RNTCP.pptx revised national tuberculosis program

revised national tuberculosis program

1. RNTCP SUPRIYA

2. Global scenario 0f TB Tuberculosis (TB) is one of the top 10 causes of death worldwide . In 2016, 10.4 million people fell ill with TB, and 1.7 million died from the disease (including 0.4 million among people with HIV). Over 95% of TB deaths occur in low- and middle-income countries . Seven countries account for 64% of the total, with India leading the count, followed by Indonesia, China, Philippines, Pakistan, Nigeria, and South Africa .

3. Global scenario 0f TB In 2016, an estimated 1 million children became ill with TB and 250 000 children died of TB (including children with HIV associated TB). TB is a leading killer of HIV-positive people: in 2016, 40% of HIV deaths were due to TB.

4. Indian scenario 0f TB India is the highest TB burden country accounting for more than one fifth of the global incidence . Global annual incidence estimate is 9.4 million cases out of which it is estimated that 1.98 million cases are from India . India is 14th among 22 High Burden Countries in terms of TB incidence rate (Source: WHO global TB report 2013).

5. Tb burden in India In 2015 TB BURDEN NUMBER (MILLIONS) (95% CI) RATE PER 100000 PERSONS (95% CI) INCIDENCE 2.1(2-2.3) 167(156-179) PREVALENCE 2.5 (1.7-3.5) 195(131-271) MORTALITY 0.22 (0.15-0.35) 17(12-27)

6. Background Information Tuberculosis (TB) is a contagious disease caused by Mycobacterium tuberculosis Left untreated, each person with infectious pulmonary TB will infect an average of between 10 and 15 people every year . One in ten people infected with TB (but who are not infected with HIV) become ill with TB at some time during their life . People with both HIV and TB infection are much more likely to become ill with TB.

7. TUBERCULOSIS CONTROL IN INDIA National TB Control Programme (NTP) 1962 RNTCP – 1993 as pilot project RNTCP : 1997 expanded across the country in a phased manner with support from the World Bank and other development partners RNTCP I: 1997-2006 RNTCP II: 2006-2011 (Sept.)

8. National Tuberculosis Programme (NTP) Ground-breaking research in the 1950s and early 1960s by the Tuberculosis Research Centre at Chennai and the National TB Institute at Bangalore, a National Tuberculosis Programme (NTP) was implemented by Government of India in 1962 . The NTP was implemented on a 50:50 cost sharing basis between Centre and State.

9. National Tuberculosis Programme (NTP) Based on strategic principles of domiciliary treatment Use of a self-administered standard drug regimen of initially 12-18 months duration Treatment free of cost Priority to newly diagnosed patients over previously treated patient

10. National Tuberculosis Programme (NTP) Treatment organization decentralized to district level. The NTP created an extensive infrastructure for TB control, with a network of 446 district TB centres and 330 TB clinics.

11. FAILURE OF NTP Inadequate budget and insufficient managerial capacity. Shortage of drugs. Less than 40% of patients completed the treatment. Emphasis on x-ray diagnosis resulting in inaccurate diagnosis. Poor quality sputum microscopy. Multiplicity of treatment regimens.

12. objectives Emphasis on the cure of infectious and seriously ill patients of tuberculosis, through administration of supervised Short Course Chemotherapy to achieve a cure rate of at least 85%. Augmentation of the case finding activities to detect 70% of estimated cases, only after having achieved the desired cure rate.

13. Revised strategy Augmentation of organizational support at central and state levels for meaningful coordination. Increased budgetary outlay. Use of sputum testing as the primary method of diagnosis among self-reporting patients. Standardized treatment regimens.

14. Revised strategy Augmentation of the peripheral level supervision through the creation of a sub-district supervisory unit. Ensuring a regular, uninterrupted supply of drugs up to the most peripheral level. Emphasis on training, IEC, Operational research and NGO involvement in the program.

15. interventions Strengthening of the TB cells at the central and state levels. Strengthening of the training institutes for tuberculosis at the central and state levels . Gradual implementation of the revised strategy for TB control covering a population.

16. interventions Strengthening of the NTCP in remaining Short Course Chemotherapy districts as transitional step to adopt the RNTCP. Providing for an uninterrupted supply of anti- TB for sputum positive patients throughout the country.

17. Difference between NTP and RNTCP SCC-short course chemotherapy DOTS-directly observed treatment short course Objective Early diagnosis and treatment Operational targets Not defined Strategy SCC unsupervised Conventional: long term domiciliary treatment with INH+Thiacetazone Objective Breaking the chain of transmission Operational targets Cure rate 85% Case findings 70% Strategy DOTS Uninterrupted drug supply.

18. Difference between NTP and RNTCP . . Diagnosis More emphasis on x-rays. 2 sputum smears. One sputum positive is considered a case. Diagnosis Mainly sputum microscopy. Two sputum smears One smear positive/clinically positive is a case.

19. Stop tb STOP TB strategy announced by WHO and adopted by RNTCP. Components: Pursuing quality DOTS-expansion and enhancement. Addressing TB/HIV and MDR-TB. Contributing to health system strengthening. Engaging all care providers. Empowering patients and communities. Enabling and promoting research.

20. DIAGNOSIS OF A TUBERCULOSIS DIRECT METHOD INDIRECT METHOD

21. Diagnosis of a tuberculosis DIRECT METHODS

22. Diagnosis of a tuberculosis

23. Diagnosis of a tuberculosis Cough for 2 weeks or more 2 sputum smears 2 or 1 (+) 2 (-) Antibiotic (12-14 days) Symptom persist (+) X-rays (-) Sputum smear (-) TB neg for TB Smear (+) for /TB Anti-TB treatment non TB Anti-TB treatment

24. category Type of patient Regimens in month color duration New cases New sputum smears(+) Seriously ill sputum (-) Seriously ill extra-pulmonary Sputum (-) extra-pulmonary not Seriously ill 2 (HRZE) 3 IP + 4(HR) 3 CP Red 6 month Re-treatment cases Sputum (+) relapse Sputum (+) failure Sputum (+) treatment after default 2(HRZES)3 + 1(HRZE)3 IP 5(HRE)3 CP Blue 8 months MDR-TB cases 6(9) KOEtCZE /18OEtCE 24-27 TREATMENT REGIMEN

25. Drugs use in tb medication Action Dose No of pills in combipack ISONIAZID Bactericidal 600 mg 2 RIFAMPICIN Bactericidal 450 mg 1 PYRAZINAMIDE Bactericidal 1.5 gm. 2-3 STREPTOMYCIN Bactericidal 0.75 gm. - ETHAMBUTOL Bactericidal 1200mg 2-3 THIACETAZONE Bactericidal OFLAXOCINE Bactericidal KANAMYCINE Bactericidal ETHIONAMIDE Bactericidal CYCLOSERINE Bactericidal

26. MDR-TB & XDR-TB MDR-TB is defined as resistance to isoniazid and rifampicin, with or without resistance to other anti-TB drugs . XDR-TB is defined as resistance to at least Isoniazid and Rifampicin (i.e. MDR-TB) plus resistance to any of the fluoro -quinolones and any one of the second line injectable drugs ( amikacin , kanamycin or capreomycin ). Cure rate for MDR-TB is 20-30%.

27. Xdr – tb DOTS plus Capreomycin Moxifloxacin Linezolid Clofazimine High dose of INH Clarithromycin Augmentin

28. New initiatives Use of CB NAAT for diagnosis Nikshay TB notification every month in a given format Ban on TB serology

29. New initiatives NIKSHAY Central TB division in collaboration with National Informatics Centre has undertaken the initiative to develop a case based application named NIKSHAY .

30. Components of NIKSHAY :

31. National strategic plan 2012-2017 The NSP 2012 – 2017 had the aim of achieving universal access to quality diagnosis and treatment .

32. National strategic plan 2012-2017

33. National Strategic Plan (NSP) 2017 – 2025 The National Strategic Plan (NSP) 2017 – 2025 is the plan produced by the government of India ( GOI ) which sets out what the government believes is needed to eliminate TB in India. The NSP 2017 – 2025 describes the activities and interventions that the GOI believes will bring about significant change in the incidence, prevalence and mortality from TB.

34. Targets of npp 2017-2025 Private sector engagement Plugging the “leak” from the TB care cascade (i.e. people with TB going missing from care ) Active case finding among key populations and for people in “high risk” groups, preventing the development of active TB in people with latent TB.