This document outlines the Revised National Tuberculosis Control Programme (RNTCP) in India. It summarizes that tuberculosis poses a major public health burden in India, accounting for 1/3rd of global cases. The National Tuberculosis Control Programme started in 1962, but failed due to low treatment completion rates and organizational issues. RNTCP was launched in 1997 with DOTS strategy, which involves directly observed treatment, short-course. RNTCP aims to reduce morbidity, mortality, and transmission of TB in India through early case detection and standardized treatment. It utilizes a decentralized organizational structure and relies on community health workers to observe treatment. If fully implemented, RNTCP aims to achieve global targets for TB control by improving cure rates and case

2. Outline of presentation
• INTRODUCTION
• EPIDEMIOLOGY
• REASON FOR FAILURE OF NTCP
• RNTCP
• OBJECTIVES OF RNTCP
• UNIQUE FEATURE
• FUNDING
• ORGANISATIONAL STRUCTURE
• STRATEGY
• IMPLIMENTATION OF TREATMENT
• DOTS
• CHALLENGES

3. INTRODUCTION
• TBis oneof mostimportantpublic healthproblems worldwide.
•Itstands 7th
inthetenleadingcauses of globaldisability
•Indiaaccounts fornearly1/3rdof theglobaltuberculosis burden.
•Tuberculosis in India continues to take a toll of 1,000 per dayor one every
minute.
•NationalTuberculosis ControlProgrammewas startedin1962.
•The objectives of the Programme were to reduce the morbidityandmortality,
to reduce disease transmission and to diagnose as manycases of tuberculosis
as possibleandtoprovidefreetreatment.

6. Reason for failure of National tuberculosis control
programme
 Completion rate of treatment was 30%
 Inadequate budgetary outlay
 Shortage and irregular supply of anti-tuberculosis drugs
 Poor quality of sputum microscopy
 More emphasis on case detection rather then cure
 Poor organizational setup and support
 Multiplicity of treatment regimes
 Poor awareness of TB patients about the disease
 Non availability of trained staff

21. MAJOR CHALLENGES IN DOTS
IMPLIMENTATION
Expansion
Private sector involvement
IEC and health Education
Migratory population
Social stigma

23. COLOUR OF BOXES AND QUANTITY OF DRUGS
RED COLOURED BOX 24 DOSES FOR TWO
MONTHS OF INTENSIVE
PHASE
18 CALENTERED
WEEKLY MULTIBLISTER
COMBI PACK FOR FOUR
MONTHSOF
CONTINUATION PHASE

24. COLOUR OF BOXES AND QUANTITY OF DRUGS
BLUE COLOURED BOX 36 DOSES FOR THREE
MONTH OF INTENSIVE
PHASE
22 CALENDERED
WEEKLY MULTIBLISTER
COMBI PACK FOR FIVE
MONTHS OF
CONTINUATION PHASE

25. COLOUR OF BOXES AND QUANTITY OF DRUGS
GREEN COLOURED
BOX
24 DOSES FOR TWO
MONTHS OF INTENSIVE
PHASE
18 CALENTERED
WEEKLY MULTIBLISTER
COMBIBACK FOR FOUR
MONTH OF
CONTINUATION PHASE

26. Drug resistence survillance
under RNTCP
previlence of resistence to TB can be taken as an
indicator of the efectiveness of TB conrol activities over
a period of time and therefore RNTCP has taken steps to
mesure this important indicator.
The aim of DRS is to determine the pevilence of
antimycrobial drug resistence among new sputam smear
positive pulmonary TB patients and also amoungst
previously treated sputam smear positive patients

27. Treatment observes or Drug providers or
Dots agent
Health inspectors
Pharmacists
Malaria field workers
Work place supervisors
Railway school teachers
Shopkeepers
Cured patients
Wife of medical officers
Self help group volunteers
Mid-wife
Senior dressers
 Multi purpose health workers
Any person

28. TYPE OF TUBERCULOSIS PATIENT
UNDER RNTCP
NEW CASE
RELAPSE
DEFAULTER
FAILURE CASE
CHRONIC CASE

30. TB/HIV collaborative
activities
• HIV infection makes an individual more prone to develop TB
disease .it is a most powerful risk factor of TB progression.
 TB/HIVAction Plan - implemented by RNTCP .
 jointly, focuses on:
– Training of service provider
– Service delivery linkages
– Monitoring
– Information, Education, and Communication

31. MONITORING
INDICATORS
1. Annualized detection of New Smear Positive
Cases
2. Ratio of New S-ve cases to S+ve Cases
3. Smear Conversion Rate
This indicator is reported one quarter after patients begin
treatment, and applies to every patient started on
treatment, without exceptions.
4. Treatment Success Rate
Percentage of new smear-positive (infectious) patients
who are documented to either be cured, or to successfully
complete treatment.

32. RECORDS AND REGISTER
TB laboratory register
TB treatment card
Laboratory form for sputum exam.
Patient identity card.
Quarterly report form

33. FUTURE PLAN
 Maintaining/improving quality and reach of DOTS
 Scaling up of MDR-TB management
 Engaging all care providers
 Promoting community involvement and ownership
 Further strengthening TB-HIV collaborative activities
 Introduction of newer diagnostics

34. Continued……
• BY 2005--- atleast 70% of people with sputam smear
positive TB will be diagnosed and at least 85% cured
• BY 2015– the global burden of TB will be reduced by
50%
• BY 2050—the global incidence of TB will be less than
or equal to 1 case per million popullation per year

35.
Tuberculosis is a major public health problem in India.This serious situation
will further worsen with TB/HIV co-infection and multidrug resistant
TB.Several members in India have begun to implement the revised strategy but
there are many constrains which require both national and regional
efforts.Strong and sustainable revised RNTCPs must be established in order to
achieve the global targets at a 85% cure and 70% case finding by the year
2010.Without DOTS it is highly unlikely that countries will be able to develop
effective and sustainable national tuberculosis programme.With the
introduction of DOTS, achieving the global targets for tuberculosis control has
now become a realistic proposition.“Is it now time for DOTS to become the
standard of care in tuberculosis worldwide”.
CONCLUSION

36. THANK YOU