RNTCP

national tuberculosis eradication program

1. BY ABRAR AHMAD Ro-1 AKASH CHAUHAN Ro-2 RNTCP(revised national tuberculosis control program)

2. contents Tuberculosis Burden RNTCP Goal & Objectives Organization Strategies Diagnosis Treatment Monitoring and evaluation References

3. Pathogenesis -bacteria attacks first in hilar areas in lung because air flow is maximum & forms ghon’s focus. At this stage the person becomes TB infected but non-infectious k/a primary TB Primary TB -95% case- healed TB - 2-4% case- latent TB -1-2% case-progressive primary TB The most common symptom of pulmonary  TB  is a productive cough for more than 2 weeks, which may be accompanied by other respiratory symptoms (shortness of breath, chest pains, haemoptysis ) and/or constitutional symptoms (loss of appetite, weight loss, fever, night sweats, and fatigue)

4. BURDEN 1 TB case untreated 10-20 new t.B cases/year TB incidence is 204/1lakh population/year Incidence of MDR TB-10/1lakh population Mortality rate- 32/1lakh population Case fatality rate-0.16/1lakh population Antibiotic resistance in TB –6.19% of all TB cases turn to MDR T.B 2.18% of new T.B cases become ab resistance 11.2% of previously treated become ab resistant If treated a case of TB-90% become non infectious within 48hr ->95% non infectious within 2 weeks

5. RNTCP The National TB Programme (NTP) was started in 1962 for TB control in India. This programme was not able to give expected results in India. REASONS: More emphasis on detection rather than cure Inadequate budget and insufficient managerial capacity Shortage and interrupted supply of drugs Emphasis on x-ray diagnosis resulting in inaccurate diagnosis Poor quality sputum microscopy. Multiplicity of treatment regimens As a result of the review and pilot studies in 1993, the DOTS strategy was adopted in India under the Revised National TB control Programme - RNTCP The programme was implemented in a phase manner and by 24th March 2006, the entire country was covered under the programme . The program is renamed as national TB eradication program in 2020

6. Goals & objectives 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. To achieve and maintain: Cure rate of at least 90% among newly detected smear positive (infectious) pulmonary TB cases and Case detection of at least 90% of the expected new smear positive TB cases in the community Eliminate TB from india by 2025

7. One/ 100,000 (50,000 in hilly/ difficult/ tribal area) (2 0,000 population TB Health Visitors (TBHV), DOT Provider (MPW, NGO, PP, ASHA, Community Volunteers ) Medical Officer, paramedical staff And Laboratory Technicia n Medical officer-TB Control, Senior Treatment supervisor(STS), Senior TB Laboratory Supervisor(STLS ) State TB cente District TB Centre Tuberculosis Unit Microscopy Centre DOT Centre Nodal point for TB control State Medical Officer and other supporting staff Central TB division District Collector DTO, MO-DTC , LT, DEO, Driver, Urban TB Coordinators, TBHVs, Communication Facilitators ORGANISATION

8. statergy

9. Incentives –# private practioner for providing 1 st line TB tx-1000/- # treatment provider for MDR TB -2000/- end of I.P 3000/-end of C.P # patient gets 500/month for good nutrition under “ nikshay poshan yojna ” # Giving information about a T.B case-500/- TB notification within 30 days of dx/ tx Fortnight clinical review of all TB cases

10. Diagnosis Sputum-taken as spot(a)/ morning(b) ->5ml,mucoid/ prulent ,<10% of squammous epithelial cells -Testing done by ZN,auramine stain within 24hr -Observe under microscope Culture- LJ media 60day -LPA(line probe assay) <2day Identification of bacilli from clinical sample Genotypic method-PCR,NAAT(CBNAAT /True NAAT) Phenotypic method-phage based TB detection system Serological methods IGRA(interferon gamma release assay) Tuberculin test(TST)

11. Regimes for treatment Drug sensitive TB Tx-first line 2(HRZE)+4(HRE) where,H - Isoniazid,R - rifampin,Z - pyrazinamide,E -Ethambutol Feature- tx for new TB & Presumptive TB cases -daily dose/ fdc (H-75mg,R-150mg,Z-400mg,E-275mg - no requirement to extend intensive phase - body weight based tablets I.P(2)HRZE C.P(4)HRE 25-34kg 35-49kg 2 3 2 3 50-64kg 4 4 65-75kg 5 5 >75kg 6 6

12. MDR TB(resistant to isoniazid and rifampin ) Shorter MDR-4-6(CHOKZEE)+ 5(COZE) where,C - clofazimine,H -high dose isoniazid,O-moxifloxacin,K-kanamycin,Z-pyrazinamide,E-ethambutol,E-ethionamide Conventional MDR-6-9(COKZEE)+ 18(COEE) where,C-cycloserine,O-levofloxacin,K-kanamycin,Z-pyrazinamide,E-ethionamide,E-ethambutol H mono/poly drug resistance tx-6(ZERO) where,Z - pYrizinamide,E - ethambutol,R - rifampin,O -levofloxacin Follow up protocol for MDR/H mono Weight monthly If moxifloxacin used-ECG monthly If Capreomycin used – KFT monthly KFT/LFT- 3monthly

13. Monitoring and evaluation Best indicator of TB burden- prevalence of TB disese Best indicator of evaluation of program- incidence of infection ‘Ii’ k/a ARTI/TCI( Tubeculin conversion index) is defiend as number of newly converted montoux positive individual in a specific population in a year If ARTI is 1% it means 50 new sputum positive patient India ARTI-1.7 Incidence of TB in India – 75/LAC/YR

14. References

15. T H A N K Y O U