Health - Guidelines for tuberculosis notification sent out

Guidelines for tuberculosis notification sent out
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The Central TB Division has set the ball in motionby setting out
guidelines on how to notify TB cases. The notification has to be done
by health providers, both in the private and public
sector,laboratories, hospitals/clinics/nursing homes.
All stakeholders, both public and private, are required to notify TB
cases when patients havebeen diagnosed or whenanti-TB treatment has
already been initiated. They are supposed to report the cases to the
nodal public health authority "at least on monthly basis," the
Division's FAQ notes. "All cases diagnosed/treated since April 7, 2012
may be notified," states the TB notification module ofNikshay. Nikshay
is an information communication technology (ICT) application developed
bythe government to specifically provide real time surveillance data
of TB cases.
Many options
The notification can be done through hard copy, email, mobile phones
(IVRS or SMS), or by uploading the information directly on to the
Nikshay portal ( http://nikshay.gov.in ). They can also get in touch
with the respectivenearest nodal officers ( http://tbcindia.nic.in )
to notify the cases.
To start with, all health establishments are required to first
register themselves with Nikshay to facilitate the entry of TB cases
notified by them. Notification covers pulmonary and extra-pulmonary TB
cases of all three patient types — new cases, recurrent TB cases (who
were successfully treated earlier), and those whosetreatment is being
changed (either due to failure of current regimen, or initiation of
new treatment regimen).Details of rifampicin resistance — resistant,
sensitive and data not available — are to be provided.
Aside from TB related details, stakeholders are required to provide
the patient's name, address, phone number and personal unique
identification number like driving licence or Aadhaar.
There is bound to be disagreement or resistance from private
practitioners and healthcare establishments in sharingpersonal details
of patients.
"As per MCI code of Ethics – Rules & regulations 2002…it is the duty
of theregistered medical to divulge this information to the authorized
notification official as regards communicable and notifiable
diseases," the FAQ states. "In case ofcommunicable/notifiablediseases,
concerned public health authorities should be informed immediately."
It also states that there are provisions to take punitive/legal action
against those who do notnotify TB cases.
Contentious issue
There is another contentious issue.
The FAQ makes it explicitly clear that the public health staff will
extend "support system for treatment initiation, adherence, follow-up,
default retrieval, and contact tracing" of patients even as they seek
medical care from those "outside" the national TB control programme.
It is true that private practitioners are ill equipped to ensure
"treatment adherence and follow up" of their patients and cannot
tracelost patients. But will all patients who approach private
practitioners like public health staff to come into the picture?
TB was made a notifiabledisease by the government in May this year.
The main intent is for ensuring proper diagnosis and care management,
to have in place a proper mechanism that will help in treatment
adherence (even by those who seek private care) and to "mitigate the
impending drug resistant TB epidemic."
"Complete and accurate data obtained from notification will allow
continuous evaluation of the trend of the disease with better
estimation ofburden/impact," the guidelines state.
The guidance and frequently asked questions (FAQs) on TB notification
have been sent to certain nodal TB institutions, and they in turn have
been asked to disseminate the information to all health care
providers.

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