REVISED NATIONAL TUBERCULOSIS

CONTROL PROGRAMME (RNTCP)

  National Tuberculosis Programme (NTP) has been in
operation since 1962
 2 objectives:

Long term objectives 1. One case infects less than one new person annually
2. The prevalence of infection in the age group below 14 years is
brought down to less than 1 percent.

Short term objectives 1. To detect maximum number of TB cases among the out patients
attending any health institution with symptoms suggestive of
tuberculosis & treat them effectively
2. To vaccinate new born & infant with BCG
3. To undertake the above objectives in an integrated manner through
all the exciting health institution in the country
Shortcomings of NTP
 The treatment success rates were unacceptably low

 The death and default rates remained high

 Spread of multidrug resistant TB was threatening to further

worsen the situation
1992 Government of India reviewed the TB situation in
the country and came up with following conclusions

 NTP, though technically sound, suffered from managerial

weaknesses

 Inadequate funding

 Over-reliance on X-ray for diagnosis

 Frequent interrupted supplies of drugs

 Low rates of treatment completion

 In 1993 – in order to overcome these lacunae
 Government of India has formulated

The Revised National TB Control Programme

(RNTCP)
The objectives of the RNTCP
 Achievement of at least 85 per cent cure rate of infectious
cases of tuberculosis; through DOTS involving peripheral
health functionaries

 Augmentation of case finding activities through quality

sputum microscopy to detect at least 70 per cent of
estimated cases
 In 2006, “STOP TB” strategy was announced by WHO
and adopted by RNTCP

The components are as follows :

- 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 (diagnosis, treatment, vaccine)
The salient features of this strategy

 Achievement of at least 85 % cure rate of infectious cases through

supervised short course chemotherapy involving peripheral health
functionaries

 Augmentation of case finding activities through quality sputum

microscopy to detect at least 70% estimated cases

 Involvement of NGO’s information, education& communication &

improved operational research
Revised strategy
 Augmentation of organizational support at Central and State levels for
meaningful coordination
 Increased budgetary outlay
 Use sputum testing as the primary method of diagnosis among self
reported patients
 Standardized treatment regimens
 Augmentation of the peripheral level supervision through the creation of
sub distinct supervisory unit
 Ensuring a regular, uninterrupted supply of drugs up to the most
peripheral level
 Emphasis on training, Operational research and NGO involvement in the
programme
Diagnosis of tuberculosis in RNTCP
Prevention and Control of TB

Medical interventions Non medical interventions

1. Immunoprophylaxis 1. Exercise – lifestyle modifications
2. Chemoprophylaxis 2. Nutrition – to prevent malnutrition in
3. Treatment of HIV infected / AIDS cases children and adults
4. Strategies for prevention of HIV 3. Health education to increase
infection as per NACO guidelines community awareness, roll of BCG
5. Silicosis : Screen patients with silicosis vaccination etc.
once 6 months and treat for TB when 4. Intervention to reduce poverty and
necessary economic condition
6. For extra pulmonary TB surgery 5. Training
sometimes required 6. Incentives
7. Monitoring and evaluation
 NTP vs RNTCP
National Tuberculosis Revised NTCP
Programme (NTP)
Objective Early diagnosis & Treatment Breaking the chain of transmission
Operational Targets 1. Not defined 1.Cure rate 85 %
2. Case finding 70% of estimated
cases
Stratergy 1.Short Course Chemotherapy (SCC) 1. DOTS (Directly Observed
unsupervised Treatment Short Course)
2. Conventional Chemotherapy
2. Uninterrupted drug supply

Diagnosis 1. More emphasis on X-rays 1. Mainly sputum microscopy

2. Two sputum smears 2. Three sputum smears
3. One sputum positive is 3. One positive is not a case
considered as a case
Direct Observed Therapy Short-term (DOTS)

 DOTS is a community based TB treatment and care strategy which

combines the benefits of supervised treatment, and the benefits of
community based care and support.

 DOTS are given by peripheral health staff such as MPWs or through

voluntary workers such as teachers, Anganwadi workers, Dais, Ex-patients,
Social workers etc.

 They known as DOT ‘agent’ & ‘paid’ incentive / honorarium of 150 per
patient completing the treatment.
Components of DOTS
 Case detection with the help of microscopy with a system of multi-tier
cross-checking and quality of sputum smear

 Regular and uninterrupted supply of drugs :Patient wise box.

 Direct observation while the patient is getting Chemotherapy by the

health worker or community volunteers

 Systemic evaluation and monitoring to ensure cure

 Political and administrative commitment to ensure financial support and

sustainability.
Drugs and regimen used in RNTCP

All the drugs are administered Thrice weekly

 R = Rifampicin  K = Kanamycin
 E = Ethambutol  O = Ofloxacin
 H = INH  Et = Ethionamide
 S = Streptomycin  C = Cycloserine
 Z = Pyrazinamide
DOTS plus
 DOTS-Plus for MDR-TB is a comprehensive management
initiative

 The goal of DOTS-Plus - to prevent further development and

spread of MDR-TB

 DOTS - Plus - not intended for universal application

 Treatment under RNTCP
Type of patients Treatment Sputum testing

Category 1 New cases sputum Regimen : 6 months on 2,4,6 month of treatment.

(Red Box- smear +ve Intensive phase : 2(HRZE)3 if sputum +ve at 4 months then another
high Seriously ill sputum Continuation pahse :4(HR)3 sputum smear test is done on 5 month.
priority) -ve H=INH R=Rifampicin Z=pyrazinamide if +ve the patient is declare failure. registered
Seriously ill extra- E=Ethambutol as fresh case on the category II regimen.
pulmonary

Category II Sputum +ve relapse Regimen:8 months If sputum smear is +ve even after 3 months of
(blue box Sputum +ve failure Intensive phase 5(HRZE)3 + 1(HRZE)3 the start of treatment in category II patients
high Sputum +ve Continuation phase : 2(HRE)3 Then 4 drugs (HRZE)3 excluding streptomycin is
priority) treatment after extended for one more month.
default

Category III Sputum -ve Regimen : 6 months Two smears are examined for follow up at the
(Green Box- Extra – pulmonary Intensive phase : 2 (HRZ)3 end of 2 months of treatment
Low not seriously ill Continuation phase : 4(HR)3 Also at the end of the treatment (6 months)
Priority) If the patient become sputum positive during
the treatment he is started on a treatment
regimen afresh

Category IV Multidrug resistant Regimen : 24 months All drugs are to be administered daily under direct
(Multi drug TB cases Intensive phase : 6(KOCZEEt) observation by a trained DOT provider
resistant Continuation phase : 18(OCEEt) accompanied by a regular follow up taking smear
TB ) and culture examination as per the protocol based
on international guidelines
Drug resistance surveillance (DRS) under RNTCP

 The aim of DRS

 To determine the prevalence of drug resistance TB among new sputum
smear positive pulmonary tuberculosis (PTB) patients
 and also amongst previously treated sputum smear positive PTB
patients
New Initiatives
 NIKSHAY: TB surveillance using case based web based IT system
 Central TB Division in collaboration with National Informatics Centre has undertaken the initiative to
develop a case based web based application named Nikshay.
 The word the is combination of two Hindi words NI and KSHAY, meaning eradication of TB.
 This software was launched in May 2012 and has following functional components.
 Master management
 User details
 TB Patient registration and details of diagnosis, DOT provider, HIV status, follow-up, contact tracing,
outcomes.
 Details of solid and liquid culture and DST, LPA, CBNAAT details.
 DR-TB patient registration with details.
 Referral and transfer of patients.
 Private health facility registration and TB notification
 Mobile application for TB notification.
 SMS alerts to patients on registration.
 SMS alerts to programme officers
 Automated periodic reports:. A. Case finding B. Sputum conversion C. Treatment outcome.