Tuberculosis control in india

TUBERCULOSIS CONTROL IN INDIA-
HISTORY AND RECENT ADVANCES
Presented By: Dr. Imrose Rashid
Guide/Mentor: Dr. (Prof.) S.M. Salim Khan

CONTENTS
• INTRODUCTION
• HISTORY OF TUBERCULOSIS
• NATIONAL TB CONTROL PROGRAMME
• REVISED NATIONAL TB CONTROL PROGRAMME
I (RNTCP- I)
• DIRECTLY OBSERVED TREATMENT SHORT
COURSE (DOTS)
• STOP TB STRATEGY
• REVISED NATIONAL TB CONTROL PROGRAMME
II (RNTCP- II)
• BACKGROUND FOR NSP (2012-2017)
• NATIONAL STRATEGIC PLAN (2012-2017)
• END TB STRATEGY
• BURDEN OF TB IN INDIA – 2017
• NATIONAL STRATEGIC PLAN (2017-2025)
• RECENT ADVANCES IN TB CONTROL

INTRODUCTION
• TB is a specific chronic infectious disease caused by M. tuberculosis.
• The disease primarily affects lungs.
• It can also affect intestine, meninges, bones, joints, lymph nodes, skin
and other tissues of body.
• The disease is preventable and curable.
• TB is spread from person to person through the air.
Park's Preventive and Social Medicine 24th Edition

HISTORY OF TUBERCULOSIS
• The genus Mycobacterium originated more than 150 million years
ago.
• Known as “phthisis” in ancient Greece, “tabes” in ancient Rome.
• Hippocrates was the first to describe the symptoms of Phthisis.
• Isocrates was the first author supposing that TB was an infectious
disease.
• 1720 - The infectious origin of TB was conjectured by Benjamin
Marten.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5432783/

• 18th century - TB had become epidemic in western Europe.
• The extreme pallor of affected people lead to the origin of the term
"white plague”.
• 1779 - Extra-pulmonary tubercles were described by Sir Percivall Pott,
as "Pott's disease“.
• 1793 - “Cheese-like” abscesses were named "tubercles" by the
Scottish pathologist Matthew Baille.
• 1810 - French physician Gaspard Laurent described the disseminated
"miliary tuberculosis”.

• Mid-19th century - Johann Lukas coined the term "tuberculosis“.
• 1854 - First successful remedy was the introduction of “sanatorium
cure” described by Hermann Brehmer.
• 1882 - Robert Kotch first identified
the specific causative agent of tuberculosis.
• 1908- Mantoux tuberculin skin test.
BCG vaccine.
ROBERT KOTCH

• First recorded mention of TB in India arises in religious texts dating
back 1500BC.
• 1906 - First open-air sanatorium in India was established at Tilonia
near Ajmer.
• 1939 - The Tuberculosis Association of India was started.
• 1948 - BCG vaccine was introduced in India.
• 1948 - BCG vaccine production centre was established in Chennai
with the assistance of WHO and UNICEF.

• 1940 - Streptomycin and Para-Amino Salicylic Acid (PAS) were first
introduced.
• 1950s - Thioacetazone and Isonicotinic Acid Hydrazide (INH)
introduced.
• First tried on smaller scale from New Delhi TB Centre in 1951,
Calcutta in 1952 and Andhra Pradesh in 1953.
• 1946 -The Bhore Committee report came out with an estimate that
there were about 2.5 million patients in the country.
http://medind.nic.in/ibr/t05/i2/ibrt05i2p63.pdf

• Recommended establishment of an organized domiciliary service by
setting up of TB clinics in the districts and mobile TB clinics for rural
areas.
• 1955 to 1958 - The National Sample Survey (NSS) was conducted by
ICMR which revealed that –
 The bacillary cases were 4/1000.
 X-ray active cases 16/1000.
• 1956 - Tuberculosis Research Centre (TRC), earlier known as
Tuberculosis Chemotherapy Centre (TCC) was established at Madras.

• 1959 - National tuberculosis Institute of Bangalore (NTIB) was
established with assistance from WHO and UNICEF.
• The primary purpose of establishing the NTI was
• To formulate a nationally applicable programme for TB control
• Training of district TB key personnel and
• Orientation training for medical officers and paramedical TB
workers.
• 1962 - The National TB Control Programme (NTCP) formulated.

NATIONAL TB CONTROL PROGRAMME
• Pilot tested in Ananthpur district of Andhra Pradesh during 1961.
• Launched in a phase wise manner in 1962 to cover 364 districts.
• Based on the strategic principles of domiciliary treatment.
• Treatment organization decentralized to district level.
• Priority to newly diagnosed patients over previously treated patients.
• Use of a self-administered standard drug regimen of 12-18 months
duration.
• Treatment to be provided free of cost.
• A 50:50 cost sharing basis between the Centre and the State.

OBJECTIVES OF NTP
1. Long term
• To reduce TB in the community to the level where it ceases to
be a public health problem.
• One infects < 1 new person annually.
• To bring down prevalence in age group <14 yrs to <1 %
2. Short term
• To detect maximum number of TB cases.
• To vaccinate with BCG.
• To integrate programme in all existing health institutions.

DRUG REGIMEN IN NTP
CODE NO. Drugs & Dosage Mode & Rhythm of
Administration
R1 Isoniazid 300 mg + Thioacetazone 150 mg. Both drugs in a single dose or in
two divided doses orally, daily
R2 Bi-weekly regimen
Inj. Streptomycin 0.75 g / 1 g. + Isoniazid 600 to 700 mg,
Pyridoxine 10 mg.
Intramuscularly
Orally.
R3 Isoniazide 300 mg + PAS 10 g. In a single dose or in two divided
doses. Both drugs orally, daily
R4 Isoniazid 300 mg + Ethambutol 800 mg. Both drugs in a single dose, daily,
orally
R5 Bi-phasic regimen
Intensive phase: Inj. Streptomycin 0.75 g / 1 g. + Isoniazid 300
mg + Thioacetazone 150 mg or Ethambutol 800 mg. Or PAS 10
g.
Followed by
Continuation phase of 10 – 16 months duration
First two months
Intramuscularly daily
In single dose orally, daily,
(Thioacetazone and PAS may be
given in two divided doses)
CONVENTIONAL CHEMOTHERAPY (1961-1986)

Short Course Chemotherapy Regimen (1986-1993)
CODE No. Drug Regimen Category of patient
RA 2EHRZ/6TH
a) Intensive Phase: EHRZ (2 months)
b) Continuation Phase: HT (6 months)
All new smear positive
patients and seriously ill
extra-pulmonary TB cases
RB 2SHRZ/2S2H2R2
a) Intensive Phase (2 months)
b) Continuation Phase (4 months)
Failures and relapses

• 1972 - Dr. Wallace Fox handed over the
greatest gift to the world i.e., SCC.
• Considered as the father of clinical trials for
chemotherapy of TB.
• 1983 - Tuberculosis Research Centre, Madras,
pilot tested SCC in 18 districts of the country.
• 1986 - Government of India (GOI) agreed to the
policy of implementation of SCC. Dr. WALLACE FOX

• 1992 - GOI with WHO and Swedish International Development
Agency (SIDA) reviewed the TB situation.
• INFRASTRUCTURE UNDER NTP
• 446 District TB Centres.
• 330 TB Clinics.
• 47,600 TB Beds.
• 1.3 million patients on TB treatment annually.

LIMITATIONS OF NTP
• Low priority to NTP in allocation of funds and political commitment
• Frequently interrupted supply of drugs.
• Poor quality sputum microscopy.
• Over reliance on X-ray for diagnosis.
• Multiplicity of treatment regimens.
• Low rate of treatment completion.
• Impending threat of HIV worsening the scenario of TB.
http://ntiindia.kar.nic.in/docs/NTI_Sntis/pages/SNTIS172.htm

REVISED NATIONAL TUBERCULOSIS CONTROL
PROGRAMME (RNTCP)
WORLD’S LARGEST DOTS PROGRAMME

REVISED NATIONAL TUBERCULOSIS PROGRAMME
(RNTCP)
YEAR EVOLUTION
1993 Formulation of RNTCP.
Pilot phase launched in 5 project areas- Delhi, Bombay, Calcutta, Bangalore and Gujarat.
1995 Extended to cover 13 states.
1997 Formal launching of RNTCP (Phase I) as a National Programme.
1998 Large scale implementation.
2001 450 million population covered
2004 80% country covered.
2006 Entire country covered by RNTCP
• Adopted the internationally recommended Directly Observed Treatment Short-
course (DOTS) strategy. http://medind.nic.in/ibr/t05/i2/ibrt05i2p63.pdf

OBJECTIVES OF RNTCP
1. To achieve and maintain a cure rate of at least 85% among newly
detected infectious (new sputum smear positive) cases.
2. To achieve and maintain detection of at least 70% of such cases in
the population.
Efforts targeted at the case-detection should be made only
after achieving 85% cure rates, which was the prime target of RNTCP.

REVISED STRATEGY
1. Augmentation of organizational support at centre and state level.
2. Use sputum testing as primary method of diagnosis.
3. Standardized treatment regimen.
4. Ensuring regular, uninterrupted supply of drugs.
5. Emphasis on training, IEC, operational research & NGO
involvement.
6. Increased budget outlay.
7. Implemented as 100% centrally sponsored program.

STRUCTURAL ORGANIZATION OF RNTCP
CENTRAL LEVEL
CENTRAL TB DIVISION
(DGHS & MOHFW)
DEPUTY DIRECTOR
GENERAL TB
STATE LEVEL STATE TB CELL STATE TB OFFICER
DISTRICT LEVEL DISTRICT TB CENTRE DISTRICT TB OFFICER
SUB-DISTRICT LEVEL TUBERCULOSIS UNIT
MEDICAL OFFICER TC
STLS, STS
1/ Lakh (0.5 in Hilly/
DA) MICROSOPY CENTRE
MEDICAL OFFICER
(PHIs)
DOT CENTRE DOT PROVIDER- MPHW

DIRECTLY OBSERVED TREATMENT SHORTCOURSE
(DOTS)

DOTS STRATEGY
• DOTS is the internationally recommended strategy for TB.
• Recognized as a highly efficient and cost-effective strategy.
• Developed by Karel Styblo of the IUATLD in the 1970s and 80s.
• Increased the proportion of people cured of TB from 40% to nearly
80%.
• 1993 - WHO declared TB a global emergency.
• 1994 - WHO developed a concise "Framework for TB Control”.
• 1995 - DOTS was launched as a WHO strategy.

COMPONENTS OF DOTS
1. Sustained political and financial commitment.
2. Diagnosis by quality ensured sputum-smear microscopy.
3. Standardized short-course anti-TB treatment (SCC) given under
direct and supportive observation (DOT).
4. A regular, uninterrupted supply of high quality anti-TB drugs.
5. Standardized recording and reporting.
A Guide to Understanding the WHO-recommended Dots TB Control Strategy Known as DOTS

ASPECTS OF DOTS STRATEGY
1. Technical Aspect:
 Case detection and diagnosis.
 Standardized short-course treatment.
 Direct observation at least during the initial phase.
 Recording and reporting of progress and cure.
2. Logistical Aspect:
 Dependable drug supply to the patient level.
 Laboratories for microscopy.
 Supervision and training of health care workers.

3. Operational Aspect:
 Five basic core elements.
 Flexibility in implementation of technical aspects.
4. Political Aspect:
 Government commitment.
 Policy formulation.
 Resource mobilization.
DOTS

Diagnostic
category
People with TB disease Intensive phase
Daily or 3 times weekly
Continuation Phase
Daily or 3 times weekly
1 New sputum smear positive
New sputum smear negative
(extensive)
Severe HIV disease or severe
forms of extra-pulmonary TB
2 (HRZE) 4 (HR)
or
6 (HE)
2 Previously treated sputum smear
positive: relapse
Re-medication after failure
Re-medication after interruption
2 (HRZES) followed by
1 (HRZE)
5 (HRE)
3 New sputum smear negative
(other than category 1)
Less severe extra-pulmonary TB
2 (HRZE) (4 HR)
Or
(6 HE)
4 Chronic and multi-drug-resistant
TB (still sputum smear positive
after supervised re-medication)
Specially designed standardized or individualized
Regimens.
STANDARDIZED TB REGIMENS UNDER DOTS

https://www.tbfacts.org/wp-content/uploads/2016/01/NSP-
2012-2017.pdf
POPULATION COVERED UNDER DOTS AND TOTAL TB PATIENTS PUT ON TREATMENT EARCH QUARTER

TREATMENT OUTCOMES BY WHO REGIONS (2001 COHORT)
https://www.tbfacts.org/wp-content/uploads/2016/01/NSP-2012-2017.pdf

• DOTS strategy proved to be an effective tool in controlling TB on mass
scale.
• 2004 - More than 20 million patients had been treated in DOTS
programme worldwide and more than 16 million of them had been
cured.
• Prime task to achieve the Millennium Development Goals (MDGs).

Goal 6:
“Combat HIV/AIDS,
malaria and other
diseases”
Target 8:
“By 2015, to have halted and begun to
reverse the incidence of malaria and
other major diseases…”
Indicator 23:
“Between 1990 and 2015 to halve prevalence
of TB disease and deaths due to TB”
Indicator 24:
“To detect 70% of new infectious cases
and to successfully treat 85% of
detected sputum positive patients”

STOP TB STRATEGY
1. MDG 6, Target 8: Halt and begin
to reverse the incidence of TB by
2015.
2. Targets linked to the MDGs and
endorsed by the Stop TB
Partnership:
– by 2015: reduce prevalence and
deaths due to TB by 50%
compared with a baseline of 1990.
– by 2050: eliminate TB as a public
health problem.
TARGETS
1. Achieve universal access to high
quality care for all people with TB.
2. Reduce the human suffering
and socioeconomic burden.
3. Protect vulnerable populations
from TB, TB/HIV and multidrug-
resistant TB.
4. Support development of new
tools and enable their timely and
effective use.
5. Protect and promote human
rights in TB prevention, care and
control
OBJECTIVES
To reduce the
global burden
of TB by 2015
in line with
the MDGs
and the Stop
TB
Partnership
targets.
GOAL
A TB
FREE
WORLD
VISION
https://www.who.int/tb/strategy/stop_tb_strategy/en/

COMPONENTS OF STOP TB STRATEGY
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.
https://www.who.int/tb/strategy/stop_tb_strategy/en/

• 2007 - National AIDS Control Programme (NACP) and RNTCP
developed a framework “National framework of joint TB/HIV
collaborative activities”
• 2008 – Revised with schemes for involvement of private providers
and NGOs.
• 2007 - Programmatic management of Drug Resistant (PMDR) TB
service.
• Global fund supported engagement of IMA and CBCI.
• Task force mechanisms were established to engage Medical Colleges.
• 2013 - National coverage of PMDR TB achieved.

REVISED NATIONAL TB CONTROL PROGRAMME
PHASE-II
• India was on track to achieve the TB related goals of MDG.
• However, TB still continued to be one of the major public health
problems in India.
• RNTCP II began in 2006 in line with new WHO STOP TB strategy.
• To consolidate the gains achieved in RNTCP I.
• The design of the RNTCP II remained almost the same as that of
RNTCP I.

• Additional Requirements:
Quality assured diagnosis and treatment.
Participation of private sector providers.
Inclusion of DOTS+ for MDR TB.
 Offering treatment for XDR TB.
Advocacy, Communication and Social Mobilization.
Reach global case detection and cure targets.

DIAGNOSTIC ALGORITHM FOR PULMONARY TB

DIAGNOSTIC ALGORITHM FOR EXTRA PULMONARY TB

CBNAAT
• Cartridge Based Nucleic Acid Amplification Test.
• A molecular GeneXpert Test for diagnosis of TB by detecting the DNA.
• Results in 2 hours.
• Also detects genetic mutations associated with drug resistance.
• Developed by Foundation for Innovative New Diagnostics (FIND).
• GeneXpert system launched in 2004 and test in 2008.
• 2010 - Endorsed by WHO.
• 2012 - Started in India.
https://www.tbfacts.org/genexpert/

DRUG REGIMEN IN RNTCP
TYPE OF TB CASE INTENSIVE PHASE CONTINUATION PHASE
NEW CASE (2) HRZE (4) HRE
PREVIOUSLY TREATED (2) HRZES + (1) HRZE (5) HRE
• RNTCP had adopted thrice weekly regimen.
• Daily regimen introduced initially for 104 districts and later scaled up to
the entire country.
• The principle of treatment is to administer daily fixed dose combination
(FDC) of drugs in appropriate weight bands.
DRUG SENSITIVE TB

TYPE OF TB CASE INTENSIVE PHASE CONTINUATION PHASE
RR (6-9) Km Lfx Eto Cs Z E H (18) Lfx Eto Cs E H
INH Resistant (3-6) Km Lfx R E Z (6) Lfx R E Z
MDR TB (6-9) Km Lfx Eto Cs Z E
(Modify treatment based on level
of resistance)
(18) Lfx Eto Cs E
XDR TB (6-12) Cm, PAS, Mfx, High dose- H,
Cfz, Lzd, Amx/Clv
(18) PAS, Mfx, High dose- H, Cfz,
Lzd, Amx/Clv
DRUG RESISTANT TB CASES
• All MDR-TB isolates subjected to LC DST and appropriate modification of
treatment regimen done.
• All DR-TB treatment regimen given on daily basis under supervision.

• Since 2007, the programme consistently achieved a case detection
rate (CDR) of >70% and a treatment success rate (TSR) of >85%.
• From 2006–10 more than 27 million chest symptomatic had been
examined and 6 million treated.
• 2011 - RNTCP achieved the CDR of 72% and TSR of 88%, which was in
line with the global targets.
• The programme implemented activities effectively delivered Rs. 1545
crores expenditure.

TB Suspects examined per 100,000 population, 2001-2011

STRENGTH VS WEAKNESS OF RNTCP
STRENGTH WEAKNESS
I. DOTS has been an extremely successful strategy. I. Managing TB in Urban Areas.
II. Availability of diagnostics. II. Participation from private sector.
III. Structure setup. III. Health System Involvement.
IV. Well defined information system. IV. Rigidity of the programme.
V. Availability of guidelines and Protocols. V. Insulation from other programmes.
VI. Review Mechanisms. VI. Adequate human resource provision
VII. Technical Committees. VII. Limited Funds.
VIII. Early diagnosis and Treatment of MDR-TB. VIII. Surveillance.
IX. Trained human resources. X. Challenges to achieve universal access.

• India had the highest TB burden accounting
for one fifth (21%) of the global incidence an
estimate of 2 million cases.
• Nearly 165 deaths per day.
• More adult women died of TB every year
than from peripartum complications.
• TB was still the leading cause of illness and
death among persons living with HIV/AIDS.
BACKGROUND FOR NSP (2012-2017)

NATIONAL STRATEGIC PLAN (2012-2017)
• VISION- “TB FREE INDIA”
• GOAL- “To achieve universal access to quality TB diagnosis and
treatment for all TB patients in the community”.
• OBJECTIVES (2012-2017)-
1. To achieve 90% notification rate for all cases.
2. To achieve 90% success rate for all new and 85% for re-treatment cases.
3. To significantly improve the success outcomes of DR-TB Cases.
4. To achieve decreases morbidity and mortality of HIV-associated TB.
5. To improve outcomes of TB care in the private sector.

• The RNTCP was responsible for achieving the objectives by-
Further strengthened and improved the quality of basic DOTS
services.
Aligned the Sub-district level management unit with National
Health Mission (NHM).
Deployed improved rapid diagnostics to the field level.
Increased efforts to engage all care providers.
Strengthened urban TB control.
Expanded diagnosis and treatment of DR-TB.
Improved communication, outreach and social mobilization.

• May 2012 – GOI made TB a notifiable
disease.
• 7th June 2012 - GOI, MOHFW notified for
prohibiting the import, manufacture, sale
or use of Sero diagnostic kits.
• June 2012 - To support TB notification and
surveillance a web based TB notification
system- NIKSHAY was established

• 2013 - India achieved complete
geographical coverage for diagnostic
and treatment services for MDR-TB.
• 2014 - RNTCP and WHO jointly
prepared “Standards of TB Care” in
India.
• 2015 - 93,000 persons with MDR-TB
were diagnosed and put on treatment.

STANDARD OF TB CARE in INDIA
• Based on International guidelines and standards for TB care.
• Specialists from public and private sectors brought together by The
Joint TB Monitoring Mission (JMM) of the RNTCP.
• 26 Standards were developed.
6 standards for diagnosis.
5 standards for treatment.
9 standards for public health.
6 standards for social inclusion.

GLOBAL BURDEN OF TB 2014
 9.6 million fell ill with TB.
 1.5 million men, women and children died from TB.
 1.2 million people with HIV developed TB.
 4,80,000 people developed MDR-TB.
http://apps.who.int/medicinedocs/documents/s21634en/s216
34en.pdf

END TB STRATEGY
• Resolution passed at Geneva in May 2014.
• Started by WHO in 2015.
• VISION- “A WORLD FREE OF TB”
 Zero deaths, disease and suffering due to TB.
• GOAL- “END THE GLOBAL TB EPIDEMIC”
• GOI is signatory to END TB Strategy and is fully committed to its
components.

PILLAR 1
INTEGRATED,
PATIENT
CENTERED TB
CARE AND
PREVENTION
PILLAR 2
BOLD POLICIES
AND SUPPORTIVE
SYSTEM
PILLAR 3
INTENSIFIED
RESEARCH AND
INNOVATION
GOVERNMENT STEWARDSHIP AND ACCOUNTABILITY WITH MONITORING AND EVALUATION
STRONG COALITION WITH CIVIL SOCIETY ORGANIZATIONS AND COMMUNITIES
PROTECTION AND PROMOTION OF HUMAN RIGHTS, ETHICS AND EQUITY
ADAPTATION OF STRATEGY AND TARGETS AT COUNTRY LEVEL, WITH GLOBAL COLLABORATION
PRINCIPLES
PILLARS

TARGETS
SDG END TB
2030 2035
MILESTONES
2020 2025
90% 95%REDUCTION IN
NUMBER OF TB DEATHS
REDUCTION IN TB
INCIDENCE RATE
35% 75%
20% 50% 80% 90%
TB AFFECTED FAMILIES
FACING CATESTROPHIC
COST DUE TO TB
0% 0% 0% 0%
(COMPARED WITH 2015)
https://www.who.int/tb/End_TB_brochure.pdf

Desired decline in global TB incidence rates to reach the 2035 targets

BURDEN OF TB IN INDIA - 2017
• India accounted for about a quarter of the global TB burden.
• TB kills an estimated 4,80,000 Indians every year.
• There are an estimated 79,000 MDR-TB patients among the notified
cases of pulmonary TB each year.
• India is also the country with the second highest number of
estimated HIV associated TB cases.
• It is estimated that 40% of Indian population is infected with TB
bacteria, the vast majority of whom have latent TB.

NATIONAL STRATEGIC PLAN – 2017-2025.
https://tbcindia.gov.in/WriteReadData/NSP%20Draft%2020.02.
2017%201.pdf

• The NSP for TB elimination 2017–25 is a framework to guide the
activities of all stakeholders relevant to TB elimination in India.
• VISION –
• “TB FREE INDIA”
with zero deaths, disease and poverty due to tuberculosis.
• GOAL –
To achieve a rapid decline in burden of TB, morbidity and
mortality while working towards elimination of TB in India by 2025.
2017%201.pdf

INDICATORS OF NSP 2017-2025
IMPACT INDICATORS
To reduce estimated TB Incidence rate
To reduce estimated TB prevalence rate
To reduce estimated mortality due to TB
To achieve zero catastrophic cost for
affected families due to TB
2017%201.pdf

OUTCOME INDICATORS
Total TB patient notification
Total patient Private providers notification
MDR/RR TB patients notified
Proportion of notified TB patients offered DST
Proportion of notified patients initiated on treatment
Treatment success rate among notified DSTB
Treatment success rate among notified DRTB
Proportion of identified targeted key affected population undergoing active case finding
Proportion of notified TB patients receiving financial support through DBT
Proportion of identified/eligible individuals for preventive therapy / LTBI s - initiated on treatment
https://tbcindia.gov.in/WriteReadData/NSP%20Draft%2020.02.2017%201.pdf

DTPB APPROACH OF NSP
• DETECT –
 Find all DS-TB and DR-TB cases with an emphasis on reaching TB patients
seeking care from private providers and undiagnosed TB in high-risk
populations.
• TREAT –
Initiate and sustain all patients on appropriate anti-TB treatment wherever
they seek care, with patient friendly systems and social support.
• PREVENT –
 Prevent the emergence of TB in susceptible populations.
• BUILD –
 Build and strengthen enabling policies, empowered institutions and human
resources with enhanced capacities.
2017%201.pdf

NEW TREATMENT STRATEGIES OF NSP
• Drug Sensitive TB-
Daily FDCs as per patient’s weight band.
• Drug Resistant TB-
I. Management of H Mono Poly Resistance by a specific 9-12 month
treatment regimen of first line drugs substantiated with a
fluoroquinolone and a second line injectable.
II. Shorter MDR TB Regimen of 9-11 months duration.
III. Newer drugs such as Bedaquiline and Delamanid containing Regimen
that would reduce treatment duration of DR TB to 4-6 months.
2017%201.pdf

RECENT ADVANCES
JANUARY-2017
• Active case finding for TB implemented in 50 districts across 18
States.
MARCH-2017
• Nutritional Support Guideline and National Framework for TB-
Diabetes Collaborative activities was released.
• Initiated SMS services to support treatment adherence under RNTCP.
APRIL-2017
• Implementation of Daily Regimen for Drug sensitive TB was launched
in a phased manner.

MAY-2017
• Approval of National Strategic Plan 2017-25 for TB elimination in
India.
AUGUST – 2017
• 99 DOTS was rolled out in five States for all patients on daily regimen.

OCTOBER – 2017
• Daily regimen for all TB patients has been initiated across the country.
• New Drug Delamanid introduced in India.
DECEMBER – 2017
• Release of guidelines on Programme Management of Drug Resistant
Tuberculosis (PMDT) in India.

• Introduction of Medication Event
Reminder Monitor System (MERM)
boxes in 2017.
• Adoption of Direct Benefit Transfer
(DBT) mechanism for transfer of
monetary support and incentives to
patients.

JANUARY – 2018
• Introduction of Delamanid in the treatment of drug-resistant TB in
India.
APRIL – 2018
• Launch of Nikshay Poshan Yojana.
AUGUST – 2018
• WHO introduced fully oral regimen as one of the preferred options
for MDR-TB treatment.
DECEMBER – 2018
• All previously treated patients ( Formerly known as Category-II) will
be initiated on standard first line Anti-TB Regimen as prescribed for
the New patients.

Tuberculosis control in india

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