The document summarizes India's Revised National Tuberculosis Control Programme (RNTCP). Some key points:
1) RNTCP was established in 1993 to address the failures of the previous National Tuberculosis Programme, such as low treatment completion rates. RNTCP's goals are to reduce TB mortality and interrupt transmission.
2) RNTCP follows the DOTS strategy - ensuring political commitment, quality diagnosis, quality drugs, direct observation of treatment, and systematic monitoring. It has treatment categories based on patient type with standardized regimens.
3) Major achievements include treating over 19 million patients since inception and achieving case detection and treatment success rates in line with global targets. However, challenges remain such as ineffective private
This ppt contains all the information about Revised NationalTuberculosis Control programme (RNTCP) It is useful for students of the medical field learning Preventive and social medicine, Swasthavritta (Ayurved) and everyone who is interested in in knowing about it.
This ppt contains all the information about Revised NationalTuberculosis Control programme (RNTCP) It is useful for students of the medical field learning Preventive and social medicine, Swasthavritta (Ayurved) and everyone who is interested in in knowing about it.
Acquired immunodeficiency syndrome (AIDS) is a chronic, potentially life-threatening condition caused by the human immunodeficiency virus (HIV). By damaging your immune system, HIV interferes with your body's ability to fight infection and disease.
The National AIDS Control Programme (NACP), launched in 1992, is being implemented as a comprehensive programme for prevention and control of HIV/AIDS in India. Over time, the focus has shifted from raising awareness to behavior change, from a national response to a more decentralized response and to increasing involvement of NGOs and networks of PLHIV.
National leprosy eradication program CHNNehaNupur8
Leprosy is a chronic infectious disease caused by ‘Mycobacterium Leprae’ an acid fast , rod shaped bacillus.
The disease mainly affects the skin , the peripheral nerves , mucosa of the upper respiratory tract and also eyes.
Cardinal Features:-
° Hypopigmented patch
° Loss of cutaneous sensation
° Thickened Nerve
° Acid fast bacilli
Leprosy has been regarded by tbe community as a contagious , mutilating and incurable disease.
Leprosy is curable and treatment provided in the early stages averts disability.
Multidrug Therapy (MDT) treatment has been made available by WHO free of charge to all patients worldwide since 1995, and provides a simple yet highly effective cure for all typesof leprosy.
After the successful NSP 2017-2025,Goi is lauching NSP 2017-2025 for elimination of TB on 24th march( World TB day ) 2017. Module is on MOHFW site but i have try to keep it brief,hope its ll be useful specially for academic and administrative purposes.
Acquired immunodeficiency syndrome (AIDS) is a chronic, potentially life-threatening condition caused by the human immunodeficiency virus (HIV). By damaging your immune system, HIV interferes with your body's ability to fight infection and disease.
The National AIDS Control Programme (NACP), launched in 1992, is being implemented as a comprehensive programme for prevention and control of HIV/AIDS in India. Over time, the focus has shifted from raising awareness to behavior change, from a national response to a more decentralized response and to increasing involvement of NGOs and networks of PLHIV.
National leprosy eradication program CHNNehaNupur8
Leprosy is a chronic infectious disease caused by ‘Mycobacterium Leprae’ an acid fast , rod shaped bacillus.
The disease mainly affects the skin , the peripheral nerves , mucosa of the upper respiratory tract and also eyes.
Cardinal Features:-
° Hypopigmented patch
° Loss of cutaneous sensation
° Thickened Nerve
° Acid fast bacilli
Leprosy has been regarded by tbe community as a contagious , mutilating and incurable disease.
Leprosy is curable and treatment provided in the early stages averts disability.
Multidrug Therapy (MDT) treatment has been made available by WHO free of charge to all patients worldwide since 1995, and provides a simple yet highly effective cure for all typesof leprosy.
After the successful NSP 2017-2025,Goi is lauching NSP 2017-2025 for elimination of TB on 24th march( World TB day ) 2017. Module is on MOHFW site but i have try to keep it brief,hope its ll be useful specially for academic and administrative purposes.
TB in the workplace and beyond - Contribution of Occupational Health Services...Jean Jacques Bernatas
The first part is a quick reminder of facts about TB that are necessary to go through part 2 and 3. Part 2 elaborate on how TB matters in OH, both as a hazardous place and as an opportunity to better screen, diagnose and treat workers. Win-win benefit for employers (TB has a huge cost for employers) and empoyees (to protect themselves, their families and communities). The conclusion will develop the concept of TB-proof workplace.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
2. • INTRODUCTION
• PROBLEM STATEMENT
• RNTCP : EVOLUTION, ORGANIZATION & COMPONENT
• TB-HIV COLLABORATION
• ACHIEVEMENTS:RNTCP
• MONITORING AND SUPERVISION
• NATIONAL STRATEGIC PLAN
• ROHTAK SCENARIO
• PGIMS SCENARIO
• FINANCING TB CONTROL 2015
• RESEARCH AND DEVELOPMENT
• END TB STRATEGY
CONTENTS
3. Introduction
Tuberculosis is one of the leading causes of mortality
in India- killing -2 persons every three minute, nearly
1,000 every day.
Tuberculosis (TB) is an infectious
disease caused by
Mycobacterium tuberculosis
If left untreated, a person with sputum positive TB
will infect an average of 10 to15 people in a year.
Multi Drug Resistance and co-infection with HIV has
weakened our battle against the disease.
4. Estimated incidence,
2014
Estimated number of
deaths, 2014
1.1 million*9.6 millionAll forms of TB
Multidrug-
resistant TB
HIV-associated TB
1.2 million 390,000
Source: WHO Global Tuberculosis Report 2015 * Excluding deaths attributed to HIV/TB
The global TB situation
300,000
6. Estimated incidence,
2014
Estimated number of
deaths, 2014
0.22 million*2.2 million
All forms of TB
Multidrug-
resistant TB
HIV-associated TB 0.11 million 31,000
Source: WHO Global Tuberculosis Report 2015 * Excluding deaths attributed to HIV/TB
India TB situation
71,000
8. Evolution of TB Control in India
2/7/2016 8
• 1950s-60s Important TB research at TRC and NTI
• 1962 National TB Programme (NTP)
1992 NTP Reviewed and concluded its failure
• 1993 RNTCP pilot began
• 1997-2006 RNTCP I
National Strategic Policy: 2012-17
• 2006 -2011 RNTCP II
9. RNTCP
Before the Revised National Tuberculosis Control
Program (RNTCP) came into force the existing
National Tuberculosis program (NTP) had the following
objectives:
• To identify and treat as large a number of TB
patients as possible so that infectious cases are
rendered non- infectious.
• To reduce the magnitude of TB problem in the
country to a level where it ceases to be a public
health problem.
10. FAILURE OF NTP
Results:
low rates of case detection and treatment completion (30%),
continuing high mortality (50 per 100,000)
high rates of default (40–60%),
REASONS:
More emphasis on detection rather than cure
Inadequate budget and insufficient managerial capacity
Shortage and interrupted supply of drugs
Emphasis on x-ray diagnosis resulting in inaccurate
diagnosis
Poor quality sputum microscopy
Multiplicity of treatment regimens.
11. Revised National Tuberculosis Control
Programme(1993)
Goals
- To reduce mortality and morbidity from tuberculosis
- To interrupt chain of transmission.
Objectives
- Achievement of at least 85% cure rate of infectious cases of
tuberculosis through DOTS involving peripheral health
functionaries.
- Augmentation of case finding activities through quality
sputum microscopy to detect at least 70% of estimated
cases.
12. DOTS:
DOTS is a systematic strategy which
emphasizes on:
Political and administrative commitment.
Good quality diagnosis.
Good quality microscopy is essential to identify the infectious patients
who need treatment the most.
Good quality drugs.
An uninterrupted supply of good quality anti-TB drugs must be available.
Directly observed treatment short-course chemotherapy
The DOTS strategy along with the other components of the Stop TB
strategy, implemented under the Revised National Tuberculosis Control
Programme (RNTCP) in India, is a comprehensive package for TB
control.
Systematic monitoring and accountability.
13. Central TB Division, DGHS,
MoH & FW
Deputy Director
General-TB
Chief Medical Officers
National institutes
(NTI, TRC, LRS, JALMA)
National Lab Committee
National TWC for TB + HIV,
National DOTS Plus committee
NTF for medical colleges,
National OR committee
Organizational structure of RNTCP
STATE TB CELL
CENTRE
14. Health Minister
Health Secretary
MD NHM Director Health
Services
Additional / Deputy / Joint
Director
(State TB Officer)
State TB Cell
Deputy STO, MO, Accountant,
IEC Officer, SA,
DEO, TB HIV Coordinator etc.,
State Training and Demonstration
Center (TB)
Director, IRL Microbiologist, MO,
Epidemiologist/statistician, IRL LTs etc.,
14
ORGANISATION STATE
15. One/ 100,000
(50,000 in hilly/ difficult/
tribal area)
One/ 500,000
(250,000 in hilly/
difficult/ tribal area)
TB Health Visitors (TBHV),
DOT Provider
(MPW, NGO, PP, ASHA,
Community Volunteers)
Medical Officer, paramedical staff
And Laboratory Technician (20-50%)
Medical officer-TB Control,
Senior Treatment supervisor(STS),
Senior TB Laboratory Supervisor(STLS)
District Health Services
District TB Centre
Tuberculosis Unit
Microscopy Centre
DOT Centre
Nodal point for TB
control
Chief Medical Officer and
other supporting staff
District Administration District Magistrate/
District Collector
DTO, MO-DTC , LT, DEO,
Driver, Urban TB Coordinators,
TBHVs, Communication Facilitators
ORGANISATION DISTRICT
16. -OSE(On site evaluation) by NRL team – at least once a year.
-Panel testing of microbiologist & LTs of IRL
NRL
LAB STRUCTURE FUNCTIONS OF EQA
TU
IRL
DTC
-OSE by IRL team – at least once a year.
-Panel testing of all STLS
-OSE by DTO – at least once in quarter
- OSE by IRL Team (sample of DMCs)during OSE of
DTC
-OSE by STLS at least once every month.
-Collection of RBRC of routine slides.
-Unblinded rechecking (5 +ves and 5 –ves)
DMC
-OSE by DTO team – at least once a month.
-OSE by IRL Team-During annual district visit.
-RBRC of routine slides
17. A&N Islands
Arunachal Pradesh
Chandigarh
D&N Haveli
Daman & Diu
Goa
Karnataka
Lakshadweep
Meghalaya
Mizoram
Nagaland
Pondicherry
Sikkim
Tripura
Haryana
Delhi
Gujarat
Andhra Pradesh
Assam
Manipur
Punjab
Kerala
West Bengal
Jammu & Kashmir
Himachal Pradesh
Rajasthan
Maharashtra
Tamil Nadu
Orissa
Madhya Pradesh
Chhatisgarh
Uttar Pradesh
Uttaranchal
Jharkhand
Bihar
TRC
RNTCP culture and DST labs
network (October-2015)
NTI
JALMA
Med Col / NGO / Private Labs (Certified)
IRL (Certified )
IRL (Under Process)
Med Col / NGO / Private Labs (Under Process)
National Reference Labs
Gurgaon
By technology
- Solid culture: 46
- LPA: 51
- Liquid culture: 28
- CB-NAAT: 121
C-DST labs: 64
SL-DST: 24
CB-NAAT Sites
18. STOP TB Strategy(2006)
■ In DOTS collaboration ,STOP TB strategy was started
with additional six components-
1. Pursue high-quality DOTS expansion and enhancement
2. Address TB/HIV, MDR-TB, and the needs of poor and
vulnerable populations
3. Contribute to health system strengthening based on
primary health care
4. Engage all care providers
5. Empower people with TB, and communities through
partnership
6. Enable and promote research
21. • Persistent Fever >2wk, without a known cause and/or
• Unremitting Cough for >2w and/or
• Wt loss of 5% in 3m or no wt gain in past 3 m
Sputum Smear (2 samples),
X-ray Chest (XRC), TST
Smear +ve
Bacteriological
confirmed TB Case
Smear –ve or
Sputum not available
XRC highly suggestive*
XRC NS shadows
TST -ve
XRC Normal
TST +ve
XRC Normal
TST -ve
Sputum/GA/IS for smear
and CB NAAT
+ve -ve
No other likely alternative diagnosis
Clinically Diagnosed TB case
Persistent shadow
and symptoms
Sputum/GA/IS for
smear and CB NAAT
+ve -ve
Refer to expert for
work up of persistent
pneumonia
Evaluate for EPTB
Refer to expert
Look for
alternate cause
Give course of
Antibiotics
Presumptive TB
21
PAEDIATRIC
T.B.
22. MDR-TB & XDR-TB
MDR-TB is defined as resistance to isoniazid and
rifampicin, with or without resistance to other anti-TB
drugs.
XDR-TB is defined as resistance to at least Isoniazid
and Rifampicin (i.e. MDR-TB) plus resistance to any
of the fluoro-quinolones and any one of the second
line injectable drugs (amikacin, kanamycin or
capreomycin).
24. Category Type of Patient Regimen Duration in
months
Category I
Color of box:
RED
New Sputum Positive Seriously
ill sputum negative, Seriously ill
extra pulmonary,
2 (HRZE)3,
4 (HR)3
6
Category II
Color of box:
BLUE
Sputum Positive relapse Sputum
Positive failure
Sputum Positive treatment after
default
2 (HRZES)3,
1 (HRZE)3
5 (HRE)3
8
TREATMENT REGIMEN
25. Interim guidance on using existing PWBs till
newer formulations available
Revised National TB Control Programme
26. TREATEMENT OF MDR T.B.
RNTCP Regimen for MDR TB: 6 (9) Km Lvx Eto Cs Z E / 18 Lvx Eto Cs E
[Reserve/Substitute drugs: PAS, Mfx, Cm]
TREATEMENT OF XDR T.B.
RNTCP Regimen for XDR TB: 6-12 Cm, PAS, Mfx, High dose-H, Cfz, Lzd, Amx/Clv
/ 18 PAS, Mfx, High dose-H, Cfz, Lzd, Amx/Clv [Reserve/Substitute drugs:
Clarithromycin, Thiacetazone]
27.
28.
29. TB HIV Collaboration
In 2007, the first National Framework for joint TB-HIV
collaborative activities was developed which endorsed a
differential strategy reflective of the heterogeneity of TB-
HIV epidemic.
Coordinated TB-HIV interventions were implemented
including establishment of a coordinating body at national
and state level, dedicated human resources, integration of
surveillance, joint monitoring and evaluation, capacity
building and operational research.
Interventions have focused on improving services for HIV-
infected patients, with intensified TB case finding at HIV
care settings and linking with TB treatment; and for TB
patients with provider initiated HIV testing and counseling,
provision of ART and decentralized CPT.
30. ESTIMATED HIV-POSTIVE INCIDENT TB CASES: 0.11 MILLION IN 2014
PERCENTAGE OF NOTIFIED TB PATIENTS WITH TESTING OF HIV : 72%
% OF TB PATIENTS WITH AN HIV TEST RESULT WHO WERE HIV-
POSITIVE: 4.3%
% OF NOTIFIED HIV-POSITIVE TB PATIENTS STARTED ON ART: 91%
TB HIV Collaboration…
94% HIV INFECTED TB PATIENTS WERE INITIATED ON CPT.
33. • Ineffective and delayed diagnosis of TB in both the private and public sector;
• Practitioners do not stick to standard RNTCP treatment protocol.
• Patients accessing private providers not linked or engaged with RNTCP;
• Large-scale expansion of patient notification from the private sector;
• Inadequate staffing at all levels, to be addressed through improved HRD, to
reduce reliance on a limited pool of TB-dedicated staff.
• Enforcement of regulations for prescribing and sale of anti-TB drugs; promoting
rational use of first- and second-line anti-TB drugs outside the programme to
prevent MDR and XDR TB;
• Developing and implementing airborne infection control measures in health
facilities.
• Major challenges : RNTCP
34.
35. Major Achievements:RNTCP
• Since its inception, the programme has initiated more than 19
million
patients on treatment, thus saving more than 3.1 million additional
lives
• Since 2007, RNTCP has also achieved the new smear-positive case-
detection rate of more than 70% in line with the global targets for TB
control while maintaining the treatment success rate of >85%.
• Treatment services were decentralized through a network of more than
640 000 DOT centres/providers using patient-wise boxes both for adults
and paediatric patients.
• Successful involvement of 330 medical colleges, 2569 NGOs, 13 150
private
practitioners and over 150 corporate sector health units was achieved
36. • By March 2013, all districts in the country were covered by PMDT services.
Major Achievements:RNTCP…
• In a workshop “TB-India Vision 2020”, RNTCP has developed strategies for
intensified TB control activities for achieving 2020 TB targets.
40. NIKSHAY
TB Patients Registered under RNTCP Till 18th March 2014 : 38,61,201
Peripheral Health Institutes (PHI) registered : 47,461
Patients notified : 20,8617
Culture & Drug Resistant Labs Patients registered : 1,20,717
Drug Resistant Tuberculosis Patients registered : 10,788
Till 18th March 2014
By end-2014, 82 309 private health facilities were registered for TB notification in
Nikshay and cumulatively 1 643 521 TB patients were notified from the private sector
through this tool.
41. IMA GFATM RNTCP
PROJECT
IMA RNTCP
GFATM PPM
Started in April 2008
Under the IMA GFATM RNTCP Project and IMA TB initiative IMA has been engaged in
the following activities:
1. Sensitization of doctors about Standards of TB care through State and District Level
Workshops
2. Need for notification - follow up and cure
3. Training of general practitioners in standards of TB care through District Level
Workshops
4. Establishment of Private Sector Peripheral Health Institution
5. IEC activities, e-IMA NEWS, IMA NEWS, JIMA, TB Newsletter
6. Media Advocacy
7. Celebrity endorsement
8. Medico-Legal Protection
9. Policy Making
10. IMA Slogan
42. • IMA in its 207th meeting of the Central Working
Committee held on 22nd April, 2012 in Mumbai resolved
as under
• “In conformity with the requirements of international standards for TB
care, IMA desires that Notifications of TB patients to the national
program be made mandatory. IMA also recommends to the General
Practitioners to follow the ISTC in diagnosis and management of TB
patients.” Subsequently, Govt. of India, MoHFW Letter No.Z-
28015/2/2012/TB dt. 7th May 2012 mandated Notification of TB Cases.
The Govt Order said “……therefore, the healthcare providers shall notify
every TB case to the local authorities……..”
” I have notified a TB patient today: have you. Do it today”
IMA RNTCP
GFATM PPM
TB: A NOTIFIABLE
DISEASE
43. ADVOCACY, COMMUNICATION AND
SOCIAL MOBILIZATION
Mobilizing political administrative commitment resulting in
availability of better resources for TB
Early case detection and early complete treatment
Combating stigma and discrimination
Generate awareness and demand in community through
well-informed and reasoned dialogue.
Reaching the unreached
46. Monitoring and supervision
• To review the performance of states and districts
regarding the implementation of ACSM, Nine
states and sixteen district were reviewed through
the structured mechanism of Central Internal
Evaluations (CIE) during the year 2014:
• RNTCP Central Internal Evaluation (CIE) of
Haryana was organized from 24th to 28th
November 2014; during the CIE, two districts
(Sonepat and Sirsa) were visited along with State
level RNTCP Institution.
47. National Strategic Plan (NSP)(2012-17)
RNTCP defined newer objectives of 'Universal Access to TB Care' for TB control in
India in 2010.
Vision
TB-free India
Goal
Decrease the morbidity and mortality by
early diagnosis and treatment to all TB
cases thereby cutting the chain of
transmission.
48. Objectives
Case detection
RNTCP Objective :
70% of estimated New Smear Positive TB cases
NSP objective:
To Achieve 90% Notification rate for all cases
Treatment
successRNTCP Objective:
85% of all New Smear positive TB cases
NSP Objective:
90% success rate amongst New & 85% amongst retreatment TB
cases registered under RNTCP
Drug resistant
TBNSP Objective:
Improve the successful outcome of treatment of MDR
cases
50. ROHTAK SCENARIO
2 FUNCTIONAL TU: MEHAM & ROHTAK
3 more TU are under process.
Total number of DMCs:12 excluding PGIMS ,Rohtak
Till now in 2015 ,33 patients are registered under
category IV treatment & one patient is on XDR
treatment.
DTO: Dr Indu
In 2014, 30 MDR patients were registered out of
them 3 died
51. PGIMS SCENARIO
DOTS CUM REFERRAL
CENTRE
Out of district :1379 cases were reported positive.
In 2015 up till 23th November 997 cases were reported
positive in Rohtak.Out of these 680 were referred to TU
Rohtak and 317 were referred to TU MEHAM
REFERRAL STAMP
52. PGIMS SCENARIO …..
FLUORESCENT MICROSCOPE is used for sputum smear examination since 2 years.
Auramine –O stain is used instead of ZN stain
2 lab technician's are there (1 from RNTCP,1 from PGI)
< 20 𝐴𝐹𝐵 𝑖𝑛 40 𝑓𝑖𝑒𝑙𝑑𝑠 𝑠𝑐𝑎𝑛𝑡𝑦
>20 AFB in 40 fields 1+
2-5 per field 2+
> 5 per field 3+
1 MOTC –CUM-MO-DRTB
54. PGIMS SCENARIO …..
Till now 517 MDR Cases & 30 XDR cases have been registered .
1 TDR case was found in 2013 but no follow up was done for that case.
5 Districts Rohtak, Jhajjar, Bhiwani, Jind, Narnaul are attached to PGI Rohtak
for CB-NAAT.
LPA is done at karnal for all Haryana except 5 Districts Ambala, Panchkula,
Yamunanagar, Kaithal, Kurukshetra which are linked to GMCH, Chd.
57. RESEARCH & DEVELOPMENT
A diagnostic platform called the GeneXpert Omni® is in development.
A next-generation cartridge called Xpert UltraR is also in development.
Eight new or repurposed anti-TB drugs are in advanced phases of clinical
development. An anti-TB drug candidate (TBA-354) is in Phase I.
testing.
Fifteen vaccine candidates are in clinical trials. Their emphasis has shifted from
children to adolescents and adults.
58.
59. TB India 2015 annual status report.
WHO Global Tuberculosis Report 2015.
Tuberculosis control in the South East Asia Region. Annual TB Report 2015.
Park’s Text Book of community medicine 23rd edition.
REFERENCES
Revised National TB Programme Training Course for program managers