Andhra Pradesh implements END TB Strategy

Dr T Rama Rao,
State Tuberculosis Officer, Government of Andhra Pradesh

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Andhra Pradesh is implementing End TB Strategy with a goal of achieving Elimination of TB by 2025 on the appeal of Hon’ble Prime Minister. To achieve the Noble goal of Elimination of TB, the cooperation of all health care providers either Private sector or Medical Colleges is required.

National TB Elimination Program (NTEP), Andhra Pradesh denotes, TB is a Communicable Disease spreads through (Air borne) Droplets Infection.

In India, in 2019, 177/Lakh (2.4 Million) cases are Notified against expected 217/Lakh. In Andhra Pradesh, In 2019, 187/Lakh (99294) cases are reported and in the year 2020, 64,787 (35% loss in notifications). To Decrease the Incidence and Mortality due to TB, GoI and GoAP have been Implementing National Tuberculosis Elimination Program with a goal of Elimination of TB by 2025.

The Diagnosis & Treatment are provided free of cost to all the TB Patients by Government:

The Strategies of NTEP:

* Active Case Finding:

All the Persons suffering from Cough & Fever for more than 2 weeks are tested for TB. All the Patients suffering from Diabetes and HIV and Contacts of TB Patients suffering from Cough are also tested for TB. All TB Patients Diagnosed in Private Sector information is also taken by Notification and TB is declared as Notifiable disease.

* Latest Diagnosis Methods for TB implemented in NTEP:

Sputum Smear Examination by Microscopy both by ZN staining and Fluorescence staining. Established Rapid, Specific and Highly Sensitive Molecular Diagnostic Tests (PCR) like CBNAAT, TrueNat & Line Probe Assay (LPA) which detect not only TB but also Drug Resistant TB in 2 hours. All these centers are established at Primary, Secondary and Tertiary Care Hospitals. In Andhra Pradesh there are 45 CBNAAT sites at identified Medical Colleges, ART Centres, District TB Centres, etc. and 240 Truenat Centres at CHCs, Area Hospitals, District Hospitals and high load PHCs, Chest X-Ray. Culture & Drug Susceptibility Test at identified Culture DST Labs along with LPA facility at Visakhapatnam, Vijayawada, Nellore and Anantapur.

* Treatment:

All the Diagnosed TB Patients are categorized into Drug Sensitive and Drug Resistant TB Patients and the Treatment is given in their respective villages through Treatment Supporters(ASHAs, ANMs, Community Volunteers & Family Members). The treatment for Drug Sensitive TB Patients is 6 months Daily Regimen with INH, Rifampicin, Pyrazinamide and Ethambutol in the form of Fixed Dose combinations based on weight bands. For Drug Resistant TB cases the treatment is given in two regimens 1. 9months shorter MDR regimen 2. 18 to 20 months All oral long regimen which contains new drugs like Bedaquiline, Delaminid, etc. and the new drug included regimen costs Rs.38,000 for each patient.

* Nutrition Support:

All the TB Patients are provided with an Incentive of @ Rs.500/- per month during the entire period of Treatment by Direct Benefit Transfer. This program started since April 2018.

In the year 2020, out of 59195 eligible TB patients, 58,630 (99%) received the benefit of DBT for nutrition support.

* IT Application in NTEP:

1. NIKSHAY – A Web based and App based portal maintaining all the Recording and Reporting system.

2. 99DOTS – IT Tool used in NTEP to monitor adherence of Treatment of all the Drug sensitive TB Patients in Andhra Pradesh.

3. MERM (Medication Event Reminder Module) boxes : It is used for monitoring Drug Resistant TB patients in Andhra Pradesh.