Epidemiology and  Public Health

 Dr. Khalid Umer Khayyam                :        Epidemiologist and HOD

 Dr. Sujata Arya                                      :        Senior Research Officer

 Dr. Neeta Singla                                    :        Senior Research Officer

Department is running Revised National Tuberculosis Control Project (RNTCP) with the help of staffs provided by STO, Delhi. It is coordinating with Department of TB & Respiratory Diseases in provision of DOTS to all categories of TB patients and also establishing a linkage to the RNTCP staff for continuation of treatment at the patient’s doorsteps.

Besides this, the department is involved in facilitating the RNTCP modular training of DTOs and STOs from different parts of the country on a continuous basis. Department is also involved in regular teaching activities of post graduate students both from within and outside the Institute. Department is also  involved in  regular RNTCP teaching programme for nursing staff of the Institute and for nursing students from other Institutes. The faculties of the department have delivered guest lectures and have attended various conferences at both national and international level. The department also has organized various workshops on involvement of NGO and PPs in DOTS and DOTS-Plus, Department is also involved in developing teaching modules for nurses for DOT-Plus.

 

The LRS Institute of TB & Respiratory Diseases has been entrusted the responsibility by the Delhi Govt. of undertaking Tuberculosis Control activity in a defined geographical area in the southern part of Delhi covering a population about 1.00 million. The domiciliary treatment services were earlier being offered to these Area patients from the OPD of the institute. With the introduction of the Revised Strategy for Tuberculosis Control (RNTCP) by the Government of India the tuberculosis control services provided by the institute have been decentralized through DOT-cum-Microscopy centres established under the RNTCP in the area covered by the institute. At places sub-centres (DOT-Centres) have also been started with NGO assistance to further bring the services closer to the patients and community. The list of the DOT-cum-Microscopy Centre is as under:-

              

Name of Centre	Medical Officer Incharge	Phone No.
DGD – Mehrauli	Dr. A.K. Gupta	29961371
MCD – Fatehpur	Dr. P. Handa	26653393
DGD – Chhatterpur	Dr. Lilly Chopra	26801602
DGD – Jaunapur	Dr. Rajni	266548444
DGD – Ber Sarai	Dr. Leena Mishra	26526942
DGD – Mahipal Pur	Dr. Krishna Verma	26783169
(i) DGD – Kapashera	Dr. Brijesh	25063139
(ii) Rajokari	Dr. Padma	25063937
(iii) Samalka	Dr. Ritu	25065397
Shahbad Mohd. Pur	Dr. Monika	25654938
LRS Institute	Dr. K.K. Mathuria	26517826 (Extn. 531)

 

In addition to the above centres, the department is collaborating with the following NGOs and Private Practitioners.

           

Name of NGOs	Contact Person	Phone No.
St. John Ambulance Brigade	Mr. Gupta	9350720451
Action India	Anupam Kataria Dr. N.I. Singh	9811530007 9810398050
St. Marry, Aaya Nagar	Dr. Anwar Hussain	5565358

 

Name of PPs	Contact Person	Phone No.
IPH & H	Dr. V.K. Ninglia	30620605
Dr. R.C. Shridhar	Dr. R.C. Shridhar	26895403
Dr. S.K. Mathur	Dr. S.K. Mathur	26178026

     The RNTCP is implemented by the DTO who is assisted by Medical Officer -TB Control (MOTC).  There are two tuberculosis units each under one MOTC who is assisted by Senior Treatment Supervisor (STS), Senior TB Laboratory Supervisor (STLS), five Laboratory Technicians and five TB Health Visitors.  The department has also a Data Entry Operator.  Most of the staff working in the department in on contract basis. 

     The RNTCP has consistently achieved the National targets of cure rate above 85% and case detection above 70% for the past several years.  The Institute is also implementing the DOTS Plus strategy for programmatiac drug resistant cases through this department.

Ongoing current Projects

• Implementation of Telemedicine

• Post treatment sequel in MDR patients

• Mw vaccine

·         WCC

Assignment of RNTCP Strategy of FNAE diagnosis (at 2 wks) and 6^th month duration of treatment for peripheral tuberculosis lymphadenitis

·         Repeat zonal level tuberculosis surveys for stipulating annual rises of tuberculosis  infection (ARTI)

·         Surveillance of Drug resistance at LRS of TB and RD, New Delhi, DOTS Area.

·         Knowledge of Tuberculosis and utilization of anti-tuberculosis in an urban slum of Delhi.

·         Respiratory problem in school children and air pollution.

·         School children and Tobacco consumption.

·         To determine reasons for default and fate of defaults under DOTS-Plus.

·         To study profile of patients dying dusing DOTS Plus treatment and as certain possible reasons.

Easily detection of drug resistance profile of patients initiated on re-treatment regimen.

Department has been involved in many publications in international and national journals and is regularly generating data of RNTCP for discussion in monthly statistical meetings.

RNTCP

 Dr. Khalid U Khayyam                                      :         District TB Officer

 Dr. Neeta Singla                                                 :         Medical Officer TB control

Dr K Mathuria                                                    :         Medical Officer TB control

 Revised National Tuberculosis Control Programme was implemented in a phased manner and the full fledged programme began in 1997. The programme uses the DOTS strategy with the objective to achieve and maintain at least 85% cure rate of new sputum smear positive and detection of at least 70% of such cases. Entire country was covered under RNTCP in march 2006.

From when LRS was part of it?

The south zone district of Delhi was offered to this institute to implement the national programme.

Currently LRS-RNTCP is looking after the 1 million population of land area starting from Ber Sarai to Shahbad Mohdppur (New Airport). This area was divided into two tuberculosis units. There are 12 designated microscopy centers and 18 DOT Centers including NGO’s and PP’s.

RNTCP ACTIVITIES: Twelve microscopy centers are being operationalised with the help of qualified  and trained Laboratory Technician  in 1 million population of South Zone of Delhi. All the chest symptomatic undergo screening for TB by smear microscopy.

A DOT provider is available in all 18 DOT centers of our area whose functions include:-

• Initial home verification of TB diagnosed patients and provision of IEC activities to family members.
• Initiation of DOTS as per RNTCP guidelines.
• Establishing the linkage by visiting the Institute on every Friday for timely enrolment of the diagnosed and referred patients to their respective DOT area.
• Continuation of DOTS to patients after discharge from the Institute.
• Sending case and contacts to LRS Institute for various ongoing research projects.
• Helping the trainees during the field visits at DOT/MC Centres during their RNTCP modular trainings.

IEC activities are done at each DOT centre on quarterly basis by 1^st level of supervision. A collaboration has been done with Department of Community Medicine of St.Stephen hospital for training of DOT-provider regarding IEC activities at DOT Centre.

A collaboration has been done with NGOs and PPs. Among the NGOs, the Action India is one of the well known organization working in tuberculosis and HIV with indoor facilities. Among PPs, IPH and H has been working on many disciplines including tuberculosis.

A collaboration has been done with other organizations like International centre for Genetic Engineering and Biotechnology for “Regulation of Human Response in Human M-tuberculosis Infection” and Jamia Hamdard(Hamdard University) for research work of M.Sc and Ph.D students.

LRS-RNTCP achieved the cure rate of 89% and the sputum conversion rate of smear positive patients of 89% during the year (table-23). This achievement resulted due to the joint efforts of LRS, NGOs, PPs and STO Delhi.

 Table-23: LRS-RNTCP Outcome Data

DOTS was given to a total number of 1930 patients that included 1009 of Category-I, 460 of Category-II and 461 of Category-III.

 DOTS PLUS PROJECT:

LRS Institute has been promoting National Tuberculosis Control Programme through implementation of DOTS in 1 million populations in South Delhi, through 12 microscopy and 18 DOT centres. It has been successful in achieving the goals of the National Tuberculosis Control Programme. The Institute started DOTS-PLUS as a pilot project in Jan’02. The project had approval of green light committee. A total of 160 patients were enrolled in the project. The seven year experience has also been published. This Experience of DOTS Plus project contributed significantly in formulation of national DOTS Plus guidelines. Faculty of LRS Institute are also members of National DOTS Plus committee for framing and revising the National Guidelines. LRS Institute is now a part of National DOTS-Plus Programme.

Currently Institute is implementing National DOTS-Plus programme since Jan’09. The activities under the programme are as follows:

·         LRS institute covers a population of 6 million for screening the MDR in its National Reference Laboratory and a population of 4 million for providing DOTS-Plus treatment. Four chest clinics namely malviya Nagar, Moti Nagar, RTRM and LRS chest clinics come under DOTS-Plus treatment.

·         The suspects for MDR are the patients who fail on CAT-I, CAT-II (4month positive) or CAT-III under DOTS. All such patients are subjected to culture and sensitivity free of cost by the LRS Microbiology Lab which is the national reference laboratory for tuberculosis. Patients with proven MDR  are enrolled in the programme. These patients are treated with daily supervised regimen for a period of 2 years with the second line drugs free of cost.

·         All the patients enrolled in the programme are evaluated by a DOTS-Plus committee. Members of the committee are specialists of chest medicine, epidemiology, internal medicine, Obs & Gynae, ENT, Nephrology, Endocrinology, Psychiatry and microbiologist. This committee meets on a weekly basis to discuss the enrollment related and other issues like adverse drug effects.

·         Approximately 125 patients are screened in 1^st quarter of 2009 and 12 patients started on treatment in the same quarter and their data were maintained on regular basis.