The document discusses India's National Tuberculosis Control Programme and its revisions. It notes that TB is a major public health problem worldwide and in India. The original programme had low case detection and treatment results. An expert committee recommended revisions in 1992, leading to the launch of the Revised National Tuberculosis Control Programme in 1993 with DOTS strategy, improved laboratories, and involvement of NGOs and private institutions. The revised programme has expanded nationwide and achieved reductions in death rates.

7. MAGNITUDE OF THE PROBLEM

8. • TB is one of the most
important public health
problems worldwide.
• There are approximately 9
million new cases of all forms
of tuberculosis occurring
annually and 3 million people
die from it each year.
• India is the highest TB
burdened country in world
and accounts for nearly 20%
of the global burden of
Tuberculosis.

9. NATIONAL TB CONTROL PROGRAMME

11. SHORT-TERM OBJECTIVE:
• TO REDUCE T.B IN THE COMMUNITY.
LONG-TERM OBJECTIVE:
• TO DETECT MAXIMUM NO.OF T.B CASES
• TO VACCINATE NEW BORNS AND INFANTS WITH B.C.G

12. DISTRICT TUBERCULOSIS
PROGRAMME
• The National tuberculosis programme (NTP) operates
through the District Tuberculosis Programme (DTP)
which is the backbone of the NTP.
• Over 600 TB clinics have been set up in the country,
• Association with general health and medical
institutions.
• Monthly once patient received the drugs through
dispensary

13. DTC
CASE FINDING
BCG
VACCINATION
HEALTH
EDUCATION
TREATMENT

14. PROGRAMME ACHIEVEMENT
• NATIONAL TB CONTROL PROGRAMME DID NOT YIELD
GOOD RESULT.
• CASE DETECTION AND CASE HOLDING RESULT WAS
LOW(25%)
• DRUG SUPPLY NOT REGULAR
• RESPONSE FROM THE PATIENTS WAS POOR

15. • INCREASED INCIDENCE OF MDR-TB
• TREATMENT REGIMENS WERE MANY
• INADEQUATE BUDGET
• NO CHANGES IN MORBIDITY AND MORTALITY RATE

16. REVISED TB CONTROL PROGRAMME
• IN 1992 GOVERNMENT OF INDIA APPOINTED
EXPERT COMMITTEE TO REVIEW THE
STRATEGIES OF TUBERCULOSIS CONTROL
PROGRAMME.

17. • CASE FINDING MUST BE PASSIVE
• SYSTEMATIC REGISTRATION OF THE CASES
• CATEGORIZATION OF THE TB CASES INTO TWO TYPES
• ONLY INTERMITTENT REGIMEN NOT DAILY REGIMEN
• DRUGS MUST BE ENSURED FREE OF COST
• EFFECTIVE HEALTH EDUCATION

18. R.N.T.C.P
• IN 1993, GOVT OF INDIA INTENSIFIED AND REVISED THE NTCP AND
RENAMED AND LAUNCHED AS “ REVISED T.B CONTROL
PROGRAMME”.
• IT WAS LAUNCHED AS A PILOT PROJECT AND EXPANDED IN 1997.
• IT FUNDED BY W.H.O AND WORLD BANK.

20. • ACHIEVEMENT OF ATLEAST 85% CURE RATE THROUGH
SUPERVISED SHORT COURSE CHEMOTHERAPY.
• INVOLVEMENT OF NGO’S AND PRIVATE INSTITUTION.
• AUGMENTATION OF CASE FINDING ACTIVITIES
THROUGH QUALITY SPUTUM MICROSCOPY
EXAMINATION.

21. REVISED STRATEGIES:
• LABORATORY NETWORK
• SPUTUM EXAMINATION
• NEW PROTOCOL FOR DIAGNOSIS
• DOTS PROGRAMME
• DRUG RESISTANCE SURVEILLANCE
• DOTS PLUS
• PAEDIATRIC TUBERCULOSIS
• TB – HIV COORDINATION
• IEC ACTIVITIES

22. 1. LABORATORY NETWORK
• A NATION WIDE NETWORK OF RNTCP
QUALITY ASSURED DESIGNATED
SPUTUM SMEAR MICROSCOPY
LABORATORIES HAS BEEN SETUP.
• THESE LABORATORIES CARRY OUT
SPUTUM MICROSCOPY WITH EXTERNAL
QUALITY ASSESSMENT (EQA) AND DRUG
RESISTANCE SURVEILLANCE (DRS)
RELATED ACTIVITIES.

23. • NEW PROTOCOLS FOR SPUTUM MICROSCOPY AND DRS HAVE BEEN
PREPARED.
• THE LABORATORY NETWORK FOR RNTCP IN INDIA CONSISTS OF THREE
DESIGNATED NRLS
• A CENTRAL LABORATORY COMMITTEE HAS BEEN CONSTITUTED WITH
THE MICROBIOLOGISTS OF THE THREE NATIONAL REFERENCE
LABORATORIES (NRLS) AND CENTRAL TB DIVISION WITH WHO
REPRESENTATIVES AS MEMBERS. THIS COMMITTEE GUIDES THE
LABORATORY RELATED ACTIVITIES OF THE PROGRAMME.

24. 2. SPUTUM EXAMINATION

25. – Case finding is passive.
– Patients presenting themselves with symptoms suspicious
of tuberculosis are screened through two sputum smear
examinations. (ON THE SPOT – EARLY MORNING)
– Sputum positive
– Sputum negative

26. 3. PROTOCOL FOR DIAGNOSIS

29. 4. DOTS PROGRAMME

30. • The Directly Observed Treatment Short Course (DOTS) is
the distinguishing feature of RNTCP.
• It is directly observed chemotherapy because the drug
intake of every patient is supervised by programme
functionaries.

31. COMPONENTS OF DOTS PROGRAMME
POLITICAL
COMMITTMENT
GOOD QUALITY
SPUTUM SMEAR
DIRECT
OBSERVATION
UNINTERUPTED
SUPPLY OF DRUGS
ACCOUNTABILITY

32. DOTS AGENTS
• MULTI PURPOSE HEALTH
WORKERS
• ANGANWADI WORKERS
• DAIS
• EX-PATIENTS
• SOCIAL WORKERS
• TEACHERS
• OTHERS

33. DRUGS REGIMEN
• ISONIAZID – 600 mg
• RIFAMPICIN – 450 mg
• PYRAZINAMIDE – 1500 mg
• ETHAMBUTOL – 1200 mg
• STREPTOMYCIN – 0.75 g

34. 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,
INTENSIVE:
2 (HRZE)3
CONTINUOUS:
4 (HR)3
6
CATEGORY II
Color of box:
BLUE
Sputum Positive
relapse
Sputum Positive
failure
Sputum Positive
treatment after
default
INTENSIVE:
2 (HRZES)3,
1 (HRZE)3
CONTINUOUS:
5 (HRE)
8

35. 5. DRUG RESISTANCE SURVEILLANCE
(DRS)
• A new protocol for state-wide DRS under RNTCP has been
developed in 2005.
• Over the next five years, RNTCP plans to systematically
carry out state-wide DRS surveys in the states of Andhra
Pradesh, Delhi, Gujarat, Kerala, Maharashtra, Orissa, Uttar
Pradesh and West Bengal.

36. DRS ACTIVITIES

37. 6. DOTS PLUS
• DOTS-Plus, conceived by the WHO and several of its partners, is
a strategy currently under development for the management of
multi-drug resistant TB(MDR-TB).
• Recognizing that the treatment of MDR-TB cases is very
complex, treatment is to follow the internationally recommended
DOTS-Plus guidelines and will be done in designated RNTCP
DOTS-Plus sites.

38. • IT LAUNCHED IN INDIA DURING 2007
• DIAGNOSIS IS CONFIRMED BY SPUTUM CULTURE AND
SUSCEPTIBILITY TEST DONE IN IRL
• TREATMENT IS DAILY REGIMEN WITH SECOND LINE DRUGS
• PATIENTS ARE ADMITTED AND TREATED IN THE RNTCP
DESIGNATED SITES
• TOTAL DURATION OF TREATMENT IS MINIMUM 2 YEARS
• I.P FOR 6-9 MONTHS C.P IS FOR 18 MONTHS

39. RECOMMENDED DOSAGE FOR DOTS PLUS
DRUGS < 45 KG >45 KG
KANAMYCIN 500 mg 750 mg
OFLOXCIN 600 mg 800 mg
ETHIONAMIDE 500 mg 750 mg
ETHAMBUTOL 800 mg 1000 mg
PYRAZINAMIDE 1250 mg 1500 mg
CYCLOSERINE 500 mg 750 mg
PARA AMINO SALICYLIC
ACID
10 mg 12 mg

40. 7. PAEDIATRIC TUBERCULOSIS
• MODIFICATION OF THE EXISTING
RNTCP GUIDELINES FOR THE
DIAGNOSIS AND TREATMENT OF
PAEDIATRIC PATIENTS.
• DRUGS FOR PAEDIATRIC TB CASES
UNDER RNTCP SHOULD BE
SUPPLIED IN PATIENT-WISE BOXES
(PWBS),

41. 8. TB – HIV COORDINATION

42. • RNTCP and the National AIDS Control Organization (NACO)
have devised a Joint Action Plan for TB-HIV coordination.
• The objective of TB-HIV coordination is to reduce TB-
associated morbidity and mortality in People Living With
HIV/AIDS (PLWHA) through collaboration between NACP and
RNTCP.
• The basic purpose of the Joint Action Plan is to ensure optimum
synergy between the two national programmes for effective
prevention and control of both the diseases.

43. ACTIVITIES IN TB – HIV COORDINATION
 Sensitization of key policy makers to address the
importance of TB-HIV co-ordination
 Co-ordination of service delivery and cross-referrals;
 A joint training programme for service providers
involved in RNTCP and NACP
 VCTC-RNTCP co-ordination for cross-referrals

44. · Use of universal precaution to prevent the spread of
tuberculosis in facilities caring for HIV infected persons, and to
prevent the spread of HIV through safe injection practices in
RNTCP
· Joint efforts at IEC and at establishing a monitoring and
evaluation system at district, state and national levels to assess
the co-ordination and treatment services for people living with
HIV/AIDS; and
· Active involvement of NGOs, private practitioners and
corporate sector.

45. 9. IEC ACTIVITIES
• Intensive IEC activities are
carried out at various levels to
promote utilization of RNTCP
services in the country. A mass
media agency has been
envisaged at the national level.
• IEC material is being prepared
by the states in local languages.

47. ORGANISATIONAL PATTERN OF RNTCP
• CENTRAL LEVEL :
• CENTRAL TB DIVISION
• STATE LEVEL
• STATE TUBERCULOSIS OFFICE
• STATE TB TRAINING AND DEMONSTRATION CENTRE

48. • DISTRICT LEVEL:
• DISTRICT TUBERCULOSIS CENTRE
• SUB DISTRICT LEVEL:
• T.B UNIT
• PERIPHERAL LEVEL:
• HEALTH UNITS
• RURAL HOSPITALS

49. ROLE OF NURSE

50. ESSENTIAL CARE

51. HEALTH EDUCATION

52. CLINICAL EXAMINATION

53. BCG VACCINATION

54. PROGRAMME ACHIEVEMENT:
• Despite rapid expansion, the overall performance of the
programme remains consistently good.
• Death rate has been brought down seven folds from 29 per cent
to 4 per cent.
• Master trainers on TB/HIV have been trained on TB/HIV related
issues in 12 states.