A change point analysis of performance indicators of revised national tuberculosis control program in Gujarat.

ABSTRACT

Background: In Asia, India is declared as High Tuberculosis/ High HIV/High MDR-TB burden country. The WHO estimates that there are 3100000 cases of TB at a rate of 256/1 lakh population, and the new cases are emerging at the rate of 185/ lakh population every year. To counter TB challenge, the country has implemented Revised National Tuberculosis Programme (RNTCP) since 1997. But, at which critical point of time the programme had significant success or failure in its indicators is important to analyze as this can help programme managers to detect measures that strengthen the impact of program. Aims & Objective: To identify periods when the program indicators had significant change and to corroborate it with activities which may have led to this change. Material and Methods: The RNTCP indicators – NSP case detection rate, NSP case notification rate, Cure rate etc. were analyzed from year 1998-2011. The change point analysis is the method used for this time series analysis. Results: NSP case detection increased significantly from 2002, while cure rate improved from 2005. The sustained case holding is the key to better results. Same way, smear positive retreatment cases, though declining are not reduced to a change point. Conclusion: The analysis suggests that the defaulter rate and failure rate among NSP is maintained in downward direction. It is indicative of better adherence, higher effectiveness and extending reach of the program.