2. Tuberculosis control
RNTCP-Revised National
Tuberculosis Control Programme
DOTS-Directly observed Treatment
Short Course Chemotherapy(Strategy
to implemente programme)
3. Objectives of RNTCP
To achieve and maintain at least 85 % cure rate
amongst new smear positive cases
To achieve and maintain at least 70 % of New
case detection rate in population
Universal access to care:
◦ Total case notification Rate: 90%
◦ Success Rate : 90 %
3
4. Most common symptom of
pulmonary TB
Cough for 2 weeks or more
Weight loss
Loss of appetite
Night sweats
Fever, with evening
rise of temperature
Chest pain
Shortness of breath
Haemoptysis
Tiredness
Other symptoms
4
6. 6
Directly Observed Treatment
Directly observed treatment (DOT) is one
element of the DOTS strategy
An observer watches and helps the patient
swallow the tablets
Direct observation ensures treatment for
the entire course
with the right drugs
in the right doses
at the right intervals
7. TB Control
The 5 components of DOT
TB Regiser
Political commitment
Diagnosis by
microscopy
Adequate supply of
the right drugs
Directly observed
treatment
Accountability
7
8. 8
Why is it necessary to directly
observe treatment?
At least one third of patients receiving self-
administered treatment do not adhere to treatment
Impossible to predict which patients will take
medicines
DOT necessary at least in the initial phase of
treatment to ensure adherence and achieve
sputum smear conversion
A TB patient missing one attendance can be traced
immediately and counseled
15. Sputum follow up schedule
End of intensive phase
End of treatment
15
16. Category of
treatment
Type of patient Regimen
New sputum smear-positive
New sputum smear-negative
New extra-pulmonary
Sputum smear-positive Relapse
Sputum smear-psotivie Failure
Sputum smear-positive TAD
Category I
2(HRZE)3
4(HR)3
Category II 2(HRZES)
3
1(HRZE)
3
5(HRE)
3
RNTCP Treatment Regimens
New Others
Others
16
17. Modes of Observation
Treatment observer must be accessible
and acceptable to the patient and
accountable to the health system
DOT providers can be:
Health care workers
Non-governmental organizations, Private
Practitioners
Community volunteers like sarpanch, etc.
Religious leaders like pujari, etc.
Anganwadi Worker,ASHA,Shop Keeper, etc.
Cured Patients
17
18. Programme Surveillance System
18
Peripheral Health
Institute
District TB Centre
Central TB Division State TB Cell
Tuberculosis Unit
Monthly Report
Quarterly Report
Quarterly Report
Quarterly
Feedback
Quarterly
Feedback
Data entry at district
level and electronic
transmission from
district to
State/National levels
20. 20
What is DOTS-Plus?
• DOTS-Plus is an integral component of RNTCP to
manage MDR-TB under programmatic conditions
• The strategy designed to manage MDR-TB using second-
line anti-TB drugs within the DOTS strategy using
standardized regimen called cat IV
Causes of inadequate treatment which can
lead to drug resistance TB
1. Providers/Programmes: Inadequate regimens
2. Drugs:Inadequate supply/quality
3. Patients:Inadequate drug intake
21. TB Notification
21
TB is now declared as a
notifiable disease by GOI
All private practitioners
must notify TB to health
department
District TB Officer is a
nodal officer for TB
notification
22. NIKSHAY – Web based case based real
time data entry of TB patients
22
23. Newer Initiatives
Ban on TB Serology
Daily regimen for pediatric TB---Child
friendly fixed dose combinations
Daily regimen for all forms of TB in five
states
Daily regimen for all TB/HIV infected
patients across the country
23
27. National Leprosy Eradication
Programme (NLEP) was launched in
1983 with the objective to arrest the
disease activity in all the known cases
of leprosy.
In order to strengthen the process of
elimination in the country, World Bank
supported projects were launched in
1993 – 94 and 2001-02, which ended
in December 2004.
27
28. Thereafter Govt. of India decided to
continue the programme activities with
domestic funds.
The programme has remained a 100%
centrally sponsored scheme through
the past five year plans.
28
32. The disease has come down to a
level of elimination i.e. less than
one case per 10,000 population at
the national level by December
2005.
However, new cases continue to be
detected and the disease is prevalent
with moderate endemicity in about
15% of the districts.
32
33. OBJECTIVES.....
Elimination of leprosy i.e. prevalence
of less than 1 case per 10,000
population in all districts of the
country.
Strengthen Disability Prevention &
Medical Rehabilitation of persons
affected by leprosy.
Reduction in the level of stigma
associated with leprosy.
33
34. Strategy - Leprosy Elimination in
India
Decentralized integrated leprosy
services through General Health Care
system.
Early detection & complete treatment
of new leprosy cases.
Carrying out house hold contact
survey in detection of Multibacillary
(MB) & child cases.
34
35. Early diagnosis & prompt MDT,
through routine and special efforts
Involvement of Accredited Social
Health Activists (ASHAs) in the
detection & complete treatment of
Leprosy cases for leprosy work
Strengthening of Disability Prevention
& Medical Rehabilitation (DPMR)
services.
35
36. Information, Education &
Communication (IEC) activities in the
community to improve self reporting
to Primary Health Centre (PHC) and
reduction of stigma.
Intensive monitoring and supervision
at Primary Health Centre/Community
Health Centre.
36
37. PROGRAMME COMPONENTS
Case Detection and Management
Disability Prevention and Medical
Rehabilitation
Information, Education and
Communication (IEC) including
Behaviour Change Communication
(BCC)
Human Resource and Capacity
building
Programme Management 37
38. Case Detection and Management
Detection of the new cases at the early
stage is the only solution to cut down the
transmission potential in the community and
also to provide relief to the leprosy affected
persons by preventing disabilities.
It is therefore suggested that the States will
draw up innovative plans
38
39. To improve access to services.
To involve women including leprosy
affected persons in case detection.
To organize skin camps for detecting
leprosy patients while providing
services for other skin conditions..
39
40. To undertake contact survey to identify
the source in the neighbourhood of
each child or M.B. case.
To increase awareness through the
ANM, AWW, ASHA and other Health
Workers visiting the villages & people
affected by leprosy, to suspect and
motivate leprosy affected persons for
early reporting to the Medical Officer
40
41. Case definitions
PB- 1-5 skin lesions or only one nerve
involvement
MB- > 5 skin lesions and more than one
nerve involvement
43. ASHA Involvement Accredited Social
Health Activists (ASHA) will be
involved to bring out suspected cases
from their villages for diagnosis at
PHC and after confirmation of
diagnosis, will follow up the patients
for completion of treatment.
43
44. The ASHA will be entitled to receive
incentive as below:
(i) At confirmation of diagnosis – Rs.
250/-
(ii)On completion of full course of
treatment in time – PB - additional
Rs.400/ MB - additional Rs.600/-
44
45. The SET Scheme
Survey Education &Treatment Centres
Under the SET Scheme, the NGOs are
presently involved for disability prevention
and ulcer care, IEC, referral of suspected
cases, Research and Rehabilitation.
The NGO support is mainly required to
follow up of the under treatment cases
particularly in urban locations and in difficult
to access areas
45
46. Disability Prevention and Medical
Rehabilitation (DPMR)
Service and care for disabilities such
as ulcers, cracks and wounds, septic
hand or feet etc. are available at all
the Health Institutions.
Complicated ulcer cases are referred
to District Hospital.
Referral centres will be developed
depending on the need, in all district
hospitals and Medical colleges.
46
47. The referral centres will be supported
by Dermatologists/Physicians of the
district hospital and a Physiotherapist
47
48. Incentive to patient
An incentive of Rs. 8,000/- will be paid
to all persons affected by leprosy
undergoing major RCS irrespective of
their financial status.
48
49. Information, Education and
Communication (IEC/BCC)
Stigma associated with the disease
and discrimination against the leprosy
affected persons are still perceived.
The effective way to deal with this
difficult challenge of stigma removal
is to embark on intensive Inter-
Personal Communication (IPC) with
the target groups.
49
50. Certain level of awareness has
developed in the communities due to
the persistent efforts in communication
during last decade.
However, continuous efforts are
needed to cover the uncovered areas.
Coverage will have to move from high
risk centric to general community at
large
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