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1
REVISED NATIONAL TUBERCULOSIS CONTROL
PROGRAMME
PRESENTED BY- Arun Kumar MauryaINTERNMBBS 2010 (Regular)
CONTENTS Introduction. RNTCP Organization. RNTCP Strategy. RNTCP Phase 2. Diagnosis Drug MDR,XDR. Stop TB Strategy.
TB- BAROMETER OF SOCIAL WELFARE
Discovered by Robert koch. Mycobacterium tuberculosis- acid
and alcohol fast. Demonstrated by ZN staining. Persists as an important public health
problem seeking attention.
4
BURDEN OF TB Prevalence of TB infection 30% Incidence of TB infection 1.5%Incidence of sputum positive TB 75/lac/yearTB mortality 33/lac casesPrevalence of sputum positive TB 0.4%MDR TB 3.5%Resistance to 4 drugs in new cases 1%
Ref: WHO Global Report, 2006
DIFFERENCE B/W NTP & RNTCP
CRITERIA NTP(1962) RNTCP(1992) Objective- early diagnosis
and treatment. Operational target –not
defined. diagnosis-more emphasis
on x-ray
Breaking chain of transmission.
Cure rate->85%,case finding->70%
mainly sputum microscopy
6
EVOLUTION OF TB CONTROL IN INDIA
1962 National TB Programme (NTP)
1992 Programme Review 1993 RNTCP pilot began 2001 450 million population covered 2004 >80% of country covered 2006 Entire country covered by RNTCP 2007 DOTS plus for MDR
TB launched 2006-2010 RNTCP Phase 2
RNTCP ORGANIZATIONCENTRAL TB DIVISION (DGHS)
STATE TB CELL
DISTRICT TB CENTRE
TUBERCULOSIS UNIT
MICROSCOPY CENTRE
PERIPHERAL HEALTH INSTITUTIONS
REVISED NATIONAL TB CONTROL PROGRAM (RNTCP)
Launched in 1997 based on WHO DOTS Strategy Entire country covered in March’06
through rapid expansion of DOTS
Implemented as 100% centrally sponsored programme Govt. of India is committed to continue the
support till TB ceases to be a public health problem in the country
All components of the STOP TB Strategy-2006 are being implemented
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 maintain detection of at least 70% of such cases in the population
RNTCP STRATEGY 1. Case finding – passive2. Two sputum smear3. Case holding and treatment – directly
observed4. TB UNIT at sub district level per every 5
lac population5. Microscopy centre per every 1 lac
population6. Present coverage is 100% , achieved in
2005
CORE ELEMENTS OF RNTCP PHASE I(1997-2006)
To ensure high quality DOTS expansion in the country, addressing the five primary components of the DOTS strategy Political and administrative
commitment Good Quality Diagnosis through
sputum Microscopy Directly observed treatment Systematic Monitoring and
Accountability Addressing stop TB strategy under
RNTCP
RNTCP PHASE II( 2006-11) The RNTCP phase II aims to
Consolidate the achievements of phase I
Maintain its progressive trend and effect further improvement in its functioning
Achieve TB related MDG goals while retaining DOTS as its core strategy
13
DIAGNOSIS OF TB IN RNTCP: SMEAR EXAMINATION
Cough for 2 weeks or More
2 sputum smears 2 Negative
Antibiotics1-2 weeks
Symptomspersist
X-ray
NegativeFor TB
Positive
Smear-Negative TB
Anti-TB Treatment
Smear-Positive TB
Anti-TB Treatment
1 or 2 positives
Repeat 2 sputum
Any +ve -ve
05/01/2023
14
ATT DRUGS AND DOSAGE
ISONIAZID 600mg (10-15mg/kg)
RIFAMPICIN 450mg (10mg/kg)
PYRAZINAMIDE 1500mg (30-35mg/kg)
ETHAMBUTOL 1200mg (30mg/kg)
STREPTOMYCIN 750mg (15mg/kg)
CATEGORIZATION & TREATMENT REGIMENS IN RNTCP
CATEGORY TYPE OF PT. REGIMEN DURATION Cat-1 new ss+ve 2(HRZE)3 +4(HR)3 6
months Cat-2 relapse,failure,default 2(HRZES)3+1(HRZE)3; 5(HRE)3 8months
Cat-4 MDR-TB 6(KOCZEEt)+ 12-18(OCEEt) 18-24months
16
PEDIATRIC TREATMENT 6-11 kg – PC 13 12-17 kg – PC 14 18-25 kg – PC 13+14 26-30 kg – PC 14+14 PC 13 has IP[ H-75 mg, R-75mg,Z-250mg, E-200mg ]and CP [H-75 mg, R-75mg.] PC 14 has IP[H-150 mg, R-150 mg, Z-
500mg, E-400 mg] and CP[H-150 mg, R -150
mg]
17
DEFINITIONS
RELAPSE – A TB patient who was declared cured but now comes back with sputum smear positive.
FAILURE – Any TB patient who is sputum smear positive at 5 months or more after starting treatment or has become sputum smear positive during treatment.
CURED – Initially sputum smear positive , has completed treatment , had sputum smear negative on two occasions one of which was at the end of treatment.
DEFAULTER - Any patient who has not taken TB treatment for two months or more consecutively after starting treatment for atleast 1 month.
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MDR TB MDR TB CASE - Any suspect who is sputum culture
positive and whose TB is due to Mycobacterium tuberculosis that are resistant in vitro to ISONIAZID and RIFAMPICIN with or without other ATT drugs .
CAUSES OF MDR TB - Incorrect prescription Irregular supply Non compliance Lack of supervision and follow up
MDR SUSPECTS - Any TB patient who fails category 1 . - Any category 2 patient sputum
positive at 4th month of treatment - Close contact of MDR TB patient found
to have smear positive TB
05/01/2023
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TREATMENT OF MDR IN PREGNANCY
First trimester – kanamycin and ethionamide are contraindicated , PAS is used instead.
Second and Third trimester- kanamycin is contraindicated.Pregnancy with MDR
<20 weeks
Advised MTP
Start cat 4
>20weeks
Start modified cat 4 --omit kanamycin, add PAS till delivery.-replace PAS with kanamycin after deliveryAnd continue till end of IP
05/01/2023
20
TREATMENT OF MDR DEFAULTER RETURNS IN <6 MONTHS
Treatment duration prior to default
<3 months 3 month to end of IP During CP
Re register Restart category 4
Last culture result Re register Continue CPDo culture - if –ve continue CP - if +ve do DST+ ve - ve
Re register Re start category 4
Re register continue cat. 4 IPDo culture if –ve switch to CP after completing IP
05/01/2023
21
RETURN IN > 6 MONTHSDo culture
+ ve - ve
No treatment required
Do 1st and 2nd line DST
MDR
Re register Start cat. 4
XDR
Start cat. 5
05/01/2023
22
XDR TUBERCULOSIS Extensive drug resistant TB – Resistance to Rifampicin and Isoniazid
and to any member of quinolones family and to one of the injectable second line drug[Kanamycin , Capreomycin, Amikacin]
Priciple for treatment of MDR and XDR are same
XDR do not transmit easily in healthy population,yet is capable of causing epidemics in HIV populations.
05/01/2023
23
STOP TB STRATEGY In 2006 WHO launched STOP TB strategy. It is
implemented over the next 10 years as described in the global plan to STOP TB 2006-2015.
Vision A world free of TB
Goal To reduce dramatically the global burden of TB by 2015 in line with the Millennium Development Goals .
Objectives To achieve universal high quality diagnosis and treatmentTo reduce the suffering and socioeconomic burdenTo protect poor and vulnerable
Targets By 2005 detect at least 70% of new sputum +ve cases and cure at least 85% .By 2015 reduce TB prevalence and death rates by 50% of 1990By 2050, eliminate TB as a public health problem.[<1/million]
CURRENT EXPERIENCE WITHDOTS
DOTS is a proven cost-effective TB treatment strategy.
DOTS quickly makes infectious cases non-infectious and breaks the cycle of transmission.
prevents the development of drug-resistant strains of TB that are often fatal and very expensive to cure.
REFERENCE Text Book of Preventive & Social
Medicine(By - K. PARK) 22nd Edition
(Page 166 to 181) Harrison’s Principles of Internal
Medicine 18th Edition, Volume 1
(Page 1340 to 1359)
THANK YOU