NATIONAL TUBERCULOSIS CONTROL PROGRAM

Prepared By:

CHRISTINE V. PARCON, RN, MAN

The National Tuberculosis Control Program

Vision: A country where TB is no longer a

public health problem

Mission: Ensure that TB DOTS services are

available, accessible, and affordable to the
communities in collaboration with the LGUs
and other partners
 Goal: To reduce prevalence and mortality
from TB by half by the year 2015 (Millenium
Development Goal)

 Target: 1. Cure at least 85% of the sputum

smear-positive TB patient discovered
2. Detect at least 70% of the
estimated new sputum smear-positive TB
cases
Key Policies
A. Casefinding

1. Direct Sputum Smear Microscopy (DSSM)

shall be the primary diagnostic tool in NTP
case finding.
2. All TB symptomatics identified shall be
asked to undergo DSSM for diagnosis before
start of treatment, regardless of whether or
not they have available X-ray results or
whether or not they are ssuspected of
having extra-pulmonary TB. The only
contraindication for sputum collection is
hemoptysis; in which case, DSSM will be
requested after control of hemoptysis
3. Pulmonary TB symptomatics shall be asked
to undergo other diagnostic tests (X-ray and
culture), if necessary, only after they have
undergone DSSM for diagnosis with 3
sputum specimens yielding negative results.
Diagnosis based on x-ray shall be made by
the TB Diagnostic Committee (TBDC).
4. Since DSSM is the primary diagnostic tool,
no TB diagnosis shall be made based on the
results of X-ray examinations alone.
Likewise results of the skin test for TB
infection (PPD skin test) should not be used
as bases for TB diagnosis in adults.
5. Active and Passive case finding shall be
implemented in all health stations.
6.Only trained medical technologies or
microscopists shall perform DSSM
(smearing, fixing, and staining of sputum
specimens, as well as reading, recording,
and reporting of results. However, in far
flung areas, BHWs may be allowed to do
smearing and fixing of specimens, as long as
they have been trained and are
supervised by their respective NTP medical
technologists/microscopists.
B. Treatment

1. Aside from clinical findings, treatment of

all TB cases shall be based on a reliable
diagnostic technique, namely, DSSM.
2. Domiciliary treatment shall be the
preferred mode of care.
C. Patients with the following conditions shall
be recommended for hospitalization:
1. Massive hemoptysis
2. Pleural effusion obliterating more than
one-half of a lung field
3. Miliary TB
4. TB meningitis
5. Those requiring surgical intervention or
with complications
D. All patients undergoing treatment shall be
supervised (DOT). No patient shall initiate
treatment unless the patient and DOTS
facility staff have agreed upon a case holding
mechanism for treatment compliance.

E. The national and local government units

shall ensure provision of drugs to all smear-
positive TB cases.
There are 2 formulations of anti-TB drugs:
1. Fixed-dose combination (FDCs)- 2 or more
first line anti-TB drugs are combined in
one tablet. There are 2-,3-, or 4-drug fixed-
dose combinations.
2. Single drug formulation (SDF)-each drug
is prepared individually. INH, Ethambutol,
and Pyrazinamide are in tablet form while
Rifampicin is in capsule form.
F. Quality of FDCs must be ensured. FDCs
must be ordered from a source with a track
record of producing FDCs according to
WHO-prescribed strenght and standard of
quality.

G. Treatment shall be based on recommended

category of treatment regimen
Category Type of TB Treatment Regimen
Patient
Intensive Phase Continuation
Phase
I •New smear-
positive PTB
•New smear-
negative PTB
with excessive
parenchymal 2HRZE 4 HR
lessions on
CXR as
assessed by the
TBDC
•EPTB, and
•Severe
concomitant HIV
disease
II •Treatment
Failure 2HRZES/1H 5HRE
•Relapse RZE
•Return
After Default
•Other
III •New smear-
negative PTB 2HRZE 4 HR
with minimal
parenchymal
lesions on
CXR as
assessed by
the TBDC
IV Chronic Refer to specialized
(still facility or DOTS
smear- Plus Center
positive Refer to
after Provincial/City NTP
supervis Coordinator
ed re-
treatment
)
 THANK YOU FOR LISTENING!!!