BYR.SIVAPIYA

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REVISED NATIONAL TUBERCULOSIS CONTROL PROGRAMME

ORIGIN NATIONAL TB PROGRAM (NTP) 1962

RNTCP IS THE REVIEWED FORM OF NTP

NEED FOR REVISED STRATEGY-OVER EMPHASIS ON X-RAYS FOR DIAGNOSIS-INADEQUATE FUNDING,POOR QUALITY MICROSCOPY-NON-STANDARD TREATMENT REGIMENS-LOW RATES OF TREATMENT COMPLETION-LACK OF SYSTEMATIC INFORMATION ON TREATMENT OUTCOME-ONLY 30% OF ESTIMATED TB PATIENTS WERE DIAGONOSED-ONLY 30% OF THE DIAGONOSED CASES WERE TREATED

SUCCESSFULLY

RNTCP STARTED IN YEAR 1992 (GOVT. OF INDIA,WHO,WORLD BANK)

GOAL TO REDUCE MORTALITY AND MORBIDITY FROM TBTO INTERRUPT CHAIN OF TRANSMISSSION

OBJECTIVES

ACHIEVEMENT OF AT LEAST 85%CURE RATE OF INFECTIOUS CASES DETECTION OF ATLEAST 70%OF ESTIMATED CASESINFORMATION, EDUCATION, COMMUNICATION AND IMPROVED

OPERATIONAL RESEARCH ACTIVITIES.

COMPONENTS

POLITICAL COMMITMENTGOOD QUALITY SPUTUM MICROSCOPYUNINTERRUPTED SUPPLY OF GOOD QUALITY DRUGSDIRECTLY OBSERVED TREATMENTACCOUNTABILITY

ORGANIZATION-PROFILE AT STATE LEVEL

STATE TUBERCULOSIS OFFICE - STATE TUBERCULOSIS

OFFICER

STATE TUBERCULOSIS TRAINING & DEMONSTRATION CENTRE - DIRECTOR

DISTRICT TUBERCULOSIS CENTRE (DTC) - DISTRICT TUBERCULOSIS

OFFICERTUBERCULOSIS UNIT - MEDICAL OFFICER

- SENIOR TREATMENT SUPERVISOR(STS)

- SENIOR TB LAB SUPERVISOR(STLS)

MICROSCOPY CENTRES AND TREATMENT CENTRES

DOTS PROVIDERS

LABORATORY NETWORK

CENTRAL TB DIVISION

NATIONAL REFERENCE LAB

STATE TB CELL

INTERMEDIATE REFERENCE LAB DISTRICT TB CENTRE

TU TU

TU

DMC II

DMC I

DMC III

NATIONAL LEVEL

STATE LEVEL

DISTRICT LEVEL(SPUTUM MICROSCOPY EQA)

(SUPERVISION) (FEEDBACK)

ROLE OF EACH LEVEL OF LABORATORY

NATIONAL REFERENCE LABORATORTY(NRL)

☻3 CENTRES- NEW DELHI, CHENNAI AND BANGALORE☻EACH CENTRE CONTROLS OVER 8-11 STATES☻SUPERVISES SPUTUM MICROSCOPY EQA ACTIVITIES.

INTERMEDIATE REFERENCE LABORATORY(IRL)

☻STATE TB TRAINING AND DEMONSTRATION CENTRES OR

PUBLIC HEALTH LAB/MEDICAL COLLEGE LABORATORY☻CONDUCTS SPUTUM MICROSCOPY EQA FOR THE STATE☻PROVIDES TECHNICAL TRAINING TO THE DISTRICT AND SUB DISTRICT TECHNICIANS AND SENIOR TB LAB SUPERVISORS.☻CONDUCTS ON SITE EVALUATION VISITS OF EACH DTC ATLEAST ONCE A YEAR☻MANUFACTURES SLIDES FOR PANEL TESTING

DISTRICT TB CENTRES

☻ CONDUCTS BLINDED RE-CHECKING OF SMEARS☻MAINTAIN GOOD QUALITY REAGENTS AND EQUIPMENTS AT ALL TB

UNITS

TUBERCULOSIS UNITS

☻AT SUB- DISTRICT LEVEL☻1 TB UNIT PER 5 LAKH POPULATION( IN HILLY AREAS 2.5 LAKH)☻CONDUCTS ON-SITE EVALUATIONS AND BLINDED RE-CHECKING OF SMEARS

DESIGNATED MICROSCOPY CENTRES

☻AT PERIPHERAL LEVEL☻1 PER 1 LAKH POPULATION( IN HILLY AREAS 50000)☻LOCATED AT EITHER IN CHC, PHC, TALUKA HOSP, TB DISPENSARIES☻EACH CENTRE HAS A SKILLED TECHNICIAN☻A SENIOR TB LAB SUPERVISOR(STLS) IS APPOINTED FOR EVERY 5 MICROSCOPY CENTRES

TREATMENT CENTRES

☻PROVIDES DRUGS FREE OF COST☻THREE COMPONENTS

APPROPRIATE MEDICAL TREATMENTSUPERVISION AND MOTIVATIONMONITORING OF THE DISEASE STATUS

DOTS PROVIDERS

☻MAY BE A PERIPHERAL HEALTH STAFF OR VOLUNTARY WORKERS(TEACHERS, SOCIAL WORKERS, ANGANWADI WORKERS, EX-PATIENTS,ETC…)☻THEY ARE KNOWN AS “DOTS AGENT”☻PAID AN INCENTIVE OF RS.150 PER PATIENT COMPLETING THE TREATMENT

SERVICES PROVIDED

SERVICES INC DRUGS – FREE OF COST

HIGH QUALITY SPUTUM MICROSCOPY WITH PROMPT REPORTING OF RESULTS

HIGH QUALITY EVALUATION AND APP. TREATMENT

HIGH QUALITY DRUGS

UNINTERRUPTED SUPPLY OF DRUGS TO THE FULL REQUIREMENT

PROVISION OF DOTS BY THE GENERAL HEALTH SERVICES OR BY COMMUNITY VOLUNTEERS

TECHNICAL ASSISTANCE

DEFAULTER ACTION

IF PATIENT FAILS TO REPORT VISIT HOMEINTENSIVE PHASE -ON NEXT DAYCONTINUATION PHASE - WITHIN A WEEK

RECORDS

TUBERCULOSIS REGISTERLABORATORY REGISTERTREATMENT CARDLABORATORY FORM FOR SPUTUM EXAMINATIONSUPERVISORY REGISTERREFERRAL FOR TREATMENT REGISTER

REPORTS

QUARTERLY REPORTS ON -CASE FINDING-SPUTUM CONVERSION-RESULTS OF TREATMENT

RNTCP REPORT ON PROGRAMME MANAGEMENT & LOGISTICS

RNTCP-PHASES

PHASE I (1992 – 2006) PHASE II ( 2006 – 2011)

PHASE I BY 1993 PILOT PHASE I PILOT PHASE II PILOT PHASE IIIBY THE END OF 1998, ONLY 2 % COVERED.BY 2006 WHOLE POPULATION COVERED.

PHASE II TO CONSOLIDATE, MAINTAIN AND FURTHER IMPROVE THE ACHIEVEMENTS OF THE PHASE I ACTIVITIES

INCREASE ACCESS OF SERVICES TO HARD-TO-REACH AREAS

STRENGHTHENING THE INTER SECTORAL COLLABORATION

SCALLING UP OF THE STATE LEVEL INTERMEDIATE REFERRAL LABORATORIES(IRL) CAPACITY

IMPLEMENTATIOIN OF DOTS-PLUS FOR MDR-TB CASES IN A PHASED MANNER

DISRIBUTION OF PAEDIATRIC DRUG BOXES

INSTITUTIONAL STRENGHTHENING AT NATIONAL, STATE AND DISTRICT LEVEL

INTRODUCTION OF TB-HIV CO-ORDINATOR ,URBAN CO-ORDINATOR AND COMMUNICATION FACILITATOR.

DRUG RESISTANCE SURVEILLANCE

AIMTO DETERMINE THE PREVALENCE OF ANTI-MYCOBACTERIAL DRUG RESISTANCE AMONG

-NEW CASE-TREATED CASE

PLANSSTATE WIDE DRS SURVEYSICMR SURVEYSBY 2010, A NETWORK OF 24 STATE-LEVEL CULTURE AND DRUG SENSITIVITY TESTING LABORATORIES

DOTS-PLUS

STRATEGY CURRENTLY UNDER DEVELOPMENT BY WHOFOR THE MANAGEMENT OF MDR-TB CASES

GOAL

TO PREVENT FURTHER DEVELOPMENT OF MDR-TB

PRE-REQUISITE

AN EFFECTIVE DOTS BASED TB CONTROL PROGRAM

ORGANISATION

DESIGNATED RNTCP DOTS-PLUS SITES ATLEAST 1 IN EACH STATEWITH READY ACCESS TO RNTCP ACCREDITED CULTURE AND DRUG SUSCEPTIBILITY TESTING(DST) LABORATORY

WHO 7-POINT PLAN OF ACTION

SHORT TERM

BASIC TB CONTROL MEASURES MEET INTERNATIONAL STANDARD FOR TB CARERAPID SURVEYS TO ACCESS THE DISTRIBUTION OF MDR-TB AND XDR-TB IN VULNERABLE POPULATIONSTRENGTHEN NATIONAL TB LAB CAPACITYIMPLEMENTING INFECTION CONTROL PRECAUTIONS IN HEALTH CARE FACILITIES

LONG TERM

ESTABLISH CAPACITY FOR CLINICAL AND PUBLIC HEALTH SERVICESPROMOTE UNIVERSAL ACCESS TO ARTs FOR TB-HIV PARIENTS FUNDING FOR RESEARCHES

MANAGEMENT OF PAEDIATRIC TUBERCULOSIS

DIAGNOSIS AND TREATMENT FOR THE PAEDIATRIC PATIENTS

ISSUING DRUGS FOR THE PAEDIATRIC CASES IN THE PATIENT WISE BOXES(PWB)

TREATMENT BASED ON CHILD’S BODY WEIGHT6-10KG WEIGHT BAND11-17KG WEIGHT BAND

CHILDREN WEIGHING 6KG WILL BE TREATED WITH LOOSE ANTI-TB DRUGS

TB HIV CO-ORDINATIONRNTCP AND NACO – “JOINT ACTION PLAN”OBJECTIVETO REDUCE TB ASSOCIATED MORBIDITY AND MORTALITY IN TB-HIV PATIENTSFOR EFFECTIVE PREVETION AND CONTROL OF BOTH THE DISEASES

PHASE I2OOIIN 6 HIGH HIV PREVALENT STATES(AP, KARNATAKA, MAHARASHTRA, MANIPUR,

NAGALAND, TN)

PHASE II20038 ADDITIONAL STATES(DELHI, GUJARAT, HP, KERALA, ORISSA,PUNJAB, RAJASTHAN, WB)PLAN TO BE EXTENDED TO ALL OTHER STATES IN DUE COURSE

ACHIEVEMENTS OF RNTCP

TREATMENT SUCCESS RATE

DEATH RATE

INVOLVEMENT OF NGOs, PRIVATE PRACTITIONERS, MEDICAL COLLEGES, PERIPHERAL LABORATORIES, DESIGNATED MICROSCOPY CENTRES, PUBLIC HEALTH CARE PROVIDERS

4 URBAN DOTS PROJECTS(MUMBAI,HYDERABAD,VARANASI,CHENNAI)

“NATIONAL FRAME WORK FOR JOINT TB-HIV COLLOBORATIVE ACTIVITIES”- BY CENTRAL TB DIVISION & NACO- REPLACES “JOINT ACTION PLAN”

NATIONAL FRAMEWORK FOR JOINT TB-HIV COLLABORATIVE ACTIVITIES

ESTABLISHMENT OF CO-ORDINATION MECHANISMS,JOINT PLANNING AND REVIEW AT NATIONAL,STATE AND DISTRICT LEVELS

SERVICE DELIVERY CO-ORDINATION

INVOLVEMENT OF NGOs

OPERATIONAL RESEARCH

INFECTION CONTROL MEASURES

STOP TB STRATEGY

VISION

A WORLD FREE OF TB

GOAL

TO DRAMATICALLY REDUCE THE GLOBAL BURDEN OF TB BY 2015 IN LINE WITH THE MILLENNIUM DEVELOPMENT GOALS AND THE STOP TB PARTNERSHIP TARGETS

COMPONENTS

☻ HIGH QUALITY DOTS EXPANSION

☻ADDRESSING TB-HIV, MDR-TB AND OTHER CHALLENGES

☻HEALTH SYSTEM STRENGHTHENING

☻ENGAGING ALL CARE PROVIDERS(PUBLIC-PUBLIC AND PUBLIC- PRIVATE MIX APPROACHES)

☻EMPOWERING PEOPLE WITH TB CARE

☻PROMOTING RESEARCH ACTIVITIES

TARGETS -BY 2015

GLOBAL BURDEN OF TB(PREVALENCE AND DEATH RATES) WIL BE REDUCED BY 50 % (INCL TB-HIV CASES)

-BY 2050GLOBAL INCIDENCE OF TB 1 CASE PER 1 MILLION POPULATION PER YEAR

IMPROVED TREATMENT ACCESS

NEW DRUGS

NEW VACCINE - DEVELOP A SAFE, AFFORDABLE VACCINE TO IMPROVE UPON THE EXISTING VACCINE

NEW DIAGNOSTICS- TO DEVELOP EFFICIENT, EFFECTIVE, AND AFFORDABLE DIAGNOSTIC TESTS FOR TB

GLOBAL PLAN TO STOP TUBERCULOSIS

AIMS

ACKNOWLEDGEMENTPROF. HOD. DR. UMADEVI MADAM, SPM

DEPT AND ALL OUR PROFESSORS.TUBERCULOSIS CENTRE, PULIANTHOPE.CHETPET TB HOSPITAL.DOTS CENTRE, KMCH AND ROYAPETTAH.THIRUVOTTESWARAR TB HOSPITAL,

OTTERI.AYNAVARAM DOTS CENTRE.