7.Rntcp

1. BY
R.SIVAPIYA
72

2. REVISED NATIONAL TUBERCULOSIS CONTROL
PROGRAMME
ORIGIN
§ NATIONAL TB PROGRAM (NTP) 1962
§ RNTCP IS THE REVIEWED FORM OF NTP
§ NEED FOR REVISED STRATEGY
-OVER EMPHASIS ON X-RAYS FOR DIAGNOSIS
-INADEQUATE FUNDING,POOR QUALITY MICROSCOPY
-NON-STANDARD TREATMENT REGIMENS
-LOW RATES OF TREATMENT COMPLETION
-LACK OF SYSTEMATIC INFORMATION ON TREATMENT OUTCOME
-ONLY 30% OF ESTIMATED TB PATIENTS WERE DIAGONOSED
-ONLY 30% OF THE DIAGONOSED CASES WERE TREATED
SUCCESSFULLY
§ RNTCP STARTED IN YEAR 1992 (GOVT. OF INDIA,WHO,WORLD BANK)

3. GOAL

§TO REDUCE MORTALITY AND MORBIDITY FROM TB
§TO INTERRUPT CHAIN OF TRANSMISSSION
OBJECTIVES
§ACHIEVEMENT OF AT LEAST 85%CURE RATE OF INFECTIOUS CASES
§DETECTION OF ATLEAST 70%OF ESTIMATED CASES
§INFORMATION, EDUCATION, COMMUNICATION AND IMPROVED
OPERATIONAL RESEARCH ACTIVITIES.
COMPONENTS
§POLITICAL COMMITMENT
§GOOD QUALITY SPUTUM MICROSCOPY
§UNINTERRUPTED SUPPLY OF GOOD QUALITY DRUGS
§DIRECTLY OBSERVED TREATMENT
§ACCOUNTABILITY

4. ORGANIZATION-PROFILE AT STATE LEVEL
STATE TUBERCULOSIS
OFFICE - STATE TUBERCULOSIS
OFFICER
STATE TUBERCULOSIS
TRAINING &
DEMONSTRATION CENTRE - DIRECTOR
DISTRICT TUBERCULOSIS
CENTRE(DTC) - DISTRICT TUBERCULOSIS
OFFICER
TUBERCULOSIS UNIT - MEDICAL OFFICER
- SENIOR TREATMENT
SUPERVISOR(STS)
- SENIOR TB LAB SUPERVISOR(STLS)
MICROSCOPY CENTRES AND TREATMENT CENTRES
DOTS PROVIDERS

5. LABORATORY NETWORK
CENTRAL TB
DIVISION
NATIONAL
REFERENCE LAB
STATE TB CELL
INTERMEDIATE

REFERENCE
LAB
DISTRICT TB CENTRE
TU
TU
TU
DMC
II
DMC
I
DMC
III
NATIONAL
LEVEL
STATE
LEVEL
DISTRICT
LEVEL
(SPUTUM
MICROSCOPY
EQA)
(SUPERVISION)
(FEEDBACK)

6. ROLE OF EACH LEVEL OF LABORATORY
NATIONAL REFERENCE LABORATORTY(NRL)
☻3 CENTRES- NEW DELHI, CHENNAI AND BANGALORE
☻EACH CENTRE CONTROLS OVER 8-11 STATES
☻SUPERVISES SPUTUM MICROSCOPY EQA ACTIVITIES.
INTERMEDIATE REFERENCE LABORATORY(IRL)
☻STATE TB TRAINING AND DEMONSTRATION CENTRES
OR
PUBLIC HEALTH LAB/MEDICAL COLLEGE LABORATORY
☻CONDUCTS SPUTUM MICROSCOPY EQA FOR THE STATE
☻PROVIDES TECHNICAL TRAINING TO THE DISTRICT AND SUB DISTRICT
TECHNICIANS AND SENIOR TB LAB SUPERVISORS.
☻CONDUCTS ON SITE EVALUATION VISITS OF EACH DTC ATLEAST ONCE A
YEAR
☻MANUFACTURES SLIDES FOR PANEL TESTING

7. DISTRICT TB CENTRES
☻ CONDUCTS BLINDED RE-CHECKING OF SMEARS
☻MAINTAIN GOOD QUALITY REAGENTS AND EQUIPMENTS AT ALL TB
UNITS
TUBERCULOSIS UNITS
☻AT SUB- DISTRICT LEVEL
☻1 TB UNIT PER 5 LAKH POPULATION( IN HILLY AREAS 2.5 LAKH)
☻CONDUCTS ON-SITE EVALUATIONS AND BLINDED RE-CHECKING OF
SMEARS
DESIGNATED MICROSCOPY CENTRES
☻AT PERIPHERAL LEVEL
☻1 PER 1 LAKH POPULATION( IN HILLY AREAS 50000)
☻LOCATED AT EITHER IN CHC, PHC, TALUKA HOSP, TB DISPENSARIES
☻EACH CENTRE HAS A SKILLED TECHNICIAN
☻A SENIOR TB LAB SUPERVISOR(STLS) IS APPOINTED FOR EVERY 5
MICROSCOPY CENTRES

8. TREATMENT CENTRES
☻PROVIDES DRUGS FREE OF COST
☻THREE COMPONENTS
APPROPRIATE MEDICAL TREATMENT
SUPERVISION AND MOTIVATION
MONITORING OF THE DISEASE STATUS
DOTS PROVIDERS
☻MAY BE A PERIPHERAL HEALTH STAFF OR VOLUNTARY WORKERS(TEACHERS,
SOCIAL WORKERS, ANGANWADI WORKERS, EX-PATIENTS,ETC…)
☻THEY ARE KNOWN AS “DOTS AGENT”
☻PAID AN INCENTIVE OF RS.150 PER PATIENT COMPLETING THE TREATMENT

9. SERVICES PROVIDED
SERVICES INC DRUGS – FREE OF COST
HIGH QUALITY SPUTUM MICROSCOPY WITH PROMPT REPORTING OF RESULTS
HIGH QUALITY EVALUATION AND APP. TREATMENT
HIGH QUALITY DRUGS
UNINTERRUPTED SUPPLY OF DRUGS TO THE FULL REQUIREMENT
PROVISION OF DOTS BY THE GENERAL HEALTH SERVICES OR BY COMMUNITY
VOLUNTEERS
TECHNICAL ASSISTANCE

10. DEFAULTER ACTION
IF PATIENT FAILS TO REPORT VISIT HOME
INTENSIVE PHASE -ON NEXT DAY
CONTINUATION PHASE - WITHIN A WEEK
RECORDS
TUBERCULOSIS REGISTER
LABORATORY REGISTER
TREATMENT CARD
LABORATORY FORM FOR SPUTUM EXAMINATION
SUPERVISORY REGISTER
REFERRAL FOR TREATMENT REGISTER
REPORTS
QUARTERLY REPORTS ON
-CASE FINDING
-SPUTUM CONVERSION
-RESULTS OF TREATMENT
RNTCP REPORT ON PROGRAMME MANAGEMENT & LOGISTICS

11. RNTCP-PHASES

PHASE I (1992 – 2006) PHASE II ( 2006 –
2011)

12. PHASE I

BY 1993
PILOT PHASE I
PILOT PHASE II
PILOT PHASE III
BY THE END OF 1998, ONLY 2 % COVERED.
BY 2006 WHOLE POPULATION COVERED.

13. PHASE II

TO CONSOLIDATE, MAINTAIN AND FURTHER IMPROVE THE ACHIEVEMENTS OF
THE PHASE I

ACTIVITIES
INCREASE ACCESS OF SERVICES TO HARD-TO-REACH AREAS
STRENGHTHENING THE INTER SECTORAL COLLABORATION
SCALLING UP OF THE STATE LEVEL INTERMEDIATE REFERRAL LABORATORIES(IRL)
CAPACITY
IMPLEMENTATIOIN OF DOTS-PLUS FOR MDR-TB CASES IN A PHASED MANNER
DISRIBUTION OF PAEDIATRIC DRUG BOXES
INSTITUTIONAL STRENGHTHENING AT NATIONAL, STATE AND DISTRICT LEVEL
INTRODUCTION OF TB-HIV CO-ORDINATOR ,URBAN CO-ORDINATOR AND
COMMUNICATION FACILITATOR.

14. DRUG RESISTANCE SURVEILLANCE
AIM
TO DETERMINE THE PREVALENCE OF ANTI-
MYCOBACTERIAL DRUG RESISTANCE AMONG
-NEW CASE
-TREATED CASE
PLANS
STATE WIDE DRS SURVEYS
ICMR SURVEYS
BY 2010, A NETWORK OF 24 STATE-LEVEL CULTURE
AND DRUG SENSITIVITY TESTING LABORATORIES

15. DOTS-PLUS
STRATEGY CURRENTLY UNDER DEVELOPMENT BY WHO
FOR THE MANAGEMENT OF MDR-TB CASES
GOAL
TO PREVENT FURTHER DEVELOPMENT OF MDR-TB
PRE-REQUISITE
AN EFFECTIVE DOTS BASED TB CONTROL PROGRAM
ORGANISATION
DESIGNATED RNTCP DOTS-PLUS SITES ATLEAST 1 IN EACH STATE
WITH READY ACCESS TO RNTCP ACCREDITED CULTURE AND DRUG
SUSCEPTIBILITY TESTING(DST) LABORATORY

16. WHO 7-POINT PLAN OF ACTION
SHORT TERM
BASIC TB CONTROL MEASURES MEET INTERNATIONAL STANDARD FOR TB CARE
RAPID SURVEYS TO ACCESS THE DISTRIBUTION OF MDR-TB AND XDR-TB IN
VULNERABLE POPULATION
STRENGTHEN NATIONAL TB LAB CAPACITY
IMPLEMENTING INFECTION CONTROL PRECAUTIONS IN HEALTH CARE FACILITIES
LONG TERM
ESTABLISH CAPACITY FOR CLINICAL AND PUBLIC HEALTH SERVICES
PROMOTE UNIVERSAL ACCESS TO ARTs FOR TB-HIV PARIENTS
FUNDING FOR RESEARCHES

17. MANAGEMENT OF PAEDIATRIC
TUBERCULOSIS
DIAGNOSIS AND TREATMENT FOR THE PAEDIATRIC
PATIENTS
ISSUING DRUGS FOR THE PAEDIATRIC CASES IN THE
PATIENT WISE BOXES(PWB)
TREATMENT BASED ON CHILD’S BODY WEIGHT
6-10KG WEIGHT BAND
11-17KG WEIGHT BAND
CHILDREN WEIGHING < 6KG WILL BE TREATED WITH
LOOSE ANTI-TB DRUGS

18. TB HIV CO-ORDINATION
RNTCP AND NACO – “JOINT ACTION PLAN”
OBJECTIVE
TO REDUCE TB ASSOCIATED MORBIDITY AND MORTALITY IN TB-HIV
PATIENTS
FOR EFFECTIVE PREVETION AND CONTROL OF BOTH THE DISEASES
PHASE I
2OOI
IN 6 HIGH HIV PREVALENT STATES(AP, KARNATAKA, MAHARASHTRA, MANIPUR,
NAGALAND, TN)
PHASE II
2003
8 ADDITIONAL STATES(DELHI, GUJARAT, HP, KERALA, ORISSA,PUNJAB,
RAJASTHAN, WB)
PLAN TO BE EXTENDED TO ALL OTHER STATES IN DUE COURSE

19. ACHIEVEMENTS OF RNTCP
TREATMENT SUCCESS RATE
DEATH RATE
INVOLVEMENT OF NGOs,
PRIVATE PRACTITIONERS,
MEDICAL COLLEGES,
PERIPHERAL LABORATORIES,
DESIGNATED MICROSCOPY CENTRES,
PUBLIC HEALTH CARE PROVIDERS
4 URBAN DOTS PROJECTS(MUMBAI,HYDERABAD,VARANASI,CHENNAI)
“NATIONAL FRAME WORK FOR JOINT TB-HIV COLLOBORATIVE ACTIVITIES”
- BY CENTRAL TB DIVISION & NACO
- REPLACES “JOINT ACTION PLAN”

20. NATIONAL FRAMEWORK FOR JOINT TB-HIV COLLABORATIVE
ACTIVITIES
§ESTABLISHMENT OF CO-ORDINATION MECHANISMS,JOINT PLANNING AND REVIEW
AT NATIONAL,STATE AND DISTRICT LEVELS
§SERVICE DELIVERY CO-ORDINATION
§INVOLVEMENT OF NGOs
§OPERATIONAL RESEARCH
§INFECTION CONTROL MEASURES

21. STOP TB STRATEGY
VISION
A WORLD FREE OF TB
GOAL
TO DRAMATICALLY REDUCE THE GLOBAL
BURDEN OF TB BY 2015 IN LINE WITH THE
MILLENNIUM DEVELOPMENT GOALS AND THE
STOP TB PARTNERSHIP TARGETS

22. COMPONENTS
☻ HIGH QUALITY DOTS EXPANSION
☻ADDRESSING TB-HIV, MDR-TB AND OTHER CHALLENGES
☻HEALTH SYSTEM STRENGHTHENING
☻ENGAGING ALL CARE PROVIDERS(PUBLIC-PUBLIC AND PUBLIC-
PRIVATE MIX APPROACHES)
☻EMPOWERING PEOPLE WITH TB CARE
☻PROMOTING RESEARCH ACTIVITIES
TARGETS
-BY 2015
GLOBAL BURDEN OF TB(PREVALENCE AND DEATH RATES) WIL BE REDUCED BY 50 %
(INCL TB-HIV CASES)
-BY 2050
GLOBAL INCIDENCE OF TB £1 CASE PER 1 MILLION POPULATION PER YEAR

23. IMPROVED TREATMENT ACCESS
NEW DRUGS
NEW VACCINE - DEVELOP A SAFE, AFFORDABLE VACCINE TO IMPROVE UPON
THE EXISTING VACCINE
NEW DIAGNOSTICS- TO DEVELOP EFFICIENT, EFFECTIVE, AND AFFORDABLE
DIAGNOSTIC TESTS FOR TB
GLOBAL PLAN TO STOP TUBERCULOSIS
AIMS

25. ACKNOWLEDGEMENT
PROF. HOD. DR. UMADEVI MADAM, SPM DEPT
AND ALL OUR PROFESSORS.
TUBERCULOSIS CENTRE, PULIANTHOPE.
CHETPET TB HOSPITAL.
DOTS CENTRE, KMCH AND ROYAPETTAH.
THIRUVOTTESWARAR TB HOSPITAL, OTTERI.
AYNAVARAM DOTS CENTRE.