RNTCP-REVISED

NATIONAL
TUBERCULOSIS
CONTROL
PROGRAMME
WHAT IS TUBERCULOSIS?
 TB is a disease caused by bacterium M.tb
 Airborne transmission
 Any individual can be infected
 An individual infected with M. tb has only 10% life time risk to
develop active TB disease
 Co-infection with HIV or any immuno-deficient condition
increases this risk
 More than 80% TB affects the lungs
 About 50% are sputum smear positive and are infectious
 Any other organ of the body (except hair and nails) can be
affected- Extra- Pulmonary TB
 The best way to control TB is early detection and cure of infectious
pulmonary TB cases
STATUS OF TB-
 World-Incidence of TB-9.2 million new cases of TB
in2006.Of which 4.1 million were new smear positive
cases.
 Prevelance-14.4 million.
 Death due to TB-1.7 million.
 India-Upto,April-2010, total153,888 new sputum
positive patients registered for treatment
 In addition to this, 91,466new sputum negative cases,
 57,388 new extra pulmonary cases,
 48,252 sputum positive retreatment cases were
repported.
STATUS OF TB IN M.P.
 Total cases registered for T/T-20,394.
 New smear Positive registered cases-7810.
 % of sputum positive out of new total PTB-55%.
 % of new extra pulmonary cases out of all new cases-
14%.

 Source-http://www.tbcindia.org
NTP (NATIONAL TUBERCULOSIS PROGRAMME)

In operation since 1962

 Strategies-Early detection &t/t there by converting infectious to
non infectious cases.
 Diagnosis through sputum microscopy & radiology.
 Free domiciliary treatment through primary health services.
 Establishing District tuberculosis centre in every district.
 Extend coverage under Short Course Chemotherapy.
 Strengthen TB training & demonstration centers.
 NTP

Reasons of failure-
 Inadequate budgets.
 More emphasis on case detection than
cure.
 Undue emphasis on CXR,poor quality
sputum microscopy.
 Shortage & irregular supply of ATT,
hence completion rate of t/t is 30%.
 RNTCP
(REVISED NATIONAL TUBERCULOSIS CONTROL
PROGRAMME)
 Started on pilot scale in 1993
 RNTCP launched as a national programme in 1997
 Expansion was planned in a phased manner
 Rapid RNTCP expansion began in late 1998.
 Entire country covered under RNTCP by March’06
 RNTCP – GOAL AND OBJECTIVES
Goal
 The goal of TB control Programme is to decrease mortality and morbidity
due to TB and cut transmission of infection until TB ceases to be a major
public health problem in India. i.e.
 When one case infects less than one person annually.
 The prevalence of infection in the age group below 14 years is brought down
to less than 1%
Objectives:
 To achieve and maintain a cure rate of at least 85% in infectious cases
through supervised short course chemotherapy.
 To achieve and maintain a case detection of at least 70% of through quality
sputum microscopy.
 Involvement of NGOs; information , education and communication and
improved operational research.
 FIRST PHASE OF RNTCP (1998-2005)
 In the first phase the programme’s focus was on ensuring
expansion of quality DOTS services to the entire country.
SECOND PHASE OF RNTCP (2006-2011) .
 To strengthen the quality of DOTS through implementation of
RNTCP quality assurance protocol for sputum microscopy.
 Decentralized accessible & patient friendly DOTS services.
 Proactive public –pvt mix activities to increase the reach of
DOTS services.
 Rational use of standardized Ist & 2nd line ATT.
 Need based advocacy communication & social mobilization to
generate awareness & demand for quality services.
COMPONENTS OF DOTS

1. Political and administrative commitment

2. Good quality sputum microscopy
3. Uninterrupted supply of good quality anti TB
drugs-patient wise boxes.
4. Direct observation while patient is getting
chemotherapy by health worker or community
worker
5. Systematic monitoring and accountability
DOTS
 Results of sputum microscopy

If the slide has Result Grading No of fields to be

examined

> 10 AFB per oil immersion Pos 3+ 20

field

1-10 AFB per oil immersion Pos 2+ 50

field

10-00 AFB per 100 oil Pos 1+ 100

immersion field

1-9 AFB per 100 oil Pos Scanty 100

immersion fields

No AFB in 100 oil Neg 100

immersion fields
 LABORATORY NETWORK
Central TB division National reference lab National
(3) level
lab
committee
State TB division Intermediate reference State
lab(24) level

District TB centre District level

(11,000)

TU TU TU

DMC1 DMC2 DMC3

DEFINATIONS
TREATMENT REGIMENS IN RNTCP
All new cases - smear
Category I positive or negative, 2(HRZE)3 / 4(HR)3
Seriously ill sputum smear-
ve & seriously ill extra
pulmonary

Previously treated smear– 2(HRZES)3 /

Category II positive (relapse, failure,
1(HRZE)3 / 5(HRE)3
treatment after default)

H-Isoniazid,R-Rifampicin,Z-Pyrizinamide,E-Ethambutol
S-Streptomycin
ANTI-TUBERCULAR DRUGS
Medication Drug action Dose(Thrice Dose in children(mg/kg)
a week)***

Isoniazid Bactericidal 600 mg 10-15

Rifampicin Bactericidal 450 mg* 10

Pyrazinamide Bactericidal 1500 mg 25

Ethambutol Bacteriostatic 1200 mg 15

Streptomycin Bactericidal 0.75 g** 15

*Patients who weigh 60 kg or more at the start of treatment are given an extra 150mg
dose of rifampicin
**Patients over 50 years of age are given 0.5g of streptomycin
*** Adult patients weighing <30kg receive drugs in patients-wise from the weight band
suggested for pediatric patients
INTENSIVE PHASE
 In this phase all the doses are to be taken in
front of the DOTS provider
 Aims for a rapid killing of bacilli
 A state of non-infectiousness within 2 weeks
 Quick relief of symptoms
 Prevent development of drug resistance 
multi-drug regimens and DOT
CONTINUATION PHASE

 In this the first dose is taken in front of

DOTS provider, and rest dose of one week
is given to pt.The dose of the next week—
only after returning the empty blister
packs
 Aims to eliminate remaining bacilli
 Killing of “persisters” prevents relapses
SECOND-LINE ANTI-TUBERCULARDRUGS
 Flouroquinolones-Ofloxacin,Ciprofloxacin
 Kanamycin, Capreomycin
 Cycloserine
 Ethionamide
 PAS
 Amikacin
 SCHEDULE OF FOLLOW UP SPUTUM
SMEAR EXAMINATION
Cat. Pre–Rx Test at If: Then
of Rx Sputum month result

- C.P. – Sputum at 4 & 6 m

+ 2
Cat–1 + I.P. for 1month, Sp. At 3, 5 & 7

- C.P. Sputum at 6 months

- 2
+ I.P. for 1 month, SP. at 3, 5 & 7

Cat–II
- C.P. Sputum at 5 & 8 months
+ 3
+ I.P. for 1 month, Sp. at 4, 6 & 9
MANAGEMENT OF TB PT. ON DOTS IN SPECIAL SITUATONS
Multidrug Resistant (MDR) Tuberculosis : Resistant TB describes
strains of tuberculosis that are resistant to at least the two main
first - line TB drugs - isoniazid and rifampicin.

Dignosis-Cat-II-SSP +ve after 4 months of supervised T/T.Sent to IRL

for culture & DST.

RNTCP advocates using-a standardised treatment regimen

comprising of six drugs-(kanamycin, ofloxacin, ethionamide,
pyrazinamide, ethambutol and cycloserine) during 6 - 9 months of
the Intensive Phase
and
 4 drugs (ofloxacin, ethionamide, ethambutol and cycloserine)during
the 18 months of the Continuation Phase for cases of MDR - TB.
 EXTENSIVELY DRUG RESISTANT TUBERCULOSIS : XDR-TB

Resistant is MDR - TB WITH additional resistance to

Fluroquinolones & inject able 2nd line of drugs-
Kanamycin,Capreomycin,Amikacin.
TB+HIV
HIV and Tuberculosis are very strongly associated.HIV positive TB infected
person has a 50-60% lifetime risks of developing TB disease as compared
to an HIV negative TB infected person who has a 10% lifetime risk of
developing TB disease.
 Anti - TB treatment is the same for HIV – infected persons as it is for
HIV negative TB patients.
 All new TB cases known to be HIV positive are classified as seriously ill
and treated with Category I regimen.
 The re - treatment cases are to be treated with Category II regimen.
 TB patients should be encouraged to voluntarily share their HIV status
with the treating physician. for the purpose of taking clinical decisions
like categorization for treatment of TB, treatment of other opportunistic
infections and provision of ART.
 ART started in Extra pulmonary TB stage-4+Pulmonary TB with CD4
count <350cells/dl.
Treatment of TB during pregnancy and
postnatal period
•Streptomycin,Fluroquinolones,Ethionamide should not
be given,HRZE are safe
•Continuation of breast-feeding regardless of mother’s
TB status
•Advise to cover the mouth of the mother during breast-
feeding if she smear +ve.
•Chemoprophylaxis of the baby if mother is smear +ve
Isoniazid (5 mg per kg body wt)for 3months.
•Tuberculin test is done-
•test is more than>6mm-INH for 3 mths.
•Tuberculin test- give BCG in non vaccinated.
 FINANCIAL RESOURCES
 World bank
 Department for international development(DFID)
 Global TB drug facility(GDF)
 Global fund to fight AIDS , Tuberculosis and Malaria(GFATM)
 United States agency for international development (USAID)
 DANIDA
THANK YOU