Lok Sabha Question No. 1081 (UNSTARRED), answered on 2016-04-29
Subject: Eradication of TB
Ministry: HEALTH AND FAMILY WELFARE
Asked by: HEENA VIJAYKUMAR GAVIT, NAGENDRA KUMAR PRADHAN, SUPRIYA SADANAND SULE, SHIVAJI ADHALRAO PATIL, VIJAYSINH MOHITE PATIL, SHRIKANT EKNATH SHINDE, ANANDRAO  ADSUL, C.S. PUTTARAJU, DHARMENDRA YADAV, RAJEEV SHANKARRAO SATAV, JITENDRA CHAUDHURY, DHANANJAY BHIMRAO MAHADIK, T. RADHAKRISHNAN, NAGARAJAN P., JAYSHREEBEN  PATEL

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

LOK SABHA UNSTARRED  QUESTION NO. 1081 TO BE ANSWERED ON 29 TH APRIL, 2016

## ERADICATION OF TB

## 1081. DR. HEENA VIJAYKUMAR GAVIT:

SHRI NAGENDRA KUMAR PRADHAN:

SHRIMATI SUPRIYA SULE:

SHRI ADHALRAO PATIL SHIVAJIRAO:

SHRI MOHITE PATIL VIJAYSINH SHANKARRAO:

DR. SHRIKANT EKNATH SHINDE:

SHRI ANANDRAO ADSUL:

SHRI C.S. PUTTA RAJU:

SHRI DHARMENDRA YADAV:

SHRI SATAV RAJEEV:

SHRI JITENDRA CHAUDHURY:

SHRI DHANANJAY MAHADIK:

SHRI T. RADHAKRISHNAN:

SHRI P. NAGARAJAN:

SHRIMATI JAYSHREEBEN PATEL:

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

- (a) whether India is the tuberculosis (TB) epidemic centre having 23 per cent of global cases of TB despite existing programme for eradication in the country and if so, the details thereof;
- (b) whether the Government made any survey/ assessment to find out the factors responsible for such  upward  trend  of  TB/ Multi  drugs  resistant  TB  cases  and  if  so, thedetails  and  outcome thereof;
- (c) whether four out of the six drugs given to MDR - TB  patients  under  the Revised National Tuberculosis Control Programme (RNTCP) are ineffective in nearly 70 per cent of patients, if so, thedetails thereof and the reasons th erefor;
- (d) whether the Government is considering to effect changes in the RNTCP, if so, the details thereof and if not, the reasons therefor; and
- (e) the details of TB cases reported, funds allocated under the programmes/ schemes to eradicate TB, new in itiative and research conducted during the last three years, State/UT/year - wise?

## ANSWER THE MINISTER OF HEALTH AND FAMILY WELFARE (SHRI JAGAT PRAKASH NADDA)

(a) & (b): As per the World Health Organization (WHO) Global TB report 2015, in the year 2014, 2.2 million cases were estimated in India accounting for 23 percent of global cases.

However, this high number is because of our large population even though the incide prevalence and mortality due to TB in India has been consistently declining over the last 15 yea s and  India  has  also  achieved  the  Millennium  Development  Goal  and  has  halved  the  TB prevalence and mortality as compared to 1990 levels.

Amongst the 22 high Burden countries in the world India ranks 17th in incidence r According  to  the  WH O  Global  TB  Reports  from  2013  to  2015,  the  estimated  proportion  of Multi - Drug  Resistant  TB  Cases  in  India  is  not  increasing.  The  proportion  of  MDR  cases estimated to be in between 1.9 -2.6 percent among new TB cases and between 11 -19 percent among re treatment cases.

However, the detection of MDR - TB cases has been increasing due to availability of more diagnostic  facilities  for  MDR  TB  and  coverage  of  the  entire  country  through  Programma Management  of  Drug  Resistant  TB  under  the  Revised  National  TB  C ontrol  Programme (RNTCP), achieved between 2007 and 2013.

(c): No.

(d): RNTCP was launched more than 20 years back. Since then, changes have been effected in the programme from time to time, so as to further improve the programme and its reach.

(e): The details  of  the  TB  cases  reported  and  funds  allocated  State/UT  wise  and  n initiatives during the last three years are at annexure I, II & III .

## State/UT wise TB cases registered in the last three years

| S No   | State/UTs            | 2013    | 2014    |    2015 |
|--------|----------------------|---------|---------|---------|
| 1      | Andaman & Nicobar    | 738     | 756     |     584 |
| 2      | Andhra Pradesh       | 103707  | 88638   |   61758 |
| 3      | Arunachal Pradesh    | 2500    | 2691    |    2748 |
| 4      | Assam                | 35624   | 38317   |   38014 |
| 5      | Bihar                | 67020   | 67991   |   64928 |
| 6      | Chandigarh           | 2890    | 2869    |    3143 |
| 7      | Chhattisgarh         | 25889   | 28864   |   29950 |
| 8      | Dadar & Nagar Haveli | 411     | 450     |     487 |
| 9      | Daman & Diu          | 742     | 279     |     284 |
| 10     | Delhi                | 50727   | 54037   |   55260 |
| 11     | Goa                  | 1778    | 1660    |    1599 |
| 12     | Gujarat              | 74086   | 77395   |   82585 |
| 13     | Haryana              | 38104   | 39498   |   40913 |
| 14     | Himachal Pradesh     | 13691   | 14441   |   14333 |
| 15     | Jammu & Kashmir      | 11038   | 10243   |    9873 |
| 16     | Jharkhand            | 34941   | 35907   |   34792 |
| 17     | Karnataka            | 61446   | 61328   |   59932 |
| 18     | Kerala               | 24204   | 23439   |   22785 |
| 19     | Lakshadweep          | 23      | 27      |      40 |
| 20     | Madhya Pradesh       | 92420   | 100034  |  103108 |
| 21     | Maharashtra          | 137237  | 135465  |  130874 |
| 22     | Manipur              | 2329    | 2198    |    1881 |
| 23     | Meghalaya            | 5002    | 4944    |    4674 |
| 24     | Mizoram              | 2005    | 1993    |    2088 |
| 25     | Nagaland             | 3339    | 3298    |    3316 |
| 26     | Orissa               | 45269   | 45777   |   45814 |
| 27     | Pondicherry          | 1458    | 1409    |    1288 |
| 28     | Punjab               | 37258   | 38152   |   38625 |
| 29     | Rajasthan            | 94698   | 94908   |   90296 |
| 30     | Sikkim               | 1637    | 1630    |    1400 |
| 31     | Tamil Nadu           | 80407   | 84570   |   80543 |
| 32     | Telangana            | -       | 18655*  |   39498 |
| 33     | Tripura              | 2540    | 2507    |    7394 |
| 34     | Uttar Pradesh        | 256733  | 255364  |  246589 |
| 35     | Uttarakhand          | 13700   | 14429   |   14317 |
| 36     | West Bengal          | 90423   | 89819   |   87468 |
|        | TOTAL                | 1416014 | 1443942 | 1423181 |

| S No   | State/UTs         | 2013     |     2014 |     2015 |
|--------|-------------------|----------|----------|----------|
| 1      | Andaman & Nicobar | 87.15    |    87.15 |    90.9  |
| 2      | Andhra Pradesh    | 4907.34  |  2861.96 |  2200.34 |
| 3      | Arunachal Pradesh | 565.36   |   565.36 |   552.32 |
| 4      | Assam             | 4303.74  |  4303.74 |  2527.13 |
| 5      | Bihar             | 4094.59  |  4094.59 |  2963.81 |
| 6      | Chandigarh        | 154.54   |   154.54 |   156.14 |
| 7      | Chattisgarh       | 1440.6   |  1440.6  |  1401.08 |
| 8      | D & N Haveli      | 68.05    |    68.05 |    72.03 |
| 9      | Daman & Diu       | 43.47    |    43.47 |    45.98 |
| 10     | Delhi             | 1820.02  |  1820.02 |  1705.12 |
| 11     | Goa               | 116.34   |   116.34 |   127.78 |
| 12     | Gujarat           | 4857.52  |  4857.52 |  3298.04 |
| 13     | Haryana           | 1292.26  |  1292.26 |  1207.93 |
| 14     | Himachal Pradesh  | 581.22   |   581.22 |   837.57 |
| 15     | Jammu & Kashmir   | 943.43   |   943.43 |  1038.26 |
| 16     | Jharkhand         | 1783.56  |  1783.56 |  1512.16 |
| 17     | Karnataka         | 3195.23  |  3195.23 |  3186.19 |
| 18     | Kerala            | 1440.91  |  1440.91 |  1395.33 |
| 19     | Lakshadweep       | 35.39    |    35.39 |    37.95 |
| 20     | Madhya Pradesh    | 3081.84  |  3081.84 |  2880.71 |
| 21     | Maharashtra       | 6657.74  |  6657.74 |  8085.75 |
| 22     | Manipur           | 657.22   |   657.22 |   524.57 |
| 23     | Meghalaya         | 550.67   |   550.67 |   427.62 |
| 24     | Mizoram           | 414.39   |   414.39 |   392.75 |
| 25     | Nagaland          | 596.41   |   596.41 |   460.49 |
| 26     | Orissa            | 2141.81  |  2141.81 |  1991.54 |
| 27     | Puducherry        | 183.56   |   183.56 |   187.88 |
| 28     | Punjab            | 1207.19  |  1207.19 |  1273.22 |
| 29     | Rajasthan         | 3653.38  |  3653.38 |  2792.23 |
| 30     | Sikkim            | 242.98   |   242.98 |   426.92 |
| 31     | Tamilnadu         | 3131.84  |  3131.84 |  3367.31 |
| 32     | Telangana         |          |  2045.38 |  1672.53 |
| 33     | Tripura           | 583.71   |   583.71 |   290.2  |
| 34     | Uttar Pradesh     | 7631.54  |  7631.54 |  7350.9  |
| 35     | Uttrakhand        | 661.14   |   661.14 |   651.62 |
| 36     | West Bengal       | 3834.82  |  3834.82 |  3187.7  |
|        | TOTAL             | 66960.96 | 66961    | 60320    |

## RNTCP newer initiatives in the last three years

|   Year | Initiative                                                                                                                                                                                                                                                                                                                                                                                                         |
|--------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
|   2013 | 1. Nationwide coverage of Programmatic Management of Drug Resistant Tuberculosis(PMDT)                                                                                                                                                                                                                                                                                                                             |
|   2013 | 2. Integration of Pharmacovigilance programme of India and of RNTCP patient safety i n 17 Drug Resistant T uberculosis centers                                                                                                                                                                                                                                                                                     |
|   2013 | 3. Cartridge based nucleic acid amplification technique (CBNNATtest ) machines services expanded to 40 sites across country                                                                                                                                                                                                                                                                                        |
|   2013 | 4. Policy of prioritizing to offer rapid molecular cartridge based amplification technique test (CBNNAT) to all presumptive TB cases PLHIV for early diagnosis of TB as well as Rif ampicinresistance across country.                                                                                                                                                                                              |
|   2014 | 1. Module for PMDT andLaboratories in Nikshay, the case based web programme for surveillance of TB started across the country.                                                                                                                                                                                                                                                                                     |
|   2014 | 2. Launch of the first national anti - TB drug resistance survey.                                                                                                                                                                                                                                                                                                                                                  |
|   2014 | 3. Accelerating access to quality TB diagnosis for pediatric cases cities of New Delhi, Kolkata, Chennai and Hyderabad.                                                                                                                                                                                                                                                                                            |
|   2014 | 4. Center of excellence for -Extra Pulmonary Tuberculosis started in the Medicine, All India Institute of Medical Sciences, New Delhi.                                                                                                                                                                                                                                                                             |
|   2014 | 5. Expansion of CBNAAT sites for rapid diagnosis of MDR TB to 80 country.                                                                                                                                                                                                                                                                                                                                          |
|   2014 | 6. Release of 'Standards for Tuberculosis Care in India'                                                                                                                                                                                                                                                                                                                                                           |
|   2015 | 1. Call to Action for TB Free India launched. Government of India's efforts accelerate TB prevention and care in partnership with all emphasysed.                                                                                                                                                                                                                                                                  |
|   2015 | 2. Implementation of 'Intensified TB case finding and appropriate treatment' focusing on comprehensive strategies to reduce the burden of TB living with HIV AIDS (PLHA) with single window service delivery for HIV, rapid diagnosis with CB NAAT, Airborne Infection Control Anti - Retroviral Treatment center and Fixed Dose Combination daily Tuberculosis across 30 high burden ART Centers i n five S tates |
|   2015 | 3. Procurement of 300 CBNAAT machines for rapid diagnosis of TB and Rifampicin resistance in addition to 121 existing CB NAAT machines l inking all districts in the country to rapid TB diagnostic                                                                                                                                                                                                                |
|   2015 | 4. Introducing Baseline second line Drug Susceptibility testing under PMDT across the country.                                                                                                                                                                                                                                                                                                                     |
|   2015 | 5. Bedaquiline Conditional Access Programme inNew Delhi (2 sites), Ahmedabad, Chennai and Mumbai                                                                                                                                                                                                                                                                                                                   |
|   2015 | 6. Missed Call campaign initiated in the states of Punjab, Haryana, and Delhito disseminate information regarding Tuberculosis and available under RNTCP.                                                                                                                                                                                                                                                          |
|   2015 | 7. Launch of RNTCP Media campaign for dissemination of information Tuberculosis and the availability of services across country.                                                                                                                                                                                                                                                                                   |