District TB-comorbidity Coordination Committees [DTCC]

Along with the early diagnosis of all TB cases and appropriate treatment, screening for comorbidity, appropriate management of comorbidity and periodic clinical review of TB patients is of utmost importance in order to improve TB treatment outcomes.

Adapting the learnings from the TB-HIV collaborative framework, the National Strategic Plan (NSP) 2017-2025 recommended the setting up of the National TB Comorbidity Coordination Committee to address various comorbidities affecting the TB treatment. Subsequently, the State and District TB comorbidity Coordination Committees (DTCCs) were established.

Constitution of DTCC

The DTCC consist of:

• Head: District Collector (District Magistrate/ Deputy Commissioner)
• Members:
  • Joint Director of Medical and Health Services (CMHO/ DHO)
  • City TB officers (wherever applicable)
  • District TB Officer (DTO)
  • Deputy Director of Health Services (wherever applicable)
  • District Nodal Officers – District AIDS Prevention and Control Unit, National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular diseases and Stroke (NPCDCS), Maternal and Child Health (MCH), National Tobacco Control Programme (NTCP), Health and Wellness Centres
  • TB and comorbidity experts from academic institutes
  • Representatives from partner organisations involved in TB elimination activities in the district

Objectives of the DTCC

• To ensure smooth implementation and regular review of collaborative activities with all the other comorbidities (i.e., HIV, AIDS, diabetes, non-communicable diseases, tobacco, maternal and child health) affecting TB treatment
• To improve screening and detection of active TB in patients with other conditions
• To intensify early screening and diagnosis of comorbidities in registered TB patients in TB clinics.
• To strengthen referral mechanisms across National TB Elimination Programme (NTEP) and other programmes.
• To strengthen the management of TB–comorbidities in patients across NTEP and other programmes.
• To establish surveillance and Monitoring and Evaluation (M&E) mechanisms for collaborative activity

Overall mandates of the DTCC

• Strengthen coordination between the NTEP and the other programme staff in the district
• Address issues related to training of key programme staff and general health staff
• Promote participation of Non-government Organisations (NGOs)/ Community Based organisations (CBOs) and other private practitioners
• Ensure timeliness of reports from peripheral health institutions
• Review availability of TB elimination facilities in the other programme set-ups
• Review performance indicators mentioned under the collaborative activity
• Review outcomes of joint monitoring of the collaborative activity

Operation of DTCC

• The DTCC should meet on a quarterly basis, preferably within 15 days of submitting the NTEP quarterly reports.
• The DTO should be responsible for organising the DTCC meetings.
• The nodal officers of all participating programmes under the DTCC should actively participate during the meetings and ensure harmonious collaborative activities.
• Minutes of these meetings should be sent to State TB Cell as well as to the state cells of the other programmes involved.

Resources

• Guidelines on Programmatic Management of Drug-resistant TB (PMDT) in India, CTD, MoHFW, India, 2021.
• National Framework for Joint HIV/TB Collaborative Activities, NACO and CTD, MoHFW, India, 2009.
• National Framework for Joint TB-Diabetes Collaborative Activities, NPCDCS and NTEP, MoHFW, India, 2017.
• National Framework for Joint TB-Tobacco Collaborative Activities, NTCP and NTEP, MoHFW, India, 2017.

Assessment