The Central TB Division has set the ball in motion by 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 have been diagnosed or when anti-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 of Nikshay. Nikshay is an information communication technology (ICT) application developed by the government to specifically provide real time surveillance data of TB cases.
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. They can also get in touch with the respective nearest nodal officers 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 whose treatment 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 sharing personal details of patients.
“As per MCI code of Ethics – Rules & regulations 2002…it is the duty of the registered medical to divulge this information to the authorized notification official as regards communicable and notifiable diseases,” the FAQ states. “In case of communicable/notifiable diseases, concerned public health authorities should be informed immediately.”
It also states that there are provisions to take punitive/legal action against those who do not notify TB cases.
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 trace lost patients. But will all patients who approach private practitioners like public health staff to come into the picture?
TB was made a notifiable disease 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 of burden/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.