Newer initiatives of rntcp

Newer initiatives of RNTCP

1. PRESENTED BY- DR. Santosh Kr Soren . (JRA-3) DEPT. OF PSM RIMS, RANCHI. Newer Initiatives of RNTCP Venue: Seminar Hall Time :30min 1

2. Newer Initiatives of RNTCP Introduction of CBNAAT/ Gene-Expert for diagnosis of TB. Category 2 abolished on 18/12/18 and cat 2 patient (R/D/F) are now included in cat 1. All MDR-TB cases would be subjected to liquid culture & drug sensitivity test at baseline for fluoroquinolones and second line injectables . Introduction of newer bactericidal drug like Bedaquiline and Delamanid for MDR & XDR. 2

3. Introduction of daily regimen in 4 weight band for adult which is recently changed on date 14/05/19 into 5 weight band and for pediatric 6 weight band is there. To support TB notification and Strengthen TB surveillance, a case based, web based TB notification system Nikshay was established to provide platform for recording and reporting from both public and private sectors. 3

4. 99 DOTS is a ICT enabled solution for patient centric adherence support. Intensified TB case finding by door to door visit in communities or vulnerable population. After completion of the treatment, follow up of the patient should be done on 6,12,18 & 24 month by clinical and sputum examination. 4

5. Incentive for private doctor on successful completion of treatment is 1000 rupees and 750 rs given to patient on treatment completion in hilly/ tribal areas. Non declaration of TB is now a punishable offence under IPC 269,270 in which there can be imprisonment from 6 months to 2 years. Nikshay Poshan Yojna (NPY) in which patient gets 500 Rs/month for nutritional support throughout the duration of treatment of TB. “End TB by 2025” declared by P.M of India on Delhi TB Summit on 13 th march 2018. 5

6. Recent Guidelines for Daily Regimen Daily regimen for both new and previously treated cases and duration is 6 month(2+4) started in whole country since October 2017. Addition of Ethambutol in C.P phase. FDC available in 5 weight bands for adult and 6 weight bands for children. No need for extension of IP phase in DS- TB. For both new and retreated cases CP may be extended by 3-6 month in CNS or Skeletal or Disseminated TB. Loose individual ATT drugs may be needed as substitution in case of ADR or with co-morbid condition. 6

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8. Real-Time Medication Event Reminder-Monitor Device (RT-MERM) The RT-MERM technology ( i ) is highly accurate, affordable, re-usable, and suitable for TB medications, (ii) provides programmable visual and audible reminders of daily dosing and of monthly refill, and (iii) compiles and transmits automatically detailed, and patient-specific information regarding medication taking and medication adherence. 8

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10. This reminder-monitor utilizes an innovative two-part, consisting of a container (the “Container”) that will hold the patient’s medications and a small electronic module housed within the Container (the “Monitoring Technology”) that will transmit captured information. When the Container is opened, it records the date and time of each such medication taking event, store the date/time data, and automatically transmits (via integrated, affordable 2G data transmission capability) such date/time dosing information for centralized collection, analysis, and use by health care providers via systems such as eNikshay or 99DOTS . 10

11. References National Strategic Plan for Tuberculosis Control 2017–2025; RNTCP Tbcindia.gov.in TB FACTS.ORG ; Information about Tuberculosis TB India 2018; Annual Status Report Global Tuberculosis Report 2018 by WHO Standards for TB Care in India Manual by WHO. K. Park PSM text book. D.K. Taneja Programme book. 11