Lok Sabha Question No. 1087 (UNSTARRED), answered on 2019-02-08
Subject: Patients Affected by Drug Resistant TB
Ministry: HEALTH AND FAMILY WELFARE
Asked by: BHARTRUHARI MAHTAB, SANJAY SHAMRAO DHOTRE, RAHUL RAMESH SHEWALE, RAJENDRA AGRAWAL

## GOVERNMENT OF INDIA MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENT OF HEALTH AND FAMILY WELFARE

LOK SABHA UNSTARRED QUESTION NO. 1087 TO BE ANSWERED ON 08 TH FEBRUARY, 2019

## PATIENTS AFFECTED BY DRUG RESISTANT TB

## 1087. SHRI BHARTRUHARI MAHTAB:

SHRI SANJAY DHOTRE:

SHRI RAHUL SHEWALE:

SHRI RAJENDRA AGRAWAL:

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

- (a) whether the number of patients affected by Drug Resistant Tuberculosis and deaths therefrom have increased in the country during each of the last three years and the current year;
- (b) if so, the details thereof, State/UT wiseand the reasons therefor;
- (c) whether the Revised National TB Control Programme has achieved the desired results and addressed the problem of Drug Resistant TB successfully in the country and if so, the details thereof and if not, the reasons therefor;
- (d) the details of the funds provided by the Government under the said programme during the said period, State/ UT - wise; and
- (e)  whether the  Government  has  any proposal  to  review  the  Revised  National TB  Control Programme to control the Drug Resistant TB effectively across the country and if so, the details thereof along with the time by which it is likely to be reviewed?

## ANSWER THE MINIST ER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE

(SHRI ASHWINI KUMAR CHOUBEY)

(a) & (b): No. the estimated number of Mulit - Drug Resistant (MDR)/ Rifampicin Resistant (RR) TB patients has reduced from 147000 in 2017 to 135000 for the year 2018 as p er the WHO Global TB report 2018. However, the number of MDR patients diagnosed is increasing year year due to increase in availability of diagnostic facilities and proportion of TB pati screened for the presence of drug resistance. With the i mplementation of the Revised Diagnostic Algorithm  and  countrywide  Universal - Drug  Susceptibility  Test  (DST)  in  2018,  all  patients diagnosed with tuberculosis are being offered rapid molecular diagnostic tests for dete drug resistance, further leadi ng to increased detection of Drug Resistant (DR) TB cases.

The number of MDR TB patients notified under the programme for the last 3 years are under:

|   Year | Number of notified MDR - TB patients   |
|--------|----------------------------------------|
|   2016 | 33,820                                 |
|   2017 | 38,605                                 |
|   2018 | 55,519                                 |

State - wise number of MDR - TB patients diagnosed over the past three years is attached a annexure I .

(c): RNTCP is in line to achieve the desired results for addressing DRTB successfully i country. The Government has taken up many steps in order to tackle this problem:

- Revised  guidelines  for  Programmatic  Management  of  Drug  Resistant  TB  (PMDT)  is  being implemented since Dec'2017.

-Increase  in  diagnostic  and  management  capacity  for  early  detection  and  consequent  ea initiation of treatment. This will aid in decreasi ng mortality and cutting down transmission of the infection.

The  country  has  1180  functional  CBNAAT  sites,  89  Culture  and  Drug  Susceptibilit Testing (C -DST) laboratories certified in various technologies for drug resistance - TB detection.

Newer evidence - based regimens were introduced to improve the treatment outcomes of drug resistance TB patients.

- The Shorter MDR Regimen for MDR/RR TB patients (9 - 11 months of regimen instead of 24 months of conventions regimen)
- Newer drugs (Bedaquiline) containing regimen has been introduced country -wide under the program and made accessible to all districts during 2018. Total 3550 patients i on newer drug containing regimen till end of 2018.
- Newer drugs (Delamanid) containing regimen has been in troduced in 7 states based on their capacity, to reach maximum patients.

- Various interventions like Integrated mechanism for management of Adverse Drug Reactio (ADRs),  provision  of  patients  &  family  counselling  at  the  time  of  diagnosis  and  durin course of treatment, airborne infection control as well as grievance redressal system a implemented to improve patient compliance.

- Private  sector  engagement  is  being  promoted  to  reach  out  to  all  patients  who  are  s treatment  in  the  private  s ector  and  efforts  are  being  made  to  provide  them  all  diagnosti treatment  and  care  facilities,  including  public  health  action  such  as  counselling,  n support, contact tracing etc.

(d): The funds provided/released to States/UTs for the last three years and current year i.e. 2015- 16,2016 - 17 and 2018 - 19 is placed at Annexure II

(e): Review of activities related to prevention and management of drug resistant TB i integral part of  RNTCP, regularly conducted at National/ State/ District levels through various mechanisms like:

- Desk Review
- Review Meetings
- State Internal Evaluations (SIE)
- Central Internal Evaluations (CIE)
- Focussed thematic reviews

Through these meetings, gaps in the implementation of RNTCP policies are identifi and corrective measures taken accordingly.

## Annexure -I

| Name of state       | Number of MDR - TB casesnotified   |   Number of MDR - TB casesnotified | Number of MDR - TB casesnotified   |
|---------------------|------------------------------------|------------------------------------|------------------------------------|
|                     | 2016                               |                               2017 | 2018 #                             |
| Andaman & Nicobar   | 56                                 |                                 54 | 68                                 |
| Andhra Pradesh      | 946                                |                                892 | 1829                               |
| Arunachal Pradesh   | 182                                |                                197 | 163                                |
| Assam               | 409                                |                                410 | 575                                |
| Bihar               | 1914                               |                               1848 | 4055                               |
| Chandigarh          | 73                                 |                                 59 | 47                                 |
| Chhattisgarh        | 242                                |                                328 | 321                                |
| Dadra &Nagar Haveli | *                                  |                                 19 | 33                                 |
| Daman &Diu          | *                                  |                                  8 | 11                                 |
| Delhi               | 1367                               |                               1074 | 1474                               |
| Goa                 | 49                                 |                                 54 | 66                                 |
| Gujarat             | 2437                               |                               2266 | 3255                               |
| Haryana             | 589                                |                                856 | 1581                               |
| Himachal Pradesh    | 250                                |                                222 | 250                                |
| Jammu &Kashmir      | 124                                |                                155 | 120                                |
| Jharkhand           | 392                                |                                595 | 892                                |
| Karnataka           | 1338                               |                               1182 | 1770                               |
| Kerala              | 213                                |                                236 | 226                                |
| Lakshadweep         | *                                  |                                  0 | 0                                  |
| Madhya Pradesh      | 1794                               |                               1870 | 2981                               |
| Maharashtra         | 6286                               |                               8465 | 7185                               |
| Manipur             | 60                                 |                                 54 | 26                                 |
| Meghalaya           | 225                                |                                200 | 304                                |
| Mizoram             | 50                                 |                                 62 | 97                                 |
| Nagaland            | 47                                 |                                 66 | 105                                |
| Odisha              | 229                                |                                328 | 483                                |
| Puducherry          | 14                                 |                                 15 | 16                                 |
| Punjab              | 616                                |                                554 | 831                                |
| Rajasthan           | 2118                               |                               2402 | 4366                               |
| Sikkim              | 231                                |                                233 | 206                                |
| Tamil Nadu          | 1546                               |                               1492 | 1708                               |
| Telangana           | 726                                |                                961 | 1123                               |
| Tripura             | 13                                 |                                 30 | 27                                 |
| Uttar Pradesh       | 6928                               |                               9138 | 15573                              |
| Uttarakhand         | 364                                |                                448 | 539                                |
| West Bengal         | 1992                               |                               1832 | 3213                               |
| Grand Total         | 33820                              |                              38605 | 55450                              |

## Revised National TB Control Programme State wise Releases

| Sl.No.   | Name of the State / UT   | 2015-16 Releases   | 2016-17 Releases   | 2017-18 Releases   | 2018-19 Releases (till 31.01.2019)   |
|----------|--------------------------|--------------------|--------------------|--------------------|--------------------------------------|
| Sl.No.   | Name of the State / UT   | Cash               | Cash               | Cash               | Cash                                 |
| 1        | Andhra Pradesh           | 1817.88            | 1817.88            | 3270.00            | 1882.00                              |
| 2        | Andaman & Nicobar        | 87.36              | 98.25              | 168.00             | 0.00                                 |
| 3        | Arunachal Pradesh        | 495.37             | 371.53             | 709.00             | 960.00                               |
| 4        | Assam                    | 1360.43            | 1360.43            | 3006.00            | 2636.00                              |
| 5        | Bihar                    | 2126.81            | 2835.74            | 2711.00            | 2934.00                              |
| 6        | Chandigarh               | 146.14             | 255.49             | 142.00             | 284.00                               |
| 7        | Chattisgarh              | 898.84             | 1198.45            | 2430.00            | 2235.00                              |
| 8        | D & N Haveli             | 60.87              | 68.6               | 88.00              | 127.00                               |
| 9        | Daman & Diu              | 43.55              | 32.66              | 53.00              | 82.00                                |
| 10       | Delhi                    | 1595.39            | 934.27             | 2721.00            | 1659.00                              |
| 11       | Goa                      | 58.25              | 87.38              | 152.00             | 121.00                               |
| 12       | Gujarat                  | 2221.07            | 3018.88            | 5578.00            | 2298.00                              |
| 13       | Haryana                  | 1007.26            | 1157.26            | 1256.00            | 2584.00                              |
| 14       | Himachal Pradesh         | 584.12             | 565.12             | 1016.00            | 908.00                               |
| 15       | Jammu & Kashmir          | 703.91             | 938.55             | 1778.00            | 1681.00                              |
| 16       | Jharkhand                | 1087.07            | 1449.43            | 1949.00            | 1500.00                              |
| 17       | Karnataka                | 1303.43            | 3571.14            | 4922.00            | 4420.00                              |
| 18       | Kerala                   | 1133.56            | 928.91             | 1749.00            | 2072.00                              |
| 19       | Lakshadweep              | 37.35              | 28.00              | 32.00              | 71.00                                |
| 20       | Madhya Pradesh           | 2706.44            | 2618.48            | 3343.00            | 4200.00                              |
| 21       | Maharashtra              | 6417.95            | 6304.95            | 7621.00            | 6524.00                              |
| 22       | Manipur                  | 413.41             | 310.00             | 639.00             | 951.00                               |
| 23       | Meghalaya                | 304.35             | 304.35             | 732.00             | 740.00                               |
| 24       | Mizoram                  | 348.10             | 261.08             | 613.00             | 825.00                               |
| 25       | Nagaland                 | 381.41             | 286.06             | 705.00             | 889.00                               |
| 26       | Orissa                   | 1247.84            | 1663.79            | 3827.00            | 1721.00                              |
| 27       | Puducherry               | 196.61             | 76.73              | 200.00             | 126.00                               |
| 28       | Punjab                   | 1056.64            | 792.48             | 1297.00            | 2015.00                              |
| 29       | Rajasthan                | 2049.13            | 1536.85            | 2916.00            | 2120.00                              |
| 30       | Sikkim                   | 202.40             | 202.40             | 323.00             | 452.00                               |
| 31       | Tamil Nadu               | 2400.74            | 2244.74            | 5360.00            | 4100.00                              |
| 32       | Tripura                  | 242.53             | 242.53             | 164.00             | 470.00                               |
| 33       | Uttar Pradesh            | 9160.51            | 10610.98           | 19113.00           | 6696.00                              |
| 34       | Uttrakhand               | 571.80             | 951.8              | 850.00             | 1112.00                              |
| 35       | West Bengal              | 2875.60            | 3217.15            | 3142.00            | 4463.00                              |
| 36       | Telangana                | 974.39             | 974.39             | 2561.00            | 2766.00                              |
|          | Total                    | 48318.51           | 53316.73           | 87136.00           | 68624.00                             |

(Rs. In lakhs)