Transition to Nikshay based reporting for DR TB

Transition to Nikshay based reporting for DR TB patients Treatment cohort monitoring

Timelines for transition to Nikshay Type of quarterly report Transition to Nikshay based reporting for the patient enrolled in respective quarter Case finding report Currently through google spreadsheet switch to Nikshay whenever available Case holding report 1 Q 20 onwards Interim outcome report 1 Q 18 onwards Final outcome report 1 Q 18 onwards

Case holding report (Table 2 of PMDT quarterly report) Reporting quarter 4 Q 17 1 Q 18 2 Q 18 3 Q 18 4 Q 18 1 Q 19 2 Q 19 3 Q 19 4 Q 19 1 Q 20 H mono/poly & Shorter MDR TB Pts enroll ed in 4 Q 17 (Man ually) Pts enroll ed in 1 Q 18 (Man ually) Pts enroll ed in 2 Q 18 (Man ually) Pts enroll ed in 3 Q 18 (Manu ally) Pts enrolle d in 4 Q 18 (Manu ally) Pts enroll ed in 1 Q 19 (Niks hay) Pts enroll ed in 2 Q 19 (Niks hay) Pts enroll ed in 3 Q 19 (Niks hay) Pts enroll ed in 4 Q 19 (Niks hay) Pts enroll ed in 1 Q 20 (Niks hay) All regimen with >1 Pts yr duration enroll ed in 4 Q 17 (Man ually) Pts enroll ed in 1 Q 18 (Niks hay) Pts enroll ed in 2 Q 18 (Niks hay) Pts enroll ed in 3 Q 18 (Niksh ay) Pts enrolle d in 4 Q 18 (Niksh ay) Pts enroll ed in 1 Q 19 (Niks hay) Pts enroll ed in 2 Q 19 (Niks hay) Pts enroll ed in 3 Q 19 (Niks hay) Pts enroll ed in 4 Q 19 (Niks hay) Pts enroll ed in 1 Q 20 (Niks hay) · Case holding report of all DR TB regimen will be based on Nikshay for patients registered from 1 Q 2018. All reports before 1 Q 2018 will be prepared/reported manually.

Interim Report (Table 3 of PMDT quarterly report) Reporting quarter 4 Q 17 1 Q 18 2 Q 18 3 Q 18 4 Q 18 1 Q 19 2 Q 19 3 Q 19 4 Q 19 1 Q 20 H mono/poly & Shorter MDR TB -4 th month interim (Smear) Pts enroll ed in 2 Q 17 (Manu ally) Pts enroll ed in 3 Q 17 (Manu ally) Pts enroll ed in 4 Q 17 (Manu ally) Pts enrolle d in 1 Q 18 (Manu ally) Pts enrolle d in 2 Q 18 (Manu ally) Pts enroll ed in 3 Q 18 (Man ually) Pts enroll ed in 4 Q 18 (Man ually) Pts enroll ed in 1 Q 19 (Niksh ay) Pts enroll ed in 2 Q 19 (Niksh ay) Pts enroll ed in 3 Q 19 (Niksh ay) All regimen with >1 yr duration 6 th Month interim (Culture) Pts enroll ed in 1 Q 17 (Manu ally) Pts enroll ed in 2 Q 17 (Manu ally) Pts enroll ed in 3 Q 17 (Manu ally) Pts enrolle d in 4 Q 17 (Manu ally) Pts enrolle d in 1 Q 18 (Niksha y) Pts enroll ed in 2 Q 18 (Niks hay) Pts enroll ed in 3 Q 18 (Niksh ay) Pts enroll ed in 4 Q 18 (Niksh ay) Pts enroll ed in 1 Q 19 (Niksh ay) Pts enroll ed in 2 Q 19 (Niksh ay)

Final treatment outcome report (Table 4 of PMDT quarterly report) Reporting quarter 1 Q 19 2 Q 19 3 Q 19 4 Q 19 1 Q 20 2 Q 20 3 Q 20 4 Q 20 1 Q 21 Treatment outcome for H mono/poly & Shorter MDR TB - Pts enroll ed in 1 Q 18 (Man ually) Pts enroll ed in 2 Q 18 (Man ually) Pts enroll ed in 3 Q 18 (Man ually) Pts enroll ed in 4 Q 18 (Manu ally) Pts enrolle d in 1 Q 19 (Niksh ay) Pts enroll ed in 2 Q 19 (Niks hay) Pts enroll ed in 3 Q 19 (Niks hay) Pts enroll ed in 4 Q 19 (Niks hay) Pts enroll ed in 2 Q 19 (Niks hay) Pts enroll ed in 3 Q 19 (Niks hay) Treatment outcome of All longer regimen (>1 yr duration) Pts enroll ed in 3 Q 16 (Man ually) Pts enroll ed in 4 Q 16 (Man ually) Pts enroll ed in 1 Q 17 (Man ually) Pts enroll ed in 2 Q 17 (Manu ally) Pts enrolle d in 3 Q 17 (Manu ally) Pts enroll ed in 4 Q 17 (Man ually) Pts enroll ed in 1 Q 18 (Niks hay) Pts enroll ed in 2 Q 18 (Niks hay) Pts enroll ed in 3 Q 18 (Niks hay) Pts enroll ed in 4 Q 18 (Niks hay)

Nikshay entry of the pending DR TB patients episodes Each district need to assess the patients those who are enrolled physically are there in the Nikshay or not For the patients transferred out to other district, the district where the patient currently located need to ensure the entries of such DR TB patients in coordination with respective districts. Follow the episode creation requirement as suggested in guidelines

Shorter MDR TB regimen Status of DR TB entries in Nikshay. India Conventiona H mono l regimen poly New drug All oral (MDR) All oral (XDR) Nikshay entry against the quarterly report (2018) 97% 80% 98% NA NA NA Interim follow up entry carried out (2018) 5% 4% 3% NA NA NA Treatment outcome entry carried out (2018) 91% 45%* 93% NA NA NA Nikshay entry against the quarterly report (2019) 93% NA 92% 95% 126% 135% Interim follow up entry carried out (2019) 9% NA 10% 6% 2% 1% Treatment outcome entry carried out (2019) 45%* NA 55%* 18%* 9%* National level status based on data extracted from Nikshay as on 15 th April 2020

Status of DR TB entries in Nikshay. Uttar Pradesh Shorter MDR TB regimen Conventiona H mono All oral New drug l regimen poly (MDR) All oral (XDR) Nikshay entry against the quarterly report (2018) 137% 83% 117% NA NA NA Nikshay entry against the quarterly report (2019) 98% NA 89% 95% 126% 135% National level status based on data extracted from Nikshay as on 15 th April 2020

● General guidance to complete backlog entries ● ● ● Hence forth, all C-DST Laboratories, DR TBCs and Districts must ensure the relevant component of data entry should be made in real-time C-DST labs with LIMS mechanism should enter information in LIMS which will be sync with Nikshay automatically. All patients currently on treatment within district must be reflected in Nikshay including transferred in patients. While entering any test results for DR TB patients, select the reason for test as ‘Diagnosis of DR TB’ or ‘follow up of DR TB’ Coordination between CDST lab, DR TB Centres and District is essential to ensure completeness To complete pending entries, the district where the patient is currently resides need to ensure the pending entries.

Classifying PHIs as “DRTB” Centre Via User Management Essential to provide patient access to treating DR TB centre

Enable DRTB/ART Facility for a PHI Select PHi Click on Modify

Enable ART/DRTB Facility for a PHI • • A PHI can be marked as having an ART or DRTB facility or both, by editing the services provided by that PHI under the User Management Tab. For Nodal DR TBC, check ‘yes’ for both nodal as well as district DR TBCs

Assigning patients to “ART” and “DRTB” centres

Update ART and DRTB Facility • A user can assign an ART / DRTB Facility to a patient by clicking on the ‘Edit’ button under the Health Facilities Tab. • PHIs with ART or DRTB facility selected as ‘Yes’ will appear under this list. • If an ART user notifies a patient, “Current Facility” gets auto assigned as the ART Facility (PHI) and user can edit the ART facility if required • Similarly if an DRTB user notifies a patient, “Current Facility” gets auto assigned as the DRTB Facility (PHI) and user can edit the DRTB facility if required

● A PHI should be mapped for the various available services ● Specific ART centre logins will be discontinued ● DRTB Centre and ART centres should use the PHI login of the health facility to view the patient mapped to their facility ● Unified page has been created to provide patient detail access to the health facility as per the health facilities linkages for that patient. ● While transferring any patient, DRTB & ART facility need to be changed along with the current residential PHI. This will enable DRTB & ART Centre to access their linked patients with onus of public health action lies with the current PHI.

The unified episode search page

Reason for change: ► In the version of Nikshay prior to this change, to access a list of patients, one need to perform multiple clicks, drill down to a PHI/TU to access patient wise lists. ► Apart from multiple clicks the user has to perform to generate a list of patients, at each click the page is rel 0 aded, resulting in multiple page loads significantly Description of Changes reducing system performance. ► This view limits the user interface in such a way that the user can only access patients currently assigned under that District/TU/PHI. The change made: ► A single search page for patients assigned under health facility replaces the multiple stage wise hierarchical drill down. ► User will be able to generate all lists and also make a specific filter based search to identify patients based on various criteria, ► This page will also enable access to patients that are not currently under the PHI/TU/District, but those that are also assigned through the ART centre, DRTB Centre patient linkage as well.

► Patients can now be assigned to an “ART” or “DRTB” Centers in addition to current PHI. Additional view for PHI that are ART or DRTB Centre ► This will enable ART and DRTB Centers to view patient based outside their PHIs. ► The Unified episode search page will also enable these PHIs to access the above linked patients, in addition to their currently assigned patients. ► Currently to view patient list based on ART and DRTB centres is only available in PHI Logins. Gradually access to view patient based on Current Health Facility, ART and DRTB Facility will be given to TU and District Logins

Patient List: 4 – View Patient List by ART / DRTB Only PHI Login can view patient by “Current Health Facility” / “ART” and “DRTB” • PHI and Patient assignment as “ART” and “DRTB” centre is explained in training material – ‘PHI and Patient assignment as “ART” and “DRTB” Centre (March 2020)’

● In any case, if regimen changes New Episode should be created from Outcome tab New Episode

New Episode requirement Any modification in DR TB regimen, update the prescription for the patient for H mono/poly regimen and all oral longer regimen without creating any additional episode. If H mono/poly patient is switched to shorter or all oral longer regimen , episode needs to be created Modification in composition of shorter MDR TB regimen is not permitted. If required to change the regimen, all oral longer regimen should be initiated, create subsequent episode in such case.

How to review the status DR TB Reports available in Nikshay

Report section ● DR TB Reports ● UDST report – Type of patient (public/ private) & Type of case ( New / PT) and Type of disease ( P/EP) PMDT report – Case holding report, interim report & Treatment outcome report Patient wise list ● Patient List UDST Not Offered ● DRTB Treatment Register ● Patient Lab Register. Care cascade of DR TB diagnosis and treatment initiation.

● Information regarding the UDST offered (CBNAAT, Truenat or FL LPA) ● Split for UDST <7 days, 7 to 15 days and >15 days UDST report ● Average time taken for UDST

Selection of Type of case options Type of regimen UDST report – FL LPA screening ● Evaluate the FL LPA screening offered for Previously treated TB patients, MDR RR TB patients especially initiated on shorter MDR TB regimen.

● All DR TB episodes provide the calculation for patients initiated on treatment PMDT – 2. Case holding repot report ● ● extra pulmonary DR TB patients female DR TB patients children (< 15 yrs) HIV +ve DR TB patients

PMDT – 3. Interim case finding report PMDT – 4. Treatment outcome report ● Report based on current PHI, treatment initiation cohort

Download with DR TB filter every month Utility of DR TB register - Check total patient initiated on treatment based on the current PHI - Analyse : type of regimen, comorbidity parameters, treatment outcome updates, - Delays in treatment initiation Download provision available for notification cohort and treatment initiation cohort.

Download with DR TB filter every month Utility of Patient lab register - Check for basis of diagnosis - Check CBNAAT, LPA, Truenat entry as per eligibility - Delay in data entry (Reporting date- Nikshay entry date) - Delay in testing (Specimen collection date- Report date) - For Shorter MDR TB regimen, check FL & SL LPA test result updated or not - Follow up culture and smear microscopy done for respective time points

Example District wise No. of days between diagnosis and treatment initiation District Vyara Botad Chhotaudepur Ahmedabad (R) Surendranagar Rajkot Anand Patan Gir Somnath Narmada Vadodara (R) Sabarkantha Junagadh Morbi SMC Kheda Amreli Valsad Avg No. of days b/w Dia & Rx 4. 3 5. 0 5. 2 5. 7 6. 7 7. 1 7. 3 7. 5 7. 8 7. 9 8. 2 8. 4 8. 5 9. 1 9. 2 District Navsari Arvalli Gandhinagar Mahisagar Kachchh Dahod Bhavnagar Surat (R) Jamnagar Bharuch Porbandar Banaskantha AMC VMC Devbhumi Dwarka Mahesana Panchmahals Total Avg No. of days b/w Dia & Rx 9. 3 9. 5 9. 6 9. 8 9. 9 10. 6 10. 7 10. 8 11. 3 11. 4 11. 9 13. 8 14. 0 19. 4 9. 2

District Example Gap in Data entry in Nikshay (1 Q 20) Ahmedabad (R) AMC Total DRTB patient on put on treatment (as treatment per Nikshay Difference (as per DRTB quarterly treatment report) register) District Total DRTB patient on put on treatment (as treatment per Nikshay Difference (as per DRTB quarterly treatment report) register) 29 293 23 228 6 65 Mahesana Mahisagar 31 22 28 22 3 0 Amreli 9 9 0 Morbi 8 10 -2 Anand 60 48 12 Narmada 9 8 1 Arvalli Banaskantha 31 56 31 45 0 11 Navsari Panchmahals 12 75 12 59 0 16 Bharuch Bhavnagar 45 25 39 25 6 0 Patan Porbandar 24 5 20 6 4 -1 Botad 11 2 9 Rajkot 48 40 8 Chhotaudepur 29 11 18 Sabarkantha 14 11 3 Dahod 64 67 -3 SMC 145 98 47 Devbhumi Dwarka 4 4 0 Surat (R) 22 23 -1 Gandhinagar 26 22 4 Surendranagar 23 20 3 Gir Somnath Jamnagar 13 24 10 23 3 1 The Dangs Vadodara (R) 1 37 30 1 7 Junagadh 14 9 5 Valsad 25 19 6 Kachchh 25 20 5 VMC 45 30 15 Kheda 60 55 5 Vyara 6 8 -2 Total 1356 1115 241

Utility of DR TB follow up register Download with DR TB filter every month - Follow up culture and smear microscopy done for respective time points including long term follow up details - test results and final interpretation of test result is available.

NPY for DR TB ● NPY payment will be generated until the final outcome is not updated. ● If subsequent episode is created within 2 month of prior episode, NPY benefit generated at the time of notification may be deferred based on the duration of treatment taken. Subsequent payment to be made through Nikshay.

● Mapping of PHI as DRTB Centres in Nikshay (Nodal & District + Summary points for action ● ● ● ● District standalone) Assigning DRTB & ART Centre facility for all existing DR TB patients Access the patient through unified patient page for DRTB Centres Real time entries from CDST labs, DR TBCs and Districts Regular review of through PMDT report , UDST not offered list, DR TB register and patient lab register. Gap in Nikshay entries (Manual reporting Vs Nikshay entries) for case holding report Check for average delay in Treatment initiation, Nikshay entries, turnaround time for UDST and follow on test (Nikshay) Communicate to ctdpmdt@rntcp. org for any query.

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