National Tuberculosis Control Program
National Tuberculosis Control Program (According to Annual Report 2075/76, DoHS, Nepal)
Ø 1996 AD: DOTS was started as a pilot program in 4 districts
Ø April 2001 AD: DOTS has been implemented successfully throughout the country.
Ø FY 2069/70: Community based DOTS program was started in 21 districts.
Ø 2002 AD: PAL (Practical Approach to Lung) program was piloted in 2 districts and then implemented in 19 districts in 2069/70.
Ø Sept. 2005: DOTS plus program started & MDR TB management program was initiated at 5 treatment centers and 16 sub treatment centers.
Ø In 2006 AD: 2.4% of TB patients also had HIV infection in NTP survey.
Ø 2007 AD: Fixed Dose Combination system was stared.
Ø 2009 AD: NTP adopted TB/HIV strategy and policy.
Ø By 16th July 2010: DOTS has been expanded to 1122 treatment centers with 3098 sub centers.
Ø 2010 AD: XDR TB treatment started.
Ø 2012 AD: use of Xpert MTB/RIF started in Nepal and there are 26 Xpert MTB/RIF centres in Nepal.
Ø The Xpert MTB/RIF test is a valuable, sensitive, and specific new tool for early TB detection and for determining rifampicin resistance.
Ø 2012 AD: Isoniazid Preventive Therapy (IPT) started to a patient with HIV positive and baby birth by bacteriologically confirmed tuberculosis infected mother. In IPT, Isoniazid 10 mg/kg body weight for 6 months should be given.
Ø National TB Reference Laboratories (NRL), NTC and GENETUP, are providing culture and drug susceptibility test (DST) services and the plan is to establish centres in all regions in 2073/74.
Ø Every year 44,000 people develop active TB and of whom 20,500 have infection with pulmonary TB.
Ø Every year 5000-7000 people die from Tuberculosis.
Ø World TB day is celebrated on 24th March.
Ø According to the latest WHO data (May 2016), tuberculosis deaths in Nepal reached 5,506, 3.5 % of all deaths.
Ø The age adjusted death rate was 27.80 per 100,000 of population, which ranks Nepalas the forty-third most affected country.
Ø Most of TB cases and deaths occur among men in a ratio of 2 male cases for every female case.
Ø NTP has adopted the global End TB Strategy and the achievement of the SDGs as the country’s TB control strategy.
Ø MDR TB survey was conducted in collaboration with WHO and results at 2.9%.
Ø The cure rate of MDR TB has been found 71%.
Ø The strategy of NTC to establishment of treatment center in population is 70,000 – 150,000.
Ø Evaluation of NTP progress is done every 4 monthly cohort analysis.
Ø Vision: Tuberculosis free Nepal
Ø Long term goal: End the tuberculosis epidemic by 2050.
Ø Short term goal: Reduce TB incidence by 20%by 2021 compared to 2015 and increase case notifications by a cumulative total of 20,000 from July 2016 to July 2021.
Ø Objectives
• Increase case notification through improved health facility-based diagnosis.
• Maintain the treatment success rate at 90% of patients (for all forms of TB) through to 2021.
• Provide drug resistance diagnostic services for 50% of persons with presumptive drug resistant TB by 2018 and 100% by 2021 and successfully treat at least 75% of diagnosed drug resistant patients.
• Further expand case finding by engaging the private sector.
• Strengthen community systems for the management, advocacy, support and rights of TB patients in order to create an enabling environment to detect and manage TB cases in 60% of all districts by 2018 and 100% of districts by 2021.
• Contribute to health system strengthening through TB human resource management, capacity development, financial management, and infrastructure, procurement and supply management.
• Develop a comprehensive TB surveillance, monitoring and evaluation system
• Develop a plan to continue NTP services in the aftermath of natural disasters and public health emergencies.
Ø Targets
• SDG31 global targets: By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases.
• SDG and End TB Strategy (see Box 4.7.2)-related targets: Detect 100% of new sputum smear-positive TB cases and cure at least 85% of these cases.
• By 2050, eliminate TB as a public health problem (threshold of <1 case per million population).
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