Background

The NTEP is committed to fulfill India’s contribution to the global achievement of the targets set by the first ever United Nations High level meeting on TB (UNHLM-TB) in September 2018 by successfully treating 11.47 million people with TB, including 1.13 million children and 439,660 people with DR-TB; and initiating 6.9 million people on TPT by 2022.  India has rolled out an ambitious National Strategic Plan (NSP) for the period 2017-2025.The NTEP is also now focused on the important element of institutional strengthening and has proposed the concept of institutional strengthening, especially through establishment of Centres of Excellence (COE) under the recently drafted Revised National Strategic Plan (NSP) to End Tuberculosis in India 2020–2025 .Since the commitments made in the United Nations High Level Meeting (UNHLM-TB) in 2018, nearly 8 million people with TB were notified and 6.74 million people were successfully treated during 2018 and 2021, including 323,677 children. During the same period, out of 222,513 people with DR-TB diagnosed, 189,023 people with DR-TB were put on treatment and 1.9 million people were initiated on TPT .  

NTEP will adopt a hub and spoke model approach to demonstrate institutional strengthening through identified national and state level institutes. The project will augment capacities and efficiencies of strategic TB and DR-TB Care institutes as “Hubs” that will impact the program implementation at the linked institutes and geographies - the “Spokes”. This model allows for the rapid spread of knowledge, tools, and evidence, while simultaneously providing guidance and mentoring for the spoke institutions, to offer standards of excellence. Hub institutions will play a critical role in diffusing skills and expertise across the public and private healthcare facilities to increase efficiencies across a range of institutions.

A range of institutions provide DR-TB care under NTEP. This includes medical colleges, tertiary health care centres, teaching institutes, laboratories and hospitals in public and the private sector. There are close to 150 NDR-TB and 500 DDR-TB Centres situated in national institutions, medical colleges, tertiary care institutes and district hospitals.  With an intention to improve the quality of DR-TB care in terms of early and complete identification of DR-TB, to initiate all diagnosed cases on appropriate treatment timely and ensure follow up of all patients to ensure successful treatment completion, the project has been supporting NTEP in establishing a hub and spoke model through establishment of Center of Excellence in DR-TB care. These CoEs are envisaged to demonstrate excellence in DR-TB care by providing distinct care to complicated TB/DR-TB cases using advanced diagnostics, new combination of medicines, aDSM, adverse drug reaction (ADR) management, surgical interventions, psychosocial support, rehabilitation and palliative care. In addition, these CoEs will innovate and demonstrate best practices in clinical management, treatment adherence and infection prevention and control.
The proposed CoEs will mentor linked NDR-TB Centres and support replication of the best practices-based care models. Eventually, CoEs will also support NTEP in policy decisions, development of guidelines, generating evidence, and development of implementation tools and job-aids.

NTEP will work with identified institutions and  improve  service delivery, learning, knowledge management, analytics, gender sensitivity and monitoring & evaluation capacity. This will be achieved through critical gap filling for infrastructure, human resources, capacity building, technology, and partnerships. The project intends to demonstrate improvement in DR-TB care through institutional strengthening, with CoEs and linked institutions and geographies. The project support will result in establishment of functional CoEs and demonstrating institutional strengthening through hub and spoke model engaging CoEs, NDR-TB and DDR-TB Centres. The project also intends to support documentation and dissemination of best practices and to create a community of practice for institutional strengthening.