One of the very successful initiative of the Institute has been to train the peripheral medical and paramedical staff on the digital platform. NITRD took an important step of joining hands with ECHO India, a healthcare nonprofit organization. to start the first digital knowledge sharing platform for Drug Resistant TB (DR-TB) “ECHO – DR-TB Clinic” in November 2016. This is a unique program for knowledge sharing on tuberculosis. The program has been overwhelmingly successful. This initiative later expanded to HIV-TB and other initiatives, and has since benefited countless patients by providing critical training to healthcare professionals across India.
NITRD has launched the following ECHO programs
- NITRD TB ECHO
- NITRD-SHARE HIV-TB ECHO
- NITRD-ECHO Bedaquilline Training
- NITRD DR-TB ECHO for Medical Colleges
- NITRD TB ASHA ECHO for community volunteers
- NITRD TB-COVID-19 Series
- NITRD DNB-Post graduate ECHO
- NITRD-CTD-NTF Difficult to Treat TB Clinic
- NITRD Thoracic Surgery sessions
- Nurses’ Efforts to Eliminate TB (e-NEETI) in India
- Pediatric TB ECHO Clinic
- NITRD NRL – Diagnostic Management of TB for IRL, C&DST Lab and TDC through ECHO
NITRD TB ECHO Program:
These TB-ECHO sessions were started realizing the need for gaps in knowledge regarding management of DRTB. This Clinic is managed by Dr. Neeta Singla & the team of experts from the Institute under the chairmanship of Director, NITRD. The clinic first involved the 25 District TB Officers and all the four Drug Resistant TB (DRTB) Centers of Delhi to address the difficulties in the management of Drug resistant TB (DR TB). The heart of the ECHO model is its hub-and-spoke knowledge sharing networks, led by expert teams who use multi-point video conferencing to conduct virtual clinics and empower primary care doctors, nurses and clinicians to provide excellent specialty care to patients in their own community. The TB-ECHO clinic session includes a didactic presentation by an expert, followed by “difficult to manage” case presentation by one of the DTOs from the periphery through video conferencing on ECHO platform. The cases presented are the patients in which the treating physician is facing some challenges and is looking for guidance from team of experts. The expert team comprises of Chest Specialist, Microbiologist and specific disease specialist as per the need of the case being presented. The experts discuss the case and answer the queries raised by the participants.
The panel then gives its final recommendations on the case. The recommendations are then circulated to all the participants by mail for future references. This not only helps the patient in the peripheral treatment center by getting the opinion of the senior team of consultants from tertiary institute of the country but also helps the participating DTOs in capacity building for management of such cases in the future.
The goal of these tele-ECHO clinics is to address the complex issues of DRTB, sharing best practices and suggesting the best treatment/ solution by combining the knowledge of every participant attending the clinic, with the aim to eventually develop the capacity of the participants (DTOs) as experts in the treatment of DRTB over time. The TB-ECHO Clinic which started with 30-35 centers with approximately 70-75 participants expanded to 75-80 centers with 150-200 participants joining the clinic. These include the State TB Training and Demonstration Centre (STDC) New Delhi, The State TB Control Office (STO) Delhi, STO offices from Assam, Gujarat, Tamil Nadu, Maharashtra along with NTI Bengaluru and NIRT Chennai. clinic is also attended by international participants from USA, Cameroon and URC West Africa& The UNION. These clinics are widely appreciated for knowledge sharing and capacity building efforts.
The overwhelming response to these clinics were noticed by the prime minister’s office, who attended one of the clinics and instructed Central TB Division, Ministry of health to expand to cover all the states and all the medical colleges of the country. This success also prompted institute to expand to other fields within the Institute like HIV, education of ASHA workers, Medical colleges etc.
The overwhelming response to these clinics were noticed by the prime minister’s office, who attended one of the clinics and instructed Central TB Division, Ministry of health to expand to cover all the states and all the medical colleges of the country. This success also prompted institute to expand to other fields within the Institute like HIV, education of ASHA workers, Medical colleges etc.
e-NISCHIT
National AIDS Control programme and National TB Programme launched their first joint technology based capacity building initiative to strengthen the implementation of Prevention and Management guidelines on TB in PLHIV at ART centers. The initiative, “National Initiative to Strengthen Collaboration between HIV-TB through e-Learning (eNISCHIT)” was supported by CDC and its implementing partners (ECHO India and SHARE INDIA) along with National Institute of TB & Respiratory Diseases (NITRD), acting as central Hub. It is managed by Dr Upasna and the team from NITRD. The technology-based capacity building initiative aimed to augment and update the knowledge & skills of the medical officers and other functionaries of the antiretroviral therapy (ART) centres for prevention and management of HIV-Tuberculosis co-infections.
Launched in May’2018; the virtual, case based learning model based on ECHO platform has since reached 1500 health care providers in 115 ART centers located across four states of India, namely Delhi, Uttar Pradesh, Andhra Pradesh and Tamil Nadu. In addition to ART center staff, health officials from respective State AIDS Control Societies and State TB Program also participated in the sessions.
In the year 2019-2020, the program achieved a milestone with 51 successful interactive sessions on management of HIV-TB. In each session, a critical case from the ART centre was presented and about 45 experts in HIV-TB from Government and private health institutions provided their expert opinion and insight on HIV-TB in addition to the clinical and technical inputs.
Each session was attended by an average 140 to 200 participants. Furthermore, to provide knowledge on management of HIV-TB patients with COVID-19, a special eNISCHIT session was conducted on “COVID-19, An Overview of Existing Knowledge: The Virus, It’s Spread and Prevention, Clinical Case Definition and Management” by the senior faculty member and Nodal Officer for COVID-19 from NITRD, New Delhi.
NITRD-ECHO Bedaquilline Training
The use of ECHO platform gave unexpected results for rollout of the new drug “Bedaquilline” for treatment of DR- TB. Central TB Division entrusted NITRD with the task of expansion of use of Bedaquiline, as the uptake and training for use of this drug was taking time. NITRD took up the challenge and starting October 2018, teleECHO sessions were designed to cover 143 DRTB centres in 39 states & UTs in 5 batches. These were covered over 15 sessions each session was attended by an average of 109 participants. These sessions were conducted by expert faculty of the Institute who have a vast experience of treating TB and DR-TB. These sessions led to 300% increase in the use of the new drug – Bedaquiline, within 6 months by building confidence that drug is good and Adverse Drug Reactions (ADRs) can be managed if addressed properly.
NITRD MDR TB ECHO - Medical Colleges (Launched in August 2019)
More than a year after the launch and subsequent success of the HIV-TB program – NITRD decided to leverage the ECHO Model to training of faculty of medical colleges to disseminate knowledge regarding TB elimination programme. Beginning with the region of North India, 13 medical colleges were chosen from the states of Himachal Pradesh, Uttarakhand, Uttar Pradesh, Delhi, Punjab and Haryana.
This initiaive is managed by Dr Prahpreet Sethi and team of experts from NITRD.Launched in August 2019, 208 man-hours of training for medical colleges have been done so far with an average of 27 participants per session. In these sessions apart from didactic by an expert, medical residents present cases that are discussed amongst the participants so that they can collectively come up with the best way to manage the patient.
NITRD TB ASHA ECHO (Launched in January 2020)
Encompassing the optimum goal to amplify capacity and share best practices at the grass root level, the latest program launched by NITRD-ECHO “TB training for ASHA workers” working in field under south Delhi dispensaries. These sessions aim to provide and strengthen TB management training to field level workers. This program is appreciated not only by the workers but by the Incharges of dispensaries. This programme is a great success in a very short span. This program is being managed by Dr Khalid and his team along with experts from NITRD.
The clinic involves 6 Dispensaries in Delhi and all the ASHAs are addressed regarding TB in their respective area. On an average, every session is being attended by more than 100 ASHAs. In each session, an ASHA worker presents a case concerning the medical, social as well as psychological aspects of TB in their respective areas. Addressing the issue, DTO/Microbiologist, STS and STLS located at the hub provide resolution for the presented case.
NITRD TB-COVID-19 Series
The COVID pandemic has disrupted healthcare systems around the world: with the number of COVID cases rising in India, NITRD took the lead to run multiple ECHO sessions to sensitize the physicians dealing in Tuberculosis with various aspects of the TB-COVID co-infection . This clinic is managed by Dr. Rupak Singla, HOD, TB & Chest along with team of experts from the NITRD. Leading Physicians from across the country have participated in these sessions. Dr. Sarabjit Chadha from FIND took sessions on Lab diagnosis. Dr. Prabhat Chand of NIMHANS on Doctor’s well-being and mental issues with the COVID disease. Padma awardee Dr. Behera took session on Epidemiology of TB &COVID. Dr. Saini and Dr. Rupak Singla covered issues in dealing with Tb & COVID and the infection control measures.
DNB- Post Graduate ECHO
NITRD is a teaching Institute with 40-45 Post graduate students. From June’2020, complete academic schedule has been shifted to virtual platform and the curriculum is now covered in the NITRD Academic-ECHO sessions. It is first of its kind where all the academic activities are being done on ECHO platform. These sessions are managed by Dr. Rupak Singla and Dr. Amitesh Gupta along with expert faculty of NITRD.
NITRD-CTD-NTF Difficult to treat Clinic:
These sessions were started with the objective of providing the solution to various clinical issues being faced by the peripheral nodal DR-TB centres across the country with the help of national level experts. Dr Rupak Singla, Consultant, Dept. of Respiratory Medicine developed the concept of Difficult to treat TB (DTTC) on ECHO platform. The idea was supported by Central TB Division and National Task Force (NTF) under the National TB Elimination Program (NTEP). The clinic was named as NITRD-CTD-NTF DTTC clinic. A group of national experts with sufficient experience were identified to support this clinic. A structured clinical proforma was designed to send the case details by the peripheral nodal DR-TB centers. WHO NTEP technical support network consultants were also asked to support the clinic. First DTTC was held on 30th August 2020 wherein all stake holders were briefed about the clinic. Since then, DTTC is held once a month where clinical cases are presented and discussed and is usually attended by 500-800 doctors across the country.The DTTC clinic has helped in supporting Nodal DRTB sites in decision making of difficult TB cases and has addressed the knowledge gap that existed in the light of new drugs and new treatment regimen. It has also helped in capacity building of the medical colleges across the country through NTF mechanism. It has become a good platform to update knowledge about newer drugs and guidelines for the management of DR-TB. Looking at the success of DTTC clinic CTD has asked all the states to start state level DTTC in their states and NITRD-CTD-NTF DTTC will be functioning at national level to mentor these state DTTC.
Thoracic Surgery ECHO Sessions
It was launched in June’21. These are monthly sessions and are a joint collaborative effort of the Indian Society of Thoracic Surgeon and Trust (ISTST) and the National Institute of Tuberculosis & Respiratory Diseases (NITRD) to improve patient care through ECHO learning platform.
- To facilitate continuous learning among general as well as thoracic and cardiothoracic surgeons to improve the patient care for thoracic surgical ailments at every district hospital.
- Capacity building of the students pursuing super-specialty
Nurses’ Efforts to Eliminate TB (e-NEETI) in India
NITRD launched e-NEETI ECHO Clinic in August 2023 using Hub and Spoke model supported by ECHO. It targets TB Nurses in medical colleges and Institute through interactive case-based clinics, featuring expert insights, best practices and mentoring. The Launch of Nurses’ Efforts to Eliminate Tuberculosis in India (e-NEETI) was organised by NITRD and ECHO India on 17th August 2023. Dr. Deepika Cecil Khakha, Nursing Advisor, Ministry of Health and Welfare, Government of India joined the session as the Chief Guest.
The objective of the program is to disseminate best practices of nursing care for TB Patients, dissemination of newer regimes, drugs and strategies and to build the capacity of the nurses working in TB care and management. Since the launch, 24 sessions have been conducted with both national and international guests joining the session. Till now, 844 participants have participated in the sessions.
Pediatric TB ECHO Clinic
NITRD launched Paediatric TB ECHO Clinic on 21st May 2024 in collaboration with the Regional Paediatric Centre of Excellences (RPCoE) namely IPGME&R and SSKM Hospital, Kolkata, West Bengal; Agartala Government Medical College & Govind Ballabh Pant Hospital, Agartala, Tripura; Byramjee Jeejeebhoy Government Medical College (BJGMC), Maharashtra; Advanced Pediatrics Centre (APC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh and Institute Of Child Health and Hospital for Children (ICH and HC), Chennai.
The Pediatric TB ECHO clinic aims to disseminate the Pediatric TB Guidelines and enhance the capacity of healthcare providers in managing Pediatric TB at the peripheral level. The Department of Pediatrics at NITRD is continuously contributing to the global cause of TB elimination by providing excellent care through treatment, training, research, and policy decisions for Pediatric tuberculosis control in the country. Since the launch, the program has conducted a total of 17 sessions with clinicians and TB Pediatricians joining from all the states of the country.
NRL, NITRD - Capacity Building for IRL, C&DST Lab and TDC through ECHO
This is the recently launched ECHO Program from NRL NITRD called ‘Capacity Building for IRL, C&DST Lab and TDC through ECHO’. The primary objective of the program is to enhance the efficiency, accuracy, overall quality of laboratory operations and ultimately leading to better patient care. The key objectives of the program are to enhance Diagnostic Skills, promote Quality Assurance, improve Treatment Outcomes, facilitate Data Management, address Challenges in TB Care and strengthen the Laboratory Network of the linked IRLs, C&DCT labs and TDCs of the states.
The launched session was conducted on 25th September 2025 with 298 participants joining from the states of Delhi, Bihar, Himachal Pradesh, Punjab, Jammu & Kashmir, Chandigarh, Haryana and Ladakh.
Plans for expansion
The success of the TB-ECHO sessions has led to its adoption by Central TB Division. It has been included in National guidelines for TB control. The Central TB Division has made it mandatory to expand it to all states in the country. Currently the sessions conducted by NITRD has national presence and are attended by DRTB centers, medical colleges, STDC and STOs and private practitioners across India.