Detailed discription about RNTCP programme

GOVERNMENT AYURVEDIC MEDICAL COLLEGE,
AKHNOOR.
DEPARTMENT OF SWASTHAVRITTA EVAM YOGA.
TOPIC: REVISED NATIONAL TUBERCULOSIS CONTROL PROGRAM
GUIDED BY:
• DR. ABHISHEK MAGOTRA [ASSOCIATE PROFESSOR]
• DR .SHEETAL GUPTA [ASSISTANT PROFESSOR ] PRESENTED BY.
• MADHUSUDAN RATHORE.
• ROLL NO : 24 .

REVISED NATIONAL
TUBERCULOSIS CONTROL
PROGRAM

CONTENTS
▶ Tuberculosis
▶ Burden of the disease
▶ History
▶ NTP [National Tuberculosis Program]
▶ RNTCP [Revised National TB Control
Program]
▶ DOTS Strategy
▶ Achievements

TUBERCULOSIS
▶ Tuberculosis is a contagious bacterial disease caused by Mycobacterium tuberculosis
(which was discovered by Robert Koch).
▶ The most common organ involved is lung(>80%) but it can involve any organ of the
human body (except hair and nails).
▶ It usually affects human in the age group of 15 to 60 yrs.
▶ Most infections show no symptoms, in which case it is known as latent tuberculosis.
▶ It was historically called consumption due to the weight loss.
▶ WORLD TUBERCULOSIS DAY is celebrated on 24th March every year since 1982.

CLASSIFICATION OF TB
TB
Pulmonary (85-90%) Extra-pulmonary (10-15%)
Sputum
Positive TB
(Those who
have
bacteria in
sputum)
Sputum
Negative TB
(Those who
do not have
bacteria in
sputum)
• Lymph Nodes
• Joints
• Genitourinary
tract
• Spinal tract
• Intestines

HOW TB SPREADS ?
▶ Those who have Tuberculosis of the lungs are the one who can spread the disease to others.
People with latent TB do not spread the disease.
▶ When these infectious people cough, sneeze, talk or spit, they can spread TB bacteria into
the air in the form of tiny droplets.
▶ When these droplets are inhaled by a healthy person he/she can get infected
with tuberculosis.
▶ A sputum positive TB patient can infect an average of 10-15 persons in a year.

WHEN TO SUSPECT
▶ TB should be suspected in anyone with cough for 2 weeks or
more.
▶ These persons should have sputum
examination in the nearest Microscopy Centre at the
earliest

TB-HIV CO-INFECTION
▶ TB is the most common opportunistic infection amongst HIV
infected individuals.
▶ An HIV infected person newly infected with TB has 10-30 times
higher chances of developing TB than those without HIV.
▶ In India, 55-60% of AIDS cases reported had TB and TB is one of the
leading
causes of death in “People Living with HIV AIDS”.

WORLD SCENARIO
▶ TB continues to be one of the most important public health
problems worldwide.
▶ TB is one of the top 10 causes of death worldwide.
▶ In 2019, about 10 million people developed TB.
▶ Of these, 56% were men, 32% were women and 12% were children
(aged
<15); overall, 8.2% of people with TB were living with HIV.
▶ In 2019,it caused 1.4 million deaths, including 208000 among HIV-
positive people.

INDIAN SCENARIO
•▶ India accounts for 26% of TB cases globally.
• ▶ India is the highest TB burden country with an estimated incidence of 26.9
lakh cases in 2019 (WHO).
• ▶ India accounts for about 24% of the global prevalence, 23% of the global
incident cases, and 21% of the global TB deaths.
•▶ India has the largest number of individuals suffering from drug-resistant versions of
the TB.
•▶ TB along with HIV leading to TB cases flare up and now in Corona virus pandemic
• ,reduced immunity in TB patents leading to life threatening morbidity.

HISTORY
▶ 1906- First open air TB sanatorium founded in India.
▶ 1939- TB association of India.
- setting up model institutions for training TB workers
- education of the public regarding preventive measures
▶ 1946- Bhore Committee recommended to the GOI, setting up TB clinics
in the districts and mobile TB clinics in rural areas.
▶ 1947- GOI established a TB division under DGHS (Directorate General of
Health Services).

▶ 1951- Mass BCG vaccination campaign covering 65 million children in collaboration with IUAT
(International Union Against Tuberculosis).
▶ 1959- National TB Institute (NTI) established in Bangalore by GoI, with the
active cooperation of the WHO, to develop a TB control programme.
▶ 1962- National Tuberculosis Program(NTP) was started.

NATIONAL TUBERCULOSIS PROGRAM
(1962)

NATIONAL TUBERCULOSIS PROGRAM
•▶ It was launched by The Government of India in 1962.
•▶ Involved with BC G vaccination and TB treatment.
• ▶ However, the treatment success rates were low and the death and default
rates remained high. Spread of multidrug resistant TB was threatening to further
worsen the situation. In view of this, in 1992 Government of India along with WHO
and SIDA reviewed the TB situation in the country and came up with following
conclusions :
- Managerial weaknesses
- Inadequate funding
- Over-reliance on X-rays for diagnosis
- Shortage of drugs
- Low rates of treatment completion

▶ Around the same time in 1993, WHO declared TB as a Global Emergency
and recommended to follow DOTS by all the countries.
▶ The Government of India revitalized NTP as Revised National Tuberculosis Control
Program in the same year.

REVISED NATIONAL TUBERCULOSIS
CONTROL PROGRAM (RNTCP)

RNTCP
▶ Launched in the year 1993.
▶ 1997- RNTCP started as a National Program.
▶ Based on the internationally recommended Directly Observed
Treatment Short-course (DOTS) strategy.
▶ DOTS was adopted as a strategy for provision of treatment to increase
the treatment completion rates.
▶ Adoption of smear microscopy for reliable and early diagnosis
was introduced.
▶ Supply of drugs was also strengthened to provide assured supply of
drugs to meet the requirements of the system.

GOAL
The goal of RNTCP is to decrease the mortality and morbidity due to
tuberculosis and cut down the chain of transmission of infection until
TB ceases to be a public health problem.

OBJECTIVES
The objectives of the programme are:
▶ To achieve and maintain cure rate of at least 85% among New
Sputum Positive (NSP) or infectious cases of tuberculosis through DOTS.
▶ To achieve and maintain case detection of at least 70% of the
estimated NSP cases in the community.

》• The revised strategy was introduced in the country in a phased manner as Pilot Phase
I, Pilot Phase II and Pilot Phase III.
▶ By the end of 1998, only 2% of the total population of India was covered by RNTCP.
▶ Large-scale implementation began in late 1998. The RNTCP has expanded rapidly
over the years and since March 2006, it covers the whole country.
▶ The new initiatives and the wider collaboration with other sectors aim to
provide standardized treatment and diagnostic facilities to all TB patients.
▶ RNTCP is built upon infrastructure already established by the previous national
tuberculosis programme.

DOTS (DIRECTLY OBSERVED
TREATMENT SHORT-COURSE)
▶ Directly observed treatment, short-course (DOTS, also known as TB-DOTS) is the name
given to the Tuberculosis control strategy recommended by the WHO.
▶ According to WHO, "The most cost-effective way to stop the spread of TB in
communities with a high incidence is by curing it. The best curative method for TB is
known as DOTS.
▶ Under the DOTS strategy, anti-tuberculosis medications are taken by patients under the
supervision of a health worker (DOT) thereby ensuring that proper medications are
given at proper intervals and at the right doses.

PHASES OF DOTS
There are two phases in DOTS treatment:
1. Intensive Phase(IP):-
▶ Intensive phase is of 2 to 3 months duration
▶ Patient take medicine under the observation of a health worker during IP
.
▶ Medicines are taken 3 times a week on alternate days.
▶ If the sputum is negative for bacteria after IP
, continuation phase is
started.

2. Continuation Phase
▶ This phase is of 4 or 5 months duration
▶ The patient is provided with a weekly blister pack to take home.
▶ The medicines from the blister pack are taken on alternate days, three times a week
and in the remaining days, Vitamin tablets are taken.
▶ The first dose of the weekly blister pack is taken under direct observation of the
health worker.
▶ Empty blister packs are collected to ensure that the medicines are taken at home by
the patient.

COMPONENTS OF DOTS
STRATEGY
▶ DOTS strategy adopted by Revised National TB Control Programme initially had
the following five main components:
1. Political and administrative commitment: establishment of a centralized system of TB
monitoring, recording and training.
2. Diagnosis by quality assured sputum smear microscopy: Good quality microscopy is
essential to identify the infectious patients who need treatment the most.
3. Good quality drugs: Adequate supply or an uninterrupted supply of good quality anti-TB
drugs must be available.
4. Directly observed treatment: Standardized treatment regimen of 6 to 8 months for at
least all confirmed sputum smear positive cases, with DOTS for at least the initial 2
months
5. Systematic monitoring and accountability: A standardized recording and reporting
system that allows assessment of treatment results.

》 In 2006, STOP TB strategy was announced by WHO and adopted by RNTCP. The components
are as follows :
▶ Pursuing quality DOTS - expansion and enhancement.
▶ Addressing TB/HIV and MDR-TB.
▶ Contributing to health system strengthening.
▶ Engaging all care providers.
▶ Empowering patients and communities.
▶ Enabling and promoting research (diagnosis, treatment, vaccine).

INITIATIVES TAKEN BY RNTCP UNDER THE STRATEGY
“STOP TB”
developing
feasibility
of National
Airborne
Infection
Control
Guidelines
developing
and piloting
strategy for
'Practical
Approach to
Lung Health'

IMPACT
▶ Whereas less than 2% of infectious TB patients were being detected and
cured, with DOTS treatment services in 1990 approximately 60% have
been benefitted from this care.
▶ Since 1995, 41 million people have been successfully treated and up to
6 million lives saved through DOTS and the Stop TB Strategy.
》 In 2014, the World Health Assembly unanimously approved to end global
TB epidemic by "End TB Strategy" , a 20 year programme with vision of a world
with zero death, disease and suffering due to TB.

STRUCTURE OF LABORATORY
NETWORK
3 tier system
1. National Reference Labs (NRL):
6 NRLs at present
▶ National Institute for Research in Tuberculosis (NIRT) Chennai
▶ National TB Institute(NTI) ,Bangalore
▶ LRS Institute of TB and Respiratory Diseases, New Delhi
▶ JALMA Institute, Agra
▶ Regional Medical Research Centre, Bhubaneswar and
▶ Bhopal Memorial Hospital and Research Centre, Bhopal

2. Intermediate Reference Labs: One IRL at State TB Training and
Demonstration Centres (STDCs)
▶ Provide technical training to district and sub-district laboratory
technicians and senior TB laboratory supervisors.
3. Designated Microscopy Centres (DMCs): At the periphery.
▶ Serves a population of around 100,000 [50,000 in tribal and hilly areas].
▶ These focus on issues such as human resources, training ,bio-
medical waste disposal,infection control measures etc.

ORGANISATION OF RNTCP
State Tuberculosis
Office
• State Tuberculosis
Officer
State Tuberclosis
Training and
Demonstration Centre
• Director.
District Tuberculosis
Centre
• District Tuberculosis
Officer
Tuberculosis Unit
• Medical Officer
• Senior Treatment
Supervisor
• Senior TB laboratory
supervisor
Microscopy Centres &
Treatment Centres DOTS providers

FINANCIAL RESOURCES
▶ 100 % central government sponsored
▶ The program is assisted by World bank and The Department for
International Development (DFID).
▶ Other supporting agencies are
- Global TB Drug Facility(GDF)
- Global Fund to Fight AIDS, TB and Malaria(GFATM)
- United States Agency for International Development(USAID)
- Danish International Development Agency (DANIDA)

TB-HIV COLLABORATIVE
ACTIVITIES
• Specific TB-HIV collaborative activities undertaken are:
• ▶ Establishment/Strengthening NACP-RNTCP co-ordination mechanisms at
national, state and district level.
•▶ Training of the programme and field staff on HIV/TB.
•▶ Offer of HIV testing to TB patients.
• ▶ Linking of HIV-infected TB patients to NACP for HIV care and support and to
RNTCP for TB treatment.
• ▶ Involvement of NGOs and affected communities working with NACP and
RNTCP for all activities on TB/HIV collaboration.
• ▶ Operational research to improve the implementation and impact of TB/HIV
collaborative activities.

NEW INITIATIVES
• NIKSHAY
• ▶ To keep a track of the TB patients across the country, the Government of India has
introduced a system called NIKSHAY.
•▶ Web enabled application.
•▶ Developed by NIC (National Informatics Centre) & Central TB Division
•▶ Launched in M a y 2012.
• ▶ Functional components: - TB Patient registration and details of diagnosis,DOT
provider, HIV status.
- DR-TB patient registration with details.
- Referral and transfer of patients.
- SMS alerts to patients on registration.
- SMS alerts to programme officers.

TB NOTIFICATION
According to the Government of India notification dated 7th May 2012, it is now mandatory
for all healthcare providers to notify every TB case to local authorities i.e. District Health
Officer/Chief Medical Officer of a district and Municipal health officer, every month in a
given format.
BAN ON TB SEROLOGY
Currently available serological tests are having poor specificity and should not be used for
the diagnosis of pulmonary or extra-pulmonary TB. Their import, manufacturing, sale,
distribution and use is banned by the Government of India.

ACHIEVEMENTS
▶ Around 24.04 Lakh TB patients have been notified in 2019. This amounts
to a 14% increase in TB notification as compared to the year 2018.
▶ Achieving on-line notification of TB patients through the NIKSHAY system.
▶ Private sector notifications increased by 35% with 6.78 lakh TB patients
notified.
▶ Provision of HIV testing for all notified TB patients increased from 67% in
2018 to
81% in 2019.
▶ More than 4.5 lakh DOT Centers provide treatment covering almost
every village across the country.
▶ Nikshay Poshan Yojana (NPY) to TB patients.
(The Annual TB Report 2020 by Dr Harsh Vardhan, Union Minister for Health
and Family Welfare)

RNTCP was re-named as the National TB Elimination
Program. The change came into effect from 1st January
2020.

Detailed discription about RNTCP programme

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