RNTCP ARPIT.pptx

RNTCP

1. REVISED NATIONAL TUBERCULOSIS CONTROL PROGRAMME.

2. REVISED NATIONAL TB CONTROL PROGRAMME: India has the highest tuberculosis Barden country in the world. Accounting nearly one-fifth of the global incidence. In 2009 out of the estimated annual global incidence of 9.4 million TB cases; 2million was estimated to have in India. Tuberculosis is continues to be one of the most common infectious causes of morbidity; which despite being a curable and preventable disease. Continuous to impose and enormous health and an economic burden on India. The RNTCP is based on internationally DOTS strategy was launched in India 1997 and expended entire the country in a phased manner. Full nationwide coverage is achieved in March 2006

3. The goal of TB control program is to decrease mortality and morbidity due to TB and cut transmission of TB until ceases to be major public health problem of India. The twin objective of program were to achieved and maintain accuracy at least 85% among new sputum positive (NSP) patients and to achieve and maintain case detection of the at least 70%of the estimated NSP cases in the country.

4. Magnitude of the problem Global burden of tuberculosis Tuberculosis is the one of the leading cause of death due to infectious disease in the world. Almost 2 billion people are infected with mycobacterium tuberculosis each year about 2 million people are developing TB disease. About 2 million people die of TB. On the national scale the high burden of TB in Is illustrated by the estimated that TB accounts for 17.6% of deaths from communicable disease and for 3.5% of all of mortality (WHO 2004). than 89% of the burden of tb due to premature death as measured in terms of disability-adjusted life years lost.

5. WHO estimated TB mortality in India as 276,000(24/10000 population) in 2008. With RNTCP Implementation. There is 43% decline in death due to TB in India by 2008 is compared to 1990. It was estimated that the TB mortality was over 500000 annually at the beginning of RNTCP Data from specific surveys, however, suggest the case fatality rate prior to RNTCP were generally greater than 25% in RNTCP era case fatality was remained less than 5% for new case registered under the program

6. The beginning: National tuberculosis programme Before the RNTCP come into force, the existing TB program had started upon diagnosing the cases through direct smear microscopy and self administered domiciliary treatment on monthly basis with the following objectives: To identify and treat as a large 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 level where it ceases to be public health problem.

7. Organization and implementation of tuberculosis program Organization and administration of TB program also expanded in the three level at central level, beside the tuberculosis division in the directorate general health service, national tuberculosis institute, Bangalore. Tuberculosis research centre Chennai at district level, a district constitutes a functional unit of the NTCP and is called district tuberculosis control program. The peripheral level comprises of chest clinics and PHC who is providing treatment for TB. the program activities very generally comprises of case detection, case treatment, health education, BCG vaccine despite a nationwide network of facilities NTCP Failed to yield satisfactory result.

8. The situation does not change much the case finding efficiency was only 30 of the expected level, Although the mortality rate decreased to 53/100000 Population. The Government of India launched RNTCP in 1997 encouraged by the result of pilot studies were tested in 1993-1994.

9. Evolution of the TB control in India 1950-60: Important TB research at TRC and NTI. 1962: National TB program. 1992: Review of national TB program and the result is only 30% of patients diagnosed and among of these diagnosed the patients, only 30% treated successfully. 1993: RNTCP pilot begun. 1998: RNTCP scale- up. 2001: 450 million populations covered 2004: >80% of country covered. 2006: Entire country covered by RNTCP.

10. 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 maintained detection of at least 70% of such case in the population.

11. Strategy Augmentation of organizational support at the central and state level for meaningful coordination Increase in budgetary outlay Use of sputum microscopy as a primary method of diagnosis among self reporting patient. Standardized treatment regimens augmentation of the peripheral level supervision through the creation of a sub districts supervisory unit Ensuring the regular uninterrupted supply of drugs up to the most peripheral level Emphasis on training, IEC, operational research and NGO involvement in the program

12. Case finding : In the rural area the existing laboratories at the PHC/ CHC level up to a maximum of one per lakh population will be strengthened to function as microscopic center. Treatment and case holding: drugs for a three days a week will be given throughout the intensive phase. Facility of treatment will be made available at sub centers/ Treatment centers close to patient’s residence village to enhance patient compliance.

13. TB SUSPECT(COUGH>2 WEEK) DIAGNOSIS CATEGORIZATION START OF TREATMENT REGISTRATION FOLLOW UP AND OUTCOME REPORTING

14. Patient wise drug boxes: A unique feature of RNT CP are the patient wise drug boxes (for adult and pediatric cases) which improve patient care, adherence and drug supply and drug stock management. all patient receive free drugs under direct observation by a dot provider accessible and acceptable to the patient and accountable to the health system.

15. DIRECTLY OBSERVED TREATMENT It is necessary to prevent patient from interrupting treatment throughout the duration of treatment It ensures that patient receive The right drug In the right dose For the right duration of treatment

16. Mechanism of dot Dot provider can be anybody who is accessible and acceptable to the patient and accountable to the health system and who is not a family member. Can be health care worker, Asha worker, anganwadi worker, ngo workers, private Practitioner, community volunteer, shopkeepers, cured patients, etc. During intensive phase first 2-3 months all those are given to the patient under the direct observation of the dot provider. During continuation phase remaining part of treatment the first dose of the week is given to the patients under direct observation of the dot provider

17. Information education and communication: It is a great importance to enhance the knowledge and awareness of providers, users and community at large about different aspect of tuberculosis and its control measures through IEC. Training of staff: The training of staff at central, state and district level will be appropriately strengthening in terms of staff, equipment, vehicles and civil worker. it is proposed to train the kid trainers at central and state level and this in turn will train district trainers who will be responsible for giving training to all categories of staff within the district Management information system: It is required to have MIS to show main indicators of program effectiveness

18. Program surveillance, supervision and monitoring strategy: Need for continuous supervision and monitoring in order to identify problems and implement corrective action in the program. Involvement of medical colleges: Under the RNTCP, initiative to increase the involvement of medical colleges is gaining momentum. Presently, two third of medical colleges in RNTCP implementing areas are participating in the program. RNTCP nodal Centers for medical colleges are proposed to be established in all zones of India.

19. Collaboration with naco : The RNTCP and national aids control organization are collaborating to implement HIV/TB action plan. It is envisaged To provide services for HIV infected TB patient under the same roof by establishing critical linkage centers and RNTCP microscopy centers, By involving common NGOs and through combined IEC activities and infection control measures. multi drug resistant : To improve tuberculosis control, it is essential to improve treatment of patients so that drug resistant tuberculosis is not created. Among the few patients who are not cured, The overwhelming response is failure to ensure that the drugs are taken as prescribed, rather than failure Of the drugs to work properly.

20. Phases of RNTCP: Tuberculosis control activities are implemented in the country for more then 50 years, NTP launched by the GOVT. of India in 1962 in the form of district. PHASE: 1 In 1978 BCG vaccination was shifted under the expanded program on immunization. a joint review of NTP was done by Government of India. WHO and the Swedish International Development agency in 1992 and some short comings Where founded in the programs such as a managerial weakness, inadequate funding, over reliance on X ray, non standard treatment regimen, low rate of treatment completion and lack of systematic information on treatment outcomes.

21. Around the same time in 1993, the WHO declared TB is a global emergency, devised the directly observed treatment short course and recommended to follow it by all countries. The Government of India revitalized NTP as the revised national TB control program. in the same year dots was officially launched as the RNTCP strategy in 1997 and by the end of 2005 the entire country was covered under the program. Phase:2 Anticipate improved the quality and reach of services and worked to reach global case detection and cure targets these targets were achieved by 2007-2008.

22. despite this achievement undiagnosed and mistreated cases continued to drive the TB epidemic TB was the leading cause of illness and death among persons living with HIV/aids and large number of multidrug resistance tb ( mdr-tb ) case were reported every year. Phase:3 During this period the achievement of the long term vision of a “TB free India” national strategic plan for tuberculosis control 2012-2017 was documented with the goal of universal access to quality TB diagnosis and treatment for all TB patients in the community. Significant interventions and initiatives where taken during NSP 2012-2017 in terms of mandatory notification of all TB cases integration of the program with the general health services,expansion of diagnostic services,

23. programmatic management of drug resistant TB service expansion single windows service for TB HIV cases national drug resistance surveillance and revision of partnership guidelines. Component of dots Political and administrative commitment Good quality diagnosis Good quality drugs The right treatment given in the right way Systematic monitoring and accountability

24. Nikshay poshan yojana Nutritional support to TB patient BENEFITS:- Financial incentive of ₹500 per month 4 notified TV patient Incentive for the complete duration of entity be treatment to the patient The incentive is given where direct benefit transfer

25. Role of community health nurse in RNTCP Immunize with BCG at birth Under RNTCP active case-finding is not pursued. However, people found to be with symptoms of tuberculosis in the clinic and during the home visits can be encouraged for further investigations Convey the message that tuberculosis is curable and free Treatment facilities available Help to remove fears and taboos about the disease Advising on balanced diet to protect from infections Motivating the people with symptoms to clinic

26. Collecting thorough history Show high-level of interest in contact screening Teaching on how to take out sputum by coughing when test for AFB suggested Administer tuberculin test, if ordered Stress on importance of continuation of regular treatment as prescribed. Stress on the point “not default” which is bad for his family as well to community Teach good practices like closing the mouth and speaking, maintaining considerable physical distance to avoid sprinkling of saliva on others Teach how to dispose sputum safely Close follow-up on treatment compliance.