The document summarizes India's Revised National Tuberculosis Control Programme (RNTCP). Some key points: - TB poses a major public health burden in India, with over 2 million estimated cases annually. - RNTCP was launched in 1997 based on the DOTS strategy to decrease TB mortality and morbidity. Its objectives are to achieve 85% cure rates for new sputum-positive cases and detect 70% of estimated cases. - RNTCP implements standardized treatment regimens, with drugs administered under direct observation at least during the intensive phase. This along with other measures like improved diagnostics and supervision have helped reduce TB prevalence. - The program has expanded nationwide in phases since 1997 to achieve universal

1. REVISED NATIONAL
TUBERCULOSIS CONTROL
PROGRAMME.

2. REVISED NATIONAL TB CONTROL
PROGRAMME:
 India has the highest tuberculosis Barden country in the
world. Accounting nearly one-fifth of the global incidence.
In 2009 out of the estimated annual global incidence of 9.4
millionTB cases; 2million was estimated to have in India.
Tuberculosis is continues to be one of the most common
infectious causes of morbidity; which despite being a
curable and preventable disease. Continuous to impose
and enormous health and an economic burden on India.
The RNTCP is based on internationally DOTS strategy
was launched in India 1997 and expended entire the
country in a phased manner. Full nationwide coverage is
achieved in March 2006

3.  The goal ofTB control program is to decrease
mortality and morbidity due toTB and cut
transmission ofTB until ceases to be major public
health problem of India.The twin objective of
program were to achieved and maintain accuracy
at least 85% among new sputum positive (NSP)
patients and to achieve and maintain case
detection of the at least 70%of the estimated
NSP cases in the country.

4. Magnitude of the problem
 Global burden of tuberculosis
 Tuberculosis is the one of the leading cause of death due
to infectious disease in the world. Almost 2 billion people
are infected with mycobacterium tuberculosis each year
about 2 million people are developingTB disease.About
2 million people die ofTB.
 On the national scale the high burden of TB in Is
illustrated by the estimated that TB accounts for 17.6% of
deaths from communicable disease and for 3.5% of all of
mortality (WHO 2004). than 89% of the burden of tb due
to premature death as measured in terms of disability-
adjusted life years lost.

5.  WHO estimated TB mortality in India as
276,000(24/10000 population) in 2008. With RNTCP
Implementation. There is 43% decline in death due to
TB in India by 2008 is compared to 1990. It was
estimated that the TB mortality was over 500000
annually at the beginning of RNTCP Data from specific
surveys, however, suggest the case fatality rate prior to
RNTCP were generally greater than 25% in RNTCP era
case fatality was remained less than 5% for new case
registered under the program

6. The beginning: National
tuberculosis programme
 Before the RNTCP come into force, the existing TB
program had started upon diagnosing the cases through
direct smear microscopy and self administered
domiciliary treatment on monthly basis with the
following objectives:
 To identify and treat as a large 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
level where it ceases to be public health problem.

7. Organization and implementation of
tuberculosis program
 Organization and administration of TB program also
expanded in the three level at central level, beside the
tuberculosis division in the directorate general health
service, national tuberculosis institute, Bangalore.
 Tuberculosis research centre Chennai at district level, a
district constitutes a functional unit of the NTCP and is
called district tuberculosis control program. The
peripheral level comprises of chest clinics and PHC who
is providing treatment for TB. the program activities very
generally comprises of case detection, case treatment,
health education, BCG vaccine despite a nationwide
network of facilities NTCP Failed to yield satisfactory
result.

8.  The situation does not change much the case finding
efficiency was only 30 of the expected level,
Although the mortality rate decreased to 53/100000
Population.The Government of India launched
RNTCP in 1997 encouraged by the result of pilot
studies were tested in 1993-1994.

9. Evolution of the TB control in
India
 1950-60: ImportantTB research atTRC and NTI.
 1962: NationalTB program.
 1992: Review of nationalTB program and the result is
only 30% of patients diagnosed and among of these
diagnosed the patients, only 30% treated
successfully.
 1993: RNTCP pilot begun.
 1998: RNTCP scale- up.
 2001: 450 million populations covered
 2004: >80% of country covered.
 2006: Entire country covered by RNTCP.

10. Objectives of RNTCP
 To achieve and maintain a cure rate of at least 85%
among newly detected infectious (New sputum
smear positive cases)
 To achieve and maintained detection of at least 70%
of such case in the population.

11. Strategy
 Augmentation of organizational support at the central
and state level for meaningful coordination
 Increase in budgetary outlay
 Use of sputum microscopy as a primary method of
diagnosis among self reporting patient.
 Standardized treatment regimens
 augmentation of the peripheral level supervision through
the creation of a sub districts supervisory unit
 Ensuring the regular uninterrupted supply of drugs up to
the most peripheral level
 Emphasis on training, IEC, operational research and NGO
involvement in the program

12.  Case finding: In the rural area the existing
laboratories at the PHC/ CHC level up to a maximum of
one per lakh population will be strengthened to
function as microscopic center.
 Treatment and case holding: drugs for a three
days a week will be given throughout the intensive
phase. Facility of treatment will be made available at
sub centers/ Treatment centers close to patient’s
residence village to enhance patient compliance.

13. TB SUSPECT(COUGH>2WEEK)
DIAGNOSIS
CATEGORIZATION
START OFTREATMENT
REGISTRATION
FOLLOW UP AND OUTCOME REPORTING

14.  Patient wise drug boxes: A unique feature of RNT
CP are the patient wise drug boxes (for adult and
pediatric cases) which improve patient care, adherence
and drug supply and drug stock management. all
patient receive free drugs under direct observation by a
dot provider accessible and acceptable to the patient
and accountable to the health system.

15. DIRECTLY OBSERVED TREATMENT
 It is necessary to prevent patient from interrupting
treatment throughout the duration of treatment
 It ensures that patient receive
• The right drug
• In the right dose
• For the right duration of treatment

16. Mechanism of dot
 Dot provider can be anybody who is accessible and
acceptable to the patient and accountable to the health
system and who is not a family member.
 Can be health care worker, Asha worker, anganwadi
worker, ngo workers, private Practitioner, community
volunteer, shopkeepers, cured patients, etc.
 During intensive phase first 2-3 months all those are
given to the patient under the direct observation of the
dot provider.
 During continuation phase remaining part of treatment
the first dose of the week is given to the patients under
direct observation of the dot provider

17.  Information education and communication: It is
a great importance to enhance the knowledge and
awareness of providers, users and community at large
about different aspect of tuberculosis and its control
measures through IEC.
 Training of staff: The training of staff at central, state
and district level will be appropriately strengthening in
terms of staff, equipment, vehicles and civil worker. it is
proposed to train the kid trainers at central and state
level and this in turn will train district trainers who will be
responsible for giving training to all categories of staff
within the district
 Management information system: It is required
to have MIS to show main indicators of program
effectiveness

18.  Program surveillance, supervision and
monitoring strategy: Need for continuous
supervision and monitoring in order to identify
problems and implement corrective action in the
program.
 Involvement of medical colleges: Under the
RNTCP, initiative to increase the involvement of
medical colleges is gaining momentum. Presently, two
third of medical colleges in RNTCP implementing areas
are participating in the program. RNTCP nodal Centers
for medical colleges are proposed to be established in
all zones of India.

19.  Collaboration with naco : The RNTCP and national
aids control organization are collaborating to
implement HIV/TB action plan. It is envisaged To
provide services for HIV infected TB patient under the
same roof by establishing critical linkage centers and
RNTCP microscopy centers, By involving common
NGOs and through combined IEC activities and
infection control measures.
 multi drug resistant : To improve tuberculosis
control, it is essential to improve treatment of patients
so that drug resistant tuberculosis is not created.
Among the few patients who are not cured, The
overwhelming response is failure to ensure that the
drugs are taken as prescribed, rather than failure Of the
drugs to work properly.

22. Phases of RNTCP:
 Tuberculosis control activities are implemented in the
country for more then 50 years, NTP launched by the
GOVT. of India in 1962 in the form of district.
 PHASE: 1
 In 1978 BCG vaccination was shifted under the
expanded program on immunization. a joint review of
NTP was done by Government of India. WHO and the
Swedish International Development agency in 1992 and
some short comings Where founded in the programs
such as a managerial weakness, inadequate funding,
over reliance on X ray, non standard treatment regimen,
low rate of treatment completion and lack of systematic
information on treatment outcomes.

23.  Around the same time in 1993, the WHO declared TB is
a global emergency, devised the directly observed
treatment short course and recommended to follow it
by all countries. The Government of India revitalized
NTP as the revised national TB control program. in the
same year dots was officially launched as the RNTCP
strategy in 1997 and by the end of 2005 the entire
country was covered under the program.
 Phase:2
 Anticipate improved the quality and reach of services
and worked to reach global case detection and cure
targets these targets were achieved by 2007-2008.

24.  despite this achievement undiagnosed and mistreated
cases continued to drive the TB epidemic TB was the
leading cause of illness and death among persons living
with HIV/aids and large number of multidrug resistance
tb (mdr-tb) case were reported every year.
 Phase:3
 During this period the achievement of the long term
vision of a “TB free India” national strategic plan for
tuberculosis control 2012-2017 was documented with
the goal of universal access to quality TB diagnosis and
treatment for all TB patients in the community.
Significant interventions and initiatives where taken
during NSP 2012-2017 in terms of mandatory
notification of all TB cases integration of the program
with the general health services,expansion of diagnostic
services,

25.  programmatic management of drug resistantTB
service expansion single windows service forTB HIV
cases national drug resistance surveillance and revision
of partnership guidelines.
 Component of dots
 Political and administrative commitment
 Good quality diagnosis
 Good quality drugs
 The right treatment given in the right way
 Systematic monitoring and accountability

26. Nikshay poshan yojana
 Nutritional support toTB patient
 BENEFITS:-
 Financial incentive of ₹500 per month 4 notifiedTV
patient
 Incentive for the complete duration of entity be
treatment to the patient
 The incentive is given where direct benefit transfer

37. Role of community health nurse in
RNTCP
 Immunize with BCG at birth
 Under RNTCP active case-finding is not pursued.
However, people found to be with symptoms of
tuberculosis in the clinic and during the home visits can
be encouraged for further investigations
 Convey the message that tuberculosis is curable and
freeTreatment facilities available
 Help to remove fears and taboos about the disease
 Advising on balanced diet to protect from infections
 Motivating the people with symptoms to clinic

38.  Collecting thorough history
 Show high-level of interest in contact screening
 Teaching on how to take out sputum by coughing when
test for AFB suggested
 Administer tuberculin test, if ordered
 Stress on importance of continuation of regular
treatment as prescribed. Stress on the point “not
default” which is bad for his family as well to
community
 Teach good practices like closing the mouth and
speaking, maintaining considerable physical distance to
avoid sprinkling of saliva on others
 Teach how to dispose sputum safely
 Close follow-up on treatment compliance.