Tb programme

REVISED NATIONAL TUBERCULOSIS CONTROL PROGRAMME

1. MAGNITUDE OF THE PROBLEM

2. TB is one of the most important public health problems worldwide. There are approximately 9 million new cases of all forms of tuberculosis occurring annually and 3 million people die from it each year. India is the highest TB burdened country in world and accounts for nearly 20% of the global burden of Tuberculosis .

3. NATIONAL TB CONTROL PROGRAMME

4. SHORT-TERM OBJECTIVE: TO REDUCE T.B IN THE COMMUNITY . LONG-TERM OBJECTIVE: TO DETECT MAXIMUM NO.OF T.B CASES TO VACCINATE NEW BORNS AND INFANTS WITH B.C.G

5. DISTRICT TUBERCULOSIS PROGRAMME The National tuberculosis programme (NTP) operates through the District Tuberculosis Programme (DTP) which is the backbone of the NTP. Over 600 TB clinics have been set up in the country, Association with general health and medical institutions. Monthly once patient received the drugs through dispensary

6. PROGRAMME ACHIEVEMENT NATIONAL TB CONTROL PROGRAMME DID NOT YIELD GOOD RESULT. CASE DETECTION AND CASE HOLDING RESULT WAS LOW(25%) DRUG SUPPLY NOT REGULAR RESPONSE FROM THE PATIENTS WAS POOR

7. INCREASED INCIDENCE OF MDR-TB TREATMENT REGIMENS WERE MANY INADEQUATE BUDGET NO CHANGES IN MORBIDITY AND MORTALITY RATE

8. REVISED TB CONTROL PROGRAMME IN 1992 GOVERNMENT OF INDIA APPOINTED EXPERT COMMITTEE TO REVIEW THE STRATEGIES OF TUBERCULOSIS CONTROL PROGRAMME .

9. CASE FINDING MUST BE PASSIVE SYSTEMATIC REGISTRATION OF THE CASES CATEGORIZATION OF THE TB CASES INTO TWO TYPES ONLY INTERMITTENT REGIMEN NOT DAILY REGIMEN DRUGS MUST BE ENSURED FREE OF COST EFFECTIVE HEALTH EDUCATION

10. R.N.T.C.P IN 1993, GOVT OF INDIA INTENSIFIED AND REVISED THE NTCP AND RENAMED AND LAUNCHED AS “ REVISED T.B CONTROL PROGRAMME”. IT WAS LAUNCHED AS A PILOT PROJECT AND EXPANDED IN 1997. IT FUNDED BY W.H.O AND WORLD BANK.

11. ACHIEVEMENT OF ATLEAST 85% CURE RATE THROUGH SUPERVISED SHORT COURSE CHEMOTHERAPY. INVOLVEMENT OF NGO’S AND PRIVATE INSTITUTION. AUGMENTATION OF CASE FINDING ACTIVITIES THROUGH QUALITY SPUTUM MICROSCOPY EXAMINATION.

12. REVISED STRATEGIES: LABORATORY NETWORK SPUTUM EXAMINATION NEW PROTOCOL FOR DIAGNOSIS DOTS PROGRAMME DRUG RESISTANCE SURVEILLANCE DOTS PLUS PAEDIATRIC TUBERCULOSIS TB – HIV COORDINATION IEC ACTIVITIES

13. 1 . LABORATORY NETWORK A NATION WIDE NETWORK OF RNTCP QUALITY ASSURED DESIGNATED SPUTUM SMEAR MICROSCOPY LABORATORIES HAS BEEN SETUP. THESE LABORATORIES CARRY OUT SPUTUM MICROSCOPY WITH EXTERNAL QUALITY ASSESSMENT (EQA) AND DRUG RESISTANCE SURVEILLANCE (DRS) RELATED ACTIVITIES.

14. NEW PROTOCOLS FOR SPUTUM MICROSCOPY AND DRS HAVE BEEN PREPARED. THE LABORATORY NETWORK FOR RNTCP IN INDIA CONSISTS OF THREE DESIGNATED NRLS A CENTRAL LABORATORY COMMITTEE HAS BEEN CONSTITUTED WITH THE MICROBIOLOGISTS OF THE THREE NATIONAL REFERENCE LABORATORIES (NRLS) AND CENTRAL TB DIVISION WITH WHO REPRESENTATIVES AS MEMBERS. THIS COMMITTEE GUIDES THE LABORATORY RELATED ACTIVITIES OF THE PROGRAMME.

15. 2. SPUTUM EXAMINATION

16. Case finding is passive. Patients presenting themselves with symptoms suspicious of tuberculosis are screened through two sputum smear examinations. (ON THE SPOT – EARLY MORNING) Sputum positive Sputum negative

17. 3. PROTOCOL FOR DIAGNOSIS

18. 4. DOTS PROGRAMME

19. The Directly Observed Treatment Short Course (DOTS) is the distinguishing feature of RNTCP. It is directly observed chemotherapy because the drug intake of every patient is supervised by programme functionaries.

20. COMPONENTS OF DOTS PROGRAMME

21. DOTS AGENTS MULTI PURPOSE HEALTH WORKERS ANGANWADI WORKERS DAIS EX-PATIENTS SOCIAL WORKERS TEACHERS OTHERS

22. DRUGS REGIMEN ISONIAZID – 600 mg RIFAMPICIN – 450 mg PYRAZINAMIDE – 1500 mg ETHAMBUTOL – 1200 mg STREPTOMYCIN – 0.75 g

23. CATEGORY TYPE OF PATIENT REGIMEN DURATION IN MONTHS CATEGORY I Color of box: RED New Sputum Positive Seriously ill sputum negative, Seriously ill extra pulmonary, INTENSIVE: 2 (HRZE) 3 CONTINUOUS: 4 (HR) 3 6 CATEGORY II Color of box: BLUE Sputum Positive relapse Sputum Positive failure Sputum Positive treatment after default INTENSIVE: 2 (HRZES) 3 , 1 (HRZE) 3 CONTINUOUS: 5 (HRE) 3 8

24. 5. DRUG RESISTANCE SURVEILLANCE (DRS) A new protocol for state-wide DRS under RNTCP has been developed in 2005. Over the next five years, RNTCP plans to systematically carry out state-wide DRS surveys in the states of Andhra Pradesh, Delhi, Gujarat, Kerala, Maharashtra, Orissa, Uttar Pradesh and West Bengal.

25. DRS ACTIVITIES

26. 6. DOTS PLUS DOTS-Plus, conceived by the WHO and several of its partners, is a strategy currently under development for the management of multi-drug resistant TB(MDR-TB). Recognizing that the treatment of MDR-TB cases is very complex, treatment is to follow the internationally recommended DOTS-Plus guidelines and will be done in designated RNTCP DOTS-Plus sites.

27. IT LAUNCHED IN INDIA DURING 2007 DIAGNOSIS IS CONFIRMED BY SPUTUM CULTURE AND SUSCEPTIBILITY TEST DONE IN IRL TREATMENT IS DAILY REGIMEN WITH SECOND LINE DRUGS PATIENTS ARE ADMITTED AND TREATED IN THE RNTCP DESIGNATED SITES TOTAL DURATION OF TREATMENT IS MINIMUM 2 YEARS I.P FOR 6-9 MONTHS C.P IS FOR 18 MONTHS

28. RECOMMENDED DOSAGE FOR DOTS PLUS DRUGS < 45 KG >45 KG KANAMYCIN 500 mg 750 mg OFLOXCIN 600 mg 800 mg ETHIONAMIDE 500 mg 750 mg ETHAMBUTOL 800 mg 1000 mg PYRAZINAMIDE 1250 mg 1500 mg CYCLOSERINE 500 mg 750 mg PARA AMINO SALICYLIC ACID 10 mg 12 mg

29. 7. PAEDIATRIC TUBERCULOSIS MODIFICATION OF THE EXISTING RNTCP GUIDELINES FOR THE DIAGNOSIS AND TREATMENT OF PAEDIATRIC PATIENTS. DRUGS FOR PAEDIATRIC TB CASES UNDER RNTCP SHOULD BE SUPPLIED IN PATIENT-WISE BOXES (PWBS),

30. 8. TB – HIV COORDINATION

31. RNTCP and the National AIDS Control Organization (NACO) have devised a Joint Action Plan for TB-HIV coordination. The objective of TB-HIV coordination is to reduce TB-associated morbidity and mortality in People Living With HIV/AIDS (PLWHA) through collaboration between NACP and RNTCP. The basic purpose of the Joint Action Plan is to ensure optimum synergy between the two national programmes for effective prevention and control of both the diseases.

32. ACTIVITIES IN TB – HIV COORDINATION Sensitization of key policy makers to address the importance of TB-HIV co-ordination Co-ordination of service delivery and cross-referrals; A joint training programme for service providers involved in RNTCP and NACP VCTC-RNTCP co-ordination for cross-referrals

33. · Use of universal precaution to prevent the spread of tuberculosis in facilities caring for HIV infected persons, and to prevent the spread of HIV through safe injection practices in RNTCP · Joint efforts at IEC and at establishing a monitoring and evaluation system at district, state and national levels to assess the co-ordination and treatment services for people living with HIV/AIDS; and · Active involvement of NGOs, private practitioners and corporate sector.

34. 9. IEC ACTIVITIES Intensive IEC activities are carried out at various levels to promote utilization of RNTCP services in the country. A mass media agency has been envisaged at the national level. IEC material is being prepared by the states in local languages.

35. ORGANISATIONAL PATTERN OF RNTCP CENTRAL LEVEL : CENTRAL TB DIVISION STATE LEVEL STATE TUBERCULOSIS OFFICE STATE TB TRAINING AND DEMONSTRATION CENTRE

36. DISTRICT LEVEL: DISTRICT TUBERCULOSIS CENTRE SUB DISTRICT LEVEL: T.B UNIT PERIPHERAL LEVEL: HEALTH UNITS RURAL HOSPITALS

37. ROLE OF NURSE

38. ESSENTIAL CARE

39. HEALTH EDUCATION

40. CLINICAL EXAMINATION

41. BCG VACCINATION

42. PROGRAMME ACHIEVEMENT: Despite rapid expansion, the overall performance of the programme remains consistently good. Death rate has been brought down seven folds from 29 per cent to 4 per cent. Master trainers on TB/HIV have been trained on TB/HIV related issues in 12 states.