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Part 2

Critical analysis of the T.B. Control Programme. NTP & RNTCP. Part 2.

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  1. Critical analysis of the T.B. Control Programme NTP & RNTCP Part 2

  2. 7.Ensure that :-A.The Patient is put on treatment as early as possible. B.The patient completes the full course of treatment.C.The Patient is subjected to follow up sputum Exams as per Schedule. D.The Patient must be subjected to the last follow up sputum exam.

  3. 7.Always give a course of Non- tubercular broad spectrum antibiotics for 10-15 days 8.Always take a good history of previous treatment 9. Good classification of cases ensures better treatment & better outcome.

  4. Diagnosis of Pulmonary Tuberculosis1.Patients with T.B.feel ill and seek care promptly.2.Active case finding is unneccesary&unproductive.(No Use of Organising Camps,Their only use is political)

  5. 3.Microscopy is appropiate technology,indicating infectiousness,risk of death,&priorityfor treatment. X-ray is non-specific for T.B.diagnosis.4.Serological & amplification technologies(PCRetc) currently of no proven value in T.B.Control.

  6. Role of Chest X-Raya)No chest X-Ray pattern is typical of T.B.b)10-15 % of culture-positive T.B.patients are not diagnosed by X-Ray. (K.TOMAN-1997)

  7. c) 40 % of patients diagnosed as having T.B. on the basis of x-ray alone do not have active T,B.Conclusion:-Xray is unreliable for diagnosing and monitoring treatment of Tuberculosis(K.TOMAN-1997)

  8. Objectivity & Reliability of Microscopy V/S X-Ray (inter observer Agreement)

  9. Specificity of sputum Examination v/s Chest X-Ray Examination

  10. Role of THREE Sputum Exams. (Three Sputum Smears are Optimal)

  11. Priority to Sput.+vecasesWHY ?1.Smear positive patients usually seek care. 2.Smear positive patients are 4-20 times more infectious

  12. 3.Untreated, a smear +ve patient may infect 10- 15 persons / year.4.Smear positive patients are much more likely to die if left untreated.

  13. Treatment Regimens of N.T.P Standard-Conventional Regimens:-(Inj under supervision,Drugs issued monthly) R-1 All New Pulmonary Sputum Positive Cases 2STH / 10 TH or 2SEH / 10 EH R-2 All Pulmonary Sputum Negative Cases &Extra- Pulmonary cases 12 TH or 12 EH (contd)

  14. Short Course Chaemotherapy(Inj Under supervision,Drugs issued fortnightly)R-A All New Pulm.Sputum +ve cases 2EHRZ /6 TH OR 6 EHR-B All Retreatment cases(Relapse,Failure,T.A.D.) 2SHRZ / S2H2R2 (Intensive phase under Supervision)

  15. Improvements in R.N.T.C.P.1.Societies formed at State & distt to facilitate flow of funds. 1.Burden of diagnosing &completing treatment of the patient is on the service provider,not on the patient.

  16. 2.The patient is now aV.I.P.3.The programme has been decentralized to a level of virtual T.B.Clinic at a popln.of 5 Lakhs & upto the level of DOT centres (popln. of 5000-7500).

  17. 4.Diagnosis is through a Diagnostic Algorhythm which gives the maximumyield of T.B.patients.

  18. 5.Emphasis is now on a better tool of diagnosis viz-SPUTUM EXAMINATION,that too with a Binocular microscope and with 3 sputum specimens.

  19. 6.Treatment is by standarized regimens(Categories) 7.Almost all the doses are by means of DOTS.

  20. 8Default retrieval by means of a well developed system consisting of:- a)Registration of only those patients who reside within distt. b)checking of addresses before doing registration. c)Default retrieval of all the patients within a maximum of 2 days(before the next dose)

  21. 9.Supply of drugs in seperate patientwise boxes. No shortage of drugs at any point & at any centre. 10.Strong system of Supervision-Provision of contractual S.T.S &S.T.L.S & one two wheeler with P.O.L.provided at T.U.level.

  22. 11. Strong system of accountability is in place.The resposibility of reporting patient’s outcome is that of the registering unit. 12.Goals are clearly defined ie- 85 % Cure rates & then 70 % case detection.

  23. 13.Monitoring & supervision from the level of C.T.D.to the level of T.B.Unit. 14.Concept of I.E.C. developed in the prog. Funds provided to theDistt.T.B.Socities.

  24. 15.N.G.O. Participation is being encouraged in a big way.Honest and dedicated N.G.Os are being invited to own one of the 5 schemes of the program.

  25. R.N.T.C.P. The 5 commitments of R.N.T.C.P. • Political commitment. • Diagnosis by microscopy. • Adequate supply of S.C.C. Drugs. • Directly Observed Treatment. • Accontabilility.

  26. Goals of R.N.T.C.P. 1. 85 % C U R E R A T E S And then 2. 70 % CASE DETECTION

  27. Treatment CategoriesCAT-I 1.New Pulm.Smear Positive T.B.cases 2.Seriously ill Pulm.Smear Neg. & Extra –Pulm.Cases Regimen- 2(EHRZ)3 4(HR)3

  28. CAT-2 Retreatment Cases-Relapse,Failure & Treatment after Default Cases.Regimen-2/3(SHERZ)3 5(HRE)

  29. CAT-3New Pulm Smear Neg T.B.Cases,New less Serious forms of Exrta Pulm T.B.CasesReg.-2(HRZ)3 4(HR)

  30. Directly Observed Treatment(DOTS)Why ? D O T S • An observer watches and helps the patient swallow the tablets. • Direct Observation ensures treatment for the entire course

  31. IS THE TREATMENT OFThe right Drugs In the right Doses & At the right interval D O T S

  32. Ensure that:- 1.Treatment Observer must be accesible& acceptable to the Patient and accountable to the Health System 2 .Observation is a service to the patients & providers D O T S D. O. T. S

  33. DOTS gives the desired results even when:- 1.Many patients do not take medicines regularly, even if excellent Health education is provided. 2.Impossible to predict which patient will take medicines

  34. .Why is it necessary to Directly Observe the Treatment ? 1.At least 1/3 of patients receiving self administered treatment do not adhere to treatment. 2.Impossible to predict which patients will take medicines. 3.DOT necessary at least in the initial phase of treament to ensure adherence and achieve Sputum smear conversion. 4.A T.B. patient missing one attendance can be traced immediately and counseled. D O T S

  35. T H A N K Y O U S I R Dr.S.K.Srivastava Dr.S.K.Srivastava

  36. Back To Part 1

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