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

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

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.

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

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

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