The document describes India's Revised National Tuberculosis Control Programme (RNTCP). It outlines the objectives, history, organization, and initiatives of the RNTCP. Key points include: the RNTCP adopted the internationally recommended DOTS strategy in 1993 to address low treatment success rates; its laboratory network includes national reference labs, intermediate reference labs, and microscopy centers; it treats TB using standard short course chemotherapy regimens; and new initiatives include the Nikshay case-based surveillance system and expanding rapid diagnostics and drug-resistant TB treatment. The national strategic plan for 2012-2017 aims for universal TB care access through early detection and treatment of 90% of cases.

1. Revised National Tuberculosis Control
Programme

2. Objectives
● describe Revised National Tuberculosis
Control Programme
● explain organization
● describe laboratory network
● list new initiatives
● explain National strategic plan (2012-2017

3. Introduction
● TB is one of the most ancient diseases.
● It has been referred in the Vedas and
Ayurvedic Samhitas.
● It is caused by Mycobacterium tuberculosis
● In India, the first open air sanatorium was
founded in 1906

4. ● TB surveys -(1939) and Introduction of
BCG vaccination (1948)
● Under Dr Frimodt Moller
● First TB dispensary established in Bombay
in 1917
● India became a member of the International
Union Against Tuberculosis (IUAT) in 1929.

5. Incident in India(2016)
Estimates of TB burden*,
2016
Rate
(per 100 000 population)
Mortality (excludes HIV+TB) 32(24–40)
Mortality (HIV+TB only) 0.92(0.5–1.5)
Incidence (includes
HIV+TB)
211(109–345)
Incidence (HIV+TB only) 6.6(4.3–9.4)
Incidence (MDR/RR-TB)** 11(7.2–15)

6. National Tuberculosis Programme (NTP)
● National Tuberculosis Programme (NTP)
has been in operation since 1962.
● However, the treatment success rates were
unacceptably low and the death and default
rates remained high.
● Spread of multidrug resistant TB was
threatening to further worsen the situation.

7. ● In view of this, 1992 GOI along with WHO
and SIDA reviewed the TB situation in the
country and came up with following
conclusion:
● -NTP, though technically sound, suffered
from managerial weakness.
● - Inadequate funding
● - Over-reliance on X- Ray for diagnosis
● - Frequent interrupted supplies of drugs
● - Low rates of treatment completion

8. ● In 1993, in order to overcome these,
RNTCP started with the assistance from
international agencies.
● adopted the internationally recommend
Directly Observed Short-Course(DOTS)
strategy

9. Objectives
● Achievement of at least 85 % cure rate of
infectious cases of TB, through DOTS
involving peripheral health functionaries;
and
● Augmentation of case finding activities
through quality sputum microscopy to
detect at least 70% of estimated cases.

10. ● The revised strategy was introduced in the
country in a phased manner as Pilot phase
I, Pilot phase II and pilot phase III.

11. DOTS strategy: Components
● Political will and administrative commitment
● Diagnosis by quality assured sputum smear
microscopy
● Adequate supply of quality assured short course
chemotherapy drugs.
● Directly Observed treatment
● Systematic monitoring and accountability

12. The Stop TB Strategy 2006
● Vision: A TB-FREE WORLD
● Goal: To dramatically reduce the global
burden of TB by 2015 in line with the
Millennium Development Goals and the
Stop TB Partnership targets

13. Objectives
● Achieve universal access to high-quality care
for all people with TB
● Reduce the human suffering and
socioeconomic burden associated with TB
● Protect vulnerable populations from TB, TB/HIV
and multidrug-resistant TB

14. ● Support development of new tools and
enable their timely and effective use
● Protect and promote human rights in TB
prevention, care and control

15. Targets
● MDG 6, Target 8: Halt and begin to reverse the
incidence of TB by 2015
● Targets linked to the MDGs and endorsed by the
Stop TB Partnership:
– by 2015: reduce prevalence and deaths due to
TB by 50% compared with a baseline of 1990
– by 2050: eliminate TB as a public health
problem

16. Stratergy
● 1. Pursue high-quality DOTS expansion
and enhancement
● Secure political commitment, with adequate
and sustained financing
● Ensure early case detection, and diagnosis
through quality-assured bacteriology
● Provide standardized treatment with
supervision, and patient support

17. ● 2. Address TB-HIV, MDR-TB, and the
needs of poor and vulnerable populations
● Scale-up collaborative TB/HIV activities
● Scale-up prevention and management of
multidrug-resistant TB (MDR-TB)
● Address the needs of TB contacts, and of
poor and vulnerable populations

18. ● 3. Contribute to health system
strengthening based on primary health
care
● Help improve health policies, human resource
development, financing, supplies, service
delivery and information
● Strengthen infection control in health
services, other congregate settings and
households
● Upgrade laboratory networks, and implement
the Practical Approach to Lung Health (PAL)

19. ● 4. Engage all care providers
● Involve all public, voluntary, corporate and
private providers through Public-Private Mix
(PPM) approaches
● Promote use of the International Standards
for Tuberculosis Care (ISTC)

20. ● 5. Empower people with TB, and
communities through partnership
● Pursue advocacy, communication and social
mobilization
● Foster community participation in TB care,
prevention and health promotion
● Promote use of the Patients' Charter for
Tuberculosis Care

21. ● 6. Enable and promote research
● Conduct programme-based operational
research
● Advocate for and participate in research to
develop new diagnostics, drugs and
vaccines

23. The End TB Strategy 2014
● Vision
● A world free of TB. Zero deaths, disease and
suffering due to TB.
● Goal
● End the global tuberculosis epidemic.

24. Indicators
● 95% reduction by 2035 in number of TB
deaths compared with 2015.
● 90% reduction by 2035 in TB
incidence rate compared with 2015.
● Zero TB-affected families
facing catastrophic costs due to TB by
2035.

25. Principles
● Government stewardship and accountability,
with monitoring and evaluation.
● Strong coalition with civil society organizations
and communities.
● Protection and promotion of human rights,
ethics and equity.
● Adaptation of the strategy and targets at
country level, with global collaboration.

26. Pillars and components
● Integrated, patient-centred care and prevention
○Early diagnosis of tuberculosis including universal drug-susceptibility testing, and systematic screening of
contacts and high-risk groups.
○Treatment of all people with tuberculosis
○Collaborative tuberculosis/HIV activities,

27. ● Bold policies and supportive systems
○Political commitment with adequate resources for tuberculosis care and prevention.
○Engagement of communities
○Universal health coverage policy, and regulatory frameworks for case notification,
○Social protection,

28. ● Intensified research and innovation
○Discovery, development and rapid uptake of new tools, interventions and strategies.
○Research to optimize implementation and impact, and promote innovations.

29. ● Ending the TB epidemic
● Ending the global TB epidemic is feasible with
dramatic decline in TB deaths and cases, and
elimination of economic and social burden of
TB. Failure to do so will carry serious
individual and global public health
consequences.

30. Organization

31. Laboratory Network

32. National reference laboratories
● NRLs works closely with IRLs, monitor and
supervise the IRL staff in EQA, culture and
DST, LPA and CBNAAT activities.
● Three microbiologist
● four laboratory technicians
● The NRL microbiologist and laboratory
supervisor/ technician
● Quality improvement workshop

33. Immediate reference laboratory
● The functions of IRL are supervision and
monitoring of EQA activities, mycobacterial
culture and DST and also drug resistance
surveillance in selected states.
● Technical training to laboratory technicians
and senior TB laboratory supervisor.
● The ILR undertake on site evaluation (district
in the state)

34. Designated microscopy Centres (DMC):
● DMC which serves a population of around
100000
● The quality assurance activities include:
● - onsite evaluation
● -panel testing
● -Random blinded rechecking
● Culture and DST laboratory

35. ● In addition to IRLs,
● Microbiology department of medical colleges
● 64 C and DST laboratories
● Solid culture certifications: 45.
● Liquid culture certifications: 28 laboratories.

36. ● Line probe assay: Rapid diagnosis of MDR-
TB by LPA.
● Second line DST: 25 laboratory
● Expanding CBNAAT service: The time to
diagnosis of TB and drug resistant TB has
been significantly reduced with the availability
of CBNAAT, which is a rapid molecular assay
that detects M. Tuberculosis and Rifampicin
resistance. The test is fully automated and
provides results in two hours. Currently there
are 121 machines.

37. TB diagnostic
● Smear microscopy for acid fast bacilli.
● - sputum smear stained with ZN staining
● - Fluorescence stains and examined under
direct or indirect microscopy with or without
LED.
● 2. Culture
● - solid media
● -liquid media

38. ● 3. Rapid diagnostic molecular test.
● - Conventional PCR based line probe assay
for MTB complex
● -Real-time PCR based nucleic acid
amplification test NAAT for MTB complex.
● 4. Radiography
● 5. Tuberculin skin test

39. TB diagnostic algorithm
● Adult
● Paediatric

40. Standard Drug regimen
● New case
● Intensive phase
● 2 months of HRZE
● Continuation phase
● 4 months of HRE

41. Standard Drug regimen
● Previously treated
● Intensive phase
● 2 months of HRZES and 1 Month of HRZE
● Continuation phase
● 5 months of HRE

42. Paediatric dose

43. Dose
Drug Dose and range
(mg/kg body
weight)
Maximum(mg)
isoniazid 5(4–6) 300
rifampicin 10 (8–12) 600
pyrazinamide 25 (20–30)
ethambutol 15 (15–20)
Streptomycina 15 (12–18)

44. New initiatives

45. 1. Nikshay
● TB surveillance
using case based
web IT system.
● Central TB division in
collaboration with
National informatics
centre
● launched in May
2012

46. ● TB patient registration and details of
diagnosis, DOT provider, HIV status, follow
up, contact tracing, outcomes.
● Details of solid and liquid culture and DST,
LPA, CBNAAT details.
● DR-TB patient registration
● Referral and transfer of patients.
● Private health facility registration and TB
notification

47. ● Mobile application for TB notification
● SMS alert to patients on registration
● SMS alerts to Programme officers.
● Automated period report
● - case finding
● -sputum conservation
● -treatment outcome.

48. 2. TB notification
● According to the government of India
notification dated 7th May 2012, it is now
mandatory for all healthcare providers to
notify every TB cases to local authorities.
● 3. Ban on TB serology
● The serology tests are based on antibody
response, which is highly variable in TB and
may reflect remote infection rather than active
disease.

49. Newer initiatives
● 1. Daily regimen for pediatric TB
● 2. Daily regimen for all forms of TB in five
States.
● 3. Daily regimen for all TB/ HIV co-infected
patients across the country.
● 4. Pilots for universal access to TB cases.
● 5. Bedaquilline conditional access program.
● Drug resistance surveillance under RNTCP

50. TB-HIV coordination
● dedicated human resources, integration of
surveillance, joint monitoring and evaluation,
capacity building and operational research.
● Activities as follows
● Intensified TB case finding has been
extended to all ART centres.
● HIV testing of TB patients is now routine
through provider initiated testing and
counseling,

51. ● free HIV care at (ART) centre.
● Policy decisions has been taken by National
technical working group on TB/HIV
collaborative activities to expand coverage of
whole blood finger prick HIV screening test at
all DMC without a stand alone.
● Provider initiated HIV testing and counseling
among presumptive TB cases is now a policy

52. ● . Intensified case finding activities to be
specifically monitored among HIV infected
pregnant women and children living with
HIV infected pregnant women and children
with HIV.

53. ● 7. The national aids control programme and
RNTCP have taken the policy decision to
adopt isoniazid prophylaxis therapy as a
strategy for prevention of TB among
PLHIV. The implementation will be in a
phased manner.
●

54. ● ,8. The RNTCP has prioritized presumptive
TB cases among people living with HIV for
diagnosis of TB and Rifampicin resistance
with rapid diagnostic tools having high
sensitivity.

55. National strategic plan (2012-2017
● Target : universal access to TB care.
● Strategic vision to move towards universal access
● Vision: TB free India

56. Areas:
● Strengthening and improving the quality of
basic DOTS service.
● Further strengthen and align with health
system under NRHM
● Deploying improved rapid diagnosis at the
field level.
● Exapand efforts to engage all care
providers

57. ● Strengthen urban TB control
● Expand diagnosis and treatment of drug resistant TB
● Improve communication and outreach
● Promote research for development and implementation of improved tools and strategy.

58. Objective: are
● Early detection and treatment of at least 90
% estimated all type of TB cases in
community including drug resistant and HIV
associated TB.
● Successful treatment of at least 90% of new
TB patients, and at least 85% of previously-
treated TB patients.
● Reduction in default rate of new TB cases to
less than 5% and re-treatment TB cases to
less than 10%.

59. ● Initial screening of all re-treatment smear
positive till 2015, and all smear positive TB
patients by year 2017 for drug resistance
TB and provision of treatment services for
MDR-TB patients
● Offering counseling
● Expand RNTCP service to private sector.

60. Targets
● Detections and treatment if about 87 lakh TB
patients during 12th five year plan.
● Detections and treatment of at least 2 lakh
MDR-TB patients during the 12th five year plan.
● Reduction in delay in diagnosis and treatment
of all types of TB cases.
● Increase in access to service to marginalized
and hard to reach population, and high risk and
vulnerable groups.

61. Achievement
● The treatment success rate has more than treblrd from 25% in 1998 to 88% in 2015.
● Death rates reduced to 4% from 29%>
● 731 DTCs, 4888 TB units and 13886 DMC are functional in the country.

62. Financial resources
● - world bank and department for international development via WHO
● Global TB drug facility
● Global fund to fight AIDS, Tuberculosis and malaria, the United States agencies for
international development and DANIDA.
● Government of India provides 100% grant in aid to the implementing agencies. State/ UTs,
besides free drugs. The states are expected to use the existing infrastructure and also to
provide some manpower resources.

63. NTI
● The NTI had believed in assessment and
evaluation as an ongoing process. It
welcomed the idea of periodic assessment,
especially from experts, on scientific lines
as they are vital to the growth and
improvement in the programme.

64. Active case finding
● This is initiated to identify the TB cases in the community by conducting survey. Health care
professionals gathers the history, and assess for the signs and symptom of TB among the
general population.

65. Conclusion

66. REFERENCES
● Park, K. (2015). Park's textbook of preventive and social medicine (23rd ed.). Jabalpur: M/S Banarsidas
Bhanot.
● Lal, S., A., & P. (2014). Textbook of community medicine: preventive and social medicine (3rd ed.). New
Delhi: CBS & Distributors Pvt. Ltd.
● Ministry of Health & Family Welfare-Government of India. (n.d.). About us. Retrieved November 09, 2017,
from https://tbcindia.gov.in/index4.php?lang=1&level=0&linkid=399&lid=2768
● Soyam, V., & Boro, P. (2015). Newer initiatives in revised national tuberculosis control programme and its
current implementation status. Asian Journal of Medical Sciences, 6(5). doi:10.3126/ajms.v6i5.11945