The document summarizes a seminar presentation on India's Revised National TB Control Programme (RNTCP). It provides an introduction to tuberculosis, the burden of TB in India, and a brief history of TB control efforts. It then describes the key aspects of RNTCP Phase I and Phase II, including the DOTS strategy of ensuring quality microscopy, adequate drug supply, directly observed treatment, and accountability. Advanced diagnostic techniques introduced in RNTCP Phase II like GeneXpert were also mentioned. The document highlights India's strategy of passive case detection and the laboratory network established under RNTCP.

1. Seminar on
Revised National TB Control
Programme
Presented by:
Nisha Yadav
M.Sc. Nursing 2nd year
NINE, PGIMER
Presented To:
Mrs. Manjula Thakur
Tutor, NINE
PGIMER, Chandigarh

2. Learning Objectives
• Introduction to Tuberculosis
• Burden of Tuberculosis
• History of Tuberculosis
• National TB Control Programme
• RNTCP-I
• RNTCP-II
• National Strategic Plan for TB Control 2012-17
• New National Strategic Plan for TB Elimination
2017-25.

3. INTRODUCTION
• Tuberculosis (TB) is a communicable disease
• One of the top 10 causes of death worldwide
• Globally, there were 1.2 million (range, 1.1–1.3
million) TB deaths among HIV-negative people in
2018 (a 27% reduction from 1.7 million in 2000)
and an additional 251 000 deaths (range, 223 000–
281 000) among HIV-positive people (a 60%
reduction from 620 000 in 2000).

11. BURDEN
• In 2018, there were an estimated 10 (9.0—11.1) million
new (incident) TB cases worldwide, of which 5.7 million
were men, 3.2 million were women and 1.1 million
were children.
• Eight countries accounted for 66% of the new cases:
India, China, Indonesia, the Philippines, Pakistan,
Nigeria, Bangladesh, and South Africa.
• In 2018, 1.5 (1.4—1.6) million people died from TB,
including 251 000 (223 000—281 000) people with HIV.

12. INCIDENCE OF TB VARIES AMONG COUNTRIES…
Source: Global TB report, 2019

15. • In 1880s it was widely
believed that TB was an
inherited disease.
• Incidence and prevalence are
high
• Disease of social stigma and
leads to isolation.
• A curse on family.
History
of
Tuberculosis

16. Milestones…
• 1906- First open air TB sanatorium founded in India.
• 1939- TB association of India
• 1946- Bhore Committee recommended to the GOI, setting up
TB clinics in the districts and mobile TB clinics in rural areas.
• 1951- Mass BCG vaccination campaign covering 65 million
children in collaboration with IUAT • 165 million tuberculin
tests were administered to find the prevalence of TB in India
• 1955-58 - National Sample Survey conducted under ICMR to
find the magnitude of TB problem in India
• 1962- National TB Control Program(NTCP) started
• 1992- Programme Review showed - only 30% of patients
diagnosed and only 30% of them treated successfully
•

17. • 1993- WHO Declared TB as a global emergency, RNTCP
was initiated applying the principles of DOTS as a pilot
project
• 1997- RNTCP started as a national programme
• 1998- Massive RNTCP expansion began, RNTCP Ist phase
(1998-2005)
• Early 2000 - 135 million population covered; Monitoring
Mission conducted 
• Sept 2003 - 741 million population covered; Monitoring
Mission appreciates rapid expansion and overall quality
• End 2005- 97% population covered; next 5-year plan
approved with additional activities, such as DOTS- Plus 
• March 2006- The entire country covered by DOTS 
• Oct 2006 - RNTCP phase II started for 5 years ( to Sep’11)
• 2007 - New sputum + case detection was 70% and
• May 2012- Notification of TB is made mandatory by GOI

18. History
The evolution of the national programme against
tuberculosis is studied in 5 stages:
Stage Year Programme
I 1962- 92 National TB Programme
II 1993- 05 RNTCP- Phase 1
III 2005- 11 RNTCP- Phase 2
IV 2012- 17 National Strategic Plan for TN
Control
V 2017- 25 National Strategic Plan for TB
Elimination

19. National TB Programme
• Launched in 1962
• Short term objective: To detect maximum number
of TB Cases, giving them treatment and to
vaccinate all the newborns and infants with BCG
vaccine.
• Long term objective: To reduce the prevalence of
TB infection among children below 14 years of age,
to less than 1%, which was then about 30%.

20. DTC was identified as main structural
unit of NTP with following activities:
1. The TB cases were detected actively by the health
workers male, by taking single sputum smear
2. Registered sputum smear positive cases were
instructed to collect the drugs from MO of PHC,
for a month, on a Fixed day.
3. Systematic mass BCG vaccination
4. Weekly report to all the registered cases with
details of treatment was sent by MO to District
Hospital Officer.
5. Supervisory visit by District TB team periodically

21. • In 1972, Short Course Chemotherapy was
introduced. (Rifampicin and Pyrazinamide
included).
• In 1992, it was revealed that the magnitude of TB
problem in country had not improved but there
was increased incidence of Multi Drug Resistant TB
cases and emergence of HIV infection made
condition worse.

22. Reasons for failure
Low quality microscopy
Low case detection rate
Over reliance on clinical and radiological diagnosis of TB
More reliance on case detection rather than cure
Inadequate budget outlay
Shortage & irregular supply of drugs
Low treatment completion rate

23. Weakness
• 1992 Govt. of India, WHO
and SIDA reviewed TB
situation and concluded that
– NTP suffered managerial
weakness
– Inadequate funding.
– Over-reliance of X-ray for
diagnosis.
– Frequent interrupted
supplies of drugs.
– Low rate of treatment
completion.

24. Revised National TB Control
Programme Phase 1
• Therefore it was recommended that NTP must be
revised and revitalized with a new thrust to TB
control activities by overcoming all the lacunae.
• So, GoI in 1993 renamed NTP and launched the
programme as “Revised National TB Programme”.
• Started as a pilot project & expanded in 1997, in
phased manner, to cover the entire country by
2005.

25. • Vision- TB free India
• Aim- Universal Access for quality diagnosis and
treatment for all TB patients

26. Objectives
• To detect at least 70% of the estimated cases
• To achieve at least 85% cure rate among the newly
detected sputum smear positive cases, initiated on
treatment.
Directly Observed Treatment Short Course
Chemotherapy (DOTS) was identified as the
KEY strategy to achieve these twin
objectives

27. DOTS Strategy
Political
commitment
Quality
microscopy
Adequate supply
of drugs
Directly
Observed
Treatment (DOT)
Accountability

28. Political Commitment
• GoI borrowed a soft loan of US$ 142 million from
World Bank for the implementation of RNTCP
• Celebration of World Stop TB Day on 24th March
every year by conducting rally especially by TB
cured patients to create public awareness that TB
is a curable disease.

29. Quality Microscopy
• Case finding is “passive” by microscopic examination
of two sputa samples (spot & morning)
• Patients were categorized and treated accordingly
with intermittent regimen (thrice weekly).
Color of
box
Category Type of patient Intensive
phase
Continuation
phase
Red I New Sputum smear positive/
sputum smear negative
extrapulmonary
2 (HRZE)3 4(HR) 3
Blue II Previously
treated
Smear positive
• Relapse
• Failure
• Treatment after default
Others
2(HRZES) 3
1(HRZE) 3
5(HRE) 3

30. Case Definitions
• New patient: A patient who has never taken anti TB
treatment or has taken for less than 1 month
• Previously treated patients: A patient who has
taken anti TB drugs for a month or more in past,
further classified into-
• Relapse: A patient who has taken TB drugs &
declared cured by doctor and the sputum smear
has become positive. It may be true relapse or a
new episode of TB infection.

31. • Failure: A previously treated patient, whose
sputum has remained positive, even after
complete course of treatment.
• Treatment after default: A previously treated
patient, who is lost to follow up at the end of
treatment
• Others: These are pulmonary or extrapulmonary
patients, whose sputum smear is negative and have
relapse or failure.

32. Adequate supply of right drugs
• The entire course of drug supply is ensured free of
cost, before beginning the treatment, thus ensuring
regular supply without interruption.
• The drugs are supplied by patient-wise, colored
coded boxes, red and blue, containing full course of
treatment.
• Each box is ear marked for each registered patient.
• These patient-wise boxes helped to improve
patient care, adherence, drug supply and stock
management.
• Pediatric wise boxes were also available for
children.

33. Directly Observed Treatment
• It envisages the direct observation, watching and
supporting TB patients, swallowing every dose of anti
TB (ATD), all at a time preferable in empty stomach, in
the intensive phase and only first dose of the week
during continuation phase, by the treatment observer.
• They are paid an incentive of Rs. 250 per patient
completing the treatment.
• Thus DOTS is the strategy of RNTCP & DOT is the
component of DOTS. DOTS- PLUS is the strategy for
the diagnosis, management and treatment of MDR-TB
cases.

34. Accountability
• RNTCP ensures systematic monitoring supervision
and accountability at every level from national level
to individual patient level.
• For effective supervision and monitoring, a sub
district level “Tuberculosis Unit” has been created.

35. Tuberculosis Unit
• A TB unit is established at sub-district level.
• Each TB unit covers a population of about 5 lakhs.
• It is staffed by one Senior Treatment Supervisor
(STS) and one Senior TB Laboratory Supervisor
(STLS)
• The designated medical officer of PHC supervises
the work of the TB unit in addition to his/ her other
responsibilities.

36. Accountability at various levels
State
VIP
Health Worker (AWW)
STS & STLS
Medical Officer
District TB Officer
District
PHC
TB Unit
Grass Root
TB patient
State TB Officer
National Ministry of Health & Family Welfare

37. DOTS logo
• New logo of RNTCP has
been in use from World TB
Day 2011(24th March 2011).
• The visual icon of DOTS
represents this major
communication shifts.
• The visual icon, when
deciphered, presents a
graphic of human anatomy
divided in two parts – half
red and half orange.

38. Rationale for new Logo
• Building on Existing Foundation
• Change with Continuity
‘DOTS: Pura course, pakka ilaaj’

39. Comparison between NTCP & RNTCP
S.No. NTCP RNTCP- I
1 Launched in 1962 Launched in 1993 & expanded in 1997
2 Objective was case detection &
treatment
Objectives were two: 70% case detection
& 85% cure rate
3 Strategy: Case detective was
“Active” by health worker
District TB center was
functional unit
Strategy: DOTS and case detection is
Passive by quality microscopy.
TB unit is functional unit.
4 Patients were not categorized Patients were categorized into I & II.
5 Chemotherapy was not
supervised
Chemotherapy was supervised by DOTS
provider
6 Treatment regimens were
many & not standardized
Treatment regimens were standardized
7 Drug supply & follow up was
not regular.
Drug supply & follow up was regular.

40. RNTCP Phase 2 (2006-2011)
• RNTCP phase 1 lasted till September 2006
• The second phase of RNTCP commenced on 1st
October 2006 for a further period of 5 years
• Aim of RNTCP phase II is to consolidate the gains
achieved in Phase I (1993-05) and to further
improve the achievements.
• Phase II was designed to initiate the services to
address TB-HIV.
• It also included DOTS- Plus strategy for diagnosis,
treatment & management of MDR-TB and XDR-TB.

41. RNTCP Phase II emphasized on:
• To strengthen the quality of DOTS through quality
assurance protocol for sputum microscopy
• Decentralized accessible and patient friendly DOTS
services through intersectoral collaboration, e.g.,
Medical colleges, NGOs, etc.
• To provide services for marginalized groups such as
urban slum dwellers and tribals by strengthening IEC
activities
• Rational use of standardized first and second line anti-
TB drugs.
• Need based advocacy communication and social
mobilization to generate awareness and demand for
quality services.

42. Advanced techniques of
diagnostic tools
• Genotypic methods
• PCR
• TMA- NAA
• CBNAAT
• GeneXpert MTB/RIF

43. CONT…
• Polymerase Chain Reaction: With this the
sequence of DNA present in the mycobacterium
can be visualized and identified. It is rapid method
and the result is obtained within a day or two.
• Transcription and mediated amplification and
nucleic acid amplification (TMA & NAA): This test
helps to differentiate between tuberculous and non
tuberculous mycobacterium.

44. • Cartridge based nuclei acid amplification test
(CBNAAT): It is rapid molecular test helps not only
in rapid and accurate diagnosis of tuberculosis; but
also helps in finding out Rifampicin resistance
confessing mutations, in the sputum specimen as
well as specimen from extrapulmonary sites. This is
preferably helpful among children, people living
with HIV (PLHIV) and extrapulmonary TB.

45. • GeneXpert Test: This is a new rapid molecular test,
not only helps in making a diagnosis of TB by
detecting DNA, but also in testing for resistance to
Rifampicin.
• It gives result within two hours.
• WHO recommended that the test should be used
as a diagnostic test in individuals suspected of
having MDR- TB or HIV associated TB.

46. Laboratory Network in RNTCP
• The credibility, success and sustainability of the
programme depend upon the strength of the
laboratory network.
• Providing high quality smear microscopy services is
of the highest priority for RNTCP.
• Therefore, for effective quality assurance (QA)
system of RNTCP, sputum smear microscopy
network is crucial important.
• To optimize QA, decentralization of the supervision
and monitoring of the lab network is essential.

47. • Designated Microscopy Center (DMC) is the most
peripheral laboratory under RNTCP.
• Internal Quality Control: it is the process of
systematic monitoring and checking of the work in
microscopy center such as equipments
(microscope)
• External Quality Assessment: it is a process of
assessing the lab performance by evaluation of
entire process of microscopy such as unblinded
reading of smears.

48. Organization of Lab Network
1. National level
2. State level
3. TB unit level
At each level, EQA is carried out by three activities:
1. Onsite evaluation
2. Panel testing
3. Random blinded rechecking

50. Strategy of Case Detection under
RNTCP
New guidelines effective from April 2009:
• Every patient who has cough for 2 weeks or more with or
without other symptoms should have 2 sputum samples
examined(spot and early morning). Ideally all the 2
specimen should be collected within 2 days.
• Screening of all patients with TB risk factors, change of TB
suspect definition in high risk groups to cough of any
duration or fever with night sweats.
• The number of specimen required for diagnosis of smear
positive pulmonary TB is two, compared to three in the
previous guidelines, with one of the two, being a morning
sputum specimen.
• One specimen out of the two is enough to declare a
patient as smear positive TB as against two out of three
samples as per the previous guidelines.

51. Cont..
• Smear positive TB is further classified as a new or retreatment case
based on their previous treatment history and appropriate therapy is
prescribed.
• Patients in whom both specimen are smear negative should be
prescribed symptomatic treatment and broad spectrum antibiotics
for 10-14 days.
• In such cases, antibiotics such fluroquinolones (ciprofloxacin) which
are active against TB should not be used. If the symptoms persist
after a course of broad spectrum antibiotics, repeat sputum
examination (2 samples) must be done for such patients.
• Patients suspected of extrapulmonary TB, and patients who are
contacts of sputum smear positive patients, should have their
sputum examined for AFB if they have cough of any duration.
• Extrapulmonary TB cases will be diagnosed by the physicians and
referred to DTC chest clinic or MO TB control. Procedure undertaken
to arrive at the diagnosis must e mentioned on the treatment card.

52. Treatment Outcome and Type of
Patients
• Cured- Initially sputum smear positive patient who
have completed treatment and had negative sputum
smear on two, one of which was at completion of
treatment.
• New- a patient who has never had treatment for TB or
has anti TB drugs for less than one month.
• Relapse- A patient cured for TB by a physician or
completed treatment but who reports to the health
service and is found to be bacteriologically positive.
• Transfer Out- a patient who has been transferred to
another TB unit/ district and whose treatment outcome
is still not known.

53. Cont…
• Failure- a smear positive patient who remain smear
positive at 5 months or more after starting
treatment. Failure also includes a patient who was
initially smear negative but who becomes smear
positive during treatment.
• Treatment after default- a patient who received anti
TB treatment for one month or more from any source
and returns from treatment after having defaulted.
• Others- Patients who do not fit into above mentioned
type. Reasons for defining a patient a patient as “ other
must be specified”.

54. Cont…
• Defaulted- a patient after treatment initiation has
interrupted treatment consecutively for >2 months.
• Died- A patient who died during the course of
treatment.

55. First Line Drugs Class Side Effect
Isoniazid Antibiotic Increased levels of liver enzymes and Numbness
in the hands and feet,
Liver inflammation
Rifampicin Antibiotic Hepatitis
nausea, vomiting, Abdominal cramps, Diarrhea
Malaise and dysphoria
Redness and watering of eyes
Pyrizinamide Antibiotic nausea, loss of appetite, muscle pains, and rash
sensitivity to sunlight
gout, liver toxicity
Ethambutol Antibiotic Optic neuritis (hence contraindicated in children
below six years of age)
Red-green color blindness
Peripheral neuropathy
Arthralgia
Hyperuricaemia
Vertical nystagmus
Milk skin reaction
Inj. Streptomycin Antibiotic Ototoxic, Nephrotoxic
tinnitus, vertigo, ataxia

56. Second Line Drugs
• Aminoglycosides:
e.g., amikacin (AMK), kanamycin
(KM)
• Polypeptides
e.g., capreomycin, viomycin, envi
omycin
• Fluoroquinolones:
e.g., ciprofloxacin (CIP), levofloxa
cin, moxifloxacin(MXF)
• Thioamides:
e.g. Ethionamide, Prothionamide
• Cycloserine
• Terizidone
Third line Drugs
• Rifabutin
• macrolides:
e.g., clarithromycin (CLR)
• Linezolid(LZD)
• Thioacetazone(T)
• thioridazine
• arginine
• vitamin D
• bedaquiline

57. Category of Treatment
Treatment Groups Type of Patients Regimen
Intensive
Phase
Continuation
Phase
New (Category 1) New sputum smear positive
New sputum smear negative
New extrapulmonary
New others
2(HRZE)3 4(HR)3
Previously Treated (Category
2)
Smear positive relapse
Smear positive failure
Smear positive treatment after
default and others
2(HRZES)3
1(HRZE)3
5(HRE)3

58. Patient wise box
• Drugs are supplied in patient wise boxes container
• Intensive Phase= blister pack = One day medication
• Continuation Phase= blister pack = One week
medication

60. TB/HIV Collaboration
• The joint HIV/TB activities in India started in 2001
with 6 states
• The first national policy framework was developed
based on experience gained during programme
implementation in initial years
• Overall purpose is to articulate the national policy
for TB/HIV Collaborative Activities between RNTCP
and NACP so as to ensure reduction of TB and HIV
burden in India.

62. Objectives:
1. To maintain close coordination between RNTCP and NACP
at National, State and District levels.
2. To decrease morbidity and mortality due to TB among
persons living with HIV/AIDS.
3. To decrease impact of HIV in TB patients and provide
access to HIV related care and support to HIV-infected TB
patients.
4. To significantly reduce morbidity and mortality due to
HIV/TB through prevention, early detection and prompt
management of HIV and TB together.

64. Strategies
Existing HIV/TB Collaborative Activities
a. Strong NACP-RNTCP coordination mechanisms at
national, state and district level
b. Joint monitoring and evaluation with standardized
reporting shared between NACP and RNTCP
c. Joint training of key programme and field staff in
HIV/TB activities
d. Operational research to strengthen
implementation of HIV/TB Collaborative Activities
e. Implementation of basic infection control
measures at ART centres e.g. fast tracking

65. Cont…
Activities to reduce burden of HIV among TB
patients:
a. Provider initiated HIV testing and counselling
(PITC) among TB patients
b. Provision of co-trimoxazole preventive therapy
(CPT) for HIV infected TB patients
c. Provision of Anti-Retroviral Therapy (ART) for HIV
infected TB patients
d. Provision of HIV prevention education for
patients with presumptive or diagnosed TB cases

66. Cont…
Activities to reduce burden of TB among HIV
infected individuals:
a. Intensified (TB) case finding (ICF) at ICTC
b. Intensified (TB) case finding (ICF) at ART centres
and Link ART centres
c. Air borne infection control measures for
prevention of TB transmission at HIV care settings
d. Implementation of Isoniazid preventive
treatment (IPT) for all PLHIV (On ART + Pre-ART)

67. What is new in National Framework 2013?
1. Emphasis on Integrated TB and HIV
services e.g. HIV screening at RNTCP
DMC
2. Focus on early detection and early care:
a. Early detection of TB in PLHIV:
i. Early suspicion of TB–symptoms of any
duration among PLHIV
ii. Use of an expanded clinical algorithm for
TB screening that relies on presence of
four clinical symptoms (current cough,
weight loss, fever or night sweats) instead
of only cough, to identify patients with
presumptive TB
iii. Strengthen ICF at ART, Link ART centre
(LAC) and Targeted intervention projects
(TI) for High Risk Group (HRG) specially
Injection Drug Users (IDU)

68. b. Early detection HIV/TB:
i. Enhance HIV testing facilities in settings with lack of co-located
HIV and TB testing facilities, by establishing HIV screening
services using whole blood finger prick test (WBT)
ii. Strengthen HIV testing of TB patients in high HIV prevalent
settings by promoting establishment of Facility Integrated
Counselling and Testing Centre(F-ICTC) where DMC exists
iii. PITC among patients being evaluated by diagnostic smear
microscopy presumptive TB cases in high HIV prevalent settings.
3. Early detection and care of HIV infected Drug Resistant TB
patients (DR-TB/HIV):
i. Strengthen HIV testing in presumptive DR-TB cases (Criteria C)
ii. Ensure access to culture and drug susceptibility testing for HIV
infected TB patients
iii. Prompt linkage of HIV infected DR-TB cases to ART centres
iv. Prompt initiation of ART in HIV infected DR-TB cases

69. 4. Prevention of TB among HIV infected adults and
children:
i. Implementation of IPT for all PLHIV (On ART + Pre-
ART)
ii. Strengthen implementation of air borne infection
control strategies.
5. Strengthen HIV/TB activities among children and
pregnant women
6. Promotion of participation of private, NGO, CBO
health facilities and affected communities working
with NACP and RNTCP to strengthen HIV/TB
Collaborative Activities.

70. TB Notification
• Since 2012, TB is a notifiable disease in India
• As to estimate the number of TB cases in the
community more correctly
• Help policy makers to make rational and evidence-
based planning with regard to strengthening of the
existing infrastructure

71. Nikshay
• Web-based, care-based, software application/ solution
developed by National Informatics Center, in 2012, to
effectively monitor the TB patients under RNTCP.
• Used by health functionaries at various levels across the
country in association with Central TB division, Ministry
of Family & Welfare, GoI.
• Nikshay involves better surveillance and tracking of all
TB patients, including those in private sector.
• It enables proper care, management, treatment
adherence, HIV status, drug resistance, culture report,
different outcomes, thus various aspects of controlling
TB using technological innovations.

72. Cont…
• Apart from web-based technology, SMS services
(mobile applications) have been used effectively for
communication with patients and monitoring the
programme on day to day basis thereby Nikshay
enables better surveillance and treatment of TB cases.
• Thus, Nikshay provides a platform to support
notification of every TB case diagnosed and treated by
public and private sector and thus strengthen TB
surveillance, decreases lead time of data transmission
and increases the use of information for betterment of
care delivery services.

73. • New strategies

74. Changes in definitions
As per the previous guidelines, a
pulmonary TB suspect was
defined as:
• An individual having cough
for 2 weeks or more
• Contacts of smear-positive
TB patients having cough
for any duration
• Suspected/confirmed
extra-pulmonary TB having
cough for any duration
• HIV-positive patient
having cough for any
duration.
But according to the new
guidelines
Presumptive pulmonary
TB refers to a person with
any of the symptoms or
signs suggestive of TB:
• cough >2 weeks,
• fever >2 weeks,
• significant weight loss,
• haemoptysis,
• any abnormalities in chest
radiography
In addition, contact of microbiologically confirmed TB
patients, PL HIV, diabetics, malnourished, cancer patients,
patients on immunosuppressive therapy or steroid should
be regularly screened for signs and symptoms of TB.

75. Previously treated patients have received one month or more ATD
in the past. This may be:
• Recurrent TB case – A TB patient previously declared as successfully treated
(cured/treatment completed) and who is subsequently found to be
microbiologically confirmed TB case is a recurrent TB case. (Previously called
relapse.)
• Treatment after failure – Patients are those who have previously been treated
for TB and whose treatment failed at the end of their most recent course of
treatment.
Previously, it was called failure where a TB patient is sputum-positive at 5
months or more after initiation of treatment.
• Treatment after loss to follow-up – A TB patient previously treated for TB for
one month or more and who was declared lost to follow-up in their most recent
course of treatment and subsequently found microbiologically confirmed TB
cases.
Previously called treatment after default – a patient who has received
treatment for TB for a month or more from any source and return for
treatment after having defaulted, that is, not taking ATD consecutively for 2
months or more and found to have smear-positive.

76. Diagnostic Algorithm For Pulmonary TB For Adults (Previous Guidelines)

77. Diagnostic Algorithm For Pediatric TB(Previous
Guidelines)

81. Drug Regimen
According to the previous
guidelines
• Standard intermittent regimen
with 2 categories of treatment
• Treatment under direct
observation of DP
• Category decided by MO
(category I/II)
• Drugs to be taken three times a
week under direct observation of
the DP
• Intensive phase (IP) for 2–3
months – all doses given under
supervision
• Continuation phase (CP) for 4–5
months – first dose of the week
given under supervision.
According to the new
guidelines
• Principle of treatment of TB
has been shifted towards daily
regimen with administration
of daily fixed dose
combination of first-line ATD

82. Treatment Regimen

83. Drug Dosage for Adult TB(New Guidelines)

85. Difference of RNTCP regimen between
new and previous guidelines

86. • Bedaquiline: A new drug approved for treatment of
multidrug-resistant tuberculosis

87. • The Food and Drug Administration (FDA), on 28 December 2012, granted
accelerated approval to SIRTURO™ (bedaquiline) Tablets as a part of combination
therapy in adults with multi-drug-resistant TB (MDR-TB).
• Bedaquiline is available as 100 mg tablet for oral administration. Bedaquiline should
be administered as directly observed therapy (DOT) along with standard MDR-TB
regimen.
• The most common side-effects reported with bedaquiline therapy are nausea (30%),
arthralgia (26%), headache (22%), hemoptysis (14%), chest pain (9%), anorexia (7%),
and rash (6%). Important cardiovascular adverse effect is QT prolongation. Other
important adverse effect is elevation of hepatic transaminases, which is moderate
and reversible on discontinuation of therapy.
• There are no clinical data in pediatric patients, adolescents (<18 yrs), and pregnant
and lactating women. The safety and efficacy of bedaquiline for treatment of drug-
sensitive TB, extra-pulmonary TB, and HIV-infected patients is not established.
Therefore, use of bedaquiline is not recommended in these settings.
Criteria- Adult Age > 18 years having
Pulmonary MDR TB. Female should not be
pregnant.

89. Introduction
• India’s ambitious National Strategic Plan (NSP) to
achieve Universal Access to quality TB diagnosis
and treatment has guided activities and created
accountability against results.
• India achieved complete geographical coverage for
diagnostic and treatment services for multi-drug
resistant TB (MDR-TB) in 2013
• 93,000 persons with MDR-TB diagnosed and put
on treatment till 2015

90. OBJECTIVES
• 1. To ensure early and improved diagnosis of all TB
patients including drug and HIV-associated TB
• 2. To provide access to high-quality treatment for
all diagnosed cases of TB
• 3. To scale-up access to effective treatment for
drug-resistant TB
• 4. To decrease the morbidity and mortality of HIV-
associated TB
• 5. To extend RNTCP services to patients diagnosed
and treated in the private sector.

91. Strategies
• Import of sero- diagnostic test kits for tuberculosis
• an innovative and visionary electronic recording and
reporting system (Nikshay) across the country in 2012,
• Modern media are being creatively used for TB control with
India’s leading actor, Amitabh Bachchan’s campaign, “TB
Harega, Desh Jeetega”,
• Case Finding and Diagnostics
• Patient Friendly Treatment Services
• Scale-up of Programmatic Management of Drug Resistant
TB
• Scale –up of Joint TB-HIV Collaborative Activities
• Integration with Health Systems

93. Case Finding and Diagnostics

95. Introduction
• Focus on to eliminate TB in India
• describes the activities and interventions bring
about significant change in the incidence,
prevalence and mortality from TB.
• The Vision is of a TB free India with zero deaths,
disease and poverty due to tuberculosis
• The Goal is to achieve a rapid decline in the burden
of TB, mortality and morbidity, while working
towards the elimination of TB in India by 2025

96. Targets
• Private sector engagement;
• Plugging the “leak” from the TB care cascade (i.e.
people with TB going missing from care);
• Active case finding among key populations;
• and for people in “high risk” groups, preventing the
development of active TB in people with latent TB

98. Strategies

101. CHALLENGES
• Collection of appropriate specimens from children
and EPTB. The capacity for specimen collection
(children and EPTB) at district level is also deficient.
Transportation of specimens from hard to reach
areas (hilly, tribal, deserts, etc.) continues to be
challenging despite local efforts to improve the
sputum collection and transport system.
• Establishment of TB containment labs at state level.

102. • Retention of trained staff and compensation
Procurement of equipments with original
manufacturers from outside the country having no or
restricted post sales services in the country threatens
unhindered lab operations. With only a limited
number of firms in country with capacity to provide
AMC services in select locations, the cost of AMC is
high. AMC for equipments is an issue due to limited
technical knowledge and availability of funds
• Packages is a barrier for sustainability for ensuring
consistent performance.

103. • RNTCP IN
CHANDIGARH

104. • In Chandigarh, RNTCP was launched on 25th
January 2002.
• Chandigarh has been ranking among the top
performing states
• Case detection rate of more than 90% and among
those, the cure rate being more than 85% each
year.

105. Infrastructure:
• RNTCP in Chandigarh covers the whole UT including
the Urban, Rural and Slum population falling under
the map
• -3 Tuberculosis Units (TU)
-17 Designated Microscopy Centres (DMC) + 1 DMC in
private sector under Public Private Mix.
- More than 171 DOTS centers including Government as well
as Private DOTS Centres.

106. 1. Programmatic management of Drug
Resistant Tuberculosis (PMDT)
• DOTS- Plus program has been launched in Chandigarh in
October 2010 to address the emerging issue of Drug
Resistant Tuberculosis (DRTB).
• The diagnostic services were launched in Oct 2010
• The treatment services were initiated from Jan 2011.
• DOTS plus site has been created at GMCH-32
• For the diagnosis of DR-TB, RNTCP lab at the Microbiology
Department of PGIMER- Chd has been accredited for Line
Probe Assay (LPA) testing.

107. TB/HIV Co-infection:
• In Chandigarh, this TB/HIV Intensified Package of
services was launched in April 2010. Since then,
RNTCP and NACP are working hand in hand by
means of:
• Referral of all TB patients to nearest ICTC for HIV
counselling and testing.
• Linking all the Co-infected patients to ART centre at
PGIMER.

109. • TB- A Notifiable Disease
From 7th May 2012, TB has been declared as a notifiable disease.
• NIKSHAY

110. NGOs Area Of Work Schemes
• YUVSATTA Colony No.4 Slum Scheme & Adherence
Scheme
• Mother Teresa Home Sector-23 Adherence Scheme
• Pingalwara Charitable Society Palsora Adherence
Scheme
• Surya Foundation Vikas Nagar, Maulijagran Adherence
Scheme
• Godwine Education Society Hallo Majra Slum Scheme
• Bharat Vikas Parishad (Mani Majra) Indira Colony, Mani
Majra Transport Scheme

111. Innovations
• Self addressed post cards are given to each patient
who is being referred out of Chandigarh for
intimation regarding the start of treatment.
• Self inking stamps for the OPD cards with message
of TB has been circulated among the dispensaries.
• Pamphlets in Hindi, Punjabi and Urdu are being
circulated.
• Wall paintings in Urdu on the message on
Tuberculosis have been developed at Mosque in
Mani Majra and Bapu Dham colony for the Urdu
speaking population.

112. Role of Nurse in RNTCP

113. Care Provider
• Nurse providing Care to TB patients in physical,
Mental and social aspect.
 Nurses provides DOTS Treatment to patients.
 Identify Side effects of treatment quickly.
 Make home visits.
 Prevent Infections.
 Provide Counselling and explore feelings.
 Socialize the patient.

115. • Nurse provide education to students on
 RNTCP and its functions
 Diagnosis and Treatment of TB patients
 Care of TB patients in hospital as well as
community setting
 Health education to patients

117. Advocate
• Nurses can advocate rights of patients regarding their
incentives through Nikshay scheme and free
treatment from private practioners and various
arising through social stigma related to disease.

118. Take home
message

120. REFERENCES
1. Shanthosh Priyan. RNTCP [Internet]. Healthcare presented at;
07:04:15 UTC [cited 2019 Dec 1]. Available from:
https://www.slideshare.net/shanthoshpriyan/rntcp-57543326
2. WHO | Global tuberculosis report 2019 [Internet]. WHO. [cited
2019 Dec 1]. Available from:
http://www.who.int/tb/publications/global_report/en/
3. 9789241565714-eng.pdf [Internet]. [cited 2019 Dec 1].
Available from:
https://apps.who.int/iris/bitstream/handle/10665/329368/978
9241565714-eng.pdf?ua=1
4. Rntcp and national strategic plan(nsp) for tb [Internet]. [cited
2019 Dec 1]. Available from:
https://www.slideshare.net/eternal05/rntcp-and-national-
strategic-plannsp-for-tb
5. NSP Draft 20.02.2017 1.pdf [Internet]. [cited 2019 Dec 1].
Available from:
https://tbcindia.gov.in/WriteReadData/NSP20Draft2020.02.201
7201.pdf