rntcp training course for program manager module 5 - 9

7/25/2019 RNTCP Training Course for Program Manager Module 5 - 9

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MODULE 5 to 9

Module 5 : 1-82

Programme Monitoring

Module 6 : 83-153

Programme Management

Module 7 : 157-198

Programme Logistics Management Including preventivemaintenance

Module 8 : 201-221

Program Supervision and Evaluation

Module 9 : 225-244

Managerial Skills for TB Program Managers


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Table of Contents

Module - 5

Programme Monitoring

Learning Objectives .................................................................................................................... 1

Follow the Report or Feedback .................................................................................................. 2

Analysis of the quarterly report of case finding ......................................................................... 10

Quarterly report on sputum conversion .................................................................................... 13

Quarterly report on treatment outcome .................................................................................... 20

General Information ................................................................................................................... 22Procedure for preparing & reviewing quarterly report on Treatment outcome ....................... 28

TB treatment outcome of HIV positive patients ........................................................................ 29

Report on programme management and logistics ..................................................................... 33

PHI level monthly report on programme management and logistics ........................................ 34

Quarterly report on programme management and logistics TU level ....................................... 38

Quality of DOTS implementation ............................................................................................... 40

Medications, Consumables and equipments ............................................................................. 41

Quarterly report on programme management and logistics state level .................................... 45

Analysis of quarterly reports ...................................................................................................... 49

Provision of feedback ................................................................................................................. 51

Method of providing feedback ................................................................................................... 52Time Schedule for feedback ........................................................................................................ 52

Record to be used for preparing the reports .............................................................................. 52

Quarterly report on programme management and logistics state level Format ....................... 71


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Training Course for Program Manager

1

MODULE 5

Learning objectives.

Monitoring of the programme

Flow of reports including time schedule

Preparation of quarterly reports on Case finding

Sputum conversion of new and previously treated cases

Treatment outcome

Programme logistics and management Data management, including analysis of programme indicators, quality of

reports and actionable feedback

Electronic data management system in RNTCP

Introduction

In the previous module we have learnt about registering of cases in TB register andmonitoring of the treatment of the patient till the declaration of the treatment outcome. In theensuing module we will learn how to utilize the information recorded in the TB register for

generation of periodical reports on the programme activities and learn to monitor theperformance of the programme through these reports.

Monitoring: It is a centralized systematic ongoing collection, collation, analysis andinterpretation of the data with a view to detect any deviations from the expected normsfollowed by dissemination of feedback information to the peripheral authorities for correctiveactions.

Monitoring is a process of observing whether an activity or service is occurring as planned.Monitoring aims at identifying any diversion from a planned course of action and allowingtimely solutions to problems In management, the continuous oversight of the

implementation of an activity seeking to ensure that input deliveries, work schedules,targeted outputs, and other required actions are proceeding according to plan.

Monitoring of the programme

Monitoring is an essential component of the programme implementation. It is undertaken atdifferent levels:

1. National LevelCentral TB Division

2. State Level - State Health Society and State TB Cell with the support of STDC

3. District Level - District Health Society and District TB Officer

4. TB Unit LevelMedical OfficerTB Control

5. Peripheral health institutionsMedical Officer (In-charge)


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Maintenance of accurate records and timely preparation and dispatch of validated reports isa prerequisite for successful monitoring. Different formats of records and the monthly PHIreport have been described in detail in relevant modules.

Quarterly reports

Under the monitoring system there are four types of quarterly reports. These reportsfurnish information on case finding, sputum conversion and treatment outcome of aquarterly cohort of patients. The fourth one is a quarterly report on the programmemanagement and logistics report (PMR) generated at different levels PHI (monthly), TU,District and State.

Flow of reports and feedback:

The monthly PHI level PMR is prepared by the MO of the PHI and sent to the district and

TU. At the TU a quarterly PMR is prepared by the MOTC with support of STS/STLS andsent to the DTO.

Quarterly reports on case finding, sputum conversion and treatment outcome are preparedat the TU level from the TB register. The STS is responsible for preparing the reportsmentioned above under the overall supervision of the MOTC at TU level. The MOTC isresponsible for validating and signing the reports and sent it to DTO.

The quarterly reports received from all the TUs in the district are consolidated atDistrict TB Centre. District TB Officers in turn are responsible for reporting the same to thestate level authorities [STC and STDC] and CTD. The reports are consolidated at STC

and sent to CTD. The reports are analysed at the STC/STDC and feedback given todistricts. The quarterly reports are also analysed by CTD and feedback is provided to thestate for corrective actions. All the above reporting activities are undertaken on a quarterlybasis from TU to central level. A diagrammatic flow chart is provided below depicting themonitoring process.

Flow of reports

Tuberculosis Unit

District TB Centre

Central TB Division State TB Cell

uarterl Re orts

Quarterly Reports

Feed Back

Electronic TransmissionFeed back


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Cohort: In RNTCP, a cohort is a group of patients who were registered for treatment in aspecified area (TU, district, state, country) over a specified period of time (quarterly,annual)

Quarter

. The date of registration in the TB register is used to demarcate the cohort.

The specified quarterly cohort periods are:

From To

First 1stJanuary 31stMarch

Second 1s April 30 June

Third 1s July 30 September

Fourth 1s October 31s December

Quarterly report on Case finding:

Type of cases to be reported

In this report, total number of all tuberculosis patients registered in a quarter under DOTSregimen viz., new or previously treated are recorded. The patients put on RNTCP Non-DOTS regimen and transfer-in cases are not reflected in the report though they areregistered in TB register. This information is compiled at the level of the TB Unit from theTB Register.

Expected t imel ine for subm it t ing the reports

The monthly and quarterly reports should be completed and submitted to higher levels asmentioned below:

Quarter Preparation andsubmission of reports

from PHI

Preparation andsubmission of reports

from TU to District

Last date forsubmissionof district

reports fromDistrict to

STC/STDC

and CTD

Last date forsubmission ofconsolidatedstate reportsfrom State to

CTD

First By the 5thof next month 7thApril 24thApril 30thApril

Second By the 5 of next month 7 July 24 July 30 July

Third By the 5 of next month 7 October 24 October 30 October

Fourth By the 5thof next month 7thJanuary 24thJanuary 30thJanuary


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Description of the format The format is to be referred while reading the quarterlyreports.

The quarterly report on case finding comprises of:

a. General information reflecting

The quarter under report (eg. 1Q, 2Q, 3Q, 4Q suffixed by calendar year)

Eg. Patients registered during the first quarter will be reported in the first month ofthe second quarter to different levels as furnished in the table above.

Name of the TB Unit and its code number (as assigned by CTD)

Name of the reporter (Name of the MO-TC/DTO/STO)

Date of completion of the form (self explanatory)

b. BLOCK 1: This block contains the total number of new and previously treated cases

diagnosed and registered in a particular quarter.New cases are subdivided into four columns comprising:

New smear positive pulmonary TB

New smear negative pulmonary TB

New extra pulmonary TB

New others

Previously treated cases are subdivided into four columns comprising

Relapse

Failure Treatment after default

Others

Break-up of cases in the age group 0-14, 15 years and above and their total is provided forboth new and previously treated cases. Sex-wise break up is also provided for all newcases and relapses among previously treated cases.

Block 1: All new and previously treated patients registered in the quarter.

Age

New cases Previously Treated Cases

TotalSmear

positivepulmonary

TB

Smearnegative

pulmonaryTB

Extrapulmonary

TBOthers Relapse

TreatmentFailure

TreatmentAfter

DefaultOthers

0-14 Yrs

15 Yrs

Total

Male

Female

Total

c. BLOCK 2:Break up of new smear positive pulmonary tuberculosis cases, age wise andsex wise is provided in Block 2. This block facilitates drawing inferences on theepidemiological trend and efficiency of the TB control measures currently in force.


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Block 2: New Smear Positive Pulmonary TB cases only: from Block 1

Age group 0 14 15 24 25- 34 35 44 45 - 54 55 64 65 Total

Male

FemaleTotal

d. BLOCK 3: The programme monitors the proportion of TB patients getting tested for HIVto know prevalence of HIV infection among TB patients, thus ensuring appropriate HIVcare in TB patients. Block 3 furnishes information on TB-HIV collaborative activities andprovides information on total number of registered TB cases tested for HIV either beforeor during treatment and number found to be infected.

Block 3: TB/HIV Collaboration

Of all Registered TB cases, Number

known to be tested for HIV before orduring the TB treatment(a)

Of (a)Number known to be HIV infected

(b)

Procedure for preparing & reviewing the quarterly report on case findings

BLOCK 1:

The pages pertaining to the quarter to be reported & reviewed are located in the TBregister. It can easily be located by going through the pages since the cases areregistered on a new page every quarter. For eg. Patients registered from 1 stJanuary

31stMarch.

Identify new and previously treated TB cases by age and sex in each page. Fill theirexact number in the appropriate box provided under summary at the bottom on the leftside of TB register on each page as soon as the page is completed.

Count the total number of similar cases in all the summary boxes of each page of the TBregister for the age group for the entire quarter. Their exact number (sum) is entered inthe appropriate boxes of the Block 1 of the quarterly report on case finding. For eg.smear positive cases in the age group of 0-14 years of all the pages for the quarter inthe TB register are added and total of that is recorded in the box in Column 1 against 0-14 years row. The same procedure is adopted for all the types of cases.

BLOCK 2

This block contains age and sex-wise break up of only new smear positive casesregistered in a specific quarter of Block 1.

The new smear positive cases registered in all the pages pertaining to the quarter of theTB register are identified in the seven age groups (0-14, 15-24, 25-34, 35-44, 45-54,55-64, 65 & above) provided in the Block 2. Worksheet provided in the module may beused for this purpose. These are internationally recognized age groups.

The number of new smear positive cases males, females and total should match with

those reported Block1


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BLOCK 3

The purpose of this block is to provide information on the process of ascertaining HIVstatus of TB patients.

Total number of TB patients whose HIV status is known either before diagnosis orduring diagnosis and treatment is to be reflected in column (a). Enter the sum of all TBpatients registered in the quarter with their HIV status recorded as either positive (P) ornegative (N).

Total number of TB cases found HIV positive either before diagnosis or during diagnosisand treatment is to be reflected in column (b). The sum of all TB patients registered inthe quarter with their HIV Status recorded as positive (P) in the TB register.

It is to be noted that number of patients known to be HIV positive may be less than thenumber that will ultimately be reported in the treatment outcome quarterly report, as it isexpected that some will undergo HIV testing during the course of treatment after the

case finding report is submitted.

EXERCISE 1

Using the five pages of the Tuberculosis Register in Exercise Workbook 3, complete all thethree Blocks of the Quarterly Report on Case Finding. Use the information from thecorresponding summary table at the bottom of the Tuberculosis Register for completing theworksheets meant for Block 1, 2 & 3 respectively. The total of all types of cases thusarrived at will be transferred on to the appropriate cells in the block 1,2 & 3 of the quarterlyreport on new and previously treated cases.

For completing worksheet, one tally mark (/) is put for each case. Four tally marks areplaced consecutively (////). Subsequently, when a fifth case is recorded four tally marksalready put are crossed (-). In this way each such group represents five cases. This methodof tally marking facilitates counting.

For convenience, easy understanding and execution of the exercise during training, it isrecommended that two trainees may be allotted one page of the TB register for exercise oncase finding. This can be tallied and entered in the Block 1 of the quarterly report on casefindings. This exercise will be facilitated by the facilitator.

WORKSHEET FOR COMPLETING BLOCK 1Review every page of the TB Register for the quarter being reported. Put a tally mark(/) inthe appropriate cell and give the totals in the space provided. The summary available onthe left bottom of the first page of the TB register will help in filling up this worksheet. M & Fbreak up not needed for Previously treated cases except Relapse


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Quarterly Report on Case Finding WORKSHEET FOR COMPLETING BLOCK 1

PageNo.

AgeGroup

New Cases Previously Treated Cases

NSP NSN NEP Others RelapseTreatment

Failure

TADPreviously

Treated

Others

M F M F M F M F M F M F M F M F

1

0-14Yrs.

2

3

4

5

Total

1

15

Yrs.

2

3

4

5

Total

WORKSHEET FOR COMPLETING BLOCK 2

Review every page of the TB Register for the quarter being reported. Put a tally mark(/) inthe appropriate cell below and give the totals in the space provided. Include only patientswho are new sputum smear positive pulmonary cases.

PageNo.

Age Group / Sex

0 14 15 24 25- 34 35 44 45 - 54 55 - 64 65 Total

M F M F M F M F M F M F M F M F

12

3

4

5

Total

Note: The total number of NSP cases in block 2 should be equal to total of NSP cases in block 1 of thequarterly report on new and previously treated cases.


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WORKSHEET FOR COMPLETING BLOCK 3

The summary table furnished at the bottom of the right side of the TB register will help infilling up of this worksheet. Total number of cases tested for HIV and number known to bepositive in each page are entered under cells a and b respectively. Sum total of a and bare entered in appropriate boxes of block 3 of the quarterly report.

PageNo.

Of all Registered TB cases, Numberknown to be tested for HIV before or

during the TB treatment(a)

Of (a)Number known to be HIV infected

(b)

1

2

3

4

5

Total

Note: TB patients whose HIV status is unknown and for whom information is not available are not to beincluded in cell (a).


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REVISEDNATIONALTUBERCULOSOSCONTROLPROGRAMME

QuarterlyReport

oncasefinding

(NewandPreviouslyTreate

dCasesofTuberculosis)

Patientsregisteredduring___

__________quarterof20_____

NameofTU

/Distric

t:____________

CodeNumber#:__

__________

Nameofthereporter:______

_____________________________

Signature:_______________

Dateofco

mpletionofthisform

Block1:Allnew

andpreviouslytreatedpatientsregisteredinthequa

rter

Newcases

PreviouslyTreatedCases

Total

Newsmear

positive

pulmonaryTB

Newsmear

negative

pulmonaryTB

Newextra

pulmonaryTB

Others

Relapse

Treatment

Failure

Tr

eatment

AfterDefault

Others

0-14Yrs

15Yrs

Total

Male

Female

Total

Block2:New

SmearPositive

PulmonaryTBcasesonly:fromcolumn

above

Age

014

1524

2534

35

44

4554

5564

65

Total

Male

Female

Total

Notes:Quarterly:

1st quarterJa

nuary,February,March

Block3:TB/HIVCollaboration

2ndquarterA

pril,May,June

3rdquarterJu

ly,August,September

4thquarterOctober,November,December

#CodeNumber-Identificationnu

mberofthearea.

OfallR

egisteredTBcases,Number

known

tobetestedforHIVbeforeor

d

uringtheTBtreatment

(a)

Of(a)

NumberknowntobeHIVinfected

(b)


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Table 1A: Programme Performance Indicators based on Quarterly Report on CaseFinding

Indicator Description Calculation

Case notification ratefor New smear-positivecases

The Case notification rate of newsmear-positive cases is the number ofnew smear-positive cases registered fortreatment per 100,000 population in ayear.

The Case notification rate is importantfor observing trends in case notificationover the years. This is calculated for ayear. This could be calculated forvarious age groups and sex.

In India, the estimated incidence of

cases (used in programme planning atnational level) is 75 New smear-positivecases per lakh per year. However thereare regional variations in this figure.

Numerator:The number of Newsmear-positive cases registered in ayear in a defined area (TU, districtstate or country). (If calculatedquarterly, annualize it by a multiplierof 4)

Denominator: The estimated totalmid-year population of the area inlakhs (TU, district, state or country).

Case detection rate forNew smear-positivecases

It is the proportion of notified NSPcases out of the estimated incidence ofsmear positive cases in that population.This is expressed as a percentage. Thisindicator should ideally not be used atlevels below the district.This is becauseof the heterogeneity of smear positiveTB incidence at local levels depending

on living conditions, socioeconomicstatus, migration etc.

One of the objective of RNTCP is toachieve and maintain a NSP CDR of atleast 70%.

Numerator: Annualized/annualNSP case notification rate X 100

Denominator: Estimated incidenceof smear positive cases /lakhpopulation

Other programme performance indicators from case finding reports include:

1. Proportion of new smear positive cases among all new pulmonary cases.

2. Proportion of new extra pulmonary TB cases among all new TB cases.

3. Proportion of smear positive previously treated cases among all smear

positive cases.4. Proportion of new pediatric cases among all new cases, etc.

It is important to note that these indicators are to be analyzed for trend and regionaldifferences and any unexpected deviations should prompt programme managers tolook at the reason for the deviations and take appropriate actions.

Analysis of the quarterly report on case finding:

Quarterly Report is evaluated for correctness, consistency and completeness. Forexample, the total in Block 1 for smear-positive new cases should be the same as the total

of Block 2.


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To analyze the data on new cases, the data of one quarter (or half a year or a whole year)is compared with the data for the same period of the previous year. Reasons for anyunexpected increase or decrease in the number of new cases registered are to beexplored. Similarly other indicators regarding Case Finding should be analyzed (Table1B).

When there are variations from what is expected, possible reasons for variations aresought. Some possible ways to investigate the reasons are listed below:

Table 1B: Case Finding Indicators and possible responses to the problems

Quarterly Report Indicator Possible Actions

Expected:

New smear-positivecase detection rate:

at least 70%

Reported:

Case detectionrate of Newsmear-positivecases is less than50%

Ensure that :

Community awareness is enhanced regarding thesymptoms of TB and availability of TB services.Encourage utilization of those services by thecommunity.

Sputum smear microscopy is accessible topatients. Adequate number of functional DMCs ineach TU. Where ever needed sputum collectioncenters are established and linked to the nearbyDMC.

Every TB suspect in all peripheral health facilitiesundergoes sputum smear examination

All contacts of sputum positive TB patients arebeing screened irrespective of the duration ofcough

The laboratory technician is trained.

Good quality sputum samples are collected fromthe suspects.

Two sputum smear examinations are done for allTB suspects.

Sputum smear microscopy is done as per standardoperating procedure (expected smear positivity

rate is 5%15%).Smear-negative slides, particularly those ofpatients placed on treatment are reviewedintensively.

All smear-positives cases recorded in theLaboratory Register are started on treatment andregistered in the Tuberculosis Register.

All health care providers are involved in RNTCP


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all new TB casesshould maintain asteady trend. Initiallythere may be an

upward trend due toprogrammeinterventions andultimately decline overthe years

national/stateaverage

All children in contact of smear positive patientsare screened for symptoms and signs of TB duringinitial home visit by health workers and referred tothe MO PHI for further investigation and

appropriate management.Pediatric PWB are available and are in use.

Indicators on TB-HIV status1. Proportion of registered TB patients with known HIV status.

(Total number of registered TB patients with Known HIV status/ Number of all registered TBpatients)X100

This proportion will indicate the TB HIV case finding efforts and an increasing trend is expected

with good TB-HIV collaboration.

2. Proportion of registered TB patients found to be HIV-positive.

(Total number of TB patients found to be HIV positive/Number of registered TB patients testedfor HIV)X100

This proportion indicates the HIV positivity among the tested TB patients.

This number also gives an indication on the requirement for HIV care.

Quarterly report on Sputum Conversion

(New and previously treated cases registered 4-6 months earlier)

Sputum Conversion rate at the end of the intensive phaseis a critical early indicator ofthe effectiveness of programme implementation. If smear-positive patients take treatmentunder direct observation in the intensive phase of treatment, sputum of nearly all patientswill convert to negative within three months.

Sputum examination at the end of the intensive phase is important because:

Sputum conversion is an early and sensitive indicator of the quality of programmeimplementation. A low conversion rate indicates need for intensive supervision.

Patients whose sputum smears are still found to be positive at the end of IntensivePhase, will receive another month of intensive phase of treatment, thereby improvingtheir chances for cure.

Documentation that patients are converting from smear-positive to smear-negative givespatients and health workers confidence in RNTCP.

The quarterly report on sputum conversion should be compiled by reviewing the patientsunder RNTCP DOTS, who were registered in TB Register 4-6 months earlier. For example,if the quarterly reports are being prepared on 7th October 2010, the sputum conversionreport should include the sputum smear-positive patients registered in 2nd Quarter 2010(April to June 2010). These are the patients who were included in the Quarterly Report onCase Finding of 2nd Quarter 2010.

Calculation of sputum conversion rate involves the following steps: The number of smear-positive patients of each type put on treatment under DOTS is

obtained from the Quarterly Report on Case Finding for the corresponding quarter.


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All patients started on treatment are included in the denominator, even if they havedied, defaulted, transferred out, or not had their sputum collected for examination.

The ratio is multiplied by 100 for obtaining percentage.

Sputum conversionrate =

No. of sputum smear-positive converted to sputumsmear-negative at the end of intensive phase*

x 100Total no. of sputum smear-positive patients

registered in that particular cohort.

*For calculating sputum conversion rate for new sputum smear-positive patients only, all those who converted at the endof IP (at the end of two months) and at the end of extended IP (at the end of three months) should be added to obtain thenumerator. Previously treated Smear positive cases converted at the end of the extended intensive phase (at the end offourth month) is excluded from the numerator. This is because collection of this information would delay sputumconversion reporting by one quarter without adding significant information. Therefore in the sputum conversion report,there is no provision for reporting sputum conversion at the end of extended IP in previously treated cases.

The sputum conversion rate is not only an indicator of the efficacy of the treatmentregimen, but also of the effectiveness of programme implementation. Hence all effortsshould be made in obtaining the results of the follow up sputum examination at the end ofintensive phase of the patients transferred to different unit/district. Although sputumconversion rates are determined for all different types of smear-positive patients, the mostimportant evaluation is that of new sputum smear-positive patients.

At least 90% of new smear-positive patients put on treatment are expected to becomesmear-negative within 3 months of treatment.

Ensure that the numbers of new sputum positive cases in the sputum conversion report

matches with the numbers of new smear positive cases registered 4-6 months earlier, asper the case finding report. Similarly, the numbers of sputum positive Previously treatedcases in the sputum conversion report should match with the total of the smear positivepreviously treated cases (Relapse, Failure and TAD) in the corresponding case findingreport.

The sputum conversion rate is not only on indicator of the efficacy of the treatment regimen,but also of the effectiveness of programme implementation. Hence, all efforts should bemade in obtaining the results of the follow up sputum examination at the end of intensivephase of the patients transferred to different unit/district. Although sputum conversion ratesare determined for all different types of smear-positive patients, the most important

evaluation is that of new sputum smear-positive patients.At least 90% of new smear-positive patients put on treatment are expected to becomesmear-negative within 3 months of treatment.

Ensure that the numbers of new sputum positive cases in the sputum conversion reportmatches with the numbers of new smear positive cases registered 4-6 months earlier, asper the case finding report. Similarly, the numbers of sputum positive Previously treatedcases in the sputum conversion report should match with the total of the smear positivepreviously treated cases (Relapse, Failure and TAD) in the corresponding case findingreport.

Cohort of patients for sputum conversion report:The cohort of patients registered 46 months earlier will be assessed.


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Cohort of patients registered in the Quarter and the time of reporting

Registered During Reported in 1s week of

1s Quarter 2009 3r Quarter 2009

2n

Quarter 2009 4 Quarter 2009

3rdQuarter 2009 1stQuarter 2010

4 Quarter 2009 2n Quarter 2010

Procedure for preparing & reviewing quarterly report on sputum conversion

Source of informat ion for preparing quarter ly report on sputum conversion :

TB Register.

Quarterly Report on case finding of the quarter selected for determination of smearconversion.

General information reflecting:

Name of the area and code number (TB Unit - Self explanatory)

Name and signature of the reporter (MO-TC/ DTO/ STO)

Date of completion of this form (Not later than 1stweek of the 3rdquarter in cases ofpatients registered in 1stquarter).

The above information is self explanatory and to be filled appropriately.

Block 1: New smear positive cases only

Total number ofregistered new

sputum positivepatients

(1)

Sputum at the end of IP

(2 months)

(2)

Sputum at the end of extended IP

(3 months)(3)

Negative Positive N.A.* Negative Positive N.A.*

*Not available / Sputum examination not done.

Column 1: Total number of patients registered in the quarter being assessed forconversion is entered in this column (refer table above).

Column 2: Results of the sputum examination conducted at the end of two months (IP)among new smear positive patients are reported as negative or positive or NA as thecase may be, under the sub-columns. Patients who are not subjected to sputumexamination or whose sputum results are not available for any reason are entered underthe column NA. The above information on the follow up of sputum examination results areto be picked out from the relevant pages of the TB register pertaining to the quarter to bereported.

Column 3: Patients whose sputum results were positive in column 2and whose intensivephase was extended by one month are subjected to follow up sputum examination at the


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end of third month. Only results of these patients will be entered under the sub-columnsnegative, positive and NA as the case may be.

Block 2: Previously treated cases (excluding others)

Total number of Previouslytreated sputum - positive cases

(excluding others)

(1)

Sputum at the end of IP (3 months)(2)

Negative Positive N.A. *


Column 1: Total number of patients registered as relapse, treatment after default andtreatment failure in the quarter being assessed for conversion are entered in this column(refer table above).

Column 2: Results of the sputum examination conducted at the end of intensive phase{three months among previously treated smear positive patients (excluding others)} arereported as negative / positive / NA as the case may be in the table above. Patients whoare not subjected to sputum examination or whose sputum results are not available areentered under the column NA. The above information on the follow up of sputumexamination results are to be extracted from the relevant pages of the TB registerpertaining to the quarter being assessed.

The basis of calculation of sputum conversion rate:

The conversion rate among new smear positive cases is arrived through proportion oftotal number of patients converted to smear negative at the end of 2ndand 3rdmonth out oftotal sputum positive patients registered for treatment in the specific quarter. For example,If out of the 100 new smear positive patients registered for treatment in the 1stquarter, 85have become negative at the end of two months and 10 have become negative at the endof three months, the sputum conversion rate is the cumulative of 85 and 10 i.e., 95 out of100 = 95%.

The conversion rate among previously treated smear positive cases is arrived throughproportion of total number of patients converted to smear negative at the end of intensivephase (3rd month) out of total previously treated sputum positive patients registered

(relapse, TAD and failures) for treatment in the specific quarter.

The benefit of arriving at conversion at the end of the extended intensive phase isapplicable only for new cases and not for previously treated cases.

Points to remember

Ensure that proper cohort is selected for assessment of sputum conversion.

It is a pre-requisite that the TB register should be up to date with reference to theresults of the follow up sputum examination for the eligible patients before report onsputum conversion is prepared.

Patients whose follow-up results were not available at the end of 2/3 months for anyreason like interruption of treatment, death etc., should not be excluded from thedenominator i.e. total number of TB patients assessed in column 1.


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Patients included under sub - column NA at the end of two months of IntensivePhase should not be reflected again under the sub - column meant for Sputumresults of the positive patients at 3 months

All new and previously treated smear positive patients registered in the particular

quarter must be included in this report. Sputum conversion of the patients classified as Others under previously treated

cases is not considered in this report.

EXERCISE 3

In Mandya district, the number of New smear-positive patients started on treatment regimenfor new cases was 88. After two months of IP, 61 patients converted to smear-negative, 4remained smear-positive and 23 did not have their sputum smear examination done. Afterthe extended IP, the 4 cases which remained smear-positive had their sputum examinedand all had converted to smear-negative.

1. What is the sputum conversion rate at the end of IP (2 months)?

2. What is the sputum conversion rate at the end of the extended IP (3 months)?

3. How many patients did not have sputum smear examinations done at the end of IP andextended IP, and what are the possible reasons for this?

Use the format given below:

Total number ofnew sputum

positive patients

(1)


(2 months)

(2)


(3 months)(3)




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EXERCISE 4

Complete the Quarterly Report on Sputum Conversion on the next page using the fivepages in the Tuberculosis Register in Exercise Workbook E3. Use the worksheet provided

below.

Revised National Tuberculosis Control Programme

WORKSHEETQuarterly Report on Sputum Conversion

Review every page of the TB Register for the quarter being reported on. Ensure that all availablesputum results have been entered into the register. Put a tally mark(/) in the appropriate cell belowand give the totals in the reporting format provided. Every Sputum Positive new, relapse, failureand treatment after default cases registered must be entered in this report. Only pulmonarysputum positive tuberculosis cases are included in this report.

One tally mark (/) is put for every case. Four tally marks are placed successively (////). When thefifth case is recorded, the four tally marks already put in are crossed (-). In this way, each suchgroup represents five cases. This method of tally marking facilitates counting.

Block 1



(1)


(2 months)

(2)


(3 months)

(3)


Block 2

Total number Previously treatedof sputum -positive cases

registered (excluding others)

(1)

Sputum at the end of IP (3 months)

(2)


* N.A.: Not available / Sputum Examination not done.


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REVISED NATIONAL TUBERCULOSIS CONTROL PROGRAMME

Quarterly Report of Sputum Conversion(New and Previously Treated cases Registered 4-6 Months Earlier)

Name of reporter: _____________________

Signature:___________________________________

Date of completion of this form:

Complete this proforma for sputum smear-positive patients. The total no should be thesame as in the Quarterly Report on Case finding for New and Previously treated Cases ofTuberculosis.

Block 1



(1)


(2 months)

(2)


(3 months)

(3)


Block 2

Total number of Previouslytreated sputum -positive casesregistered (excluding Others)

(1)

Sputum at the end of IP (3 months)

(2)


* N.A.: Not available / Sputum Examination not done.

Analysis of the quarterly report on sputum conversion

It is to be ensured that number of sputum positive patients (New and Previouslytreated cases) reported in sputum conversion report matches with the number

reported in the case finding report for the same quarterly cohort

Patients Registered duringquarter of 200 .

Name of area: .Code No. ____________________


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Table 2: Sputum Conversion Indicators and possible responses to problems:

Expected Indicator Possible Actions

Conversionrate is morethan 90% ofnew smear-positivepatients at theend of 3months

Less than85% ofNew smear-positivepatientsbecomesputumsmear-negative at 3months

In the TUs with low sputum conversion rate, all PHIs shouldbe intensively supervised to identify whether:

1. Follow up sputum examination is not done in largenumber of patients, then

Ensure that:

All MO PHI and staff ensure timely follow up sputumexamination of every patient under treatment.

Sputum cups are made available to all DOT providers withclear instruction on the dose when the cups need to beprovided to the patients for follow up.

Patients who interrupt treatment, die or transferred out areminimized.

2. Many patients remain sputum positive, then

Ensure that:

Accurate history-taking regarding previous treatment for TBfrom any source is elicited for proper categorization andefficient treatment. It should be explained to patients thatonly if they provide accurate information, the most effectivetreatment can be given. Proper classification andcategorization of cases is a pre-requisite for efficienttreatment.

Sputum microscopy is of good quality. Slides of patientswho remained smear positive at the end of the intensivephase should be reviewed.

Every dose of medication is observed during the intensivephase of treatment. DOT Centre should be convenient tothe patient and treatment interrupters are promptlyretrieved back.

The quality of DOTS should be checked at the time ofsupervision, including checking of entries in the TreatmentCards with the drugs available in patient-wise boxes.

Quarterly report on treatment outcome

The long term goal of Revised National TB Control Programme is to decrease mortality andmorbidity due to tuberculosis. Early diagnosis and prompt treatment is the most effectiveand reliable method of controlling tuberculosis and will cut the chain of transmission ofinfection.


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The goal is achieved through the following objectives:

To achieve and maintain

A cure rate of at least 85% among newly detected smear-positive (infectious)pulmonary tuberculosis cases

Case detection of at least 70% of the expected new smear positive PTB cases in acommunity

It is important to know that enhancing case detection be attempted only after achieving andmaintaining 85% cure rate among new smear positive cases. The only means by which85% or more cure rate can be achieved on a programme basis is by adopting the DOTSstrategy.

The cure rate achieved for new pulmonary smear-positive cases registered in the

Tuberculosis Register under DOTS is a useful indicator to evaluate the effectiveness ofchemotherapy in treating tuberculosis cases.

The smear-positive previously treated cases are also evaluated in a similar manner. Smear-negative pulmonary cases are evaluated separately. Smear-negative pulmonary cases thathave successfully completed their treatment and have not become smear positive duringthe course of treatment are declared as treatment completed.

Findings of reports on treatment outcomes help in supervising services of health workersand monitoring of the programme. Sharing the reports on the results of treatment withhealth workers can help them understand how their efforts have improved the cure rate. If

the cure rate of 85% has been achieved, it will make them proud of the work they havedone and hence, motivate them to maintain it. Cure rates should not be calculated forindividual health facilities within TB Units. This is because the number of cases may be toolow to give correct information.

At the beginning of each quarter, the Quarterly Report on Treatment Outcome ofTuberculosis Patients Registered 1315 Months earlier will be completed (Hereafter,referred to as Quarterly Report on Treatment Outcome). It summarizes the results oftreatment of patients under DOTS who were registered in the Tuberculosis Register 1315months earlier. It is the most important report in the routine reporting system of tuberculosiscases with respect to outcome of their treatment.

This section of the module helps you in knowing how to complete this report. We will learnhow to obtain the information from the Tuberculosis Register, how to summarize the dataand to enter the data into the appropriate columns of the report. We will also learn how tocross-check the number of cases on this form with data reported earlier in the QuarterlyReport on Case Finding.

For the purpose of preparing the quarterly report on treatment outcome, only thecases put on DOTS regimen are evaluated .The cases put on Non-DOTS regimen

are not considered for this report.


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General inform at ion

Cohort of patients to be considered: In this report, outcome of patients registered in thequarter during 1315 months earlier will be assessed. This facilitates the patients put on

any category of treatment including those whose intensive phase is extended for onemonth, to complete the entire period of treatment, sufficient time for collection and collationof information and for updating the TB register. For example, Cohort of patients put onregimen for previously treated patients (requiring maximum duration of treatment) duringthe first quarter of 2010 (JanuaryMarch 2010) would have completed their treatmentincluding extension of intensive phase and missed doses by the first quarter of 2011(JanuaryMarch 2011) and will become eligible for assessment of treatment outcome andreporting in the first week of the second quarter 2011 (Refer table below).

Cohort of patients registered in the Quarter and the time of reporting

Registered

During

Reported in 1stweek

of

1stQuarter 2010 2ndQuarter 2011

2n Quarter 2010 3r Quarter 2011

3r Quarter 2010 4 Quarter 2011

4 Quarter 2010 1s Quarter 2012

Procedure for preparing of quarterly report on treatment outcome

General information reflecting:

Name of the area and code number (TB Unit)This is self explanatory

Name and signature of the reporter (MO-TC/ DTO/ STO)This is self explanatory

Date of completion of this formThis is self explanatory

This report has three blocks labelled as A, B & C. Block 'A' contains information ontreatment outcome of new and previously treated cases, B contains information on thetreatment outcome of TB patients who are co-infected with HIV and C provides informationon the total number of HIV positive TB patients and number of patients who are provided

with CPT and ART.


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BLOCK A : Treatment outcomes

Patient

reportedduring

quarter**(a)

Type of patient(b)

Treatment Outcome(c)

Totalnumber

evaluated

(sum of 1 7)(d)

CuredTreatmentcompleted

DiedTreatment

FailureDefaulted

Transferredout

Switchedover to

MDR-TBtreatment

1 2 3 4 5 6 7

NEW CASES

Smear Positive TotalNSP

Male

Female

Smear Negative

Extra pulmonary

Others

Total new casesPREVIOUSLYTREATED CASES

Smear PositiveRelapses

Smear PositiveTreatment Failure

Smear Positive TAD

Others

Total Previouslytreated cases

* The Reporter is the Medical Officer responsible, not the person completing this form.** Of these_____________ (number) were excluded from evaluation of treatment outcome (Annexe details with the hard copy).

Block 'A' provides information on the treatment outcome of new and previously treatedcases.

Column (a): This column provides information on the total number of different types ofpatients reported in the relevant quarter selected for determination of the treatmentoutcome. For example, the cohort of patients diagnosed and put on treatment in 1stquarterof 2010 will be taken up for determination of treatment outcome in the first week of 2 ndquarter of 2011, so on and so forthwith other types of cases also.

Column (b): Provides information on types of patients under the following two sub-headsNew cases-comprises smear positive, smear negative, extra pulmonary, others and totalnew cases. Sex wise break up of new smear positive cases is also provided under thiscolumn.Previously treated casescomprises smear positive relapses, smear positive failures, smearpositive treatment after default, others and total of all previously treated cases.

Column (c): There are seven sub - columns for seven possible treatment outcomesnamely, cured, treatment completed, died, failure, defaulted, transferred out and switchedto MDR-TB Treatment Regimen. The relevant treatment outcome will be indicated againstthe types of patients. It is pertinent to remember that patient will have only one treatmentoutcome.

Column (d): This will reflect the total number of cases evaluated against each type ofcases registered.


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BLOCK B: TB treatment outcomes of HIV Positive TB Patients

Type of TBcases

Total No.known tobe HIVinfected

Treatment outcomes


DiedTreatment

FailureDefaulted

Transferredout

Switchedover to

MDR-TBtreatment

NSP

All TBCases

Block 'B' has got three columns. It deals with the treatment outcomes of the HIV positive TBpatients. This provides information on number of new smear positive cases and all TBcases who are known to be HIV positive and their different treatment outcomes.

Block C: CPT and ARTTotal No. of TB patients known

to be HIV infectedNo. given CPT No. given ART

Block 'C' furnishes information on total number of TB patients known to be HIV infected andnumber of those who are on CPT and ART.

Indicators for linkage of HIV positive TB patients to CPT / ART HIV care

1. Proportion of HIV positive TB patients receiving CPT during TB treatment

2. Proportion of HIV positive TB patients receiving ART during TB treatment

EXERCISE 5

Next to the dates given below for the first week of a new quarter, write the months youwould report on in the Quarterly Report on Treatment Outcome.

Date of reporting Report on patients registered in the monthsof

1 April 2010

1 July 2010

1 October 2010

1 January 2011

1 April 2011

EXERCISE 6

Using the worksheets on the following pages, complete the Quarterly Report on Treatmentoutcome for the five pages of the Tuberculosis Register in Exercise Workbook E3. The

Quarterly Report on Treatment outcome follows the worksheets. Separate worksheets havebeen provided for completing block A (two worksheets), block B and C (one worksheet


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25

each). After completing the worksheet, page wise, transfer the data to the appropriate block/ cells in the quarterly report on treatment outcome.

Complete the top portion of the Quarterly Report on Treatment outcome as per thefollowing:

Name of area: Write the name of the sub-district/district.

Code No: Write the identification number for the sub-district/district.

Date of completion of this form: Write the day, month and year you are completing theQuarterly Report.

Patients Registered during the quarter of 20.: Write the quarter and the yearcorresponding to 13 to 15 months earlier.

Name of Reporter : Write full name of the reporting Medical Officer.

Signature: Give the complete signature.

BLOCK A:Worksheet for quarterly report on treatment outcome (new cases)

Type ofpatient

PageNo.

Sex

Treatment outcomeTotal

numberevaluated


DiedTreatment

FailureDefaulted

Transferredout

Switchedover to

MDR-TBtreatment

Smear

positivecases

1M

F

2M

F

3M

F

4M

F

5M

F

Smearnegativecases

1

2

3

4

5

Extrapulmonary

1

2

3

4

5

Others

1

2

3

4

5

Total

*One tally mark (/) is put for every case. Four tally marks are placed successively (////). When a fifth case is tobe recorded the four tally marks already put in are crossed (////). Such a group represents five cases. Thismethod of tally marking facilitates counting.


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BLOCK A: Worksheet for quarterly report on treatment outcome (previously treatedcases)

Type ofpatient

PageNo.

Treatment outcomeTotal

numberevaluated


DiedTreatment

FailureDefaulted

Transferredout

Switchedover to

MDR-TBtreatment

SmearPositiverelapses

1

2

3

4

5

SmearPositive

Treatmentfailure

1

2

3

4

5

SmearPositive TAD

12

3

4

5

Others

1

2

3

4

5

Total

BLOCK B: Worksheet for treatment outcome for HIV positive TB patients

Type of TBcases

PageNo.

TotalNo.knownto beHIVinfected

Treatment outcomes


DiedTreatment

FailureDefaulted

Transferredout

Switchedover to

MDR-TBtreatment

NSP

1

2

3

4

5

All TBCases

1

2

34

5

BLOCK C : Worksheet for CPT and ART for HIV positive TB patients

Page No.Total No. of TB patients

known to be HIVinfected

No. given CPT# No. given ART#

1

2

3

45

Total# During TB treatment


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REVISEDNATIONALTUBERCUL

OSISCONTROLPROGRAMME

QuarterlyReportonTreatmentOutcome

(Tuberculosispatientsregistered1315monthsearlier)

Nameofarea_______________

No._____

Dateofcompletionofthisform__________

Patientsregisteredduring____________

quarterof__________

NameofReporter:__

*______________

Signature:

BLOCKA:Treatmentoutcom

es

Patient

reported

during

quarter**

Typeof

patient

Cured

Treatment

completed

Died

Treatment

Failure

Defaulted

Transferred

out

Switched

overtoMDR-

TBtreatment

Totalnumber

evaluated

(sumof17)

1

2

3

4

5

6

7

NEWC

ASES

SmearPositive

Total

NSP

Male

Female

SmearNegative

Extrapulmonary

Others

Totalnewcases

PREVIOUSLYTRE

ATED

CASES

SmearPositiverela

pses

SmearPositiveTreatmentfailure

SmearPositiveTreatmentafter

Default

Others

TotalPreviouslytr

eatedcases

*TheReporteristhemedicalOfficerresponsiblenotthepersoncompletingthisform.

**Ofthese_____________

(number)we

reexcludedfromevaluationoftreatmentoutcome(A

nnexedetailswiththehardcopy).

BLOCKB:TBtreatmentoutc

omesofHIVPositiveTBPatients

BLOCK

C:CPTandART

TypeofTB

cases

TotalNo.

knownto

beHIV

infected

Treatme

ntoutcomes

Cured

Treatment

completed

Died

Treatment

Failure

Defaulte

d

Switchedover

toMDR-TB

treatment

Transferred

out

NSP

AllTBCases

TotalNo.of

TBpatients

knownt

obe

HIVinfected

No.give

CPT#

No.

given

ART#

#

DuringT

Btreatment


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Procedure for preparing & reviewing Quarterly report on Treatment outcome

Source of inform at ion for preparing quarter ly report on t reatment outco me:

TB Register

Previous quarterly Report on case finding of the quarter selected for determination oftreatment outcome (i.e., patients registered 13-15 months earlier)

Completion of the top portion of the quarterly report on treatment outcome:

General information like name and code number of the TB Unit, name of the personresponsible for reporting, date of preparation of the report etc., are to be filled up and areself explanatory.

Selection of the cohort of patients for determining treatment outcome:

For the compilation of the quarterly report on treatment outcome for the current quarter,

previous quarterly report on case findings pertaining to the patients registered 13 to 15months earlier period has to be reviewed. eg. For compilation of the quarterly report on thetreatment outcome at the beginning of the 1stquarter 2010, i.e., 1stweek of January 2010,previous quarterly report on case findings & pages of the TB register pertaining tothe patients registered 13 to 15 months period earlier i.e., October December 2008have to be reviewed.

Procedure for completion of the first column of the table in report on treatmentoutcome:

The number of different types of cases diagnosed (sex-wise only for new smear positive)are determined by looking into the appropriate previous report on case finding (asmentioned above) and filled in column 1 against each types mentioned in column 2 of thereport on treatment outcome being prepared.

The pages pertaining to the quarter in the TB register having the summary of the treatmentoutcome of TB patients is to be reviewed. This summary is arrived at after reviewing thetreatment outcome column of individual patients. The sample of the summary is reproducedbelow:Summary for treatment outcome:

Type ofcases

Treatment outcome

Cured Treatmentcompleted

Failure Defaulted Died Transferredout

Switched to MDR-TBTreatment regimen

NSP M

F

NSN

NEP

New Others

Relapse

TAD

TreatmentFailure

Previouslytreated

others


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The different outcome of all new smear positive cases, sex-wise are arrived by adding allsuch similar outcomes from all the pages pertaining to that quarter and filled in the rowagainst the type of cases mentioned in column 2. Similar procedure is followed for all thecases mentioned in column 2 of the quarterly report on treatment outcome except for

gender-wise determination of the treatment outcome. As smear negative and extrapulmonary cases cannot have the treatment outcome as cured, the corresponding area isshaded grey.

The total number evaluated is arrived by adding all the types of treatment outcomementioned against each type of cases in column 2 of the quarterly report on treatmentoutcome.

Generally, the number in the column 4 i.e., total number of patients evaluated should tallywith the number under patient registered during the quarter in column 1 of the quarterlyreport on treatment outcome. If number evaluated is less than the number registered, thismay be evaluated individually and reason for the same be mentioned in the appropriate

space provided.

TB Treatment outcome of HIV positive TB patients

Block B: In this section, treatment outcome of HIV infected TB patients are reported.Treatment outcome of patients who are reported as HIV positive is recorded against newsmear positive and all TB cases (including NSP) separately. The total number of TBpatients and new smear positive cases who are tested HIV positive before or duringdiagnosis & treatment is recorded against them in column 2 and their outcomes in column3. A sample of the Block 'B' of the quarterly report on treatment outcome is reproducedbelow:

Type ofTB case

Total No.known to

be HIVinfected

Treatment outcomes

CureTreatmentCompleted

DiedTreatment

failureDefault

Transferout

Switchedover to

MDR-TBRegimen

NSP

All TBCases

Block C: In this block, total number of TB patients who are HIV positive and number ofsuch patients put on CPT and / or ART is reported. This information has to be extractedfrom individual patients, registered in the TB register.

Total No. of TB patients

known to be HIV infectedNo. given CPT# No. given ART#

# During TB Treatment

The proportion of HIV positive TB patients receiving CPT and/or ART shows the efficacy ofthe programme to provide HIV care for the TB patients.

Points to remember

The number in the column 1 of the quarterly report on treatment outcome shouldmatch with the total number in the corresponding report on case finding for eachtype of cases

If for any reason, any of the patients registered is excluded from the evaluation, itshould be substantiated with recorded evidences.


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The summary at the bottom on the right hand side of the TB register should beupdated periodically. This will facilitate generation of quarterly report on treatmentoutcome.

Analysis of quarterly report on treatment outcomeIf the cure rate is


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Table 3: Treatment Outcome Indicators and possible solution to problems

QuarterlyReport

Indicator Possible Actions

Expected:

Cure rate forNew smear-positive casesis 85% or more

Cure rate of

New smear-positivepatients

is less than80%

Ensure that:

Visit to centres with low cure rates for discussion withstaff and patients to find out the reasons for low cure rateand possible solutions.

It is to be ensured that elicitation of accurate history istaking place at all levels. Patients must be askedcarefully about any prior treatment for tuberculosis takenfrom any source. It should be explained to patients thatonly if they provide accurate information, the mosteffective treatment can be given. If previously treated

patients are not given the regimen for previously treatedcases, they may not respond well to treatment.

It is to be ensured that case definitions are appliedcorrectly. Any smear-positive patient treated for morethan one month in the past, with default of more than twomonths, should receive the previously treated regimen.

It is to be ensured that every dose of medication isobserved during the intensive phase of treatment, and atleast one dose per week in the continuation phase.Return of empty blister packs during weekly collection ofdrugs should be insisted on. DOT centres should beconvenient for the patient.

It may be ascertained that health workers areadministering DOT as per guidelines.

Follow-up sputum smear examinations are doneaccording to guidelines.

Cure rate ofNew smear-positivenewpatients ismore than

95%.

Report is checked for accuracy. It is to be ensured thatresults of treatment are correctly recorded and reported.

All diagnosed smear-positive patients started ontreatment should be registered.

Expected:

Less than 3%of New smear-positive

patients aregiven theoutcome as

Treatmentcompleted.

New smear-Positivepatients whoare reportedas treatmentcompleted ismore than 3%

Follow-up sputum examinations are done as perguidelines and these are tracked carefully at alltreatment units.

Medical Officers and other health staff are sensitizedabout the importance of follow-up sputum examinations.

Patients who have recently completed treatment are tobe located and their sputum samples obtained forexamination.


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Expected:

Less than 5%of New

smear-positivepatients

die duringtreatment

New smear-

positivepatients who

die duringtreatment is

more than 5%

Every dose of medication is observed during theintensive phase of treatment, and at least one dose perweek in the continuation phase. DOT centres should beconvenient to the patient.

Records of patients who have died needs to be reviewedto determine the reasons.

Attempt should be made for early diagnosis and prompttreatment if it is found that seriously ill TB patients areattending the health institutions.

The other reasons for high death rate could be co-morbid conditions eg. HIV infection, Diabetes Mellitusetc. which should be addressed appropriately.

Expected:Failure: Lessthan 4%

of New smear-positive

patientscontinue to besmear-positive

at 5 months ormore

Newsmear-positivepatients

who failtreatment is

more than 4%

It is to be ensured that elicitation of accurate history istaking place at all levels. Patients must be askedcarefully about prior treatment for tuberculosis from anysource. It should be explained to patients that only if theyprovide accurate information can the most effectivetreatment be given. If previously treated patients are notgiven the retreatment regimen, they may not respondwell to treatment.

It is to be ensured that categorization, is done properly.Any smear-positive patient treated for more than onemonth in the past, with default of more than two months,

should receive the previously treated regimen.Every dose of medication is observed during theintensive phase of treatment and at least one dose perweek in the continuation phase. Return of empty blisterpacks during weekly collection of drugs in thecontinuation phase should be insisted on. DOT centresshould be convenient to the patient.

It is to be ascertained that health workers are dispensingmedication properly as per guidelines.

It is to be ensured that drugs are of acceptable quality,

stored in appropriate conditions and are used beforetheir expiry.

In spite of all the above measures if the failure rateremains higher than 5%, evaluation of the level ofprimary drug resistance in the community should beundertaken.


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Expected

Default rate isless than

5%

Default rate ofsmear-

positive new

patients ismore than 5%

Directly observed treatment is given to patients in theintensive phase and at least one dose per week isdirectly observed during the continuation phase.

Practice of retrieval of treatment interrupters should bemeticulously followed by all health care providers i.e.DOTS provider, PHI staff and supervisory staff at TU anddistrict level.

Visit to centres reporting high default rates. Interview ofstaff and patients to determine the efforts made toretrieve defaulting patients, the reasons for default andpossible solutions.

Patient history is carefully ascertained, including theaddress. A visit to patients home should be made toverify address prior to initiation of treatment and

landmarks near the house should be recorded in theTreatment Card. Services should be convenient to thepatient in terms of distance, time and attitude of staff.

During the visit to the house for verification of address,the name, address and telephone number of a contactperson in the event the patient defaults, is recorded.

Expected:

Transferredout is less than3%

Patients whoareTransferred

out is more

than 5%

Ensure that:

Transfer out can be a way of disguising default. Patientsshould be categorized as Transferred out only if theyhave been given a Transfer Form to be taken to the

facility where they are transferred. The feedback ofresults of follow up sputum examinations and treatmentoutcome are reviewed.

Apart from these it is very important to analyse the cure rates, default rates, death rates andfailure rates of previously treated patients (relapses, failures and TAD) to study thedifferences and trend of these various outcome indicators.

Report on Programme management and logistics

The following programme management and logistics reports are prepared at differentlevels:

Monthly report on programme management and logisticsPHI level Quarterly report on programme management and logisticsTU level Quarterly report on programme management and logisticsDistrict level Quarterly report on programme management and logisticsState level

This report is generated on a monthly basis at PHIs and on quarterly basis at TU, districtand state level. The monthly PHI reports are consolidated on quarterly basis at the TUlevel. The quarterly TU level reports are further consolidated at District & in turn at the StateLevel. This report facilitates monitoring of logistics and other management activities

involved in successful implementation of TB control activities.


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PHI level monthly reports on programme management and logistics

All PHIs are required to complete this report on a monthly basis in the format provided. Thishas the following sections:

a. General informationb. Medications - Stock of drugs & requirementc. Supervisory activitiesd. IEC/ACSMe. Referral activityf. Microscopy activityg. Treatment initiationh. MDR TB case finding activityi. Consumables and laboratory requirementsto be furnished by DMC.j. Equipments

This report is to be prepared after physical verification of stock on the last working day ofthe month by the MO of the PHI with the assistance of the concerned PHI staff. The reporthas to be sent to the CDHO/CDMO with a copy to the TB unit on or before the fifth of nextmonth. A copy of the report is marked to the DTO for monitoring. The copies sent to the TUlevel is used for monitoring as well as preparation of quarterly report on programmemanagement and logistics for the TU level.

General information: Details such as name of the PHI, TU, district, month and year ofreport are to be recorded under this section.

Medications:

This section has to be filled up by all the PHIs. The information regarding the stock at thebeginning of the month, stock received & consumed during the month, stock at the end ofthe month and stock requested have to be arrived at. This is done by reviewing the stockregister maintained for the drug boxes and actual physical stock available. The sameprocedure is applicable even for loose drugs and streptomycin injections. The tablesmentioned below are self explanatory and have to be filled up accurately by the personresponsible for maintenance of the drug boxes and DOT administration at the PHI.


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REVISED NATIONAL TUBERCULOSIS CONTROL PROGRAMMEMonthly Report on Programme Management and Logistics

Peripheral Health Institution Level

Note:1. All PHCs/ CHCs/ referral hospitals/ major hospitals/ specialty clinics/ TB hospitals/ Medical colleges to

submit their monthly reports in this format.2. PHIs without DMCs have to fill only the relevant details on page2.

Name of Peripheral Health Institution: _______________________________________________________

TU: ______________________ District: ____________________

Month: ______________________ Year: ______________________

Medicat ions

Adult Patient Wise Boxes

Item (PWB) Stock on firstday of month

(a)

Stock receivedduring month

(b)

Patientsinitiated ontreatment

(c)

Stock on lastday of month

(d)=a+b-c

QuantityRequested (e)=(c X 2) d

Regimen forNew patients(NT)

Regimen forpreviouslytreated patients

(PT)

Prolongation Pouches and Inj SM

Item Stock onfirst day of

month

(a)

Stockreceivedduringmonth

(b)

Consumptionduring month

(c)


(d) =(a+b)-c

Quantity Requested

(e) =(cX2) d

Prolongationpouches (Poucheseach with 12 blisterstrips)

Streptomycin 0.75 g(vials)

RNTCP loose drugs

Item Unit ofmeasure-

ment

Stock onfirst day of

month

Stockreceived

during month

Patientsinitiated ontreatment


d=(a+b)-c

QuantityRequestede=(cx2)-d

(a) (b) (c) (d) (e)

INH 300mg Tablets

INH 100mg Tablets

Rifampicin150 mg

Capsules

Ethambutol800 mg

Tablets


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Supervisory activities:

Number of visits made to the PHI in the reporting month by DTO/MO-DTC, MO-TC, STSand STLS are to be entered here. Visits undertaken by DOTS Plus & TB-HIV Supervisors

are also filled wherever these activities are being undertaken.Supervisory activities:Supervisory Visit by DTO/2

nd

MO-DTCMO-TC DOTS Plus & TB-

HIV SupervisorSTS STLS

Number of visits in last 1 month

IEC/ACSM:

Number of TB patient provider meetings and community meetings held in the reportingmonth is to be entered here. (Refer to the section on ACSM in module 6)IEC:

Number of TB Patient Provider meetings heldNumber of Community meetings held

Referral activity: This has to be filled up by PHIs referring TB suspects to the DMCs forsputum examination. This information will be obtained from the OPD register/recordsmaintained at PHI.

a) The number of new adult out patients attending the health institution is to berecorded.

b) The total number of TB suspects (out of new adult out-patients mentioned above)referred for sputum examination has to be mentioned in this section.

Referral Activity (To be filled in by all PHIs from OPD Register)

a. Number of new adult outpatient visits

b. Out of (a), number of TB suspects referred for sputum examination

Microscopy activity: This section has to be filled up by PHIs which are DesignatedMicroscopy Centres. Laboratory register is the source of information. The followinginformation is recorded in this section:

c) The number of TB suspects examined for diagnosis (including the suspectsreferred from PHIs other than DMC linked to this DMC).

d) The number found smear positive among the above patients (d)e) The number of TB suspects subjected to repeat sputum examination for diagnosis

f) The number found smear positive among repeat examination ('f' out of 'e')

g) Total number of smear positive cases diagnosed (d + f)

Microscopy Activity (To be filled in by only PHIs which are DMCs from Laboratory Register)

c. Number of TB suspects whose sputum was examined for diagnosis

d. Out of (c), number of sputum smear positive patients diagnosed

e. Number of TB suspects subjected to repeat sputum examination for diagnosis

f. Out of (e), number of sputum smear positive patients diagnosedg. Total number of sputum smear positive patients diagnosed (d + f)


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Treatment initiation

This section has to be filled up by Designated Microscopy Centers only. Information has tobe obtained from the remarks column of the laboratory register and referral for treatmentregister. This can be verified with reference to treatment cards in the health institution. Thefollowing information has to be entered in this section:

a) Number of smear positives cases (out of g) put on DOTS

b) Number of smear positives cases (out of g) put on RNTCP Non-DOTS

c) Number of smear positives cases (out of g) referred for treatment to other TUswithin the districts.

d) Number of smear positives cases (out of g) referred for treatment outside thedistrict.

Treatment Initiation (To be filled in by only PHIs which are DMCs from Laboratory Register andReferral for Treatment Register)

h. Of the smear-positive patients diagnosed (g), number put on DOTS

i. Of the number of smear-positive patients diagnosed (g), number put on RNTCP Non-DOTS (ND1 and ND2)

J Of the smear-positive patients diagnosed (g), the number referred for treatment toother TUs within the district

k. Of the smear-positive patients diagnosed (g), the number referred for treatmentoutside the district

MDR TB case finding activity

This data comes from the laboratory register at DMC.MDR-TB case finding activity (To be filled in by PHIs which are only DMCs from LaboratoryRegister)

Number of MDR-TB suspects identified

Consumables and Laboratory requirements: This has to be filled by PHIs which areDMCs. Information regarding sputum containers has to be filled by all PHIs (even by PHIswhich are not DMCs and have been supplied with sputum containers). Laboratory Stockregisters maintained for consumables will be used to record the information in the tablewhich is self explanatory. Universal containers for C&DST are to be entered only if the DMChas stock of it.


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Laboratory Consumables (To be filled in by only PHIs which are DMCs)

Item Unit ofMeasurement

Stock onfirst day ofthe Month

Stockreceived

during the

Month

Consumptionduring the

Month

Stock onlast day ofthe Month

Quantityrequested

Sputumcontainers*

Nos.

Universalcontainers forC & DST

Nos

Slides Nos.

Carbol Fuchsin(1% solution)

Litres

Methylene Blue

(0.1% solution)

Litres

Sulphuric Acid(25% solution)

Litres

Phenolicsolution (fordisinfection-~40% puresolution)

Litres

Immersion oil/Liquid Paraffin(Heavy)

mL

MethylatedSpirit

Litres

* PHIs that are not DMCs, but have been supplied with sputum containers, should complete this row.

Equipments: This information has to be provided by PHIs which are DMCs. The positionregarding the number of microscopes available, irrespective of whether it is supplied underRNTCP or other programmesand their functional status is recorded in this block.

Equipment in p lace To be f i l led in by only PHIs which are DMCs)

ItemNumber in

placeIn workingcondition

Binocular microscopes

Name of officer reporting (in Capital Letters) :

.

Signature: .

Date: .

Quarterly report on programme management and logistics - Tuberculosis Unit(TU) level

The information reported in the monthly PHI level report is consolidated for preparing

quarterly TU report. In addition, the TU report includes information on supervisoryactivities, and quality of DOTS implementation, The TU situated at the DTC will also submita quarterly report like all other TUs.


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Basic Information:

The number of DMCs in the TU under public sector, private sector and NGOs are to bereported. The number of sputum collection centers, DOT centers, providers under publicsector, private sector, NGOs and community volunteers need to be reported.

The number of monthly PHI reports expected and received in the quarter are reported in thebeginning of the report.

Supervisory Activities:

The number of institutions visited by MO-TC, STS and STLS in a quarter is reported.Although health unit may be visited more than once during the quarter, it is to be reportedas a single visit. The stipulated supervisory schedule is given in the module on supervision& monitoring.

Referral and Microscopy Activities:

The information contained in these sections is the same as that given in the PHI Levelreport. The figures given here must cover the information from all PHIs and DMCs underthe TU, including the microscopy centre of the TU consolidated for all three months of thequarter.

In referral activities the number and percentage of PHIs reporting more than 2% of TBsuspects is to be entered.

Treatment Initiation:

This part of the report is compiled from the monthly PHI Level reports. Care should be

taken to avoid duplication of cases while doing the consolidation. One of the keyresponsibilities of the STS is to ensure that every smear-positive patient who is diagnosedis either started on treatment, or is promptly referred to another area where the patientusually resides and will receive treatment.

Example:

Referral, microscopy and treatment activities of all PHIs including microscopy centres undera TU during one quarter is furnished below:

Referral Activities

Microscopy Activities

a. Number (%) of PHIs referring >2% of new adult OPD patients forsputum examination

4 out of 16(25%)

b. Number of TB suspects whose sputum was examined for diagnosis 2250

c. Out of (b), number of smear-positive patients diagnosed 215

d. Number of TB suspects subjected to repeat sputum examination

for diagnosis150

e. Out of (d), number of sputum smear-positive patients diagnosed 15

f. Total number of sputum smear-positive patients diagnosed (c + e) 230


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Treatment Initiation

In the example, there were 10 smear-positive patients who are residents of areas outsidethe TU. It may also be seen that 8 smear-positive patients [(f)(g+h+i+j)] who have neitherbeen referred for treatment outside TU area nor put on treatment under RNTCP. It is theresponsibility of the MOTC, STS and STLS to put them under treatment through theconcerned PHIs as soon as possible.

The DTO will ensure through TU level staff that all patients referred between TUs within thedistrict are put on treatment and reported appropriately.

MDR-TB case finding activity:

It is a consolidation of the PHI monthly report

Quality of DOTS implementation:

Quality of DOTS implementation is assessed by following indicators which are reported in

this sectiona. Whether the all smear-positive cases are started on DOTS within seven days of

diagnosis?

This information is taken from the TB register from the columns date of start oftreatment and date of pretreatment sputum examination. The cases included shouldbe from the same cohort which have been included in the case finding report

b. Whether all smear-positive cases started on DOTS are registered within onemonth

This information is taken from the TB register from the columns date of starting

treatment and date of registration; The cases included should be from the samecohort which have been included in the case finding report

c. Whether all cured smear-positive cases had end of sputum examination donewithin a week of the last dose.

This information is taken from the TB register from the columns date of last follow upsmear examination and date of treatment outcome; These cases should be from thesame quarterly cohort which have been included in the report of treatment outcome.

d. What is the number and proportion of TB patients (all forms) registered in thequarter receiving DOT through a community DOT provider.

This information can be obtained from TB register after making a remark in the remarkcolumn if the patient is getting DOT from a community volunteer. The cases includedshould be from the same cohort which have been included in the case finding report.

g. Out of the smear-positive patients diagnosed (f), number put on DOTS withinthe TU

200

h. Out of the number of smear-positive patients diagnosed (f), number put onRNTCP Non-DOTS within the TU

12

i. Out of the smear-positive patients diagnosed (f), the number referred fortreatment to other TUs within the district

05

j Out of the smear-positive patients diagnosed (f), the number referred fortreatment outside the district

05


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Medications, Consumables and, Equipments

The sections on Medications, Consumables, and Equipment are in the same format asthat of the PHI Level report. However, in the medications section, Regimen for MDR andpediatric patient wise boxes are added. Note the formula for number requested forRegimen for MDR drugs is with a reserve stock for one quarter.

These sections must include all PHIs in the area of the TU, and TU itself. However, thecolumns on stock on first day of quarter and stock on last day of quarter should includethe stocks at TU drug stores in addition to those reported by PHIs. If the TU drug storeis receiving drugs from DTC for onward distribution to PHIs, the column on stockreceived during quarter should include the receipts from DTC into the TU drugstore aswell as the drugs that may have been supplied to any PHI directly (bypassing the TUdrugstore) during the quarter. In rare circumstances, a TU may be asked to transferdrugs or other lab consumables to other TU. This transfer should always be routedthrough the district.

The stock on first day of quarter in the current quarter

rntcp training course for program manager module 5 - 9

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