st francis hospital natcon 2011
TRANSCRIPT
Impact of in-house RNTCP DMC in NGO Hospital –a case study
Dr Neerja Arora Regional TB Project Coordinator, CBCI-CARD GFATM RCC RNTCP Project
Dr K N GuptaState TB Officer,Rajasthan
Dr Reuben SwamickanNational TB Project Coordinator, CBCI-CARD GFATM RCC RNTCP Project
CBCI-CARD GFATM RCC RNTCP PROJECT
Setting
St.Francis hospital, a 240 bedded, multi-disciplinary NGO health facility in Ajmer inRajasthan, where RNTCP-DMC was started in2009 as part of PPM DOTS initiatives,spearheaded by the Global Fund-supportedCBCI-CARD RNTCP project
CBCI-CARD GFATM RCC RNTCP PROJECT
CBCI-CARD GFATM RCC RNTCP project
The objective of this project is to facilitate the involvement of the Catholic Church network in RNTCP across 19 states of India
There are more than 5000 Catholic Health facilities (CHFs), including large number of Hospitals and Dispensaries in the country, 85 % of which are in rural, tribal and hard to reach areas
Under this project, by 3Q11, CHFs have signed more than 200 RNTCP schemes for NGOs of which 86 are DMCs
CBCI-CARD GFATM RCC RNTCP PROJECT
St Francis Hospital, Ajmer
CBCI-CARD GFATM RCC RNTCP PROJECT
St Francis Hospital DOT Centre
5
45 41
6152
64
8499
91 90
108
0
20
40
60
80
100
120
Cat I Cat II Cat III Total
Patients put on DOTS at St Francis Hospital DOT Centre Yr 2000-2010
85 82
98
8387 84
9387 90
514
211
2 51 3 2
10
0 05 4 7 6 6 30 0 0 0 2 1 0 1 20
20
40
60
80
100
120
Yr 2001 Yr 2002 Yr 2003 Yr 2004 Yr 2005 Yr 2006 Yr 2007 Yr 2008 Yr 2009
Success Rate Default Rate Death Rate
Failure Rate TO Rate
per
cen
tag
e
Trends in Treatment outcomes of ALL Categories of patients put on DOTS at St Francis Hospital DOT Centre
( Yr 2000 to Yr 2009 )
CBCI-CARD GFATM RCC RNTCP PROJECT
1116 18
14 13
2217
2329
34
24 26
1914
17 1822
15
26
51
43
53
3936
0
10
20
30
40
50
60
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
TB suspects examined Follow-up patients examined
St Francis Hospital DMC
6
Month/
Year
2010
TB
suspects
examine
d
TB
Suspect
s found
positive
TB
Suspect
s
undergo
ing
repeat
sputum
examin
ations
TB
Suspect
s found
positive
on
repeat
examin
ation
Follow-
up
patients
examine
d
Patients
positive
in
follow
up
Total
Slides
examine
d
Total
positive
slides
Total
negative
slides
Jan 11 1 0 0 19 0 60 2 58
Feb 16 0 0 0 14 2 60 4 56
Mar 18 4 0 0 17 2 70 10 60
Apr 14 3 0 0 18 2 64 8 56
May 13 5 0 0 22 1 70 11 59
Jun 22 7 0 0 15 3 74 17 57
Jul 17 6 1 0 26 3 88 17 71
Aug 23 6 0 0 51 6 148 24 124
Sep 29 7 0 0 43 1 144 15 129
Oct 34 4 0 0 53 4 174 12 162
Nov 24 3 0 0 39 6 126 18 108
Dec 26 4 0 0 36 3 124 11 113
TOTAL 247 50 1 0 353 33 1202 149 1053
St Francis Hospital Annexure M for 2010
9.
0
22 21
38.
3235.
26. 24
12 12.515
20
0
14.12 11
5
20
12
2.
8
15
8. 9
37
14 12.516
22.19
16.
1014
912
0
10
20
30
40
50
Jan Mar May Jul Sep Nov TOTAL
Sputum positivity for diagnosis sputum positvity for follow ups
Slide positivity rate
Trends in Slide positivity Rates, positivity among Diagnoses Follow-ups in Year 2010
Trends in Sputum Examinations for Diagnoses & Follow-up in Yr 2010
CBCI-CARD GFATM RCC RNTCP PROJECT
Objectives of the study
To evaluate the impact of in-house RNTCP-DMC services on
1. Referral of TB suspects
2. Referred patients receiving sputum test
3. TB case notification.
CBCI-CARD GFATM RCC RNTCP PROJECT
Methodology
Review of referral register, RNTCP laboratory register and other relevant records. The average values of the historical data for 6 years period (2004-2009), when patients were referred to nearby DMCs, was compared with the results in the year 2010, i.e. after the introduction of in-house microscopy services
CBCI-CARD GFATM RCC RNTCP PROJECT
Year
(A)
Total
Referred
cases
(B)
Diagnosed
at DMC
( C)
Positive
(D)
Negative
(E)
Not
reached
DMC
(F)
Proportion
of Referred
suspects
undergoing
sputum
microscopy
Yr 2004 140 77 14 63 63 55%
Yr 2005 137 84 22 62 53 61%
Yr 2006 118 73 19 54 45 62%
Yr 2007 107 55 14 41 52 51%
Yr 2008 87 38 11 27 49 44%
Yr 2009 99 58 10 48 41 59%
Yr 2010 271 263 47 216 8 97%
Trends in percentage of referred chest symptomatics undergoing sputum microscopy
Yr 2004-Yr 2010
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Yr 2004 Yr 2005 Yr 2006 Yr 2007 Yr 2008 Yr 2009 Yr 2010
Trends in Percentage of Suspected Chest Symptomatics referred at St Francis Hospital, Ajmer, undergoing sputum
microscopy Yr 2004-Yr 2010
Diagnosed Not reached
CBCI-CARD GFATM RCC RNTCP PROJECT
Results
With the RNTCP-DMC within the hospital complex, annually,
• The referrals for microscopy have more than doubled (115 to 271).
• There is significant reduction in the percentage of referred patients failing to reach the laboratory (44% to 3%).
• The number of suspected TB cases that received sputum examination recorded more than four-fold increase (64 to 263).
• The number of smear positive TB cases diagnosed among the referred patients tripled (15 to 47).
CBCI-CARD GFATM RCC RNTCP PROJECT
140 137
118
107
87
99
271
7784
73
55
38
58
263
1422 19
14 11 10
47
0
50
100
150
200
250
300
Yr 2004 Yr 2005 Yr 2006 Yr 2007 Yr 2008 Yr 2009 Yr 2010
Nu
mb
er
Trends in Referral & Diagnosis of Chest Symptomatics at St Francis Hospital, Ajmer
Yr 2004 to Yr 2010
Total Referred cases Diagnosed Positive
Start of DMC at Hospital premises
CBCI-CARD GFATM RCC RNTCP PROJECT
Conclusions
• Designating the laboratory of NGO hospitals, as RNTCP-DMC can significantly increase TB notification
• This would also reduce delay in diagnosis and ensure standardized treatment.
• Presence of well functioning DMCs at government or medical college facilities in the vicinity should not be a deterrent to establish DMCs in such NGO or PP hospital which are willing and which have the capacity to attain & sustain quality microscopy activities
CBCI-CARD GFATM RCC RNTCP PROJECT
Conclusions
• This is an example of RNTCP Partnerships promoting “Universal Access”
• There is scope for replicating and scaling up similar models across the country in other private & NGO hospitals having self-sustainability
CBCI-CARD GFATM RCC RNTCP PROJECT 14
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