Rntcp 2

National Tuberculosis Control
Program
Dr. Saurabh Agrawal

20-Feb-16
Lesson Objectives
 To know about the magnitude of TB
problem
 To know about the evolution of TB
control in India
 To learn about the goals, objectives
and strategies
 To know about the achievements and
progress

20-Feb-16
Magnitude of the Problem
Source: WHO Geneva; WHO Report 2008: Global Tuberculosis Control; Surveillance, Planning and Financing
Global annual incidence = 9.1 million
India annual incidence = 1.9 million
India is 17th among 22
High Burden
Countries (in terms of
TB incidence rate)

20-Feb-16
Global Burden of Tuberculosis
 TB is one of the leading causes of death
due to infectious disease in the world
 Almost 2 billion people are infected with M.
tuberculosis
 Each year about:
 9 million people develop TB disease
 2 million people die of TB

20-Feb-16
The Beginning :National Tuberculosis
Control Program (1962)
Before the Revised National Tuberculosis
Program (NTCP) came into force the existing
Tuberculosis program had the following
objectives:
• To identify and treat as large a number of TB
patients as possible so that infectious cases are
rendered non- infectious.
• To reduce the magnitude of TB problem in the
country to a level where it ceases to be a public
health problem.

Y REVISED??
 Was technically sound but suffered
from managerial weakness
 Inadequate funding
 Overall reliance on x ray for diagnosis
 Frequent interrupted supplies of drugs
 Low rates of treatment completion
20-Feb-16

20-Feb-16
Revised National TB Control Program
(RNTCP)
 Launched in 1997 based on WHO DOTS
Strategy
 Entire country covered in March’06 through an
unprecedented rapid expansion of DOTS
 Implemented as 100% centrally sponsored
program
 Govt. of India is committed to continue the support till TB
ceases to be a public health problem in the country
 All components of the STOP TB Strategy-
2006 are being implemented

20-Feb-16
Objectives of RNTCP
 To achieve and maintain a cure rate of at
least 85% among newly detected
infectious (new sputum smear positive)
cases
 To achieve and maintain detection of at
least 70% of such cases in the population

20-Feb-16
Strategy
1. Augmentation of organizational support at
the central and state level for meaningful
coordination
2. Increase in budgetary outlay
3. Use of Sputum microscopy as a primary
method of diagnosis among self reporting
patients
4. Standardized treatment regimens.

20-Feb-16
contd.
7 Augmentation of the peripheral level
supervision through the creation of a sub
district supervisory unit
8. Ensuring a regular uninterrupted supply of
drugs up to the most peripheral level
9. Emphasis on training, IEC, operational
research and NGO involvement in the
program

20-Feb-16
Program innovations
 Creation of sub district level supervisory and monitoring
unit “TB Unit”
 Patient-wise individual drug boxes for entire course of
treatment
 Community involvement in DOTs – shopkeepers, teachers,
postmen, cured patients, etc
 Continuous Internal Evaluation of districts
 Monitoring strategy document with checklists
 NGO & PP (Private Provider) schemes
 Task Force mechanism for involvement of Medical colleges
 Web based IEC resource centre

20-Feb-16
Contd.
 District TB Control Society
 Modular training
 Patient wise boxes
 Sub-district level supervisory staff (STS,
STLS) for
 Treatment & microscopy
 Robust reporting and recording system

20-Feb-16
RNTCP Organization structure: State
level
Health Minister
Health Secretary
MD NRHM Director Health
Services
Additional / Deputy / Joint
Director
(State TB Officer)
State TB Cell
Deputy STO, MO, Accountant,
IEC Officer, SA,
DEO, TB HIV Coordinator etc.,
State Training and Demonstration
Center (TB)
Director, IRL Microbiologist, MO,
Epidemiologist/statistician, IRL LTs etc.,

20-Feb-16
Core elements of Phase I
 The core element of RNTCP in Phase I (1997-
2006)was to ensure high quality DOTS expansion in
the country, addressing the five primary components
of the DOTS strategy
 Political and administrative commitment
 Good Quality Diagnosis through sputum
Microscopy
 Directly observed treatment
 Systematic Monitoring and Accountability
 Addressing stop TB strategy under RNTCP

20-Feb-16
RNTCP Phase II( 2006-11)
 The RNTCP phase II is envisaged to:
 Consolidate the achievements of phase I
 Maintain its progressive trend and effect
further improvement in its functioning
 Achieve TB related MDG goals while
retaining DOTS as its core strategy

Diagnosis of TB in RNTCP:
Smear examination

20-Feb-16
Classification of Patients in Categories
for Standardized Treatment Regimen
Category Type of Patient Regimen Duration in
months
Category I
Color of
box: RED
New Sputum Positive
Seriously ill sputum negative,
Seriously ill extra pulmonary,
2 (HRZE)3,
4 (HR)3
6
Category II
Color of
box: BLUE
Sputum Positive relapse
Sputum Positive failure
Sputum Positive treatment
after default
2 HRZES)3,
1 (HRZE)3
5 (HRE)3
8

20-Feb-16
Contd.
Category Type of Patient Regimen Duration
in
months
Category
III
Color of
box:
GREEN
Sputum Negative,
extra pulmonary not Seriously
ill
2
(HRZ)3,
4 (HR)3
6

Pediatric TB
20-Feb-16
•For diagnosis and treatment of pediatric cases
revision was made in guidelines in 2003 in RNTCP
•The pediatric drugs has to be supplied in boxes
(PWB) similar to adults
•Treatment on bases of child body wt
•2 PWB – 6-10 kg
11-17kg
•Were available from 2006
•This was first in world

20-Feb-16
Types of Drug-Resistant TB
Mono-resistant Resistant to any one TB treatment
drug
Poly-resistant Resistant to at least any two TB
drugs (but not both isoniazid and rifampicin)
Multidrug- resistant
(MDR TB) Resistant to at least isoniazid and
rifampicin, the two best first-line TB treatment drugs
Extensively drug-resistant
(XDR TB)
Resistant to isoniazid and rifampicin, PLUS resistant to
any fluoroquinolone AND at least 1 of the 3 injectable
second-line drugs (e.g., amikacin, kanamycin, or
capreomycin)

20-Feb-16
 By 2010 DOTS-Plus services available in all states
 By 2012, universal access under RNTCP to
laboratory based quality assured MDR-TB
diagnosis for all retreatment TB cases and new
cases who have failed treatment
 By 2012, free and quality assured treatment to all
MDR-TB cases diagnosed under RNTCP (~30,000
annually)
 By 2015, universal access to MDR diagnosis and
treatment for all smear positive TB cases under
RNTCP
RNTCP- DOTS-Plus Vision

20-Feb-16
TB-HIV: Accomplishments
 Developed and implemented mechanism for TB & HIV
program collaboration at all levels (National, State,
District)
 Conducted surveillance and determined national burden
of HIV in TB patients
 Mainstreamed TB-HIV activities as core responsibility of
both programs (training & monitoring)

20-Feb-16
TB-HIV: Current Policies (2008)
TB/HIV activities in all States
 Coordination & Training on TB/HIV
 Intensified Case Finding (ICF)
 Referral of all HIV- TB patients for HIV care and
support (CPT & ART)
 Involve NGOs
Activities in high-HIV states
 Provider-initiated HIV counseling and testing for all
TB patients
 Decentralized provision of Co-trimoxazole
 Expanded TB-HIV monitoring

20-Feb-16
Quality Diagnostic and Treatment
Services
 ~12,500 decentralized designated microscopy
centers established
 External Quality Assurance (EQA) system for
sputum microscopy as per international
guidelines
 Quality assured anti-TB drugs
 Patient friendly DOT services

20-Feb-16
412766
Achievements in line with
the global targets
Achievements Under RNTCP
Since implementation
 > 40 million TB suspects examined
 > 9 million patients placed on treatment
 > 1.6 million lives saved (deaths averted)

20-Feb-16
Progress Towards Millennium
Development Goals
 Indicator 23: between 1990 and 2015 to halve
prevalence of TB disease and deaths due to TB
 Indicator 24: to detect 70% of new infectious cases
and to successfully treat 85% of detected sputum
positive patients
 The global NSP case detection rate is 61% (2006) and
treatment success rate is 85%
 RNTCP consistently achieving global bench mark of
85% treatment success rate for NSP; and case
detection rate 70% (2007)

Rntcp 2

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