revised national tuberculosis program

1. SUPRIYA

2.  Tuberculosis (TB) is one of the top 10 causes of
death worldwide.
 In 2016, 10.4 million people fell ill with TB, and
1.7 million died from the disease (including 0.4
million among people with HIV). Over 95% of TB
deaths occur in low- and middle-income
countries.
 Seven countries account for 64% of the total,
with India leading the count, followed by
Indonesia, China, Philippines, Pakistan, Nigeria,
and South Africa.

3.  In 2016, an estimated 1 million children
became ill with TB and 250 000 children died
of TB (including children with HIV associated
TB).
 TB is a leading killer of HIV-positive people:
in 2016, 40% of HIV deaths were due to TB.

4.  India is the highest TB burden country
accounting for more than one fifth of the
global incidence.
 Global annual incidence estimate is 9.4
million cases out of which it is estimated
that 1.98 million cases are from India.
 India is 14th among 22 High Burden Countries
in terms of TB incidence rate
(Source: WHO global TB report 2013).

5. TB BURDEN NUMBER (MILLIONS)
(95% CI)
RATE PER 100000
PERSONS (95% CI)
INCIDENCE 2.1(2-2.3) 167(156-179)
PREVALENCE 2.5 (1.7-3.5) 195(131-271)
MORTALITY 0.22 (0.15-0.35) 17(12-27)

6.  Tuberculosis (TB) is a contagious disease caused
by Mycobacterium tuberculosis
 Left untreated, each person with infectious
pulmonary TB will infect an average of between
10 and 15 people every year.
 One in ten people infected with TB (but who are
not infected with HIV) become ill with TB at
some time during their life.
 People with both HIV and TB infection are much
more likely to become ill with TB.

7.  National TB Control Programme (NTP) 1962
 RNTCP – 1993 as pilot project
 RNTCP: 1997 expanded across the country in
a phased manner with support from the
World Bank and other development partners
 RNTCP I: 1997-2006
 RNTCP II: 2006-2011 (Sept.)

8.  Ground-breaking research in the 1950s and
early 1960s by the Tuberculosis Research
Centre at Chennai and the National TB
Institute at Bangalore, a National
Tuberculosis Programme (NTP) was
implemented by Government of India in
1962.
 The NTP was implemented on a 50:50 cost
sharing basis between Centre and State.

9.  Based on strategic principles of domiciliary
treatment
 Use of a self-administered standard drug
regimen of initially 12-18 months duration
 Treatment free of cost
 Priority to newly diagnosed patients over
previously treated patient

10.  Treatment organization decentralized to
district level.
 The NTP created an extensive infrastructure
for TB control, with a network of 446 district
TB centres and 330 TB clinics.

11.  Inadequate budget and insufficient managerial
capacity.
 Shortage of drugs.
 Less than 40% of patients completed the treatment.
 Emphasis on x-ray diagnosis resulting in inaccurate
diagnosis.
 Poor quality sputum microscopy.
 Multiplicity of treatment regimens.

12.  Emphasis on the cure of infectious and
seriously ill patients of tuberculosis, through
administration of supervised Short Course
Chemotherapy to achieve a cure rate of at
least 85%.
 Augmentation of the case finding activities
to detect 70% of estimated cases, only after
having achieved the desired cure rate.

13.  Augmentation of organizational support at
central and state levels for meaningful
coordination.
 Increased budgetary outlay.
 Use of sputum testing as the primary method
of diagnosis among self-reporting patients.
 Standardized treatment regimens.

14.  Augmentation of the peripheral level
supervision through the creation of a sub-
district supervisory unit.
 Ensuring a regular, uninterrupted supply of
drugs up to the most peripheral level.
 Emphasis on training, IEC, Operational
research and NGO involvement in the
program.

15.  Strengthening of the TB cells at the central
and state levels.
 Strengthening of the training institutes for
tuberculosis at the central and state levels.
 Gradual implementation of the revised
strategy for TB control covering a
population.

16.  Strengthening of the NTCP in remaining
Short Course Chemotherapy districts as
transitional step to adopt the RNTCP.
 Providing for an uninterrupted supply of anti-
TB for sputum positive patients throughout
the country.

17. SCC-short course chemotherapy
DOTS-directly observed treatment
short course
Objective
 Early diagnosis and
treatment
Operational targets
 Not defined
Strategy
 SCC unsupervised
 Conventional: long term
domiciliary treatment
with INH+Thiacetazone
Objective
 Breaking the chain of
transmission
Operational targets
 Cure rate 85%
 Case findings 70%
Strategy
 DOTS
 Uninterrupted drug
supply.

18. . .
Diagnosis
 More emphasis on x-
rays.
 2 sputum smears.
 One sputum positive
is considered a case.
Diagnosis
 Mainly sputum
microscopy.
 Two sputum smears
 One smear
positive/clinically
positive is a case.

19. STOP TB strategy announced by WHO and
adopted by RNTCP.
Components:
 Pursuing quality DOTS-expansion and
enhancement.
 Addressing TB/HIV and MDR-TB.
 Contributing to health system strengthening.
 Engaging all care providers.
 Empowering patients and communities.
 Enabling and promoting research.

24. DIAGNOSIS OF A
TUBERCULOSIS
DIRECT METHOD
INDIRECT METHOD

25. SPUTUM
EXAMINATION
ROUTINE
MICROSCOPY
ZEIHL NELSEN
STAINING
CULTURE
LJ MEDIUM
BACTEC
POLYMERASE
CHAIN
REACTION
PHENOTYPIC
ASSAYS
DIRECT METHODS

26. INDIRECT
METHODS
ELISA TEST
TUBERCULIN
TEST
RESTRICTION
FRAGMENT
LENGTH
POLYMORPHISM
FAST
PLAQUE TB
QUANTIFERON
TB GOLD
ANTIBODY
DETECTION BY
TB STAT-PAK

27. Cough for 2 weeks or more
2 sputum smears
2 or 1 (+) 2 (-)
Antibiotic (12-14 days)
Symptom persist
(+) X-rays (-) Sputum
smear (-) TB neg for TB Smear (+) for /TB
Anti-TB treatment non TB Anti-TB treatment

28. category Type of patient Regimens in
month
color duratio
n
New cases New sputum smears(+)
Seriously ill sputum (-)
Seriously ill extra-pulmonary
Sputum (-)
extra-pulmonary not Seriously ill
2 (HRZE)3 IP
+
4(HR)3 CP
Red 6 month
Re-
treatment
cases
Sputum (+) relapse
Sputum (+) failure
Sputum (+) treatment after default
2(HRZES)3 +
1(HRZE)3 IP
5(HRE)3 CP
Blue 8
months
MDR-TB
cases
6(9)KOEtCZE
/18OEtCE
24-27

29. medication Action Dose No of pills in
combipack
ISONIAZID Bactericidal 600 mg 2
RIFAMPICIN Bactericidal 450 mg 1
PYRAZINAMIDE Bactericidal 1.5 gm. 2-3
STREPTOMYCIN Bactericidal 0.75 gm. -
ETHAMBUTOL Bactericidal 1200mg 2-3
THIACETAZONE Bactericidal
OFLAXOCINE Bactericidal
KANAMYCINE Bactericidal
ETHIONAMIDE Bactericidal
CYCLOSERINE Bactericidal

30.  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).
 Cure rate for MDR-TB is 20-30%.

31.  DOTS plus
 Capreomycin
 Moxifloxacin
 Linezolid
 Clofazimine
 High dose of INH
 Clarithromycin
 Augmentin

33.  Use of CB NAAT for diagnosis
 Nikshay
 TB notification every month in a given
format
 Ban on TB serology

34. NIKSHAY
Central TB division in collaboration with
National Informatics Centre has undertaken
the initiative to develop a case based
application named NIKSHAY.

36.  The NSP 2012 – 2017 had the aim of achieving
universal access to quality diagnosis and
treatment.

38.  The National Strategic Plan (NSP) 2017 – 2025
is the plan produced by the government of
India (GOI) which sets out what the
government believes is needed to eliminate
TB in India.
 The NSP 2017 – 2025 describes the activities
and interventions that the GOI believes will
bring about significant change in the
incidence, prevalence and mortality from TB.

39.  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.