Home Communicable Diseases National Tuberculosis Program Update in Nepal #WorldTBDay #EndTB

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National Tuberculosis Program Update in Nepal #WorldTBDay #EndTB


Vision

  • TB Free Nepal

Goal

  • To reduce the mortality, morbidity and transmission of tuberculosis until it is no longer a public health problem and ultimately to eliminate TB.

Recommended: National TB Prevalence Survey, 2018-19 Key findings

Objective

  • To reduce the incidence of TB by 20% by 2021 and 90% by 2035
  • To reduce the TB deaths by 35% by 2020 and 95% by 2035
  • To reduce the catastrophic cost to families due to TB to 0% by 2035

SDG targets

 20152019202220252030
SDG targets: 3.3.2 Tuberculosis incidence (per 100,000 population)15885675520

Burden of TB in Nepal

Burden of TB in Nepal


Case Notification in Rates and Numbers (National)  Annual Trend

  • Globally, an estimated 10.0 million people fell ill with TB in 2075/76.
  • Nepal population contributed to 0.35% of the global population, but with regards to TB, Nepal accounted for 0.5% of global TB cases.
  • Among 32043 reported case, 82% of pulmonary cases were bacteriologically confirmed

Screen Shot 2020 03 24 at 10.31.51


Recommended;

National TB Prevalence Survey, 2018-19 Key findings

World Tuberculosis Day 2020! It’s time to End TB!

National Guideline on Drug Resistant TB Management 2019, Nepal

National Tuberculosis Management Guideline 2019, Nepal

Global Tuberculosis Report 2019: Latest status of the tuberculosis epidemic

Case notification in numbers and rates (Provincial level)

  • Compared to National CNR – 109 / 100,000
  • Bagmati province, Province 5 and 2 shared highest burden.
  • Other provinces- under detection.

Screen Shot 2020 03 24 at 10.29.33


Screen Shot 2020 03 24 at 10.33.18


Proportion of child cases notified among TB cases 

  • National Childhood TB proportion- 5.5% (far less than Global estimates, under detection)
  • Karnali province à very high rates (14.6%) than others, needs assessment.

Treatment Success Rate (%)

Sustained High treatment success rates in Nepal. Among reported, 32313 TB cases were successfully treated (TSR >90%) à better than global commitment of 85% or more.


DR Case notification, treatment coverage and outcome

  • 392 reported cases of RR MDR; 0.6% new TB cases and 20% previously treated case (compared to 3.4% of new TB and 18% of previously treated cases globally)à possible under detection in Nepal
  • Some progress in testing, detection, and treatment of MDR/RR-TB
  • TB were tested for rifampicin resistance, up from 57% in 2074/75 to 78% in 205/76.
  • The coverage of testing was 79% for new and 74% for previously treated TB patients.
  • 71% were successfully treated (compared to global TSR of 56 %).
  • 5% of MDR TB were treated with the new shorter regimen with 65% success rates.
  • Key Challenges: nearly 38% are lost to follow up.

TB Preventives Services

NTP recommends TB preventive treatment for:

  • PLHIV
  • household contacts under 5 years of bacteriologically confirmed pulmonary TB cases.

A total of 2026 PLHIV were started on TB preventive treatment in 2075/76, based on data from NCASC.
TBPT for children under five years who are the contacts of TB cases increased by 4-fold compared to FY 74/75 to 2,397.health
BCG vaccination is being provided as part of national childhood immunization programmes. The coverage of BCG vaccine was 92% in FY 74/75.2075/76, 2 397 children and 2 026 PLHIV received the TB preventive therapy which has improved since 2074/75. BCG vaccine can also confer protection, but mostly from severe forms of TB in children. BCG coverage in Nepal was more than 90%.


Key facts regarding Facilities

Treatment Facilities

FacilitiesCurrent
DOT Centers4382
Urban DOT96
MDR Treatment Centers21
MDR Treatment Sub Centers86
DR Home1

Laboratory facilities

FacilitiesNo.Services
Microscopy Centers604Microscopy Centers
GeneXpert facility56Uses sputum sample, Result in 2 hour
Culture labs and DST2Duration of test is 2 month
Line Probe Assay(LPA)2Confirmation of DR TB from sputum positive samples, in 2 days

NTP achievements

  • Domestic resources have been increased in the program 27% in 2013/14 and 55% in 2017/18.
  • 3% decline of incidence per year, but gap still high.
  • Treatment success rate for DSTB above 90% and DRTB- nearly 70%. 
  • Successfully completion of National TB prevalence survey in Nepal
  • Expansion of sensitive molecular diagnostic tools (Genexpert) in the country from 22 Xpert centers in 2014 and 63 centers currently.
  • DRTB patients are covered under health insurance (no premium needed).
  • Tertiary hospital for TB program under construction.
  • Initiated a shorter treatment regimen (9 months) for DRTB patients all over the country from 2017 and transition into all oral longer regimen as recommended by WHO.

Note: Information published here was obtained from presentation prepared by Dr. Anuj Bhattachan, Director, National Tuberculosis Program, Nepal.  Download: World TB day 2020 NTP Presentation


Press release

World TB Day 2020 Press Release 1 1 scaled

World TB Day 2020 Press Release 2 scaled World TB Day 2020 Press Release 3 scaled


National TB Prevalence Survey, 2018-19 Key findings

World Tuberculosis Day 2020! It’s time to End TB!

Rapid Communication: Key changes to the treatment of drug-resistant tuberculosis

WHO announces updates on new molecular assays for the diagnosis of tuberculosis and drug resistance

WHO calls for urgent, aggressive actions to combat COVID-19, as cases soar in South-East Asia Region

Align national TB strategies with commitment to end TB by 2030: WHO


Recommended;

National TB Prevalence Survey, 2018-19 Key findings

World Tuberculosis Day 2020! It’s time to End TB!

National Guideline on Drug Resistant TB Management 2019, Nepal

National Tuberculosis Management Guideline 2019, Nepal

Global Tuberculosis Report 2019: Latest status of the tuberculosis epidemic

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