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Current Challenges of RNTCP in India - Achievements, Status & Future Goals

Learn about the TB burden in India, accomplishments of the Revised National TB Control Programme (RNTCP), challenges faced, and future objectives as discussed at a 2004 conference. Discover the progress, statistics, and initiatives undertaken to combat tuberculosis in India.

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Current Challenges of RNTCP in India - Achievements, Status & Future Goals

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  1. Current Challenges of the Revised National TB Control Programme (RNTCP) in India 31st Annual conference of IAPSMPGIMER: 28th February 2004 Dr LS Chauhan Deputy Director General (TB) Directorate General of Health Services Ministry of Health & Family Welfare Nirman Bhawan, New Delhi 110 011

  2. TB Burden, RNTCP and its achievements

  3. TB Burden, India (2001) - Nearly one third of the global TB burden Annually:* • Total new cases 1.8 million • New smear-positive cases 795,000 • TB deaths 417,000 Daily: • > 20,000 people become infected • More than 5,000 people develop TB • More than 1,000 people die Source: provisional WHO estimates Sept 2003

  4. Status of TB control in India • 1950s-60s: Important TB research • 1962: National TB Programme • 1992: Programme Review- only 30% of patients diagnosed and only 30% of those treated successfully • 1993: RNTCP pilots the DOTS strategy • 1998: Rapid scale-up begins • 2000: > 30% of country covered under RNTCP • 2003: >75% of country covered by DOTS

  5. RNTCP: Goal & Objectives Goal To decrease mortality and morbidity due to TB, and to interrupt the chain of transmission in order that TB is no longer a major public health problem in India Objectives To cure at least 85% of new smear positive pulmonary cases; and To detect at least 70% of estimated new smear positive cases existing in the community, after achieving the first objective

  6. India RNTCP (DOTS) implementation status by district, 31st Jan 2004

  7. Summary : RNTCP Achievements 1 Fastest expansion in the world 10-15 million million additional population covered each month >40 fold expansion of DOTS in past 4.5 yrs 2nd largest programme in the world > 80,000 patients placed on treatment every month Treatment success rate more than 85% More than 8 out of 10 patients successfully treated Treatment success rates have tripled from 25% to 85% TB death rates have been cut 7-fold from 29% to 4% To date nearly 2.8 million patients placed on treatment more than 500,000 additional lives saved

  8. Summary : RNTCP achievements 2 To achieve the above Sound training materials developed for all categories of staff > 300 000 health workers trained > 7,700 Microscopy centres established Evaluation findings: Well established logistic system 99% patients received free drugs and free microscopy services Published data at Central level reflects the programme activities in the field Highly economical costing < US$ 5 cents per capita

  9. RNTCP: Thrust areas & challenges

  10. DOTS expansion, India (1993-2005)

  11. TB/HIV Coordination • Action plan for TB/HIV collaboration developed and initiated in 6 high HIV burden states • Sensitization/training of key policy makers, programme staff and other partners undertaken • HIV/TB training manuals, treatment guidelines for TB among HIV-positive patients developed & disseminated • Referral linkages between VCTC and MCs established: as a result, 7000 HIV+ individuals put on DOTS. • TB/HIV coordination activities being expanded to 8 other States in the near future

  12. Public-private mix (PPM) • Ongoing efforts to involve all providers of care • Guidelines for private practitioners (PPs) and NGOs developed • >3000 PPs involved • Over 50 corporate sector establishments engaged • Tea Garden hospitals in West Bengal, Nilgiris in TN • Sugar mill in Meerut, Uttar Pradesh • Eastern coal fields in Bardhaman • 750 NGOs involved • Documentation of existing PPM projects (e.g., Kannur, Thane, Pune, tea gardens etc.) initiated Promising results seen from evaluation of existing PPM projects

  13. Medical Colleges & Hospitals • Consensus workshop organized to define structure and process for effective involvement of medical colleges in RNTCP • 7 nodal centres identified • 1 National, 5 Zonal Task Forces established. • 19/23 States have formed State task forces • 131 Medical colleges implementing DOTS • Action plans developed and participation of medical colleges sought in: • Providing RNTCP services • Training and teaching of RNTCP • Advocacy for RNTCP • Operational research

  14. Contribution from Medical Colleges hospitals: an example • In Gujarat, medical colleges contributed to over 11% of the chest symptomatics examined for sputum microscopy. • Most of the colleges referred > 2% of their new adult OPD patients for sputum microscopy • 543 patients were started on treatment in medical college DOT centres alone. • Medical colleges played a particularly important role in managing complicated cases of TB and in the diagnosis and management of Extra Pulmonary TB patients.

  15. Pediatric TB • Practical problems associated with diagnosis & treatment of pediatric cases under RNTCP • difficulty in obtaining sputum, organizing drug in the form of combipacks in patient wise-boxes, linked to the child’s weight, monitoring issues • Present guidelines of Indian Academy of Pediatrics not consistent with the RNTCP guidelines • Ongoing consultations to formulate guidelines for diagnosis & Rx of Pediatric TB under RNTCP • Consensus has been reached that DOTS is the recommended strategy for Pediatric TB and intermittent SCC given under DOT should be used in children

  16. Operational Research • Two central co-ordination committees established • National research agenda developed and widely disseminated - www.tbcindia.org • Important centrally funded projects completed • National Annual Risk of TB Infection • Drug Resistance Surveillance • Utilization of RNTCP services by marginalized groups • Relevant operational research projects ongoing at central institutes, other setups • Research proposals for funding invited

  17. Information, Education and Communication (IEC) • Mass Media agency hired at the national level • Baseline KAP study undertaken • Workshops conducted at national and regional levels to review IEC plans and existing materials • TV spots, radio jingles and TB logo produced • IEC materials, flip charts distributed to states • Revision of TBC India website initiated • Communication for Behavioural Impact (COMBI), initiated as a pilot project in Kerala

  18. Summary : RNTCP Challenges 1 • Implementing DOTS in a large country like India • Expansion to cover entire country whilst maintaining quality. • Maintain treatment success rates and increase case detection rate to meet global targets by 2005 • Strengthening inter-sectoral collaboration: • NACO for TB/HIV coordination • Build/strengthen partnerships: Medical colleges, NGOs, PPs, ESIS, Railways, TB hospitals etc • Mobilize community participation

  19. Summary : RNTCP Challenges 2 • Strengthen State capacity for decentralized management • Strengthen ongoing and refresher training • Improve quality of implementation in urban areas • Further intensify IEC activities • Address issues related to: • Pediatric TB • Extra Pulmonary TB • Ongoing operational research to continuously improve on the programme

  20. Conclusion • DOTS is the BEST strategy we have for controlling TB now AND • The most contentious part of DOTS – is to DO it

  21. THANK YOU

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