1

REVISED NATIONAL TUBERCULOSIS CONTROL

PROGRAMME

PRESENTED BY- Arun Kumar MauryaINTERNMBBS 2010 (Regular)

CONTENTS Introduction. RNTCP Organization. RNTCP Strategy. RNTCP Phase 2. Diagnosis Drug MDR,XDR. Stop TB Strategy.

TB- BAROMETER OF SOCIAL WELFARE

Discovered by Robert koch. Mycobacterium tuberculosis- acid

and alcohol fast. Demonstrated by ZN staining. Persists as an important public health

problem seeking attention.

4

BURDEN OF TB Prevalence of TB infection 30% Incidence of TB infection 1.5%Incidence of sputum positive TB 75/lac/yearTB mortality 33/lac casesPrevalence of sputum positive TB 0.4%MDR TB 3.5%Resistance to 4 drugs in new cases 1%

Ref: WHO Global Report, 2006

DIFFERENCE B/W NTP & RNTCP

CRITERIA NTP(1962) RNTCP(1992) Objective- early diagnosis

and treatment. Operational target –not

defined. diagnosis-more emphasis

on x-ray

Breaking chain of transmission.

Cure rate->85%,case finding->70%

mainly sputum microscopy

6

EVOLUTION OF TB CONTROL IN INDIA

1962 National TB Programme (NTP)

1992 Programme Review 1993 RNTCP pilot began 2001 450 million population covered 2004 >80% of country covered 2006 Entire country covered by RNTCP 2007 DOTS plus for MDR

TB launched 2006-2010 RNTCP Phase 2

RNTCP ORGANIZATIONCENTRAL TB DIVISION (DGHS)

STATE TB CELL

DISTRICT TB CENTRE

TUBERCULOSIS UNIT

MICROSCOPY CENTRE

PERIPHERAL HEALTH INSTITUTIONS

REVISED NATIONAL TB CONTROL PROGRAM (RNTCP)

Launched in 1997 based on WHO DOTS Strategy Entire country covered in March’06

through rapid expansion of DOTS

Implemented as 100% centrally sponsored programme 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

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

RNTCP STRATEGY 1. Case finding – passive2. Two sputum smear3. Case holding and treatment – directly

observed4. TB UNIT at sub district level per every 5

lac population5. Microscopy centre per every 1 lac

population6. Present coverage is 100% , achieved in

2005

CORE ELEMENTS OF RNTCP PHASE I(1997-2006)

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

RNTCP PHASE II( 2006-11) The RNTCP phase II aims 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

13

DIAGNOSIS OF TB IN RNTCP: SMEAR EXAMINATION

Cough for 2 weeks or More

2 sputum smears 2 Negative

Antibiotics1-2 weeks

Symptomspersist

X-ray

NegativeFor TB

Positive

Smear-Negative TB

Anti-TB Treatment

Smear-Positive TB

Anti-TB Treatment

1 or 2 positives

Repeat 2 sputum

Any +ve -ve

05/01/2023

14

ATT DRUGS AND DOSAGE

ISONIAZID 600mg (10-15mg/kg)

RIFAMPICIN 450mg (10mg/kg)

PYRAZINAMIDE 1500mg (30-35mg/kg)

ETHAMBUTOL 1200mg (30mg/kg)

STREPTOMYCIN 750mg (15mg/kg)

CATEGORIZATION & TREATMENT REGIMENS IN RNTCP

CATEGORY TYPE OF PT. REGIMEN DURATION Cat-1 new ss+ve 2(HRZE)3 +4(HR)3 6

months Cat-2 relapse,failure,default 2(HRZES)3+1(HRZE)3; 5(HRE)3 8months

Cat-4 MDR-TB 6(KOCZEEt)+ 12-18(OCEEt) 18-24months

16

PEDIATRIC TREATMENT 6-11 kg – PC 13 12-17 kg – PC 14 18-25 kg – PC 13+14 26-30 kg – PC 14+14 PC 13 has IP[ H-75 mg, R-75mg,Z-250mg, E-200mg ]and CP [H-75 mg, R-75mg.] PC 14 has IP[H-150 mg, R-150 mg, Z-

500mg, E-400 mg] and CP[H-150 mg, R -150

mg]

17

DEFINITIONS

RELAPSE – A TB patient who was declared cured but now comes back with sputum smear positive.

FAILURE – Any TB patient who is sputum smear positive at 5 months or more after starting treatment or has become sputum smear positive during treatment.

CURED – Initially sputum smear positive , has completed treatment , had sputum smear negative on two occasions one of which was at the end of treatment.

DEFAULTER - Any patient who has not taken TB treatment for two months or more consecutively after starting treatment for atleast 1 month.

18

MDR TB MDR TB CASE - Any suspect who is sputum culture

positive and whose TB is due to Mycobacterium tuberculosis that are resistant in vitro to ISONIAZID and RIFAMPICIN with or without other ATT drugs .

CAUSES OF MDR TB - Incorrect prescription Irregular supply Non compliance Lack of supervision and follow up

MDR SUSPECTS - Any TB patient who fails category 1 . - Any category 2 patient sputum

positive at 4th month of treatment - Close contact of MDR TB patient found

to have smear positive TB

05/01/2023

19

TREATMENT OF MDR IN PREGNANCY

First trimester – kanamycin and ethionamide are contraindicated , PAS is used instead.

Second and Third trimester- kanamycin is contraindicated.Pregnancy with MDR

<20 weeks

Advised MTP

Start cat 4

>20weeks

Start modified cat 4 --omit kanamycin, add PAS till delivery.-replace PAS with kanamycin after deliveryAnd continue till end of IP

05/01/2023

20

TREATMENT OF MDR DEFAULTER RETURNS IN <6 MONTHS

Treatment duration prior to default

<3 months 3 month to end of IP During CP

Re register Restart category 4

Last culture result Re register Continue CPDo culture - if –ve continue CP - if +ve do DST+ ve - ve

Re register Re start category 4

Re register continue cat. 4 IPDo culture if –ve switch to CP after completing IP

05/01/2023

21

RETURN IN > 6 MONTHSDo culture

+ ve - ve

No treatment required

Do 1st and 2nd line DST

MDR

Re register Start cat. 4

XDR

Start cat. 5

05/01/2023

22

XDR TUBERCULOSIS Extensive drug resistant TB – Resistance to Rifampicin and Isoniazid

and to any member of quinolones family and to one of the injectable second line drug[Kanamycin , Capreomycin, Amikacin]

Priciple for treatment of MDR and XDR are same

XDR do not transmit easily in healthy population,yet is capable of causing epidemics in HIV populations.

05/01/2023

23

STOP TB STRATEGY In 2006 WHO launched STOP TB strategy. It is

implemented over the next 10 years as described in the global plan to STOP TB 2006-2015.

Vision A world free of TB

Goal To reduce dramatically the global burden of TB by 2015 in line with the Millennium Development Goals .

Objectives To achieve universal high quality diagnosis and treatmentTo reduce the suffering and socioeconomic burdenTo protect poor and vulnerable

Targets By 2005 detect at least 70% of new sputum +ve cases and cure at least 85% .By 2015 reduce TB prevalence and death rates by 50% of 1990By 2050, eliminate TB as a public health problem.[<1/million]

CURRENT EXPERIENCE WITHDOTS

DOTS is a proven cost-effective TB treatment strategy.

DOTS quickly makes infectious cases non-infectious and breaks the cycle of transmission.

prevents the development of drug-resistant strains of TB that are often fatal and very expensive to cure.

REFERENCE Text Book of Preventive & Social

Medicine(By - K. PARK) 22nd Edition

(Page 166 to 181) Harrison’s Principles of Internal

Medicine 18th Edition, Volume 1

(Page 1340 to 1359)

THANK YOU