Revised national tuberculosis control programme

Revised national tuberculosis control programme

1. Revised National Tuberculosis Control Programme (RNTCP) Mohammed Shafeeqe. P MB1400 22

2. TB disease burden in India As per WHO Global TB Report, 2015, out of the estimated global annual incidence of 9.6 million TB cases, 2.2 million were estimated to have occurred in India. TB burden Number (Millions) (95% CI) Rate Per 100,000 Persons (95% CI) Incidence 2.2 (2.0–2.3) 167 (156–179) Prevalence 2.5 (1.7–3.5) 195 (131–271) Mortality 0.22 (0.15–0.35) 17 (12–27)

3. Evolution of TB Control in India 1950s-60s Important TB research at TRC and NTI 1962 National TB Programme (NTP) 1992 Programme Review only 30% of patients diagnosed; of these, only 30% treated successfully 1993 RNTCP pilot began 1998 RNTCP scale-up 2001 450 million population covered 2004 >80% of country covered 2006 Entire country covered by RNTCP

4. RNTCP RNTCP(1993) is a modification of National Tuberculosis Programme (NTP) which has been in operation since 1962. Large-scale implementation of the RNTCP began in 1997 Adopted the Directly Observed Treatment Short-course(DOTS) strategy The revised strategy was introduced in the country in a phased manner.

5. 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 will and administrative commitment Diagnosis by quality assured sputum smear microscopy Directly observed treatment Systematic Monitoring and Accountability Adequate supply of quality assured short course chemotherapy drugs

6. 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

7. Early detection & Rx of 90 % cases (DR-TB & HIV-TB) Rx 90% of new TB patients , 85 % of previously-treated Reduce default rate : new TB cases to < 5% re-treatment TB cases to < 10 % Extend RNTCP services to patients in private sector Initial screening of all re-treatment smear-positive till 2015, and all smear positive TB patients by year 2017 for drug-resistant TB and provision of treatment services for MDR-TB patients. Offer of HIV counselling and testing for all TB patients and linking HIV-infected TB patients to HIV care and support National Strategic Plan/12 th Five year plan (2012-17) 7

8. Organization The profile of RNTCP in a state is as follows State Tuberculosis Office State Tuberculosis Officer State Tuberculosis Office and Demonstration Centre Director District Tuberculosis Centre District Tuberculosis Officer Tuberculosis Unit Medical Officer(TB control) Senior Treatment Supervisor Senior TB Laboratory Supervisor Designated Microscopy Centre, Treatment Centers DOTS Providers

9. Achievements of RNTCP National coverage of DOTS strategy was achieved in the year 2006. RNTCP is currently the world’s largest DOT programme. Since inception RNTCP has treated more than 19 million TB patients under DOTS by utilizing a network of over 4 lakh DOT providers. In 2015, RNTCP covered a population of 1.28 billion. A total of 91,32,306 TB suspects were examined by sputum smear microscopy and 14,23,181 cases were registered for treatment . 79% of all registered TB cases knew their HIV status . 93% HIV infected TB patients were initiated on CPT and 92% were initiated on ART.

10. New Initiatives Introduced GeneXpert in RNTCP ( a new molecular test which diagnoses TB by detecting the presence of Mycobacterium tuberculosis , as well as testing for resistance to the drug Rifampicin) Using CB NAAT for the diagnosis of TB and MDR-TB in high risk population like HIV positive and pediatric group

11. Nikshay TB surveillance using case based web based IT system Developed by central TB division in collaboration with NIC The software was launched in May 2012

12. TB Notification Govt. of India declared Tuberculosis a notifiable disease on 7th May 2012. It is now mandatory for all healthcare providers to notify every TB case to local authorities.

13. Ban on TB Serology The 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 GOI.

14. Thank you