 69% 79% 83% 92% 74% 73% 77% 88% 77% 68% 80% 76% 94% 81% 79% 86% 88% 86% 81% 83% 72% 84% 81% 83% 88% 73% 79% 70% 57% 77% 78% 89% 62% 82% 78% 63% 63% 66% 53%
86 106 522 61 109 292 159 73 385 89 30 80 111 59 284 161 200 288 91 147 174 194 216 114 134 182 33 108 335 86 144 243 381 48 19 17 16 218 53 155 85 51 12 32 154 25 96 318 91 62 250
5% 6% 10% 4% 5% 6% 5% 6% 7% 5% 5% 5% 4% 3% 5% 5% 4% 5% 5% 4% 4% 6% 5% 6% 6% 5% 3% 5% 6% 5% 5% 6% 8% 7% 7% 4% 9% 10% 7% 9% 7% 11% 5% 5% 8% 5% 3% 4% 2% 3% 9%
95% 94% 87% 92% 97% 91% 94% 89% 85% 94% 90% 91% 89% 92% 93% 96% 92% 91% 91% 92% 87% 90% 91% 87% 97% 92% 91% 95% 91% 94% 91% 92% 91% 95% 95% 92% 92% 88% 90% 90% 84% 91% 88% 91% 89% 93% 93% 90% 87% 85% 90%
86% 83% 73% 85% 95% 82% 84% 77% 64% 84% 75% 77% 71% 84% 86% 90% 77% 76% 80% 85% 81% 73% 79% 70% 93% 85% 81% 94% 81% 84% 80% 86% 74% 89% 95% 84% 87% 71% 75% 76% 64% 71% 80% 85% 70% 75% 82% 67% 67% 66% 58%
1295 1652 3804 853 1641 3305 2178 983 3620 1274 655 821 1679 1172 3573 2079 4163 3805 1723 2402 2165 2073 3317 900 1695 2275 736 1409 3240 1339 2346 2830 2562 552 215 270 114 1124 493 1085 1015 349 156 445 1034 216 2006 3962 2286 1084 1505
93% 92% 86% 76% 97% 86% 89% 94% 93% 85% 90% 68% 89% 91% 91% 94% 93% 88% 96% 94% 85% 92% 92% 77% 94% 86% 90% 90% 89% 93% 92% 93% 90% 92% 97% 92% 87% 87% 86% 83% 96% 89% 79% 81% 93% 82% 81% 75% 79% 69% 79%
1386 1788 4165 1123 1695 3827 2437 1019 3898 1430 706 821 1874 1286 3893 2195 4464 4333 1787 2566 2542 2241 3608 1142 1799 2598 821 1573 3634 1417 2519 3042 2816 597 219 294 131 1239 533 1297 1034 391 197 550 1077 265 2382 4861 2534 1259 1744
100% 99% 94% 100% 100% 100% 100% 98% 100% 96% 97% 68% 99% 100% 99% 99% 100% 100% 100% 100% 100% 100% 100% 97% 100% 98% 100% 100% 100% 99% 98% 100% 99% 100% 99% 100% 100% 96% 93% 99% 98% 100% 100% 100% 97% 100% 96% 92% 87% 80% 91%
1122 1196 2625 804 1558 1829 1366 718 3080 1129 569 404 1490 756 2953 1825 2626 2865 1245 1184 1633 1634 2514 637 1346 1911 509 1050 2271 854 1863 2112 1928 359 176 222 133 889 343 561 473 257 166 347 872 167 1941 2517 1703 1142 1130
92% 97% 86% 80% 95% 81% 81% 89% 98% 87% 88% 52% 92% 90% 90% 91% 83% 90% 91% 66% 86% 90% 89% 71% 100% 88% 80% 87% 87% 77% 88% 94% 84% 95% 76% 82% 86% 87% 74% 55% 71% 83% 83% 83% 89% 80% 86% 62% 81% 87% 80%
1624 1710 4302 1226 3019 5321 3392 1151 2192 1456 745 1942 2024 1581 5823 2605 3960 4938 1873 3723 4282 667 4426 1789 2442 2429 850 1712 4966 1875 0 3770 3696 517 157 181 178 2102 568 1717 780 304 184 764 787 442 1017 2814 626 419 1761
81% 74% 59% 75% 100% 87% 93% 82% 32% 72% 82% 101% 66% 76% 84% 69% 72% 72% 70% 87% 86% 17% 81% 79% 81% 61% 77% 73% 66% 98% 0% 77% 70% 61% 46% 31% 71% 73% 60% 76% 40% 53% 58% 80% 33% 74% 24% 30% 14% 17% 48%
1% 30% 11% 43% 16% 5% 3% 41% 23% 1% 2% 0% 6% 18% 17% 3% 0% 18% 10% 20% 15% 21% 3% 8% 8% 4% 8% 4% 13% 20% 15% 3% 10% 27% 31% 38% 67% 52% 28% 68% 32% 18% 48% 30% 17% 38% 49% 43% 37% 14% 55%
8% 0% 1% 1% 0% 0% 5% 0% 0% 9% 0% 5% 5% 1% 0% 20% 1% 0% 2% 0% 0% 1% 3% 6% 0% 8% 18% 0% 3% 1% 3% 4% 1% 0% 2% 0% 1% 1% 1% 1% 1% 0% 0% 2% 0% 0% 1% 1% 4% 2%
0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 1% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 1% 1% 0% 1% 0% 0% 0% 0% 0% 1% 0% 1% 0% 0% 0% 0% 0% 0% 0% 0% 0% 1% 0% 1% 1%
50%
100%
0% 25% 0%
83% 100% 50%
0% 0%
0% 82%
0% 36% 0% 0% 0% 0%
0% 43% 0% 0% 0% 75%
18% 0%
36% 100%
0%
0%
67% 50% 0% 67%
33% 100% 0% 33%
0%
0%
41% 100% 18% 90%
53% 80% 53% 84%
Page162
State
District
48 39 24 31 43 37 44 46 35 48 50 38 42 39 41 45 38 48 41 34 47 48 45 43 47 38 42 44 39 43 30 46 42 52 49 52 26 59 43 51 51 43 48 49 49 42 28 53 51 39 48
73% 59% 37% 48% 66% 57% 68% 71% 53% 75% 77% 59% 65% 61% 64% 69% 58% 74% 62% 53% 73% 74% 70% 66% 72% 59% 65% 67% 60% 65% 46% 71% 64% 81% 76% 81% 40% 90% 66% 79% 78% 66% 74% 75% 76% 65% 43% 81% 78% 60% 74%
0 10 0 0 10 10 10 0 0 10 10 10 0 10 0 0 0 10 0 0 0 0 0 0 0 0 0 20 0 10 0 10 0 10 20 10 20 0 0 0 20 10 10 10 20 20 20 20 20 10 20
0% 50% 0% 0% 50% 50% 50% 0% 0% 50% 50% 50% 0% 50% 0% 0% 0% 50% 0% 0% 0% 0% 0% 0% 0% 0% 0% 100% 0% 50% 0% 50% 0% 50% 100% 50% 100% 0% 0% 0% 100% 50% 50% 50% 100% 100% 100% 100% 100% 50% 100%
20 16 16 12 12 20 16 8 20 16 8 8 20 20 20 12 20 20 12 0 20 20 4 20 4 12 20 16 12 20 20 8 16 20 12 12 8 4 12 4 20 16 12 16 20 16 16 20 12 20 20
100% 80% 80% 60% 60% 100% 80% 40% 100% 80% 40% 40% 100% 100% 100% 60% 100% 100% 60% 0% 100% 100% 20% 100% 20% 60% 100% 80% 60% 100% 100% 40% 80% 100% 60% 60% 40% 20% 60% 20% 100% 80% 60% 80% 100% 80% 80% 100% 60% 100% 100%
5 15 5 25 16 15 15 15 5 5 10 15 5 15 15 15 15 15 15 13 5 10 10 5 5 15 15 5 14 15 5 14 5 15 5 15 13 10 5 10 15 10 5 15 5 15 5 5 15 5 6
17% 50% 17% 83% 52% 50% 50% 50% 17% 17% 33% 50% 17% 50% 50% 50% 50% 50% 50% 45% 17% 33% 33% 17% 17% 50% 50% 17% 47% 50% 18% 48% 17% 50% 17% 50% 44% 33% 17% 33% 50% 33% 17% 50% 17% 50% 17% 17% 50% 17% 21%
77 70 62 76 79 70 69 75 55 71 70 81 55 80 87 75 77 70 61 77 60 78 65 75 75 67 55 70 80 70 68 72 40 88 46 55 48 45 39 69 49 68 70 74 48 60 69 66 44 33 75
67% 61% 54% 66% 68% 61% 60% 65% 48% 62% 61% 70% 48% 70% 76% 66% 67% 61% 53% 67% 52% 68% 57% 65% 65% 58% 48% 61% 69% 61% 59% 63% 35% 77% 40% 47% 42% 39% 34% 60% 42% 59% 61% 65% 42% 52% 60% 57% 38% 29% 65%
150 150 107 144 159 152 154 144 115 151 148 152 122 164 163 147 150 163 128 125 132 156 124 143 131 132 132 155 145 158 124 151 103 186 132 144 116 118 99 134 154 147 144 164 143 153 138 163 141 107 170
60% 60% 43% 58% 64% 61% 62% 58% 46% 60% 59% 61% 49% 66% 65% 59% 60% 65% 51% 50% 53% 62% 50% 57% 53% 53% 53% 62% 58% 63% 49% 60% 41% 74% 53% 58% 46% 47% 40% 53% 62% 59% 58% 66% 57% 61% 55% 65% 57% 43% 68%
Page163
State
District

1
Annual Rate of smear change in positive Annual suspects case smear examined positive notificatio per s+ n rate case case notificatio [from CFR: diagnosed sm + n rate (compared cases (from to (NSP + Rel PMR) previous + TAD) / year) Pop] 7% 5% 3% 5% 12% 5% 15% 7% 0% 18% 6% 4% 8% -2% 3% 68 65 103 62 113 89 33 69 72 58 55 64 48 63 79 58 59 96 54 71 77 29 61 67 53 55 60 48 58 68

3
West Bengal West Bengal West Bengal West Bengal West Bengal West Bengal West Bengal West Bengal West Bengal West Bengal West Bengal West Bengal West Bengal West Bengal
Haora Hugli Jalpaiguri ** Koch Bihar ** Kolkata Maldah ** Medinipur East Medinipur West Murshidabad Nadia North 24 Parganas Puruliya South 24 Parganas Uttar Dinajpur Grand Total
48 55 39 28 45 40 51 59 71 52 101 29 82 30 12102
29063 28581 37416 20154 40322 28289 23041 31374 47267 39706 49954 18089 42673 15865 7875158
150 129 242 178 225 177 113 132 166 192 124 154 131 132 163
5% 8% -7% -7% 19% -6% 1% 5% -10% 11% -1% -5% -4% -14% 1%
3314 3593 3995 1764 5049 3542 1672 4092 5105 3005 5566 1869 3886 1902 953032
9 8 9 11 8 8 14 8 9 13 9 10 11 8 8
5187 5892 6828 2880 6238 4846 2436 6663 7753 4823 9274 3764 6691 2639 1515872
107 107 176 102 139 121 48 112 109 93 92 129 82 88 125
42 49 79 47 48 66 25 52 56 42 44 51 39 50 53
17 19 31 17 17 20 6 25 19 17 11 44 13 14 28
36 28
20 19 32 24 35 14 8 17 17 15 17 11 15 11 19
18 10
28 19 35 14 39 22 8 19 17 19 20 22 15 14 25
24 20
19 12 24 9 27 14 5 10 13 12 13 10 11 9 17
15 13
Summary of performance of Tribal Districts Summary of performance of Poor and Backward Zonal Analysis North Zone South Zone West Zone East zone North East
554 2801
310030 1438932
140 128
-76% -74%
45580 190004
7 8
0% 6%
82 68
74 62
77025 304215
139 109
60 50
3000 2526 3416 2704 456
2055408 2134332 2083623 1360488 241307
171 211 153 126 132
7% -1% 1% 0% -5%
292784 186699 277833 162768 32948
7 11 7 8 7
2% 1% 4% 6% 1.1%
98 74 81 60 72
86 62 70 54 63
459042 290051 443248 264765 58766
153 115 130 98 129
66 49 52 44 51
31 26 30 23 32
25 19 18 12 22
31 21 29 18 25
22 15 19 10 13
Page164
State
District
Treatmen Treatmen t success t Success rate rate of among new smear smear positive positive previousl 5 patients y treated cases5 82% 86% 86% 85% 79% 83% 82% 88% 89% 87% 84% 89% 85% 85% 88% 63% 63% 64% 62% 59% 68% 55% 72% 69% 65% 61% 72% 64% 64% 71%
307 176 383 67 486 262 55 150 317 122 326 118 275 111 84064
4742 15511
8% 4% 7% 3% 11% 7% 3% 3% 5% 3% 4% 4% 5% 5% 7%
7% 6%
86% 88% 89% 88% 80% 89% 86% 91% 92% 90% 85% 91% 88% 88% 90%
68% 65% 66% 68% 59% 69% 58% 74% 69% 66% 58% 76% 63% 67% 73%
2508 2403 3636 1174 2924 2309 1194 2800 3906 2258 5283 1430 3158 1475 738548
85% 72% 92% 74% 87% 72% 77% 77% 80% 81% 92% 80% 78% 83% 87%
85% 87%
2889 3299 3864 1467 3359 2827 1461 2096 4714 2740 5686 1646 4044 1722 816786
97% 98% 97% 93% 100% 89% 94% 57% 96% 99% 99% 92% 99% 97% 97%
97% 97%
1940 1984 3219 1080 2533 1863 822 2037 3339 1942 4287 1218 2693 1223 548622
89% 77% 94% 78% 98% 70% 65% 70% 83% 82% 94% 78% 84% 84% 83%
77% 79%
2191 1579 692 497 1766 558 358 1125 1532 1006 5314 433 1956 397 733894
42% 27% 10% 17% 28% 12% 15% 17% 20% 21% 57% 12% 29% 15% 48%
58% 61%
72% 41% 58% 32% 81% 37% 35% 20% 36% 44% 59% 37% 38% 57% 45%
2% 1% 1% 2% 6% 1% 3% 2% 1% 2% 3% 0% 2% 3% 6%
2% 1% 1% 1% 5% 0% 1% 0% 0% 1% 2% 0% 1% 1% 3%
56% 29% 98% 67% 67% 72% 0% 100% 67% 74% 100% 29% 91%
42% 29% 78% 62% 33% 50% 50% 100% 29% 67% 97% 94% 59%
90% 90%
74% 75%
88% 89%
73% 75%
35766 153357
40604 172218
26130 106842
45053 185780
28% 22%
4% 5%
1% 1%
88% 87%
52% 53%
25781 17265 25073 12476 3469
7% 7% 7% 6% 7%
91% 90% 91% 89% 88%
77% 70% 72% 69% 68%
89% 86% 88% 87% 85%
75% 66% 70% 69% 65%
238374 139403 212059 123347 25365
91% 87% 87% 83% 86%
258812 154504 234368 141689 27413
98% 96% 96% 96% 93%
176250 103655 160520 90076 18121
87% 82% 82% 77% 78%
241532 165805 169101 135652 21804
53% 57% 38% 51% 37%
29% 85% 50% 26% 31%
1% 10% 7% 2% 3%
0% 9% 3% 1% 1%
59% 92% 94% 52% 74%
59% 57% 62% 61% 54%
* Tribal Districts (more than 50% tribal population) ** Poor/Backward District Tribal & Poor/Backward Districts Estimated New Smear Positive cases / lakh population based on ARTI data for North Zone (Chandigarh, Delhi, Haryana, Himachal Pradesh, Jammu & Kashmir, ) 9 population of( 2011 is used for calculation of case-detection rate. 1 lakh = 100,000 population & 1 Projected population based on census 2 Smear positive patients diagnosed include new smear positive cases and smear positive retreatment cases 3 Total patients registered for treatment includes new sputum smear positive cases, new smear negative cases, new extra-pulmonary cases, new others ,relapse,failure,TAD and retreatment others 4 Sputum Conversion rate is not expected for new districts that began implementing RNTCP in 4th quarter 2010 5 Cure rate and Success rate are not expected for new districts that began implementing RNTCP after 4th quarter 2009 Values for grey areas are not expected
Page165
State
District
49 48 53 46 55 42 45 44 44 47 41 37 49 46 47 41 45
76% 74% 82% 71% 84% 65% 68% 67% 68% 72% 64% 57% 76% 70% 72% 54% 49%
20 20 10 0 20 20 20 20 20 20 20 20 20 20 13 16 9
100% 100% 50% 0% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 67% 68% 65%
16 4 12 20 16 20 8 8 16 12 20 0 12 16 15 16 16
80% 20% 60% 100% 80% 100% 40% 40% 80% 60% 100% 0% 60% 80% 75% 66% 56%
13 6 5 15 12 15 25 15 15 18 26 19 30 15 12 11 12
43% 20% 17% 50% 39% 50% 83% 50% 50% 60% 86% 65% 100% 50% 40% 31% 57%
74 66 61 50 59 45 56 35 68 61 68 66 68 62 69 66 68
64% 58% 53% 43% 51% 39% 48% 31% 59% 53% 59% 57% 59% 54% 60% 48% 85%
172 144 141 131 161 143 153 122 163 158 175 143 179 159 156 149 149
69% 58% 56% 52% 64% 57% 61% 49% 65% 63% 70% 57% 72% 63% 62% 51% 86%
46
70%
11
55%
15
77%
12
41%
70
61%
154
62%
52
50 43
81%
77% 66%
14
15 14
73%
73% 69%
14
15 15
72%
77% 75%
12
12 12
40%
41% 39%
71
72 65
63%
63% 56%
163
164 148
67%
66% 59%
47
42%
12
59%
16
46%
11
22%
69
35%
155
36%
Page166
LaboratoryPerformanceIndicators
DST workload and results (from DST register) Laboratory Quality Indicators
Patients (with Propotion of smear Proportion of all diagnostic specimens) positive diagnositic specimens with culture with DST completed specimens reported as 'contaminated' results within the benchmark culture positive turn-around time
Culture workload (from culture register) S.No Name of the Culture & DST Laboratory Diagnostic Sputum SPECIMENS inoculated
[DST results summary combined all methods]
Follow-Up SPECIMENS inoculated
Solid DST Processed
LPA DST Liquid DST Total H+R Total H+R done Done Sens Res
Total H only Res
Total R only Res
Number
Number
Number
1 2 3 4 5 6 7 8 9
BPHRC,AndhraPradesh IRL,Gujarat IRL,AndhraPradesh IRL,Kerala IRL,Nagpur IRL,Orrissa SMS,Jaipur IRL,Chennai IRL,WestBengal
440 3808 2556 2108 3682 236 986 1268 926 55 467 334 2408 636 212 196 207 10 14 20549
1426 7328 2668 1230 2539 404 1678 1427 2560 75 474 92 3448 698 22 0 124 0 0 26193
156 969 310 307 464 108 173 270 346 21 0 123 531 316 62 74 122 10 6 4368
0 1383 1067 0 1486 0 109 0 0 0 0 0 0 0 0 0 0 0 0 4045
0 0 0 0 0 0 0 0 0 0 383 0 0 0 0 0 0 0 0 383
37 951 589 81 913 12 99 138 27 6 134 47 86 50 58 16 88 1 0 3333
68 729 256 149 239 56 113 77 330 6 211 38 338 113 0 39 18 9 5 2794
7 214 91 12 172 4 39 15 16 3 36 19 67 75 4 13 5 0 1 793
0 154 76 1 62 2 23 4 21 0 1 10 6 0 0 6 2 1 0 369
301 2674 1603 620 1580 170 272 441 200 40 331 143 679 368 184 144 176 10 12 9948
96 57 74 34 73 56 76 85 63 55 93 74 46 74 87 91 86 100 100 63
14 546 193 724 461 20 91 246 88 6 0 52 501 150 4 2 5 0 0 3103
1 5 4 21 8 4 3 10 3 49 0 11 9 10 2 2 2 0 0 7
133 1010 932 233 397 68 257 101 112 15 378 104 425 223 137 74 157 10 4 4770
85 67 79 18 85 89 93 46 46 93 99 86 61 90 100 88 93 100 66 66
10 CMC,Vellore 11 Hinduja,Mumbai 12 IRL,Jarkhand 13 IRL,Delhi 14 IRLAjmer 15 IRLPuducherry 16 Chotithram,Indore 17 DFIT,Nellore 18 ICMR,Jabalpur 19 BMHRC,Bhopal Total
Page167
Programmatic Management of Drug Resistant TB (PMDT) Implementation, Diagnosis, 6 months interim, 12 months Culture Conversion and Treatment Outcome of MDR TB Case (Reported by DOTS Plus Sites of Implementing States - 2011) Indicators on Coverage of MDR TB Services Indicators on MDR TB Case Finding Indicators on 6 months interim report
State
Total Popula tion (In lacs)
Total number of districts
Number of Proportion Number of MDR TB of S+ RT % MDR TB Case Populatio population Number Number of cases Number Cases registered Out of a, No. Number of n of of DOTS S+ Rewith of registered Number (%) who are detected and MDR TB districts access to Plus treatment districts in districts of MDR that were initiated on alive, on Suspects implemen cases impleme implementin TB Cases MDR TB Sites treatment registered Cat IV in subjected ting detected nting g PMDT services function registered and culture the 4 to C-DST PMDT and in 2011 in the state PMDT services under al in the in 2011 services initiated on cohorts 6-9 negative in 2011 services who were RNTCP in state (in lacs) treatment months tested for 2011 prior (2Q10in 2011 # MDR-TB $ 1Q11) (a)
Out of a, No. (%) who died
Out of a, No. (%) who defaulted
Andaman & Nicobar Andhra Pradesh Arunachal Pradesh Assam Chandigarh Chhattisgarh Delhi Goa Gujarat* (+DD&DNH) Haryana Himachal Pradesh Jammu & Kashmir Jharkhand Karnataka Kerala (+LK) Madhya Pradesh Mahara-shtra Manipur Meghalaya Mizoram Nagaland Orissa Puducherry Punjab Rajasthan Sikkim Tamil Nadu Tripura Uttar Pradesh Uttarakhand West Bengal India Total
4 847 14 312 11 255 168 15 609 254 69 125 330 611 335 726 1124 27 30 11 20 419 12 277 686 6 721 37 1996 101 913 12102
1 24 14 24 1 16 25 2 33 21 12 14 24 31 15 50 60 9 7 8 11 31 1 20 33 4 31 4 71 13 19 662
1 17 2 2 1 3 25 2 33 7 2 2 9 5 15 12 31 2 2 2 2 15 1 3 21 1 31 1 1 2 7 260
4 652 3 49 11 62 168 15 609 92 21 34 147 148 335 226 504 10 15 5 7 261 12 79 482 3 721 17 44 36 361 5129
100% 77% 21% 16% 100% 24% 100% 100% 100% 36% 30% 27% 45% 24% 100% 31% 45% 37% 50% 45% 35% 62% 100% 29% 70% 50% 100% 46% 2% 36% 40%
42%
1 4 1 1 1 1 4 1 4 1 2 2 1 1 2 2 4 1 1 1 1 1 1 2 1 1 2 1 1 1 2 50
95 16162 342 3818 372 1615 6895 274 15308 7573 2155 1825 3240 9572 2349 11443 16151 242 584 197 467 4258 238 6424 20242 231 9530 262 37783 2560 12574 202599
12 2005 34 47 33 10 2680 14 2417 380 270 67 139 293 1137 225 3275 85 10 51 38 141 135 57 1223 11 1452 6 219 76 680 17222
13% 12% 10% 1% 9% 1% 39% 5% 16% 5% 13% 4% 4% 3% 48% 2% 20% 35% 2% 26% 8% 3% 57% 1% 6% 5% 15% 2% 0.6% 3% 5%
9%
0 506 4 0 0 2 677 7 885 120 81 1 34 63 105 53 772 10 5 3 1 62 6 0 326 0 207 2 51 17 221 4221
0 435 0 0 0 1 562 5 696 82 51 0 20 43 128 35 534 0 0 2 0 47 6 0 274 0 184 2 45 16 216 3384
295
180
61%
24
8%
29 10%
360 630 58 4 11 114 281
259 344 32 2 6 75 139
72% 55% 55% 50% 55% 66% 49%
33
9%
53 15%
53 8% 55 11 19% 3 1 25% 0 1 6
9% 5% 0% 0% 4%
9% 5%
0 4
29 10% 32 11%
43
22
51% 58% 70% 100%
7%
0% 7% 5% 0%
200 125 2 255 2378
116 87 2 143 1407
20 10% 14 9 0
7% 0%
6 0
56% 12 5% 12 5% 59% 202 8% 208 9%
* Data from Daman-Diu & Dadra Nagar Haveli is included in Gujarat; Data from Lakshadweep is included in Kerala $ This indicator will be more relevant when S+ve RT cases are considered as MDR TB suspects in all districts in the state # These numbers are NOT from the same cohort of patients from which MDR diagnosed are reported, but rather from treatment initiation registers only. The current PMDT information system does not allow for cohort-based reporting of MDR TB suspects, hence this should not yet be taken as a proportion of MDR TB diagnosed and used as an indicator for efficiency of initiation on treatment. Future versions of the PMDT reporting system will be based on cohorts of patients tested in laboratories, and will be used for monitoring of timeliness and efficiency of diagnosis and initiation on treatment
Page168
Programmatic Management of Drug Resistant TB (PMDT) Implementation, Diagnosis, 6 months interim, 12 months Culture Conversion and Treatment Outcome of MDR TB Case (Reported by DOTS Plus Sites of Implementing States - 2011) Indicators on 12 months Culture Conversion Report Indicators on Treatment Outcome of MDR TB Cases
State
Number of MDR TB cases registered in the cohort, 12-15 months prior (4Q093Q10) (b)
Out of b, No. (%) who are alive, on treatment and culture negative
Out of b, No. (%) who are alive, on treatment and culture positive
Out of b, No. (%) who are Out of b, alive, on No. (%) treatment who died and culture not known
Out of b, No. (%) who defaulted
Number of MDR TB cases registered in the cohort, 3133 months prior (3Q082Q09)
Out of c, No. reported as Cured
Out of c, No. Out of c, Out of c, reported as Success No. (%) Treatment who died Rate Completed
Out of c, No. (%) who defaulted
Out of c, No. (%) who failed treatment
Andaman & Nicobar Andhra Pradesh Arunachal Pradesh Assam Chandigarh Chhattisgarh Delhi Goa Gujarat* (+DD&DNH) Haryana Himachal Pradesh Jammu & Kashmir Jharkhand Karnataka Kerala (+LK) Madhya Pradesh Mahara-shtra Manipur Meghalaya Mizoram Nagaland Orissa Puducherry Punjab Rajasthan Sikkim Tamil Nadu Tripura Uttar Pradesh Uttarakhand West Bengal India Total
* Data from Daman-Diu & Dadra Nagar Haveli is inc $ This indicator will be more relevant when S+ve RT # These numbers are NOT from the same cohort of TB diagnosed and used as an indicator for efficienc
244
114
47%
27
11%
15
6%
39
16%
47
19%
71
29
44%
16
23%
18
25%
7%
394 518 62
227 223 25
58%
27
7%
19 33 4
5% 6% 6%
46 86 9
12% 17% 15%
64 74 8
16% 14% 13%
116 108 17
55 43 6
7 8 2
53% 47% 47%
15 24 6
13% 22% 35%
31 18 1
27% 17% 6%
1 14 2
1% 13% 12%
43% 102 20% 40% 16 26%
125 173
67 71
54% 41%
10 33
8% 19%
25 21
20% 12%
10 21
8% 12%
13 26
10% 15%
56 79
24 37
16 2
71% 49%
4 12
7% 15%
8 20
14% 25%
1 6
2% 8%
26
31% 56% 58%
15% 7% 13%
11
42% 15% 14%
12% 16% 11%
0% 5% 4%
15 7 10 1 0 0
191 125
107 72
13 16
29 17
30 14
9 5
67% 14%
2 4
13% 57%
1 0
7% 0%
2 2
13% 29%
173 2031
100 58% 26 15% 19 11% 13 8% 13 8% 1014 50% 274 13% 193 10% 271 13% 259 13%
20 489
11 216
0 37
55%
52%
3 86
15% 5 18% 102
25%
21%
1 34
5%
7%
Page169
Referral of TB Suspects from ICTCs to RNTCP diagnostic units (2011) (Reported by Phase-I states implementing Joint TB-HIV Action Plan
Total Population (In lakhs) Total No. of districts Andhra Pradesh 847 24 HIV HIV Positive Negative Karnataka 611 31 HIV HIV Positive Negative Maharashtra 1124 55 HIV HIV Positive Negative Manipur 27 9 HIV HIV Positive Negative Mizoram 11 8 HIV HIV Positive Negative Nagaland 20 11 HIV HIV Positive Negative Tamil Nadu 721 31 HIV HIV Positive Negative Total 6722 169 HIV Positive HIV Negative
1. Number of TB suspects referred from VCTCs to RNTCP facilities* 2. Out of the above persons, number diagnosed as having TB: a) Sputum Positive TB b) Sputum Negative TB c) Extra-Pulmonary TB d) Total diagnosed TB patients
94743
97993
140765
991
618
1454
99316
435880
2642 964 145

3751
5612 1433 209

7254
1448 609 428

2485
3911 879 469

5259
1465 945 607

3017
7265 2423 864

10552
14 9 8
31
30 12 1
43
13 71 3
87
1 24 0
25
13 11 6
30
76 30 7
113
624 466 200

1290
2842 828 258

3928
6219 3075 1397 10691 8069
19737 5629 1808 27174 26286
3. Out of above total diagnosed 2320 6383 2099 5986 2533 9643 31 TB patients (d), number receiving DOTS Source of data: Monthly reports on TB-HIV cross referrals submitted by individual ICTC to the respective state SACS
42
26
108
1055
4120
Page170
Treatment Outcome of HIV positive TB patients registered in Annual 2010

States AllTBHIVNSP TotalCase Registered 4834 12 6 49 45 741 2689 34 3617 64 25 42 10 49 1493 68 13778 Treatment Success 77% 92% 83% 78% 67% 76% 73% 68% 72% 94% 68% 74% 50% 67% 76% 74% 75% Died Failure Default TransferredOut
AndhraPradesh Assam Chandigarh Delhi Goa Gujarat Karnataka Kerala Maharashtra Manipur Mizoram Nagaland Pondicherry Punjab TamilNadu WestBengal GrandTotal
13% 8% 17% 12% 18% 15% 18% 3% 17% 6% 8% 17% 40% 16% 15% 18% 15%
2% 0% 0% 4% 4% 2% 2% 12% 1% 2% 0% 2% 0% 4% 1% 3% 2%
4% 0% 0% 4% 9% 6% 7% 15% 5% 2% 20% 12% 10% 6% 8% 4% 5%
1% 0% 0% 2% 2% 1% 1% 0% 5% 0% 0% 5% 0% 2% 0% 1% 2%
States
AllTBHIVTotal CaseRegistered 11686 31 9 302 175 2936 8909 116 12016 203 197 137 29 102 5838 407 43093
Treatment Success 81% 77% 78% 81% 77% 76% 72% 70% 76% 71% 77% 78% 72% 57% 82% 57% 77%
Died
Failure
Default
Transferredout
AndhraPradesh Assam Chandigarh Delhi Goa Gujarat Karnataka Kerala Maharashtra Manipur Mizoram Nagaland Pondicherry Punjab TamilNadu WestBengal GrandTotal
12% 6% 0% 7% 15% 13% 16% 9% 13% 8% 10% 8% 24% 19% 11% 16% 13%
2% 3% 0% 2% 2% 1% 1% 6% 1% 2% 1% 1% 0% 4% 1% 2% 1%
4% 6% 0% 6% 4% 8% 8% 6% 7% 2% 9% 7% 3% 6% 6% 6% 6%
0% 3% 0% 3% 1% 2% 2% 4% 2% 12% 3% 6% 0% 4% 1% 12% 2%
Page171

TB India 2012 - Annual Report

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(Gulam Nabi Azad) March 2012

National Rural Health Mission

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Dr. Jagdish Prasad

Universal Access to early quality diagnosis and quality TB care

Telephone : +91-11-23062980 Telefax : +91-11-23063226 Email: ddgtb@tbcindia.nic.in website : www.tbcindia.nic.in

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Dr. Ashok kumar, M.D

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HEALTH & FAMILY WELFARE

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TB'is fully curable with complete course of DOTS

IAC ICB ICELT

Central TB Division - Activities in 2011

Tuberculosis Epidemiology - India

Global TB disease burden:

Estimated tb incidence rates, 2010

2.0 (1.6-2.4) 1.7 (1.3-2.1) 3.8 (2.8-4.7) 3.0 (1.3-5.0)

Tuberculosis Epidemiology - India

Impact of Other Determinants of TB Burden:

PAF = [P*(RR-1)] / [P*(RR-1)+1]

Drug Resistant Tuberculosis:

Tuberculosis Epidemiology - India

Evolving strategies of TB Control in India:

Evolving strategies of TB Control in India:

National Strategic Plan (2012-2017):

of HIV associated TB 5. To improve outcomes TB care in the private sector

Proposed strategies in the "National Strategic Plan 2012-2017":

Evolving strategies of TB Control in India:

RNTCP: Implementation status and activities in 2011

RNTCP planning and budgeting for States/UTs and districts

World Bank support:

Global Fund support:

Case detection through Quality Assured Bacteriology:

Table 1: States assigned to NRLs for monitoring of laboratory activities (2011)

Total nos. of IRLs assigned 12

Total nos. of states/ UTs assigned 9

External quality assessment activities of RNTCP

RNTCP: Implementation status and activities in 2011

fig 11.tif 10.tif

RNTCP: Implementation status and activities in 2011

Arunachal Pradesh Assam Bihar

Chandigarh Chhattisgarh Delhi

RNTCP: Implementation status and activities in 2011

Name of the States Gujarat

Himachal Pradesh Jammu & Kashmir Jharkhand Karnataka

Kerala Madhya Pradesh

Manipur Meghalaya Nagaland Orissa Puducherry Punjab Rajasthan

Sikkim Tamil Nadu

Name of the Laboratories

Name of the States

Type of DST Technology Solid LPA Liquid P A A P P P P P A A P A A P A P

Uttarakhand West Bengal

Procurement & Drug Logistics:

Purified Protein Derivative

(iv) BMs / LED Fluorescence Microscopes

RNTCP: Implementation status and activities in 2011

Human Resource Development

RNTCP: Implementation status and activities in 2011

Training activities in 2011:

PAF = [P(RR-1)] / [P(RR-1)+1]