The document summarizes the Revised National Tuberculosis Control Programme (RNTCP) in India. It outlines the need for a revised strategy due to low diagnosis and treatment rates under the previous program. RNTCP was launched in 1992 with goals of reducing TB mortality and interrupting transmission. Key components include political commitment, quality microscopy, drug supply, and direct observation of treatment. The program achieved scale up across India in phases from 1992 to 2006 and aims to further improve access, strengthen collaboration, and implement interventions for drug-resistant TB and TB-HIV co-infection.

1. BY R.SIVAPIYA 72

2. REVISED NATIONAL TUBERCULOSIS CONTROL PROGRAMME ORIGIN NATIONAL TB PROGRAM (NTP) 1962 RNTCP IS THE REVIEWED FORM OF NTP NEED FOR REVISED STRATEGY -OVER EMPHASIS ON X-RAYS FOR DIAGNOSIS -INADEQUATE FUNDING,POOR QUALITY MICROSCOPY -NON-STANDARD TREATMENT REGIMENS -LOW RATES OF TREATMENT COMPLETION -LACK OF SYSTEMATIC INFORMATION ON TREATMENT OUTCOME -ONLY 30% OF ESTIMATED TB PATIENTS WERE DIAGONOSED -ONLY 30% OF THE DIAGONOSED CASES WERE TREATED SUCCESSFULLY RNTCP STARTED IN YEAR 1992 (GOVT. OF INDIA,WHO,WORLD BANK)

3. GOAL TO REDUCE MORTALITY AND MORBIDITY FROM TB TO INTERRUPT CHAIN OF TRANSMISSSION OBJECTIVES ACHIEVEMENT OF AT LEAST 85%CURE RATE OF INFECTIOUS CASES DETECTION OF ATLEAST 70%OF ESTIMATED CASES INFORMATION, EDUCATION, COMMUNICATION AND IMPROVED OPERATIONAL RESEARCH ACTIVITIES. COMPONENTS POLITICAL COMMITMENT GOOD QUALITY SPUTUM MICROSCOPY UNINTERRUPTED SUPPLY OF GOOD QUALITY DRUGS DIRECTLY OBSERVED TREATMENT ACCOUNTABILITY

4. ORGANIZATION-PROFILE AT STATE LEVEL STATE TUBERCULOSIS OFFICE - STATE TUBERCULOSIS OFFICER STATE TUBERCULOSIS TRAINING & DEMONSTRATION CENTRE - DIRECTOR DISTRICT TUBERCULOSIS CENTRE (DTC) - DISTRICT TUBERCULOSIS OFFICER TUBERCULOSIS UNIT - MEDICAL OFFICER - SENIOR TREATMENT SUPERVISOR(STS) - SENIOR TB LAB SUPERVISOR(STLS) MICROSCOPY CENTRES AND TREATMENT CENTRES DOTS PROVIDERS

5. LABORATORY NETWORK CENTRAL TB DIVISION NATIONAL REFERENCE LAB STATE TB CELL INTERMEDIATE REFERENCE LAB DISTRICT TB CENTRE TU TU TU DMC II DMC I DMC III NATIONAL LEVEL STATE LEVEL DISTRICT LEVEL (SPUTUM MICROSCOPY EQA) (SUPERVISION) (FEEDBACK)

6. ROLE OF EACH LEVEL OF LABORATORY NATIONAL REFERENCE LABORATORTY(NRL) 3 CENTRES- NEW DELHI, CHENNAI AND BANGALORE EACH CENTRE CONTROLS OVER 8-11 STATES SUPERVISES SPUTUM MICROSCOPY EQA ACTIVITIES. INTERMEDIATE REFERENCE LABORATORY(IRL) STATE TB TRAINING AND DEMONSTRATION CENTRES OR PUBLIC HEALTH LAB/MEDICAL COLLEGE LABORATORY CONDUCTS SPUTUM MICROSCOPY EQA FOR THE STATE PROVIDES TECHNICAL TRAINING TO THE DISTRICT AND SUB DISTRICT TECHNICIANS AND SENIOR TB LAB SUPERVISORS. CONDUCTS ON SITE EVALUATION VISITS OF EACH DTC ATLEAST ONCE A YEAR MANUFACTURES SLIDES FOR PANEL TESTING

7. DISTRICT TB CENTRES CONDUCTS BLINDED RE-CHECKING OF SMEARS MAINTAIN GOOD QUALITY REAGENTS AND EQUIPMENTS AT ALL TB UNITS TUBERCULOSIS UNITS AT SUB- DISTRICT LEVEL 1 TB UNIT PER 5 LAKH POPULATION( IN HILLY AREAS 2.5 LAKH) CONDUCTS ON-SITE EVALUATIONS AND BLINDED RE-CHECKING OF SMEARS DESIGNATED MICROSCOPY CENTRES AT PERIPHERAL LEVEL 1 PER 1 LAKH POPULATION( IN HILLY AREAS 50000) LOCATED AT EITHER IN CHC, PHC, TALUKA HOSP, TB DISPENSARIES EACH CENTRE HAS A SKILLED TECHNICIAN A SENIOR TB LAB SUPERVISOR(STLS) IS APPOINTED FOR EVERY 5 MICROSCOPY CENTRES

8. TREATMENT CENTRES PROVIDES DRUGS FREE OF COST THREE COMPONENTS APPROPRIATE MEDICAL TREATMENT SUPERVISION AND MOTIVATION MONITORING OF THE DISEASE STATUS DOTS PROVIDERS MAY BE A PERIPHERAL HEALTH STAFF OR VOLUNTARY WORKERS(TEACHERS, SOCIAL WORKERS, ANGANWADI WORKERS, EX-PATIENTS,ETC…) THEY ARE KNOWN AS “DOTS AGENT” PAID AN INCENTIVE OF RS.150 PER PATIENT COMPLETING THE TREATMENT

9. SERVICES PROVIDED SERVICES INC DRUGS – FREE OF COST HIGH QUALITY SPUTUM MICROSCOPY WITH PROMPT REPORTING OF RESULTS HIGH QUALITY EVALUATION AND APP. TREATMENT HIGH QUALITY DRUGS UNINTERRUPTED SUPPLY OF DRUGS TO THE FULL REQUIREMENT PROVISION OF DOTS BY THE GENERAL HEALTH SERVICES OR BY COMMUNITY VOLUNTEERS TECHNICAL ASSISTANCE

10. DEFAULTER ACTION IF PATIENT FAILS TO REPORT VISIT HOME INTENSIVE PHASE -ON NEXT DAY CONTINUATION PHASE - WITHIN A WEEK RECORDS TUBERCULOSIS REGISTER LABORATORY REGISTER TREATMENT CARD LABORATORY FORM FOR SPUTUM EXAMINATION SUPERVISORY REGISTER REFERRAL FOR TREATMENT REGISTER REPORTS QUARTERLY REPORTS ON -CASE FINDING -SPUTUM CONVERSION -RESULTS OF TREATMENT RNTCP REPORT ON PROGRAMME MANAGEMENT & LOGISTICS

11. RNTCP-PHASES PHASE I (1992 – 2006) PHASE II ( 2006 – 2011 )

12. PHASE I BY 1993 PILOT PHASE I PILOT PHASE II PILOT PHASE III BY THE END OF 1998, ONLY 2 % COVERED. BY 2006 WHOLE POPULATION COVERED.

13. PHASE II TO CONSOLIDATE, MAINTAIN AND FURTHER IMPROVE THE ACHIEVEMENTS OF THE PHASE I ACTIVITIES INCREASE ACCESS OF SERVICES TO HARD-TO-REACH AREAS STRENGHTHENING THE INTER SECTORAL COLLABORATION SCALLING UP OF THE STATE LEVEL INTERMEDIATE REFERRAL LABORATORIES(IRL) CAPACITY IMPLEMENTATIOIN OF DOTS-PLUS FOR MDR-TB CASES IN A PHASED MANNER DISRIBUTION OF PAEDIATRIC DRUG BOXES INSTITUTIONAL STRENGHTHENING AT NATIONAL, STATE AND DISTRICT LEVEL INTRODUCTION OF TB-HIV CO-ORDINATOR ,URBAN CO-ORDINATOR AND COMMUNICATION FACILITATOR.

14. DRUG RESISTANCE SURVEILLANCE AIM TO DETERMINE THE PREVALENCE OF ANTI-MYCOBACTERIAL DRUG RESISTANCE AMONG -NEW CASE -TREATED CASE PLANS STATE WIDE DRS SURVEYS ICMR SURVEYS BY 2010, A NETWORK OF 24 STATE-LEVEL CULTURE AND DRUG SENSITIVITY TESTING LABORATORIES

15. DOTS-PLUS STRATEGY CURRENTLY UNDER DEVELOPMENT BY WHO FOR THE MANAGEMENT OF MDR-TB CASES GOAL TO PREVENT FURTHER DEVELOPMENT OF MDR-TB PRE-REQUISITE AN EFFECTIVE DOTS BASED TB CONTROL PROGRAM ORGANISATION DESIGNATED RNTCP DOTS-PLUS SITES ATLEAST 1 IN EACH STATE WITH READY ACCESS TO RNTCP ACCREDITED CULTURE AND DRUG SUSCEPTIBILITY TESTING(DST) LABORATORY

16. WHO 7-POINT PLAN OF ACTION SHORT TERM BASIC TB CONTROL MEASURES MEET INTERNATIONAL STANDARD FOR TB CARE RAPID SURVEYS TO ACCESS THE DISTRIBUTION OF MDR-TB AND XDR-TB IN VULNERABLE POPULATION STRENGTHEN NATIONAL TB LAB CAPACITY IMPLEMENTING INFECTION CONTROL PRECAUTIONS IN HEALTH CARE FACILITIES LONG TERM ESTABLISH CAPACITY FOR CLINICAL AND PUBLIC HEALTH SERVICES PROMOTE UNIVERSAL ACCESS TO ARTs FOR TB-HIV PARIENTS FUNDING FOR RESEARCHES

17. MANAGEMENT OF PAEDIATRIC TUBERCULOSIS DIAGNOSIS AND TREATMENT FOR THE PAEDIATRIC PATIENTS ISSUING DRUGS FOR THE PAEDIATRIC CASES IN THE PATIENT WISE BOXES(PWB) TREATMENT BASED ON CHILD’S BODY WEIGHT 6-10KG WEIGHT BAND 11-17KG WEIGHT BAND CHILDREN WEIGHING  6KG WILL BE TREATED WITH LOOSE ANTI-TB DRUGS

18. TB HIV CO-ORDINATION RNTCP AND NACO – “JOINT ACTION PLAN” OBJECTIVE TO REDUCE TB ASSOCIATED MORBIDITY AND MORTALITY IN TB-HIV PATIENTS FOR EFFECTIVE PREVETION AND CONTROL OF BOTH THE DISEASES PHASE I 2OOI IN 6 HIGH HIV PREVALENT STATES(AP, KARNATAKA, MAHARASHTRA, MANIPUR, NAGALAND, TN) PHASE II 2003 8 ADDITIONAL STATES(DELHI, GUJARAT, HP, KERALA, ORISSA,PUNJAB, RAJASTHAN, WB) PLAN TO BE EXTENDED TO ALL OTHER STATES IN DUE COURSE

19. ACHIEVEMENTS OF RNTCP TREATMENT SUCCESS RATE DEATH RATE INVOLVEMENT OF NGOs, PRIVATE PRACTITIONERS, MEDICAL COLLEGES, PERIPHERAL LABORATORIES, DESIGNATED MICROSCOPY CENTRES, PUBLIC HEALTH CARE PROVIDERS 4 URBAN DOTS PROJECTS(MUMBAI,HYDERABAD,VARANASI,CHENNAI) “ NATIONAL FRAME WORK FOR JOINT TB-HIV COLLOBORATIVE ACTIVITIES” - BY CENTRAL TB DIVISION & NACO - REPLACES “JOINT ACTION PLAN”

20. NATIONAL FRAMEWORK FOR JOINT TB-HIV COLLABORATIVE ACTIVITIES ESTABLISHMENT OF CO-ORDINATION MECHANISMS,JOINT PLANNING AND REVIEW AT NATIONAL,STATE AND DISTRICT LEVELS SERVICE DELIVERY CO-ORDINATION INVOLVEMENT OF NGOs OPERATIONAL RESEARCH INFECTION CONTROL MEASURES

21. STOP TB STRATEGY VISION A WORLD FREE OF TB GOAL TO DRAMATICALLY REDUCE THE GLOBAL BURDEN OF TB BY 2015 IN LINE WITH THE MILLENNIUM DEVELOPMENT GOALS AND THE STOP TB PARTNERSHIP TARGETS

22. COMPONENTS HIGH QUALITY DOTS EXPANSION ADDRESSING TB-HIV, MDR-TB AND OTHER CHALLENGES HEALTH SYSTEM STRENGHTHENING ENGAGING ALL CARE PROVIDERS(PUBLIC-PUBLIC AND PUBLIC- PRIVATE MIX APPROACHES) EMPOWERING PEOPLE WITH TB CARE PROMOTING RESEARCH ACTIVITIES TARGETS - BY 2015 GLOBAL BURDEN OF TB(PREVALENCE AND DEATH RATES) WIL BE REDUCED BY 50 % (INCL TB-HIV CASES) - BY 2050 GLOBAL INCIDENCE OF TB  1 CASE PER 1 MILLION POPULATION PER YEAR

23. IMPROVED TREATMENT ACCESS NEW DRUGS NEW VACCINE - DEVELOP A SAFE, AFFORDABLE VACCINE TO IMPROVE UPON THE EXISTING VACCINE NEW DIAGNOSTICS- TO DEVELOP EFFICIENT, EFFECTIVE, AND AFFORDABLE DIAGNOSTIC TESTS FOR TB GLOBAL PLAN TO STOP TUBERCULOSIS AIMS

25. ACKNOWLEDGEMENT PROF. HOD. DR. UMADEVI MADAM, SPM DEPT AND ALL OUR PROFESSORS. TUBERCULOSIS CENTRE, PULIANTHOPE. CHETPET TB HOSPITAL. DOTS CENTRE, KMCH AND ROYAPETTAH. THIRUVOTTESWARAR TB HOSPITAL, OTTERI. AYNAVARAM DOTS CENTRE.