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National Tuberculosis Control Program

National Tuberculosis Control Program. Lesson Objectives. At the end of the class students will be able to : understand the historical background of NTCP program List the objectives Explain the Organization and administration To know about the magnitude of TB problem

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National Tuberculosis Control Program

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  1. National Tuberculosis Control Program

  2. Lesson Objectives • At the end of the class students will be able to : • understand the historical background of NTCP program • List the objectives • Explain the Organization and administration • To know about the magnitude of TB problem • To know about the evolution of TB control in India • To learn about the strategies • To know about the achievements and progress

  3. REVISED NATIONAL TUBERCULOSIS CONTROL PROGRAMME Introduction India accounts for nearly one- fifth of the global TB incident . In 2007 , out of the global annual incidence of 9.23 million TB cases, 1. 96 million were estimated to have occurred in india. National tuberculosis control programme is continuing since 1962 and is associated with general health services .

  4. General Objectives Long term objective : Reducing the number of patients in the community Short term objectives : • Identifying the maximum number of TB patients amongst all those patient who are visiting the hospitals /health centers • Giving BCG vaccination to newborn babies and other children • Using all the medical institution s of country , by integrating them in achieving the above mentioned objectives

  5. Organization and administration • Central level • Besides the Tuberculosis Division in the DirectorateGeneral Health services, National Tuberculosis Institute, Bangalore and Tuberculosis Research centre at Chennai • District level • A district constitutes a functional unit of the NTCP and is called District Tuberculosis Control Program • Peripheral level • Comprises of chest clinics and Primary Health Centers (PHC)

  6. Organization for RNTCP at state Unit /officer Officer /STAFF • State TB Training and Director demonstration center • State TB office State TB officer • District TB center District TB officer, Medical officer - 1, senior Treatment Supervisor ,Senior TB Laboratory Supervisor (x- Ray Technician, Statistical assistant, Pharmacist, Health visitor etc) • Microscopy TB center DOTs provider • Treatment center

  7. Magnitude of the Problem Global annual incidence = 9.1 million India annual incidence = 1.9 million India is 17th among 22 High Burden Countries (in terms of TB incidence rate) Source: WHO Geneva; WHO Report 2008: Global Tuberculosis Control; Surveillance, Planning and Financing

  8. Global Burden of Tuberculosis • TB is one of the leading causes of death due to infectious disease in the world • Almost 2 billion people are infected with M. tuberculosis • Each year about: • 9 million people develop TB disease • 2 million people die of TB

  9. Contribution of India to Global TB Control* 5.28 m ? 4.92 m ? 23% 23% *WHO Global TB Report 2007 & 2008

  10. Program Implementation( prior to RNTCP) Program activities were: • Case detection • Case treatment • Health education • BCG vaccination

  11. Program performance and evolution of RNTCP • Despite a nationwide network of facilities , NTCP failed to yield satisfactory results. The situation did not change much. • The case finding efficiency was only 30 of the expected level although the mortality rate decreased to 53/100,00 population • Government of India launched the Revised National Tuberculosis Control Program(RNTCP) in 1997 encouraged by the results of Pilot studies were tested in 1993-94

  12. Evolution of TB Control in India • 1950s-60s Important TB research at TRC and NTI • 1962 National TB Programme (NTP) • 1992 Programme Review • only 30% of patients diagnosed; • of these, only 30% treated successfully • 1993 RNTCP pilot began • 1998 RNTCP scale-up • 2001 450 million population covered • 2004 >80% of country covered • 2006 Entire country covered by RNTCP

  13. Revised National TB Control Program(RNTCP) • Launched in 1997 based on WHO DOTS Strategy • Entire country covered in March’06 through an unprecedented rapid expansion of DOTS • Implemented as 100% centrally sponsored program • 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

  14. 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

  15. Strategy • Augmentation of organizational support at the central and state level for meaningful coordination • Increase in budgetary outlay • Use of Sputum microscopy as a primary method of diagnosis among self reporting patients • Standardized treatment regimens.

  16. contd. 7 Augmentation of the peripheral level supervision through the creation of a sub district supervisory unit 8. Ensuring a regular uninterrupted supply of drugs up to the most peripheral level 9. Emphasis on training, IEC, operational research and NGO involvement in the program

  17. Core elements of Phase I • The core element of RNTCP in Phase I (1997-2006)was 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

  18. DOTS • WHO recommended the special strategy of RNTCP , DOTS – Directly Observed Treatment Short Course was launched in the country in March 1997 and was implemented in a face manner . • By March 2006 , entire population of the country in all 632 district had been covered under the programme it was following 3 features

  19. RNTCP Phase II( 2006-11) • The RNTCP phase II is envisaged 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

  20. RNTCP • Other Aspects of RNTCP • A. Drug Resistance Surveillance • B. DOTS- Plus for management of Multi Drug Resistant TB • C. Advocacy ,communication and social Mobilization (ACSM) • D. Pediatric Tuberculosis • E. Public Private mix in RNTCP • F. Support to Medical Colleges l TB hospital • G. Urban TB for Slum Dwellers • H. TB- HIV co-ordination • I. Emphasis on quality control of diagnosis on drug and encouraging to search activities • J. Financial assistance

  21. Diagnosis of TB in RNTCP: Smear examination Cough for 3 weeks or More 3 Negative 3 sputum smears 3 or 2 positives 1 positive smear Antibiotics 1-2 weeks X- ray Symptoms persist positive smear negative Smear-Positive TB X-ray Negative For TB Positive Anti-TB Treatment Smear-Negative TB Non-TB Anti-TB Treatment

  22. Classification of Patients in Categories for Standardized Treatment Regimen

  23. Contd.

  24. Types of Drug-Resistant TB Mono-resistant Resistant to any one TB treatment drug Poly-resistant Resistant to at least any two TB drugs (but not both isoniazid and rifampicin) Multidrug- resistant (MDR TB)Resistant to at least isoniazid and rifampicin, the two best first-line TB treatment drugs Extensively drug-resistant (XDR TB) Resistant to isoniazid and rifampicin, PLUS resistant to any fluoroquinolone AND at least 1 of the 3 injectable second-line drugs (e.g., amikacin, kanamycin, or capreomycin)

  25. RNTCP Organization structure: State level Health Minister Health Secretary MD NRHM Director Health Services Additional / Deputy / Joint Director (State TB Officer) State TB Cell Deputy STO, MO, Accountant, IEC Officer, SA, DEO, TB HIV Coordinator etc., State Training and Demonstration Center (TB) Director, IRL Microbiologist, MO, Epidemiologist/statistician, IRL LTs etc.,

  26. Program innovations Creation of sub district level supervisory and monitoring unit “TB Unit” Patient-wise individual drug boxes for entire course of treatment Community involvement in DOTs – shopkeepers, teachers, postmen, cured patients, etc Continuous Internal Evaluation of districts Monitoring strategy document with checklists NGO & PP (Private Provider) schemes Task Force mechanism for involvement of Medical colleges Web based IEC/ ACSM resource centre

  27. Contd. • District TB Control Society • Modular training • Patient wise boxes • Sub-district level supervisory staff (STS, STLS) for • Treatment & microscopy • Robust reporting and recording system

  28. Quality Diagnostic and Treatment Services ~12,500 decentralized designated microscopy centers established External Quality Assurance (EQA) system for sputum microscopy as per international guidelines Quality assured anti-TB drugs Patient friendly DOT services

  29. Data Management System: RNTCP

  30. Public Private Mix (PPM) Activities for Involvement of All Health Care Providers • Involvement of NGOs and Private Practitioners • Schemes revised in 2008 • Presently > 2500 NGOs, 17,000 PPs involved • Involvement of professional bodies like IMA, IAP • Other Central government departments/PSUs • CGHS, Railways, ESI, Mining, Shipping • Corporate sector • ~150 Corporate Houses participating • Involvement of FBOs like CBCI • Involvement of Medical Colleges • Task Forces and Core Committees formed • 260 Medical colleges involved

  31. Progress Towards Millennium Development Goals 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 The global NSP case detection rate is 61% (2006) and treatment success rate is 85% RNTCP consistently achieving global bench mark of 85% treatment success rate for NSP; and case detection rate 70% (2007)

  32. TB-HIV: Accomplishments • Developed and implemented mechanism for TB & HIV program collaboration at all levels (National, State, District) • Conducted surveillance and determined national burden of HIV in TB patients • Mainstreamed TB-HIV activities as core responsibility of both programs (training & monitoring)

  33. TB-HIV: Current Policies (2008) TB/HIV activities in all States • Coordination & Training on TB/HIV • Intensified Case Finding (ICF) • Referral of all HIV- TB patients for HIV care and support (CPT & ART) • Involve NGOs Activities in high-HIV states • Provider-initiated HIV counseling and testing for all TB patients • Decentralized provision of Co-trimoxazole • Expanded TB-HIV monitoring

  34. By 2010 DOTS-Plus services available in all states By 2012, universal access under RNTCP to laboratory based quality assured MDR-TB diagnosis for all retreatment TB cases and new cases who have failed treatment By 2012, free and quality assured treatment to all MDR-TB cases diagnosed under RNTCP (~30,000 annually) By 2015, universal access to MDR diagnosis and treatment for all smear positive TB cases under RNTCP RNTCP- DOTS-Plus Vision

  35. CONCLUSION Revised National Tuberculosis Control Program is the state-run tuberculosis control initiative of the Government of India. As per the National Strategic Plan 2012–17, the program has a vision of achieving a "TB free India", and aims to achieve Universal Access to TB control services.

  36. Recapitulation List the objectives of RNTCP ? Explain the Organization and administration ? Discuss about the strategies

  37. Evaluation 1.RNTC Programme was launched in the year……….. (1972, 1997, 1955 , 1994) 2.List down the strategies of RNTCP ?

  38. Bibliography • 1.Park J E & K Park, Text Book of P & S.M., M/s BanarsidasmBhanot, Jabalpur • 2. Mahajan B K and M/C.Gupta, Text Book of P & S.M., Jaypee Publications • 3 .SwatiBhave ,Bhave's Textbook of Adolescent Medicine Paperback – 2 • 4. David MN Paperny, Handbook of Adolescent Medicine and Health Promotion, FSAHM University of Hawaii, USA • 5 S. Neinstein Lawrence, Adolescent Health Care, A Practical Guide Fifth Edition • 6. Gulani K. K, community health nursing, principles and practices . • 7. Stanhope community health nursing 1st edition.mosbyphiladelhia.

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