• The WHO report on Global
Tuberculosis Control in
2005 remarks that "India, the
country with the greatest burden of
• In India today, two deaths occur
every three minutes from
tuberculosis (TB). But these deaths
can be prevented. With proper care
and treatment, TB patients can be
cured and the battle against TB can
• Tuberculosis (TB) is an infectious
disease caused by a Bacterium,
Mycobacterium tuberculosis. It is
spread through the air by a person
suffering from TB. A single patient
can infect 10 or more people in a
SOURCE OF INFECTION
1. HUMAN SOURCE.
2. BOVINE SOURCE.
• Clients are infective as long as
they remain untreated.
• An effective anti microbial
treatment reduces infectivity by
90% within 48 Hrs.
MODE OF TRANSMISSION
1. Mainly by droplet infection.
2. Coughing generates the largest
number of droplets of all sizes.
• 1. Development of a positive
tuberculin test -3 To 6 wks.
• 2. Development of disease depends
upon the closeness of contact,
extent of disease and sputum
positivity of the case. (Several
weeks, months or years)
PROGRAMME IN INDIA
THE BASIC PRINCIPLES OF
• Political commitment for ensuring
adequate funds, staff and other key
• Establishment of diagnosis primarily
by microscopic examination of
specimens obtained from patients
presenting to health care facilities.
• Achievement of at least 85% cure
rate of infectious cases; through
• Augmentation of case finding
activities through quality sputum
microscopy to detect at least 70% of
FIRST PHASE OF RNTCP (19982005)
• In the first phase of RNTCP
(1998-2005), the programme’s
focus was on ensuring expansion
of quality DOTS services to the
• Regular and uninterrupted supply of
anti-TB drugs in the form of a patientspecific box that contains the medicines
for the entire course of treatment so
that no patient is subjected to
interruption of treatment for lack of
• Direct observation of every dose of
treatment in the intensive phase and of
at least the first dose in the
continuation phase of treatment.
• Systematic monitoring, supervision and
cohort analysis-one Senior Treatment
Laboratory Supervisor (STLS) is
responsible for organization of
uninterrupted treatment and one Senior
Tuberculosis Laboratory Supervisor for
ensuring quality laboratory service for
every 5,00,000 population.
PROGRAMME EXPANSION AND
• The initial implementation of RNTCP
started in 1993 with a population
coverage of 2.35 million at 5 sites in
different states (Delhi, Kerala, West
Bengal, Maharashtra and Gujarat). Its
expansion continued in the following
years with population coverage reaching
13.85 million in 1995.
• The Revised National Tuberculosis Control
Programme (RNTCP), based on the DOTS
strategy, began as a pilot in 1993 and was
launched as a national programme in 1997.
• Rapid RNTCP expansion began in late 1998.
By the end of 2000, 30%of the country’s
population was covered, and by the end of
2002, 50%of the country’s population was
covered under the RNTCP.
• The entire country was covered under DOTS
by 24th March 2006.
2006 - STOP TB
• “STOP TB” strategy was announced
by WHO and was adopted by India.
• COMPONENTS OF STOP TB :
1.Persuing quality DOTS expansion
2. Addressing TB/HIV & MDR-TB
3. Contributing to Health Care
4.Engaging all care providers.
5.Empowering patients and
6. Enabling and promoting
• PROFILE OF RNTCP IN A STATE :
• State TB office-State tuberculosis
• State TB Training & Demonstration
STATE TUBERCULOSIS OFFICE –STATE TB OFFICER
STATE TB TRAINING & DEMONSTRATION
DISTRICT TB CENTRE – DISTRICT TB
• The DOTS strategy is cost-effective and
is today the international standard for
TB control programmes. To date, more
than 180 countries are implementing
the DOTS strategy.
• The DOTS strategy along with the
other components of the Stop TB
strategy, implemented under the
Revised National Tuberculosis
Control Programme (RNTCP) in
India, is a comprehensive package
for TB control.
DOTS IS A SYSTEMATIC STRATEGY
WHICH HAS FIVE COMPONENTS
• Political and administrative
• Good quality diagnosis.
• Good quality drugs. An uninterrupted
supply of good quality anti-TB drugs
• Supervised treatment to ensure the
• Systematic monitoring and
RNTCP- LABORATORY NETWORK
National Reference Lab
Central TB Division
Intermediate Reference Lab
State TB Cell
District TB Centre DISTRICT
TB and HIV
• TB is the most common
opportunistic infection in people
living with HIV virus. As the HIV
breaks down the immune system,
HIV- infected people are at greatly
increased risk of TB.
• TB in turn accelerates the progression
of HIV to AIDS and shortens the
survival of patients with HIV infection.
Thus, TB and HIV are closely
interlinked. In India there are an
estimated over 5 million HIV-infected
• Directly Observed Treatment, Shortcourse (DOTS) is as effective among
HIV- infected TB patients as among
those who are HIV negative.
• MDRTB refers to strains of the
bacterium which are proven in a
laboratory to be resistant to the two
most active anti-TB drugs, isoniazid
and rifampicin. Treatment of
MDRTB is extremely expensive,
toxic, arduous, and often
• DOTS has been proven to
prevent the emergence of
MDRTB, and also to reverse the
incidence of MDRTB
SECOND PHASE OF RNTCP
• The RNTCP has now entered its second
phase in which the programme aims to
firstly consolidate the gains made to
date, to widen services both in terms of
activities and access, and
• To sustain the achievements for
decades to come in order to achieve
ultimate objective of TB control in the
All components of new Stop TB
Strategy are incorporated in the
second phase of RNTCP
NEW STOP TB STRATEGY
• Pursue quality DOTS expansion and
enhancement, by improving the case
finding are cure through an effective
patient-centred approach to reach all
patients, especially the poor.
• Address TB-HIV, MDR-TB and other
challenges, by scaling up TB-HIV joint
activities, DOTS Plus, and other relevant
• Contribute to health system
strengthening, by collaborating with
other health programmes and general
• Involve all health care providers, public,
nongovernmental and private, by
scaling up approaches based on a
public-private mix (PPM), to ensure
adherence to the International
Standards of TB care.
• Engage people with TB, and affected
communities to demand, and contribute to
effective care. This will involve scaling-up of
community TB care; creating demand
thorugh context-specific advocacy,
communication and social mobilization.
• Enable and promote research for the
development of new drugs, diagnostic and
vaccines. Operational Research will also be
needed to improve programme
VISION AND TARGETS FOR
RNTCP DURING THE 12th FIVE
YEAR PLAN (2012-2017)
• Vision and targets for RNTCP during
the 12th Five Year Plan (2012-2017)
• Early detection and treatment of at
least 90 %of estimated TB case in
the community, including HIVassociated TB
• Initial screening of all re treatment
smear positive cases for drug
resistant TB & appropriate
• Offer ofHIV counselling and testing for
all TB patients and linking HIV-infected
TB patients to HIV care and support
• Successful treatment of at least 90
percent of all new TB patients
• Extend RNTCP services to patients
diagnosed and treated in the private
NECESSARY TO ACHIEVE RNTCP
THE NATIONAL STRATEGIC
• Strengthening and improving the
quality of basic DOTS services
• Further strengthen and align with
the health system under National
Rural Health Mission (NRHM)
• Improve communication and
outreach and social mobilization
• Promote research for development
and implementation of improved
tools and strategies
• To achieve 90% notification rate for
• To achieve 90% success rate for all
new & 85% for re treatment cases.
• To achieve decreased morbidity &
mortality if HIV associated TB.
• To improve outcomes of TB care in
• To significantly improve the successful
outcomes of treatment for drug
• Death rate has been brought down seven folds
(29% to 4%).
• 662 DTCs, 2698 TB units, 13,039 DMCs are
functional in the country.
• The programme involves more than 1971
NGOs, >10894 private practitioners, >297
medical colleges & >150 corporate health
facilities are involved
• >13,000 peripheral labs & designated
microscopy centres have been
• > 6 lakh public health care providers
are trained under the prog.
• >15 million patients have been
initiated on treatment.