REVISED NATIONAL TUBERCULOSIS CONTROL PROGRAMME (RNTCP)
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RNTCP
MILE STONES OF RNTCP
1962-NTP (NATIONAL TUBERCULOSIS
PROGRAMME) 1992-GOI,WB,WHO REVIEWED NTP 1993-RNTCP PILOT PROJECT STARTED 1998-LARGE SCALE IMPLEMENTATION OF RNTCP 2006-WHOLE COUNTRY COVERED BY RNTCP
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RNTCP
NTP (1962)
OBJECTIVES: To identify and treat as large a number of TB patients as possible so that infectious cases are rendered noninfectious. To reduce the magnitude of TB problem in the country to a level where it ceases to be a public health problem. PROGRAM ACTIVITIES WERE: Case detection Case treatment Health education BCG vaccination
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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
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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
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RNTCP
Organization and administration
Central level
Tuberculosis Division in the Directorate General
Health services
National Tuberculosis Institute, Bangalore and
Tuberculosis Research centre at Chennai
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RNTCP
Health Minister
Health Secretary MD NRHM Director Health Services
Additional / Deputy / Joint Director (State TB Officer)
State Training and Demonstration Center (TB) Director, IRL Microbiologist, MO, Epidemiologist/statistician, IRL LTs etc.,
State TB Cell Deputy STO, MO, Accountant, IEC Officer, SA, DEO, TB HIV Coordinator etc.,
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IRL-INTERMEDIATE REFERNCE LABORATORY
Structure of RNTCP at district levels
District Administration
District Magistrate/ District Collector
District Health Services
Chief Medical Officer and other supporting staff
Nodal point for TB control
District TB Centre
DTO, MO-DTC
One/ 500,000 (250,000 in hilly/ difficult/ tribal area)
Tuberculosis Unit
Medical officer-TB Control, Senior Treatment supervisor(STS), Senior TB Laboratory Supervisor(STLS)
One/ 100,000
(50,000 in hilly/ difficult/ tribal area)
Microscopy Centre
Medical Officer, paramedical staff And Laboratory Technician
TB Health Visitors (TBHV), DOT Provider (MPW, NGO, ASHA, Community Volunteers)
DOT Centre
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LABORATORY NETWORK UNDER RNTCP
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RNTCP
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Diagnosis of TB in RNTCP: Smear examination
Cough for 3 weeks or More
3 sputum smears
3 or 2 positives 1 positive smear
3 Negative Antibiotics 1-2 weeks Symptoms persist X-ray Negative For TB
X- ray
positive Smear-Positive TB negative
Positive Smear-Negative TB Anti-TB Treatment
Anti-TB Treatment Non-TB
DOTS DIRECTLY OBSERVED TREATMENT SHORT COURSE
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RNTCP
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Components of DOTS
Political and administrative commitment
Good quality diagnosis, primarily by sputum smear microscopy
Uninterrupted supply of good quality drugs
Directly observed treatment (DOT)
accountabilitY
The emergence of resistance to drugs used to treat TB, and particularly multi-drug-resistant TB (MDR TB), has become a significant public health problem and an obstacle to effective TB control.
Atleast resistant to INH & Rifampicin with or without resistance to other TB drugs
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XDR TB
XDR TB = MDR TB+ Resistant to Second line injectable Anti TB drug & Fluroquinolone Second line drugs-ethionamide,capreomycin,kanamycin etc
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DOTS Plus
DOTS Plus refers to a DOTS program that adds components for MDR TB diagnosis, management, and treatment. For diagnosing MDR TB cases RNTCP has introduced state level quality assured laboratories with facilities for sputum culture.
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TB and HIV co-ordination
Key areas of focus : Sensitization of key policy makers to address importance of TB-HIV coordination. Co-ordination of service delivery and cross referrals Joint training programmes VCTC RNTCP coordination Use of universal precautions to prevent TB in HIV treatment facilities and prevent spread of HIV through safe injection practices in RNTCP. Joint IEC campaigns and evaluation systems Active involvement of NGOs,private practitioners and corporate sector.
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Pediatric tuberculosis
Drugs for pediatric TB patients are also supplied
on patient wise boxes (PWBs) Treatment based on childs body weight 2 generic pediatric PWBs 6 -10 kg weight band 11-17 kg weight band
Global first for RNTCP as no other DOTS programme has PWBs for children.
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RNTCP PHASES
RNTCP PHASE I 1997-2006 RNTCP PHASE II 2006-2011 RNTCP PHASE III 2012-2017
RNTCP in Phase I (1997-2006)was to ensure high quality DOTS expansion in the country
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RNTCP PHASE II 2006-2011
Pursue quality DOTS expansion and enhancement Address TB-HIV, MDR-TB and other challenges, Contribute to health system strengthening, Involve all health care providers, Engage people with TB, and affected communities Enable and promote research
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Programme activities necessary to achieve RNTCP III(2012-2017) targets
Strengthening and improving the quality of basic DOTS services Further strengthen and align with the health system under National Rural Health Mission (NRHM) Deploying improved rapid TB diagnostics to the field level Strengthen urban TB control Expand diagnosis and treatment of drug-resistant TB Improve communication and outreach and social mobilization Promote research for development and implementation of improved tools and strategies
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ACHIEVEMENTS OF RNTCP
COVERS WHOLE COUNTRY BY 2006
TREATMENT SUCCESS RATE INCREASED FROM 25% TO 87 %
DEATH RATE REDUCED FROM 29% TO 4%
INVOLVEMENT OF NGOS,PRIVATE PRACTITIONERS ALONG
WITH GENERAL HEALTH CARE SYSTEM
TRAINING OF MORE THAN 5 LAKH HEALTH WORKERS MORE THAN 12,000 DMCS ESTABLISHED THROUGHOUT THE
COUNTRY
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STOP TB STRATEGY BY WHO
FROM 2006-2015 (10 YEARS) DOTS IS THE CORE OF THIS STRATEGY
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