Introduction :

This blog is to make you familiar with the disease which was once considered as one of the most dreadful diseases, Tuberculosis. Before Talking about Management Systems and Data Handling of Tuberculosis(TB), first it’s important to know about Tuberculosis.

So starting from the root, Tuberculosis (TB) is a dormant dreadful infectious bacterial disease caused by MTB(Mycobacterium Tuberculosis Bacteria) that most often affects the lungs. However, it’s not only restricted to lungs, but it may also affect the brain, spine, kidneys, pleura (the covering of the lungs), in the bones, the urinary tract and sexual organs, the intestines
and even in the skin.

Types of TB :

1. Latent TB :
   It is the condition when a person has TB infection but the bacteria remain inactive
   in their body and shows no symptoms. Latent TB is not contagious. But it has a chance of
   becoming active.
2. Active TB :
   It’s a condition when the TB bacteria multiply in the patient’s body, causing them to develop the symptoms of tuberculosis. If one’s lungs get infected with active TB, he/she can easily spread the disease to others. TB is a contagious disease; i.e. it’s spread from person to person through the most common medium as air. When a patient with lung TB coughs, sneezes or spits, he/she propels the TB germs into
   the air. A healthy person needs to inhale only a few of these germs to get infected.

Symptoms :
● A persistent cough of more than two weeks that brings up phlegm and blood at
times.
● Breathlessness, mild at beginning and gradually gets worse.
● Lack of appetite and weight loss.
● Fever with a high temperature of 38ºC (100.4ºF) or above.
● Extreme tiredness or fatigue.
● Night sweats.
● Chest pains.

Causes and Risk Factors:
Other factors include:
● Tobacco use
● Malnutrition
● Alcoholism
● Diabetes
● End-stage kidney disease

● Certain cancers
● Cancer treatment, such as chemotherapy
● Immunosuppressive drugs taken to prevent organ transplant rejection
● HIV/AIDS​
Diagnostics:
There are a number of TB tests currently available for diagnosing TB. Three of these are now recommended in the new National TB Plan to be used for adults in India who might have pulmonary TB.
The three tests for Pulmonary TB(TB in Lungs) are

1. Sputum Smear Microscopy : Samples of mucus and phlegm are checked for the
   presence of bacteria.
2. Chest X -ray : This uses radiation to create an image of lungs. Few changes in the
   structure of lungs, which of lungs are visible on the X-ray.
3. Drug Susceptibility Testing: It provides a definitive diagnosis of drug- resistant TB.
4. CB-NAAT test : CBNAAT (Cartridges Based Nucleic Acid Amplification Test) is
   used to diagnose of MDR-TB and TB in high risk populations such as presumptive TB
   cases in PLHIV (people living with the HIV), EP-TB (extra-pulmonary TB) and pediatric
   populations. The CB NAAT machines are placed at most of the districts in the country.
   Tests for TB of extra pulmonary sites(TB in other parts or Organs) includes :
   ● Computerized Tomography (CT) scan: A series of X-rays of the body is taken at
   slightly different angles and a computer puts the images together to create a
   detailed picture of the inside of the body.
   ● Magnetic resonance imaging (MRI) scan: A magnetic field and radio waves are
   used to produce detailed images of the inside of the body.
   ● Ultrasound scan: High-frequency sound waves create an image of part of the
   inside of the body.
   ● Urine tests
   ● Biopsy: Small tissue sample is taken from the affected site and tested for the
   presence of disease.
   TB Management System in India:

RNTCP takes necessary measures for initiation of proper anti-TB treatment in
both, public or private health services and sustaining all TB patients on complete
treatment with a patient friendly system and social support.
All health care providers, both public and private providers, laboratories and
chemists have to notify the TB cases to local government health authorities. Notification
of cases is done with the case-based web-based TB surveillance system called
“NIKSHAY” for both government and private health care
facilities. Enhancements under NIKSHAY are for adherence support, logistics
management,patients support, direct data transfers, and to support interface agencies.

Free Drugs and Health Schemes :
Free TB drugs or medications are provided under the TB programme in form of
daily fixed dose combinations (FDCs) for all TB cases on the strategy of Directly
Observed Therapy (DOT).
DOT is a strategy, to improve adherence by any person observing the patient
taking medications in real time. The treatment observer could be a friend, a relative or a
lay person who works as a treatment supervisor or supporter and needs not to be a
healthcare worker. If treatment remains incomplete, patients may not be cured and drug
resistance may develop.
For new TB cases, the treatment in intensive phase (IP) consists of eight weeks
and in continuation phase, drugs are continued for 16 weeks.
For previously treated cases of TB, the intensive phase (IP) is 12 weeks. In the
continuation phase, drugs are continued for another 20 weeks as daily doses.
The continuation phase may be extended by 12-24 weeks for both new and
previously treated cases in certain forms of TB like skeletal, disseminated TB based on
the clinical decision of the treating physician.

Nikshay Poshak Yojana:
To encourage good nutrition during the TB treatment period, the financial incentive of Rs.500/- per month is provided as a nutritional support to each TB patient for the duration for

which the patient is on anti-TB treatment. These incentives are delivered through direct benefit transfer (DBT) scheme to bank accounts of the beneficiaries.
Public-Private Partnership:
For proper TB prevention and care, private providers are provided incentives for
TB case notification, and also for ensuring treatment adherence and treatment completion. The incentives are provided through direct beneficiary transfer.
The Incentives given to the Private Sector TB Care Provider are as follows:
● Rs 250/- on notification of each TB case diagnosed as per Standards for TB Care in India (STCI).
● Rs 250/- on completion of every month of treatment for each patient.
● Rs 500/- on completion of the entire course of TB treatment for each patient.
● Rs 2750/ for notification and management of each drug-sensitive patient over 6-9
months as per STCI.
● Rs 6750/-for notification and correct management of each drug-resistant case
which is over 24 months as per STCI.

TB was considered to be one of the most dreadful diseases over a decade ago, but now due to the developing awareness, public health schemes, science and technology it’s easily preventable and curable.