RNTCP

Preface

Arunachal Pradesh the land of rising sun is the easternmost state of India and shares international boundaries with three countries viz. China (Tibet) in the North, Myanmar in the East, Bhutan, in the West and with the states of Nagaland and Assam in the south.

Largest amongst the North Eastern states with 83,743 sq km, mostly hilly areas, Arunachal Pradesh is blessed with a delightfully variegated climate, from the snow covered mountains of Tawang to the fertile lands of Lohit, Namsai, East Siang and Lower Dibang Valley. Almost 80% of the total area is covered by green forests of the Eastern Himalayan range.

The state is mostly inhabited by the hill-tribal people with intriguing traditional and cultural life styles. The scenic beauty with flora and fauna has added to the allure of this mysterious land.

Demo-Geographic Statistics

State                –  Arunachal Pradesh

Area                –  83,743 sq km

Population       – 15.23 lakh (RNTCP Projected Population)

1. National TB Control Programme in Arunachal Pradesh

National TB Control Programme (NTCP) was implemented in the state (the then North East Frontier Agency) in the year 1967 with only 2 (two) District TB Centres – viz (1) District TB Centre, Pasighat covering the then undivided Kameng District (now Tawang , West Kameng & East Kameng) , Subansiri District (now Upper Subansiri , Lower Subansiri, Kurung Kumey & Papum Pare and Siang District (now East Siang, Upper Siang and West Siang & Siang District) while the (2) District TB Centre , Margherita covering the undivided Lohit District (now Lohit , Anjaw , Dibang Valley and Lower Dibang Valley) and Tirap District (now Tirap , Changlang & Longding Districts). Later on DTC Margherita was shifted to Deomali in Tirap district.

In the year 1974, another 4 (four) District TB Centers i.e., DTC Ziro , DTC Bomdila , DTC Tezu and DTC Aalo  were created to increase the population coverage. There were 6 DTCs during this period.

The Short course Chemotherapy (SCC) was introduced in the state during 1983-84.  Though SCC regimen proved effective compared to the earlier regimen , acute shortage of drugs and over dependence on X-ray for diagnosis resulting in false positive and false negative diagnosis led to the set back of NTCP in Arunachal Pradesh.

2. Revised National TB Control Programme (RNTCP) in Arunachal Pradesh

As per directive of the CTD, Preparation for RNTCP in Arunachal Pradesh began in the year 1999 with first phase of infrastructure creation like up-gradation of TU and DMCs , and appointment of Contractual human resources like- STS, STLS, DEO, Lab Technicians, Identification of MO-TCs for TUs at the District Level and MO (TB), Accountant, IEC Officer State DEO at the State Level was under taken.

In order to assess the preparatory ground works in the State, Central appraisal team visited Arunachal Pradesh and expressed satisfaction on the preparedness of the districts and recommended service-delivery of RNTCP in the state. The formal service delivery commenced from 20th September 2002 in the entire state under the above mentioned 6 (six) District TB Centres with the dedicated endeavor of the District TB Officers and the TB workers of the State.

In the year 2005, with assistance from the Central TB Division, the following 7 (seven) TB Units in the non-DTC districts were upgraded to DTC. DMC Koloriang has been upgraded as District TB Centre, in 2011, which was functional as DMC Koloriang under DTC Ziro, Lower Subansiri District.

  1. TU Tawang as DTC Tawang in Tawang District
  2. TU Seppa as DTC Seppa in East Kameng District
  3. TU Daporijo as DTC Daporijo in Upper Subansiri District
  4. TU Yingkiong as DTC Yingkiong in upper Siang District
  5. TU Roing as DTC Roing in Lower Dibang Valley District
  6. TU Changlang as DTC Changlang in Changlang District
  7. TU GH-Naharlagun as DTC Naharlagun in Papum Pare dist.
  8. DMC Koloriang as DTC Koloriang in Kurung Kumey District.

All the necessary equipments like- Computer, Photocopier, Fax machines and office furniture provided from the State TB Society. As per approval of Ministry of Health, GOI 7 (seven) 4-wheelers (Tata Sumo) were also provided to the new DTCs. Also State TB Training & Demonstration Centre was established to carry out all necessary trainings of DTOs, MO-TCs, LT, STS, STLS and other functionaries.

Later the Govt. of Arunachal Pradesh accorded approval to declare these TB Units as DTC and MOTCs were designated as DTOs with a view to discharge their duties independently in their respective district. The 8 (eight) newly upgraded DTCs started functioning from the first quarter of 2006.

As per the norms under RNTCP, every district should have a District TB Centre (DTC) however due to the sparse 6 new TB Units have been set up at Anini, Hayuliang, Longding, Miao, Namsai & Itanagar.

3. Core activities under RNTCP

  • Case detection
  • Treatment under DOTS (Directly Observed Treatment Short Course)
  • Supervision & Monitoring
  • PMDT Services (Programmatic Management of Drug Resistance TB)
  • TB/HIV collaboration activities
  • Un-interrupted supply of Anti-TB Drug to District Drug Store.
  • Public-Private-Mix (PPM)
  • IEC/ACSM
  • Recording & Reporting on monthly & Quarterly basis.

 

4. DOTS-Plus/PMDT Services:

The emergence of the Multi-Drug Resistant Tuberculosis in alarming proportion was noted and the DOTS Plus Services was launched under RNTCP to counter it. The DOTS Plus Services was further renamed as Programmatic Management of Drug Resistant Tuberculosis (PMDT) Services. Phase-I of PMDT Services was rolled out in the state in November 2011 after Central Appraisal and for which only two DTCs (Papum Pare and Lower Subansiri) were identified.

All patients falling under Suspect Criteria-B were sent for MDR-TB Diagnosis at LRS Institute of TB & Respiratory Diseases, New Delhi. The first dose of Cat-IV was given to the MDR TB patient at Drug Resistant TB (DR TB) Centre, Naharlagun in a simple ceremony by the Director Health Services Dr. Kartik Nishing on 13th January 2012 in presence of State TB Officer, Chairman DR TB Centre, Medical Superintendant, senior Officials and staff. Currently under Phase-II the whole of Arunachal Pradesh is covered for PMDT Services under suspect Criteria-C. The State now has two DR TB Centres approved by the State Government and CTD, Govt. of India, which are specialized in the treatment of MDR TB Treatment viz. DR TB Centre, State Hospital Naharlagun and DR TB Centre, General Hospital Pasighat.

 

5. Advocacy Communication and Social Mobilization (ACSM) activities

A.DISTRICT LEVEL

  • Outdoor publicity – Hoardings and wall paintings in all prominent locations.
  • Exhibition of communication materials – posters, banners & RNTCP Stall during all important occasion.
  • Distribution of Communication materials – pamphlets, pocket calendars, caps.
  • Community meetings
  • Media activities – Television shows and Radio talks
  • World TB Day celebration on 24th March every year
    • TB awareness public rally
    • Seminar on TB
    • Social service – cleaning up of public place like market place, public ground.

  

B. STATE LEVEL

  • Outdoor publicity- placement of Hoardings in the state capital
  • Display of IEC materials – Posters and Banners, Pocket Calendar & RNTCP Stall during important occasion – Statehood Day, Republic Day & Independence Day.
  • Printing of IEC materials – Posters, Wall calendar, Pocket Calendar, TB Information Booklet, Health Provider Guideline, Patient Provider Guidelines.
  • Distribution of IEC materials and Caps etc.
  • Media activities:
    • Radio talk on Prasar Bharti, Itanagar
    • FM Radio Talk on Ooh! La la! Itanagar
    • Talk shows on Doordarshan Itanagar
  • Celebration of World TB Day.

6.  Status of State Drug Store

The State Drug Store in the state head quarter has been set up as per CTD norms with adequate space to store RNTCP Drugs both 1st line and 2nd line received from GOI safely and distributed to the districts as per requirement.
Attached to State TB Centre with trained SDS staff.

7.  HIV / TB COLLABORATIVE ACTIVITIES

Under this programme the cross-referral between TB and HIV has been intensified. All the diagnosed TB patients will be referred to ICTC and vice-versa. Till date all the DTOs & District PMDT & TB-HIV Coordinator & Supervisory staff have been trained on Intensified HIV-TB Activities, Supervision & Monitoring.

8. Brief RNTCP Profile

 

Population

15.53 (RNTCP Projected Population)

State Area

83,743 Sq. Km

No. of Districts covered

23

District TB Centres

14

Tuberculosis Units

20

Designated Microscopy Centres (DMC)

35

Intermediate Reference Laboratory Attached with State TB Centre, Naharlagun
DR-TB Centres
(Drug Resistant TB Centres)
Tomo Riba Institute of Health & Medical Science, Naharlagun
Bakin Pertin General Hospital & Training Centre, Pasighat
CB-NAAT Sites
(Cartridge Based Nucleic Acid Amplification Test)
1 no. at IRL Naharlagun,
10 Nos. at DTCs- Bomdila, Pasighat, Tezu, Aalo, Yingkiong, Roing, Deomali , Changlang, Seppa & Ziro
LED Fluorescence Microscopes 14 nos. at DTCs
1 no at RKM Hospital Itanagar
3 nos. at IRL Naharlagun
Mobile Clinic Van fitted with CBNAAT Machine, Laptop, Printer & Genset.

 

9.  DISTRICTS TB CENTRES WITH NAME, MOBILE NO. & EMAIL OF DTOs IN THE STATE

 

Name of DTC

Districts Covered

Name of Districts TB Officers

Mobile number

Email ID

Tawang Tawang Dr.(Mrs.) Urgen Lamhu

9436051088

DTOARTWN@rntcp.org
 Bomdila West Kameng Dr. R. D. Thongchi

9436045022

DTOARWKA@rntcp.org
Seppa East Kameng Dr. Nima Bodi

9402474103

DTOAREKA@rntcp.org
Naharlagun Papum Pare Dr. P. D. Thongchi

9436052087

DTOARPMP@rntcp.org
Ziro L/Subansiri Dr. H. Nibo

9436253528

DTOARLSU@rntcp.org
Koloriang Kurung Kumey I/c. DTO
Dr. Boni Tuluk

9436898304

DTOARKKM@rntcp.org
Kra Dadi
Daporijo U/ Subansiri Dr. (Mrs) Y. Hanker

9436224577

DTOARUSU@rntcp.org
Aalo West Siang Dr. Karmar Dirchi

9436056283

DTOARWSI@rntcp.org
Lower Siang
Yingkiong Upper Siang Dr. A. Miyu

9436058086

DTOARUSI@rntcp.org
Pasighat East Siang Dr. Y. Perme

9436053117

DTOARESI@rntcp.org
Siang
Roing L/Dibang Valley Dr. S. J. Mitapo

9436048357

DTOARDIV@rntcp.org
Dibang Valley
Tezu Lohit Dr. U. K. Nath

9436056304

DTOARLOH@rntcp.org
Anjaw
Namsai
Changlang Changlang Dr. (Mrs.) M. Khimhum

9436057136

DTOARCHA@rntcp.org
Deomali Tirap Dr. (Mrs) J. Thingnok

9436046118

DTOARTRP@rntcp.org
Longding

Total – 14

20

14

 

 

INFRASTRUCTURE

 

10.  DTCs, TUBERCULOSIS UNITS & DESIGNATED MICROSCOPY CENTRES

Sl.

Name of DTC

Tuberculosis Unit

Designated Microscopic Centre (DMC)

1

Tawang TU Tawang

1

DMC Tawang

2

DMC Lumla

2

Bomdila TU Bomdila

1

DMC Bomdila

2

DMC Dirang

3

DMC Kalaktang

4

DMC Bhalukpong

3

Seppa TU Seppa

1

DMC Seppa

4

Naharlagun TU Naharlagun

1

DMC Naharlagun

2

DMC Kimin
TU Itafort

3

DMC RKMH

5

Ziro TU Ziro

1

DMC Ziro

2

DMC Yazali

6

Koloriang TU Koloriang

1

DMC Palin

2

DMC Koloriang

7

Daporijo TU Daporijo

1

DMC Daporijo

8

Aalo TU Aalo

1

DMC Aalo

2

DMC Basar

3

DMC Likabali

4

DMC Mechuka

9

Pasighat TU Pasighat

1

DMC Pasighat

2

DMC Boleng

3

DMC Ruksin

10

Yingkiong TU Yingkiong

1

DMC Yingkiong

2

DMC Tuting

11

Roing TU Roing

1

DMC Roing
TU Anini

2

DMC Anini

12

Tezu TU Tezu

1

DMC Tezu
TU Namsai

2

DMC Namsai
TU Hayuliang

3

DMC Hayuliang

13

Changlang TU Changlang

1

DMC Changlang

2

DMC Bordumsa
TU Miao

3

DMC Miao

14

Deomali TU Deomali

1

DMC Deomali

2

DMC Khonsa
TU Longding

3

DMC Longding

14

20

35

 

11.  Co-Located DMC-ICTC/FICTC

 

Sl.N Name District DMCs ICTC/FICTC/None

1

Tawang DH Tawang

ICTC

PHC Lumla

None

2

West Kameng DH Bomdila

ICTC

CHC Bhalukpong

ICTC

CHC Kalaktang

None

CHC Dirang

None

3

East Kameng DH Seppa

ICTC

4

Papum Pare ASH Naharlagun

ICTC

R.K.Mission Hops. Ita

ICTC

CHC Kimin

ICTC

5

Lower Subansiri DH Ziro

ICTC

PHC Yazali

FICTC

6

Kurung Kumey DH Koloriang

ICTC

PHC Palin

None

7

Upper Subansiri DH Daporijo

ICTC

8

West Siang DH Aalo

ICTC

CHC Likabali

ICTC

CHC Basar

ICTC

CHC Mechukha

None

9

East Siang GH Pasighat

ICTC

CHC Ruksin

ICTC

PHC Boleng

None

10

Upper Siang DH Yingkiong

ICTC

CHC Tuting

None

11

Lower Dibang Valley DH Roing

ICTC

DH Anini

ICTC

12

Lohit DTC Tezu

ICTC

CHC Namsai

ICTC

CHC Hayuliang

None

13

Changlang DH Changlang

ICTC

CHC Miao

ICTC

CHC Bordumsa

None

14

Tirap DH Khonsa

ICTC

CHC Deomali

ICTC

CHC Longding

FICTC

Total

35

26

 

 

12. INVOLVEMENT OF NGOs IN RNTCP IN ARUNACHAL PRADESH Public-Private-Mix (PPM)

 

Sl

Name of NGO

Location / Districts

RNTCP Activity

Remarks

1

Rama Krishna
Mission Hospital
Itanagar, Papum Pare Designated Microscopy Centre Functional
DOT Centres

2

Adi Baptist
Union (ABU)
  Pasighat, East Siang ACSM/Treatment Adherence
/ Sputum Collection
& Sputum Transportation
  Functional
3 Karuna Trust Lumla CHC, Tawang Designated Microscopy Centre Non
Functional
Tuting CHC, Upper Siang Designated Microscopy Centre
PHC Geying  Upper Siang
PHC Mengio, Papum Pare
PHC Khimyong, Changlang
PHC Walong, Anjaw
PHC Sangram,  K/ Kumey
PHC Italin, Dibang Valley
SC Arjoo, Dibang Valley
PHC Anpum, L/D Valley
SC Bizari, L/D Valley
SC Paglam, L/D Valley
PHC Wakka, Longding
DOT Centre Functional

4

Missionaries of Charity A-Sector, Naharlagun DOT Centre Functional
Palin & Sangram, K/Kumey
Borduria, Tirap

5

Tibetan Refugee
Camp
Tezu, Lohit district DOT Centre Functional
Miao, Changlang District
Tenzing Goan, W/ Kameng

6

St. Claret Boa Simla, Lower Subansiri DOT Centre Functional

7

Don Bosco Yachuli, Lower Subansiri DOT Centre Functional

8

Auxalium Health
Care Centre
Near Hotel Bomdila,
Itanagar Papum Pare
DOT Centre Functional

9

Prem Bhai
(Catholic Mission)
Near Buishi Yada Maruti
Workshop Banderdewa,
DOT Centre Functional

10

NN Charitable Trust PHC Deed Neelam,
L/Subansiri
DOT Centre Functional

 

 

 

 

 

 

 

13.  TB Patient registered under RNTCP from 2011 to 2018

 

Year Total TB Patient Registered

No. of Pediatric TB Patients (<14 years)

Total No.
TB Cases
registered
for
treatment

No. of
New
Smear
Positive
TB
registered

New
Smear
Negative
Pulmonary
TB

No. of
Extra
Pulmonary
TB

Re-
treatment
Cases

2011

2311

854

459

398

600

37

2012

2357

802

535

462

558

59

2013

2500

908

438

530

595

67

2014

2691

938

471

631

674

58

2015

2748

1039

477

767

660

33

2016

2735

848

520

724

634

55

2017

2628

871

467

707

493

52

2018
(1st Qtr)

376

244

198

122

30

79

Total

18643

6504

3565

4341

4244

440

14.  DTC wise MDR/XDR TB Patient under Treatment

DR TB Centre Name of DTC District MDR TB XDR TB
DR TB Centre
Naharlagun
Naharlagun Papum Pare

257

2

Ziro Lower Subansiri

13

Daporijo Upper Subansiri

11

Koloriang Kurung Kumey

5

KraDadi
Tawang Tawang

3

Seppa East Kameng

41

Bomdila West Kameng

3

Changlang Changlang

5

Deomali Tirap

3

Longding
DR TB Centre
Pasighat
Pasighat East Siang

24

Siang
Aalo West Siang

11

Yingkiong Upper Siang

5

Roing Dibang Valley

6

Lower Dibang Valley
Tezu Lohit

8

Namsai
Anjaw

Total

395

2

15.  TB-HIV COLLABORATIVE ACTIVITIES STATE LEVEL

Sl. No.

Year

Total TB patients registered during the year

Registered TB cases known to be tested for HIV during TB treatment

Known to be HIV infected

1

2011

2311

1400

4

2

2012

2357

1437

6

3

2013

2500

1770

2

4

2014

2691

2100

2

5

2015

2748

2055

1

6

2016

2735

2246

2

7

2017

2628

2245

2

8

2018
(Jan.-March

673

278

1

Total

48643

13531

20

16. Fix Dose Combination – Daily regimen launched on 31st Oct 2017. Patients initiated on FDC-DR

Sl. No

Name of District / DTC

Number of Patient initiated on FDC-Daily Regimen

1

Changlang

32

2

Dibang Valley

20

3

East Kameng

64

4

East Siang

30

5

Kurung Kumey

15

6

Lohit

40

7

Lower Subansiri

20

8

Papum Pare

249

9

Tirap

50

10

Tawang

16

11

Upper Siang

6

12

Upper Subansiri

16

13

West Kameng

15

14

West Siang

34

 

Total

607

17. Nationwide Special TB Campaign for Active Case Finding

Active TB Case finding has been successfully conducted in phase wise in 4 (four Districts of Arunachal Pradesh namely East Siang, Lower Subansiri, Papum Pare & East Kameng in III Phases. (Phase I: 16th – 30th January 2017, Phase II: 17th – 31st July 2017, Phase III: 04th – 18th December 2017).

Districts

Population Mapped/Targeted

Number Screened

Presumptive TB Cases Tested

Diagnosed as TB

East Kameng

9170

2090

61

1

Lower Subansiri

16480

10543

287

13

Papum Pare

78788

17955

1426

5

East Kameng

20339

5968

211

4

Total

124777

36556

1985

23

18. Status of DBT through Nikshay

Scheme Name

Number of Beneficiaries Processed

Number of Beneficiaries Paid

Total Amount Paid

NIKSHAY Poshan Yojana
TB Patient (Nutrition)

42

23

11500.00

TB Patient (Tribal)

101

0

 

TB Treatment Supporter

58

47

 

Private Practitioner

0

0

 

19. MOBILE CLINIC VAN FITTED WITH CBNAAT MACHINE, LAPTOP, PRINTER & GENSET. ETC. FOR ACTIVE TB CASE FINDING

20.  Activities undertaken during 2017-18

1. Training of DTO, MO-TCs, Lab. Technician, Senior Treatment Supervisor, Senior TB Laboratory Supervisor, District PMDT & TB-HIV Coordinator, on revised ToG for TB Control in India.
2. Training of DTO, MO-TCs, Lab. Technician, Senior Treatment Supervisor, Senior TB Laboratory Supervisor, District PMDT & TB-HIV Coordinator, on revised PMDT Guidelines (RNTCP).
3. Training of District Accountants on PFMS.
4. Conducted Active TB Case Finding (ACF) in 4 (four) districts namely: East Kameng, Papum Pare, Lower Subansiri & East Siang in the year 2017-18.
5. Launching of Fix Dose Daily Regimen (FDC) in all the districts in Arunachal Pradesh
6. Installation of 3 (Three) additional CBNAAT Machine in East Kameng, Lower Subansiri & Changlang Districts.
7. Training on CBMAAT Machine for STLS, LT, & DEOs.
8. Launching of shorter regimen for MDR patients
9. Procurement of Computers for District Accountant for PFMS.
10. Printing of all new modules, recording & reporting formats of revised TOG to roll out daily FDC.
11. Training of DEO on Nikshay DBT-PFMS.
12. Training of Pharmacist on DVDMS.
13. Training on Revised ToG of TBCP Staff, PMDT-TB/HIV Coordinator, STS & SDS Staff.
14. RNTCP Quarterly Review meeting of DTOs & MO-TCs.

Road Map for 2018-19

15. Timely Payment for Nutrition support to TB Patients.
16. Strengthen TB notification from the private sector
17. Schedule H1 implementation.
18. Timely Payment of Incentive for TB Notification.
19. Timely Payment of Honorarium to Treatment Supporter.
20. Procurement of ECG Machine for 12 District TB Centre for smooth rolling of Bedaquilline containing regimen for the DRTB patients.
21. Training / Re-Training of Medical Officer in Revised PMDT Guideline.
22. Establishment of 12 District DR-TB Centre for decentralized DRTB treatment services.
23. Strengthen real-time data entry of all notified TB patients in NIKSHAY portal.
24. Implementation of online drug logistic management system (NIKSHAY Aushadhi).
25. Implementation of Direct Beneficiary Transfer (DBT) through PFMS to TB Patients.
26. Internal Evaluation, Supervision & Monitoring and OSE to be taken up as per guidelines.

21.FINANCIAL STATUS

Status of fund under A.P. State Health Society (RNTCP) Arunachal Pradesh

Year

RoP Approval
(in lakh)

Opening balance
(in lakh)

Fund received from GoI
(in lakh)

Total fund available
(in lakh)

Remarks

2017-18

709.18

19.47

709.00

728.47

  1. Rs. 334 lac released as 1st Installment by GoI, on Nov. 2017 which was released by GoAP in the month of Feb. 2018.
  2. Rs. 375 lac released as 2nd installment by GoI in the month of March 2018. Which still in the state Exchequer.


NOTE:

1. Loan for Rs. 120 lac taken from NHM for payment of Contractual staff salary, Pol, TA/DA, Honorarium to TB Patients/Treatment Supporter etc in the month of March 2018.

2. Loan for Rs. 25 lac taken from NHM for payment of TB Nutrition support for TB Patients in the month of April 2018.