TB has been listed as a notifiable disease by the Union Ministry of Health since May 2012. Dr Atul Kharate, State Tuberculosis Officer, Madhya Pradesh and Directorate of Health Services, Madhya Pradesh, talks about the impact of the move, other measures undertaken in the state to curb TB incidence and more, in an interaction with Usha Sharma
In May 2012, the Union Ministry of Health listed tuberculosis (TB) as a ‘notifiable’ disease? How has the move helped?
The involvement of the private sector has increased. More and more private practitioners are getting sensitised about the standards of TB care in India. Sensitisation of private practitioners was done with the help of Indian Medical Association (IMA). Private practitioners have started referring patients to the nearest government health facilities for diagnosis and treatment facilities. So far, 2949 private practitioners are registered under NIKSHAY (a web-enabled and case-based monitoring application to monitor Revised National Tuberculosis Programme effectively)
So far, how many TB cases has been reported in the state? How many of them are covered under the Directly Observed Treatment, Short Course (DOTS) programme?
A total of 25230 TB patients have been notified till date (from May 2015). Out of the 8948 patients notified from private sectors, 3598 of them have been put on the DOTS programme (since April 2015).
What are the initiatives undertaken in the state to eradicate TB?
The state decentralised TB diagnosis and treatment services including drug resistant (DR) TB. LED microscopes are provided to all districts. In addition to this, 22 NGOs are involved in the programme under different partnership options. State-level training for DOTS officials and NGOs on partnership guidelines were also organised to identify district-wise needs for involvement of these NGOs in the programme.
Often patients do not complete their treatment course and this hinders recovery. So, how does the state educate the patients?
As soon as a patient registers for treatment, a healthcare worker (STS/ANM /MPW/TB/HV/ASHA) visits his home to confirm his address. During this visit, the patient is counselled about completing the treatment course and the ill-effects of incomplete treatment. Patient is given directly observed treatment. So, whenever a patient misses a dose, the DOTS provider tries to retrieve that patient. There are patient-provider meetings with cured TB patients to decrease the default rate. Over a period, the state’s default rate has decreased from six per cent to five per cent.
Multi–drug resistant (MDR)TB is a growing concern. How many MDR cases have been registered in the state? What are the steps taken to handle these cases?
A total of 3239 MDR TB patients are registered in the state of Madhya Pradesh. The state has established seven DR TB centres. MP has six functional CBNAAT machines. It has three certified first line solid culture & drug susceptibility testing (C&DST) laboratories and one certified second line liquid C&DST laboratory. The state also has 10 linked DR TB centres.
How will the RNTCP help in curbing TB incidence? What has been the impact of the programme?
CTD has received Rs 20 crores for the RNTCP programme management in this financial year. State health departments have good infrastructure. Central TB Division (CTD) has provided 17 new cartridge-based nucleic acid amplification testing (CBNAAT) machines to state free-of-cost under the programme. These machines will be placed at district TB centres.
Incidence of TB has been declining since the implementation of the programme, though the rate of decline is slow. The state is focusing on strengthening the different components of the programme. It is also involving private practitioners by organising workshops. Marginalised and vulnerable population (PL HIV, malnourished children, diabetics, tribal population) has given special consideration.
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