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Revised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control Programme
Revised National Tuberculosis Control ProgrammeRevised National Revised National
Revised National
Revised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control Programme
Revised National Tuberculosis Control ProgrammeRevised National Revised National
Revised National
Revised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control Programme
Revised National Tuberculosis Control ProgrammeRevised National Revised National
Revised National
Revised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control Programme
Revised National Tuberculosis Control ProgrammeRevised National Revised National
Revised National
Revised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control Programme
Revised National Tuberculosis Control ProgrammeRevised National Revised National
Revised National
Revised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control Programme
Revised National Tuberculosis Control ProgrammeRevised National Revised National
Revised National
Revised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control Programme
Revised National Tuberculosis Control ProgrammeRevised National Revised National
Revised National
Revised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control Programme
Revised National Tuberculosis Control ProgrammeRevised National Revised National
Revised National
Revised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control Programme
Revised National Tuberculosis Control ProgrammeRevised National Revised National
Revised National
Revised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control Programme
Revised National Tuberculosis Control ProgrammeRevised National Revised National
Revised National
Revised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control Programme
Revised National Tuberculosis Control ProgrammeRevised National Revised National
Revised National
Revised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control Programme
Revised National Tuberculosis Control ProgrammeRevised National Revised National
Revised National
Revised National Tuberculosis Control Programme Revised National
Rev
ised
Nat
iona
l Tub
ercu
losi
s C
ontr
ol P
rogr
amm
e
Revised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control Programme
Revised National Tuberculosis Control Programme
Revised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control Programme
Revised National Tuberculosis Control Programme
Revised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control Programme
Revised National Tuberculosis Control ProgrammeCentral TB DivisionRevised National Tuberculosis Control ProgrammeCentral TB DivisionRevised National Tuberculosis Control Programme
Directorate General of Health ServicesRevised National Tuberculosis Control Programme
Directorate General of Health ServicesRevised National Tuberculosis Control Programme
Directorate General of Health ServicesRevised National Tuberculosis Control Programme
Directorate General of Health ServicesRevised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control ProgrammeDirectorate General of Health ServicesRevised National Tuberculosis Control ProgrammeDirectorate General of Health ServicesRevised National Tuberculosis Control Programme
Directorate General of Health ServicesRevised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control ProgrammeDirectorate General of Health ServicesRevised National Tuberculosis Control ProgrammeMinistry of Health and Family WelfareRevised National Tuberculosis Control ProgrammeMinistry of Health and Family WelfareRevised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control Programme
Ministry of Health and Family WelfareRevised National Tuberculosis Control ProgrammeNirman Bhavan, New Delhi - 110 011Revised National Tuberculosis Control ProgrammeNirman Bhavan, New Delhi - 110 011Revised National Tuberculosis Control Programme
RNTCPRevised National Tuberculosis Control Programme
RNTCPRevised National Tuberculosis Control Programme
Revised National Tuberculosis Control ProgrammeRNTCPRevised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control ProgrammeRNTCPRevised National Tuberculosis Control Programme
at a Revised National Tuberculosis Control Programme
at a Revised National Tuberculosis Control Programme
Revised National Tuberculosis Control Programmeat a Revised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control Programmeat a Revised National Tuberculosis Control Programme
GLANCERevised National Tuberculosis Control Programme
GLANCERevised National Tuberculosis Control Programme
Revised National Tuberculosis Control ProgrammeGLANCERevised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control ProgrammeGLANCERevised National Tuberculosis Control Programme
CONTENTSCONTENTSCONTENTS
DEFINITIONS: THE REVISED NATIONAL TUBERCULOSIS DEFINITIONS: THE REVISED NATIONAL TUBERCULOSIS DEFINITIONS: THE REVISED NATIONAL TUBERCULOSIS CONTROL PROGRAMME 5CONTROL PROGRAMME 5CONTROL PROGRAMME 5
DIAGNOSTIC ALGORITHM FOR PULMONARY TB 6DIAGNOSTIC ALGORITHM FOR PULMONARY TB 6DIAGNOSTIC ALGORITHM FOR PULMONARY TB 6
STAINING METHOD 7STAINING METHOD 7STAINING METHOD 7
Key steps in the preparation and staining of smears 7Key steps in the preparation and staining of smears 7Key steps in the preparation and staining of smears 7
Ziehl - Neelsen Staining Method 8Ziehl - Neelsen Staining Method 8Ziehl - Neelsen Staining Method 8
TREATMENT 9TREATMENT 9TREATMENT 9
ZONAL ARTIS AND ESTIMATED NSP CASES PER LAKH ZONAL ARTIS AND ESTIMATED NSP CASES PER LAKH ZONAL ARTIS AND ESTIMATED NSP CASES PER LAKH POPULATION 9POPULATION 9POPULATION 9
TREATMENT CATEGORIES AND SPUTUM EXAMINATION TREATMENT CATEGORIES AND SPUTUM EXAMINATION TREATMENT CATEGORIES AND SPUTUM EXAMINATION SCHEDULE 10SCHEDULE 10SCHEDULE 10
MANAGEMENT OF PATIENTS WHO INTERRUPT TREATMENT 12MANAGEMENT OF PATIENTS WHO INTERRUPT TREATMENT 12MANAGEMENT OF PATIENTS WHO INTERRUPT TREATMENT 12
TREATMENT OF CHILDREN 15TREATMENT OF CHILDREN 15TREATMENT OF CHILDREN 15
Algorithm for clinical monitoring of Pediatric TB 16Algorithm for clinical monitoring of Pediatric TB 16Algorithm for clinical monitoring of Pediatric TB 16
Chemoprophylaxis for Children 17Chemoprophylaxis for Children 17Chemoprophylaxis for Children 17
SYMPTOM-BASED APPROACH TO EVALUATION OF POSSIBLE SIDE SYMPTOM-BASED APPROACH TO EVALUATION OF POSSIBLE SIDE SYMPTOM-BASED APPROACH TO EVALUATION OF POSSIBLE SIDE EFFECTS OF ANTI-TB DRUGS USED IN RNTCP 18EFFECTS OF ANTI-TB DRUGS USED IN RNTCP 18EFFECTS OF ANTI-TB DRUGS USED IN RNTCP 18
MANAGEMENT OF TB PATIENTS ON DOT IN SPECIAL MANAGEMENT OF TB PATIENTS ON DOT IN SPECIAL MANAGEMENT OF TB PATIENTS ON DOT IN SPECIAL SITUATIONS 19SITUATIONS 19SITUATIONS 19
HOSPITALIZATION OF TB PATIENTS 20HOSPITALIZATION OF TB PATIENTS 20HOSPITALIZATION OF TB PATIENTS 20
SUPERVISORY VISITS 21SUPERVISORY VISITS 21SUPERVISORY VISITS 21
SUMMARY OF KEY INDICATORS AND POSSIBLE CORRECTIVE SUMMARY OF KEY INDICATORS AND POSSIBLE CORRECTIVE SUMMARY OF KEY INDICATORS AND POSSIBLE CORRECTIVE ACTIONS 22ACTIONS 22ACTIONS 22
NEW INDICATORS 26NEW INDICATORS 26NEW INDICATORS 26
RNTCP at a Glance 5
DEF
INIT
ION
S: TH
E REV
ISED
NA
TIO
NA
L TU
BER
CU
LOSIS
CO
NTRO
L PR
OG
RA
MM
E
Cas
e de
finiti
ons
Typ
es o
f ca
ses
Tre
atm
ent
outc
omes
Pulm
onar
y Tub
ercu
losi
s, S
mea
r-Po
sitiv
eTB in
a p
atie
nt w
ith
at le
ast
2 in
itia
l spu
tum
sm
ear
exam
inat
ions
(di
rect
sm
ear
mic
rosc
opy)
pos
itiv
e fo
r A
FB.
Or:
TB in
a p
atie
nt w
ith
one
sput
um s
mea
r ex
amin
atio
n po
sitive
for
AFB
and
rad
iogr
aphi
c ab
norm
alitie
s co
nsis
tent
with
active
pul
mon
ary
TB
as d
eter
min
ed b
y th
e tr
eating
MO
.O
r: TB in
a p
atie
nt w
ith
one
sput
um s
mea
r sp
ecim
en p
ositiv
e fo
r A
FB a
nd c
ultu
re p
ositiv
e fo
r M
.tub
ercu
losi
s.Pu
lmon
ary
tube
rcul
osis
, Sm
ear-
nega
tive
TB in
a p
atie
nt w
ith
sym
ptom
s su
gges
tive
of
TB w
ith
at le
ast
3 s
putu
m s
mea
r ex
amin
atio
ns
nega
tive
for
AFB
, an
d ra
diog
raph
ic a
bnor
mal
itie
s co
nsis
tent
with
active
pul
mon
ary
TB a
s de
term
ined
by
the
tre
atin
g M
O f
ollo
wed
by
a de
cisi
on t
o tr
eat
the
patien
t w
ith
a fu
ll co
urse
of
anti-t
uber
culo
sis
ther
apy.
Or:
D
iagn
osis
bas
ed o
n po
sitive
cul
ture
but
neg
ativ
e A
FB s
putu
m s
mea
r ex
amin
atio
ns.
Ex
tra
Pulm
onar
y tu
berc
ulos
isTB o
f an
y or
gan
othe
r th
an t
he lu
ngs,
suc
h as
th
e pl
eura
(TB p
leur
isy)
, ly
mph
nod
es,
inte
stin
es,
geni
tour
inar
y tr
act,
ski
n, jo
ints
and
bon
es,
men
inge
s of
the
bra
in,
etc.
Dia
gnos
is s
houl
d be
bas
ed o
n cu
ltur
e-po
sitive
sp
ecim
en fro
m the
ext
ra-p
ulm
onar
y si
te, hi
stol
ogic
al,
radi
olog
ical
, or
str
ong
clin
ical
evi
denc
e co
nsis
tent
w
ith
active
ext
ra p
ulm
onar
y TB f
ollo
wed
by
deci
sion
of
the
tre
atin
g M
O t
o tr
eat
with
a fu
ll co
urse
of
anti-
TB t
hera
py.
Pleu
risy
is c
lass
ifie
d as
ext
ra p
ulm
onar
y TB.
A p
atie
nt d
iagn
osed
with
both
spu
tum
sm
ear
posi
tive
pul
mon
ary
and
extr
a pu
lmon
ary
TB s
houl
d be
cla
ssifie
d as
pul
mon
ary
TB.
New
A
TB p
atie
nt w
ho h
as n
ever
had
tre
atm
ent
for
tube
rcul
osis
or
has
take
n an
ti-t
uber
culo
sis
drug
s fo
r le
ss t
han
one
mon
th.
Rel
apse
A T
B p
atie
nt w
ho w
as d
ecla
red
cure
d or
tre
atm
ent
com
plet
ed b
y a
phys
icia
n, b
ut w
ho r
epor
ts b
ack
to
the
heal
th s
ervi
ce a
nd is
now
fou
nd t
o be
spu
tum
sm
ear
posi
tive
.Tra
nsfe
rred
inA
TB p
atie
nt w
ho h
as b
een
rece
ived
for
tre
atm
ent
into
a T
uber
culo
sis
Uni
t, a
fter
sta
rtin
g tr
eatm
ent
in
anot
her
unit w
here
s/h
e ha
s be
en r
egis
tere
d.Tre
atm
ent
afte
r de
faul
tA
TB p
atie
nt w
ho r
ecei
ved
anti-t
uber
culo
sis
trea
tmen
t fo
r on
e m
onth
or
mor
e fr
om a
ny s
ourc
e an
d re
turn
s to
tre
atm
ent
afte
r ha
ving
def
aulted
, i.e
., n
ot t
aken
ant
i-TB d
rugs
con
secu
tive
ly f
or t
wo
mon
ths
or m
ore,
and
is f
ound
to
be s
putu
m s
mea
r po
sitive
. Fa
ilure
Any
TB p
atie
nt w
ho is
sm
ear
posi
tive
at
5 m
onth
s or
mor
e af
ter
star
ting
tre
atm
ent.
Fai
lure
als
o in
clud
es a
pat
ient
who
was
tre
ated
with
Cat
egor
y III
reg
imen
but
who
bec
omes
sm
ear
posi
tive
dur
ing
trea
tmen
t.
Chr
onic
A T
B p
atie
nt w
ho r
emai
ns s
mea
r po
sitive
aft
er
com
plet
ing
a re
-tre
atm
ent
regi
men
.O
ther
sTB p
atie
nts
who
do
not
fit
into
the
abo
ve m
ention
ed
type
s. R
easo
ns f
or p
utting
a p
atie
nt in
thi
s ty
pe
mus
t be
spe
cified
.
Cur
edIn
itia
lly s
putu
m s
mea
r-po
sitive
pat
ient
who
has
co
mpl
eted
tre
atm
ent
and
had
nega
tive
spu
tum
sm
ears
, on
tw
o oc
casi
ons,
one
of
whi
ch w
as a
t th
e en
d of
tre
atm
ent
Tre
atm
ent
com
plet
edSpu
tum
sm
ear-
posi
tive
pat
ient
who
has
com
plet
ed
trea
tmen
t, w
ith
nega
tive
sm
ears
at
the
end
of t
he
inte
nsiv
e ph
ase
but
none
at
the
end
of t
reat
men
t.
Or:
Spu
tum
sm
ear-
nega
tive
TB p
atie
nt w
ho h
as
rece
ived
a f
ull c
ours
e of
tre
atm
ent
and
has
not
beco
me
smea
r-po
sitive
dur
ing
or a
t th
e en
d of
tr
eatm
ent.
O
r:
Extr
a-pu
lmon
ary
TB p
atie
nt w
ho h
as r
ecei
ved
a fu
ll co
urse
of
trea
tmen
t an
d ha
s no
t be
com
e sm
ear-
posi
tive
dur
ing
or a
t th
e en
d of
tre
atm
ent.
Die
dPa
tien
t w
ho d
ied
durin
g th
e co
urse
of
trea
tmen
t re
gard
less
of
caus
eFa
ilure
Any
TB p
atie
nt w
ho is
sm
ear
posi
tive
at
5 m
onth
s or
mor
e af
ter
star
ting
tre
atm
ent.
Fai
lure
als
o in
clud
es a
pat
ient
who
was
tre
ated
with
Cat
egor
y III
reg
imen
but
who
bec
omes
sm
ear
posi
tive
dur
ing
trea
tmen
t.
Def
aulte
dA
pat
ient
who
has
not
tak
en a
nti-T
B d
rugs
for
2 m
onth
s or
mor
e co
nsec
utiv
ely
afte
r st
arting
tr
eatm
ent.
Tra
nsfe
rred
out
A p
atie
nt w
ho h
as b
een
tran
sfer
red
to a
noth
er
Tub
ercu
losi
s U
nit/
Dis
tric
t an
d hi
s/he
r tr
eatm
ent
resu
lt (
outc
ome)
is n
ot k
now
n.
RNTCP at a Glance6
DIAGNOSTIC ALGORITHM FOR PULMONARY TB
COUGH FOR 3 WEEKS OR MORECOUGH FOR 3 WEEKS OR MORE
3 Sputum smears3 Sputum smears
2 or 3 Positives2 or 3 Positives 3 Negatives3 Negatives
Antibiotics 10-14 daysAntibiotics 10-14 days
Cough PersistsCough Persists
Repeat 3 Sputum Repeat 3 Sputum Examinations
1 Positive
X-Ray Negative 2 or 3 Positives2 or 3 Positives
Suggestive of TBSuggestive of TB Negative for TBNegative for TB Sputum Positive Sputum Positive TB (Anti-TB Treatment)Treatment)
X-RaySputum Positive Sputum Positive
TB (Anti-TB Treatment)Treatment)
Negative for TBNegative for TB Suggestive of TBSuggestive of TB
Sputum Smear Sputum Smear Negative TB
(Anti-TB Treatment)(Anti-TB Treatment)
Non TB
RNTCP at a Glance 7
STAINING METHODKey steps in the preparation and staining of smears
Step 1
Break a broomstick into two
Pick up the large, yellow purulent portion of sputum Spread evenly onto 2/3 of central portion of the
numbered slide
Step 2
Spread evenly onto 2/3 of central portion of the
numbered slide
Air-dry the slide for 15–30
minutes
Step 3
Fix the dry slide by heating briefly 3–5 times for 3–4
seconds each time
Place the slides in serial order on the
staining rack
Stain the slides with 1% carbol
fuchsin
Step 4
Step 5
Heat the slides from underneath until vapours rise
Let the slides stand for 5 minutes
Rinse the slides with tap water
Step 6 Step 7
Drain off excess water
Decolourize with 25% sulphuric acid and let it stand for 2–4 minutes (repeat, letting
stand for 1–3 minutes, if necessary)
Step 8
Rinse away excess stain with tap water
Drain off the water
Step 9
Step 10
Counterstain with 0.1% methylene blue and let stand for 30 seconds
Gently rinse the slides with tap water, drain the water
off, and allow the slide to dry
Examine the slides under the microscope examine
at least 100 fields.
RNTCP at a Glance8
Ziehl - Neelsen Staining Method1. Select a new unscratched slide and label the slide with the Laboratory Serial
Number with a diamond marking pencil.2. Make a smear from yellow purulent portion of the sputum using a broom stick. A
good smear is spread evenly, 2 cms x 3 cms in size and is neither too thick nor too thin. The optimum thickness of the smear can be assessed by placing the smear on a printed matter. The print should be readable through the smear. Smear preparation should be done near a flame. This is required, as six inches around the flame is considered as a sterile zone which coagulates the aerosol raised during smear preparation.
3. Allow the slide to air dry for 15–30 minutes.4. Fix the slide by passing it over a flame 3–5 times for 3–4 seconds each time.5. Pour 1% filtered carbol fuchsin to cover the entire slide.6. Gently heat the slide with carbol fuchsin on it, until vapours rise. Do not boil.7. Leave carbol fuchsin on the slide for 5 minutes.8. Gently rinse the slide with tap water until all free carbol fuchsin stain is washed
away. At this point, the smear on the slide looks red in colour.9. Pour 25% sulphuric acid onto the slide.10. Let the slide stand for 2–4 minutes.11. Rinse gently with tap water. Tilt the slide to drain off the water.12. A properly decolourised slide will appear light pink in color .If the slide is still red,
reapply sulphuric acid for 1–3 minutes and rinse gently with tap water. Wipe the back of the slide clean with a swab dipped in sulphuric acid,
13. Pour 0.1% methylene blue onto the slide.14. Leave methylene blue on the slide for 30 seconds.15. Rinse gently with tap water.16. Allow the slide to dry.17. Examine the slide under the microscope using x 40 lens to select the suitable area
and then examine under x100 lens using a drop of immersion oil.18. Record the results in the Laboratory Form and the Laboratory Register.
If the slide has: Result Grading No. of fields to be examined
More than 10 AFB per oil immersion field Pos 3+ 20
1-10 AFB per oil immersion field Pos 2+ 50
10-99 AFB per 100 oil immersion fields Pos 1+ 100
1-9 AFB per 100 oil immersion fields Pos Scanty-B* 100
No AFB in 100 oil immersion fields Neg 100
*Record actual number of bacilli seen in 100 fields – e.g. “Scanty 4”
19. Invert the slides on tissue paper till the immersion oil is completely absorbed. Do not use xylene for cleaning the slides, as it may give false results at repeat examination after storage.
20. Store all positive and negative slides serially in the same slide-box until instructed by the supervisor.
21. Disinfect all contaminated material before discarding.
RNTCP at a Glance 9
TREATMENT
Is the patient sputum-smear positive*Is the patient sputum-smear positive*
Does the patient have TB?Does the patient have TB? Has the patient been treated for TB for one month or more
previously
NO YES
NO
YES
No Anti-TB treatment
Is the patient seriously ill?**
NO YES
NO
CAT IICAT II
YES
* Patients with extra-pulmonary TB should receive Category III treatment unless they are seriously ill, in which case they should receive Category I treatment.
** Examples of seriously ill patients are those suffering from meningitis, disseminated TB, tuberculous pericarditis, peritonitis, bilateral or extensive pleurisy, spinal TB with neurological complications, smear-negative pulmonary TB with extensive parenchymal involvement, intestinal, genito-urinary TB and co-infection with HIV. All forms of pediatric smear negative TB except primary complex and pediatric extrapulmonary TB except lymph node TB and unilateral pleural effusion.
ZONAL ANNUAL RISK OF TUBERCULOUS INFECTION (ARTI) AND ESTIMATED NSP CASES PER LAKH POPULATIONZone States/Union Territories Estimated NSP cases
per lakh population
North Haryana, Himachal Pradesh, Jammu & Kashmir, Punjab, Uttar Pradesh, Chandigarh, Delhi, Uttaranchal
95
East* Assam, Bihar, Manipur, Meghalaya, Mizoram, Nagaland, Sikkim, Tripura, West Bengal, Andaman & Nicobar, Arunachal Pradesh, Jharkhand
75
South* Andhra Pradesh, Karnataka, Kerala, Tamil Nadu, Pondicherry, Lakshadweep
75
West Goa, Gujarat, Madhya Pradesh, Maharashtra, Rajasthan, Dadra & Nagar Haveli, Daman & Diu, Chhattisgarh
80
State specific Orissa 85
CAT ICAT ICAT IIICAT III
RNTCP at a Glance10
TREA
TM
ENT C
ATEG
ORIE
S A
ND
SPU
TU
M E
XA
MIN
ATIO
N S
CH
EDU
LE
TREA
TM
ENT R
EGIM
ENSPU
TU
M E
XA
MIN
ATIO
NS F
OR P
ULM
ON
ARY
TB
Cat
egor
y of
Tre
at m
ent
Typ
e of
pat
ient
Reg
imen
*Pr
e-tr
eatm
ent
sput
umTes
t at
m
onth
(e
nd IP)
If r
esul
t is
The
n
Cat
egor
y I
New
spu
tum
sm
ear-
posi
tive
2H
3R
3Z
3E 3
+
4H
3R
3
+2
–Sta
rt c
ontinu
atio
n ph
ase,
tes
t sp
utum
aga
in a
t 2 m
onth
s in
CP
(4 m
onth
s) a
nd a
t th
e en
d of
tr
eatm
ent
(6 m
onth
s)
+C
ontinu
e In
tens
ive
phas
e fo
r on
e m
ore
mon
th,
test
spu
tum
aga
in a
t en
d of
ext
ende
d IP
(3 m
onth
s),
and
then
at
2 m
onth
s in
CP
(5 m
onth
s) a
nd a
t th
e en
d of
tre
atm
ent
(7
mon
ths)
†Ser
ious
ly il
l** s
putu
m s
mea
r-ne
gative
Ser
ious
ly il
l** e
xtra
-pul
mon
ary
–2
–Sta
rt c
ontinu
atio
n ph
ase,
tes
t sp
utum
aga
in a
t th
e en
d of
tre
atm
ent
(6 m
onth
s)
+
Con
tinu
e In
tens
ive
phas
e fo
r on
e m
ore
mon
th,
test
spu
tum
aga
in a
t en
d of
ext
ende
d IP
(3 m
onth
s),
and
then
at
2 m
onth
s in
CP
(5 m
onth
s) a
nd a
t th
e en
d of
tre
atm
ent
(7
mon
ths)
†
Cat
egor
y II
Spu
tum
sm
ear-
posi
tive
Rel
apse
Spu
tum
sm
ear-
posi
tive
Fai
lure
Spu
tum
sm
ear-
posi
tive
Tre
atm
ent af
ter
defa
ult
Oth
ers*
**
2H
3R
3Z
3E 3
S3 +
1H
3R
3Z
3E 3
+
5H
3R
3E 3
+3
–Sta
rt c
ontinu
atio
n ph
ase,
tes
t sp
utum
aga
in a
t 2 m
onth
s in
CP
(5 m
onth
s) a
nd a
t th
e en
d of
tr
eatm
ent
(8 m
onth
s)
+
Con
tinu
e In
tens
ive
phas
e fo
r on
e m
ore
mon
th,
test
spu
tum
aga
in a
t en
d of
ext
ende
d IP
(4 m
onth
s),
and
then
at
2 m
onth
s in
CP
(6 m
onth
s) a
nd a
t th
e en
d of
tre
atm
ent
(9
mon
ths)
Cat
egor
y III
New
spu
tum
sm
ear-
nega
tive
,no
t se
rious
ly il
l2H
3R
3Z
3 +
4H
3R
3
–
2–
Sta
rt c
ontinu
atio
n ph
ase,
tes
t sp
utum
aga
in a
t th
e en
d of
tre
atm
ent
(6 m
onth
s)
New
ext
ra-p
ulm
onar
y, n
ot s
erio
usly
ill
+Re-
regi
ster
the
pat
ient
and
beg
in C
ateg
ory
II tr
eatm
ent†
*
The
num
ber
befo
re t
he le
tter
s re
fers
to
the
num
ber
of m
onth
s of
tre
atm
ent.
The
sub
scrip
t af
ter
the
lett
ers
refe
rs t
o th
e nu
mbe
r of
dos
es p
er w
eek.
The
dos
age
stre
ngth
s ar
e as
fo
llow
s: H
: Is
onia
zid
(600 m
g),
R:
Rifam
pici
n (4
50 m
g),
Z:
Pyra
zina
mid
e (1
500 m
g),
E: E
tham
buto
l (1200 m
g),
S:
Str
epto
myc
in (
750 m
g).
Patien
ts w
ho w
eigh
60 k
g or
mor
e re
ceiv
e ad
dition
al r
ifam
pici
n 150 m
g. P
atie
nts
who
are
mor
e th
an 5
0 y
ears
old
rec
eive
str
epto
myc
in 5
00 m
g. P
atie
nts
who
wei
gh le
ss t
han
30 k
g, r
ecei
ve d
rugs
as
per
body
w
eigh
t. P
atie
nts
in C
ateg
orie
s I an
d II
who
hav
e a
posi
tive
spu
tum
sm
ear
at t
he e
nd o
f th
e in
itia
l int
ensi
ve p
hase
rec
eive
an
addi
tion
al m
onth
of
inte
nsiv
e ph
ase
trea
tmen
t.**
Ser
ious
ly il
l als
o in
clud
es,
any
patien
t, p
ulm
onar
y or
ext
ra-p
ulm
onar
y w
ho is
HIV
pos
itiv
e an
d de
clar
es h
is s
ero-
stat
us t
o th
e ca
tego
rizin
g/ t
reat
ing
med
ical
off
icer
. F
or t
he p
urpo
se
of c
ateg
oriz
atio
n, H
IV t
esting
sho
uld
not
be d
one
*** In
rare
and
exc
eption
al c
ases
, pa
tien
ts w
ho a
re s
putu
m s
mea
r-ne
gative
or
who
hav
e ex
tra-
pulm
onar
y di
seas
e ca
n ha
ve R
elap
se o
r Fa
ilure
. Thi
s di
agno
sis
in a
ll su
ch c
ases
sho
uld
alw
ays
be m
ade
by a
n M
O a
nd s
houl
d be
sup
port
ed b
y cu
ltur
e or
his
tolo
gica
l evi
denc
e of
cur
rent
, ac
tive
TB.
In t
hese
cas
es,
the
patien
t sh
ould
be
cate
goriz
ed a
s ‘O
ther
s’ a
nd
give
n C
ateg
ory
II tr
eatm
ent.
†
Any
pat
ient
tre
ated
with
Cat
egor
y I w
ho h
as a
pos
itiv
e sm
ear
at 5
mon
ths
or la
ter
shou
ld b
e co
nsid
ered
a F
ailu
re a
nd s
tart
ed o
n C
ateg
ory
II tr
eatm
ent
afre
sh.
Any
pat
ient
on
Cat
egor
y III
who
has
a p
ositiv
e sm
ear
anyt
ime
durin
g th
e tr
eatm
ent
is a
lso
cons
ider
ed a
s Fa
ilure
and
sta
rted
on
Cat
egor
y II
trea
tmen
t.
RNTCP at a Glance 11
MEDICATIONMedication Dose (thrice a week)*** Number of pills in
combipackIsonazid 600mg 2Rifampicin 450mg* 1Pyrazinamide 1500mg 2Ethambutol 1200mg 2Streptomycin 0.75g** -
Category Duration (number of doses) TotalIntensive Phase (IP) Continuation Phase (CP)
Category I 8 weeks (24 doses) 18 weeks (54 doses) 26 weeks (78 doses)Category II 12 weeks (36 doses) 22 weeks (66 doses) 34 weeks (102 doses)Category III 8 weeks (24 doses) 18 weeks (54 doses) 26 weeks (78 doses)
Phases and duration of treatment
* Patients who weigh 60kg or more at the start of treatment are given an extra 150mg dose of rifampicin** Patients over 50 years of age and those who weigh less than 30 kg are given 0.5g of streptomycin.*** Adult patients who weigh less than 30kg receive drugs in patient-wise boxes from the weight band
suggested for pediatric patients
Regimen for non-DOTS in RNTCP areasTreatment Type of Patient RegimenNon-DOTS Regimen 1 (ND 1)
New smear-positive pulmonary Seriously ill sputum smear-negativeSeriously ill extra-pulmonary
2 HSE + 10 HE
Non-DOTS Regimen 2 (ND 2)
Smear-negative pulmonary, not seriously illExtra-pulmonary, not seriously ill
12 HE
Duration if sputum is positive at end of Intensive Phase*Category Duration (number of doses) Total
Intensive Phase (IP) Continuation Phase (CP)Category I 12 weeks (36 doses) 18 weeks (54 doses) 26 weeks (90 doses)Category II 16 weeks (48 doses) 22 weeks (66 doses) 34 weeks (114doses)
* Cat I – at the end of 2 months Cat II – at the end of 3 months
In RNTCP areas, less then 5% of patients may get Non-DOTS Treatment
RNTCP at a Glance12
MANAGEMENT OF PATIENTS WHO INTERRUPT TREATMENT
Management of patients who were smear-negative at diagnosis and who interrupt treatment
Treatment received beforeinterruption
Length ofinterruption
Do a sputumSmear examination
Result of sputumSmear examination
Outcome Re-registration
Treatment
Less than1 month
Less than2 months
No __ __ __ ResumeTreatment andComplete All doses
2 months ormore
Yes Neg __ __ ResumeTreatment
Pos Default New Begin CAT Iafresh
More than1 month
Less than2 months
No __ __ __ ResumeTreatment andCompleteAll doses
More than 2 months
Yes Neg __ __ ResumeTreatment andCompleteAll doses
Pos Default Treatment After Default
Begin CAT IITreatmentafresh
RNTCP at a Glance 13
MANAGEMENT OF PATIENTS WHO INTERRUPT TREATMENT
Treatment for New smear-positive cases who interrupt treatment (Category I)
Treatment received before interruption
Length ofinterruption
Do a sputum Smear examination?
Result of sputum Smear examination
Outcome Re-registration
Treatment
Less than1 month
Less than2 weeks
No __ __ __ Continue CAT I*
2-7 weeks No __ __ __ Start again on CAT I**
8 weeksor more
Yes Positive Default New Start again on CAT I**
Negative __ __ Continue CAT I*
1-2 months Less than2 weeks
No __ __ __ Continue CAT I*
More than2 months
2-7 weeks Yes Positive __ __ 1 extra month of intensive phase of CAT I
8 weeks or more
Yes Negative __ __ Continue CAT I*
Positive Default Treatment After Default
Start on CAT II*
Less than2 weeks
No Negative __ __ Continue CAT I*
__ __ __ Continue CAT I*
2-7 weeks Yes Positive Default*** Other Start on CAT II**
8 weeks or more
Negative __ __ Continue CAT I*
Yes Positive Default Treatment After Default
Start on CAT II**
Negative __ __ Continue CAT I*
* A patient must complete all 24 doses of the initial intensive phase. For example, if a patient has to continue his previous treatment and he took 1 month of treatment (12 doses) before interrupting. He will have to take 1 more month (12 doses) of the intensive phase treatment. The patient will then start the continuation phase of treatment.
** A patient who must start again will restart treatment from the beginning.*** Although this patient does not strictly fit the definition of default. Default most closely describes the outcome of
this patient. although at re-registration the patient should be categorized as ‘Other’.
RNTCP at a Glance14
MANAGEMENT OF PATIENTS WHO INTERRUPT TREATMENT
Treatment for smear-positive retreatment cases who interrupt treatment (Category II)
Treatment received beforeinterruption
Length ofinterruption
Do a sputumSmear examination
Result of sputum Smear examination
Outcome Re-registration
Treatment
Less than1 month
Less than2 weeks
No __ __ __ Continue CAT II*
2-7 weeks No __ __ __ Start again on CAT II**
8 weeksor more
Yes Positive Default Treatment After Default
Start again on CAT II**
Negative __ __ Continue CAT II*
1-2 months
Less than2 weeks
No __ __ __ Continue CAT II*
2-7 weeks Yes Positive __ __ 1 extra month of intensive phase of CAT II
8 weeks or more
Yes Negative __ __ Continue CAT II*
Positive Default Treatment After Default
Start again on CAT II**
More than2 months
Less than2 weeks
No Negative __ __ Continue CAT II*
__ __ __ Continue CAT II*
2-7 weeks Yes Positive Default*** Other Start again on CAT II**
8 weeks or more
Negative __ __ Continue CAT II*
Yes Positive Default Treatment After Default
Start again on CAT II
Negative __ __ Continue CAT II*
* A patient must complete all 36 doses of the initial intensive phase.** A patient who must “start again” will restart treatment from the beginning. *** Although this patient does not strictly fit the definition of default. Default most closely describes the outcome of this
patient, although at re-registration the patient should be categorized as ‘Other’.
Is expectoration present?Is expectoration present?
If yes, examine 3 sputum If yes, examine 3 sputum
2 or 3 Positives2 or 3 Positives 3 Negatives3 Negatives
Antibiotics 10-14 daysAntibiotics 10-14 days
Cough PersistsCough Persists
Repeat 3 Sputum Repeat 3 Sputum Examinations
1 Positive
X-Ray Negative 2 or 3 Positives2 or 3 Positives
Suggestive of TBSuggestive of TB Negative for TBNegative for TB Sputum Positive Sputum Positive TB (Anti-TB Treatment)
X-Ray + MantouxSputum Positive Sputum Positive
TB (Anti-TB Treatment)
Negative for TBNegative for TB Suggestive of TBSuggestive of TB
Sputum Smear Negative TB Sputum Smear Negative TB (Anti-TB Treatment)
Refer to PediatricianRefer to Pediatrician
TREATMENT OF CHILDREN
Diagnostic Algorithm for Pediatric Pulmonary TB
Pulmonary TB Suspect Fever and/or cough 3 weeks Loss of wt/ No wt. gain History of contact with suspected or diagnosed case of active TB
If no, refer to PediatricianIf no, refer to Pediatrician
RNTCP at a Glance16
Algorithm for Clinical Monitoring of Pediatric TB
Patient on treatment
Review at 2 months, Review at 2 months, satisfactory response assessed by:– improvement in symptoms– no weight loss and or
weight gain
Review at 2 months, non-Review at 2 months, non-satisfactory response assessed by:– adherence to treatment– weight loss– worsening of symptoms
Follow up clinically Refer to Pediatrician/TB Refer to Pediatrician/TB specialist for assessment (consider sputum examination)
Clinical assessment and Clinical assessment and X-ray at completion of treatment
Sputum positiveSputum positive
Failure
Category IICategory II
Sputum negative or not Sputum negative or not available
– Review diagnosis– extend IP by 1 month
No improvement = Pediatric non-responder
RNTCP at a Glance 17
Dosages for children
Drugs Dosage (Thrice a week)Isonoazid 10-15mg/kgRifampicin 10mg/kgPyrazinamide 35mg/kgStreptomycin 15mg/kgEthambutol 30mg/kg
Chemoprophylaxis for Children
Household contacts of smear-positive TB cases, especially those below 6 years of age, must be screened for symptoms of tuberculosis. In case of symptoms being present, the diagnostic algorithm for pediatric TB should be followed and the child should be given a full course of anti TB treatment if s/he is diagnosed as a TB case.
For asymptomatic children and those who are not found to be suffering from TB, chemoprophylaxis with isoniazid (5 mg per kg body wt) should be administered daily for a period of six months.
This is regardless of the BCG vaccination status.
RNTCP at a Glance18
SYMPTOM-BASED APPROACH TO EVALUATION OF POSSIBLE SIDE EFFECTS OF ANTI-TB DRUGS USED IN RNTCP
Symptom Drug (abbreviation) Action to be taken
Gastrointestinal upset
Any oral medication Reassure patient Give drugs with less water Give drugs over a longer period of time (e.g. 20 minutes) Do not give drugs on empty stomach If the above fails, give antiemetic if appropriate
Itching Isoniazid (H) (Other drugs also)
Reassure patientIf severe, stop all drugs and refer patient to MO
Burning in the hands and feet Isoniazid (H) Give pyridoxine 100 mg/day until
symptoms subside
Joint pains Pyrazinamide (Z)If severe, refer patient forEvaluation
Impaired vision Ethambutol (E) STOP ethambutol, refer patient for evaluation
Ringing in the ears Streptomycin (S) STOP streptomycin, refer patient for
evaluation
Loss of hearing Streptomycin (S) STOP streptomycin, refer patient for evaluation
Dizziness and loss of balance Streptomycin (S) STOP streptomycin, refer patient for
evaluation
JaundiceIsoniazid (H)Rifampicin (R)Pyrazinamide (Z)
STOP all drugs, refer patient for evaluation
In cases of jaundice, all anti-TB drugs should be stopped immediately and the patient referred for evaluation.
RNTCP at a Glance 19
MANAGEMENT OF TB PATIENTS ON DOT IN SPECIAL SITUATIONS
Situation ManagementHospitalization • Only extremely ill patients need hospitalization during the
treatment • Patients with significant haemoptysis, pneumothorax or large
accumulation of pleural fluid leading to breathlessness need to be hospitalized
• Flow chart for hospitalized patients is given on next pageTuberculous meningitis
• Fatal if untreated• Patient should be referred to the hospital• Total duration of treatment is 8–9 months. The continuation
phase should be given for 6–7 months• Steroids should be given initially and gradually reduced over
6–8 weeksTreatment of TB during pregnancy and postnatal period
• Streptomycin should not be given; other drugs used in RNTCP are safe
• Breast feeding should continue regardless of the mother’s TB status
• Advise the mother to cover her mouth, if she is smear-positive, while breastfeeding the baby
• Chemoprophylaxis for the baby is advisable if mother is sputum smear-positive
Treatment in patients with renal failure
• Rifampicin, isoniazid and pyrazinamide can be safely given• Streptomycin and ethambutol, if given, should be closely
monitored with reduced dosageTreatment in women taking oral contraceptive pills
• Rifampicin decreases the efficiency of oral contraceptives; increase the dosage of the oral contraceptive or switch to another method of contraception
TB and HIV • Anti-TB Treatment is same for HIV-infected people as it is for HIV negative TB patients
• DOT assumes greater importance for HIV infected patients• All new TB cases who are known to be HIV positive based
on voluntary sharing of results and/or history of anti-retroviral therapy are considered to be seriously ill
• Patients with TB-HIV should complete their TB treatment prior to beginning ART (if not already on ART). If patient is already on ART, it should be modified to be rifampicin-friendly
MDR TB • MDR-TB is drug resistant TB caused due to bacilli resistant to Isoniazid and Rifampicin, with or without resistance to other anti TB drugs.
• Management of MDR –TB is very complex• Prevention of MDR–TB rather than its treatment is the priority
under RNTCP
RNTCP at a Glance20
Patient is admittted with tuberculosis for indications Patient is admittted with tuberculosis for indications like significant haemoptysis, pneumothorax or large
accumulation of pleural fluid leading to breathlessnes
Attending physician prescribes RNTCP regimen using Attending physician prescribes RNTCP regimen using prolongation pouches
Inform DOT centre of that hospitalInform DOT centre of that hospital
Register in the TU, where the hospital belongs if the patient
is not already registered
If the patient is already If the patient is already registered, do not re-register. On discharge send back to
treating PHI to continue and complete treatment.
If the patient does not reside If the patient does not reside in the same TU, on discharge
transfer out to PHI/TU nearest to his/her residence, to continue and
complete treatment
If the patient resides in the If the patient resides in the same TU, on discharge send to the PHI nearest to his/her residence to continue and
complete treatment
HOSPITALIZATION OF TB PATIENTSSome TB patients may need hospitalization during their illness. All indoor patients are to be treated with RNTCP regimens. The treatment is given using prolongation pouches which will be supplied by District TB Officer through the STS of that TU. On discharge, patients may be given a maximum of three doses (1 week drug supply) to cover the intervening period prior to their continuation of treatment at their respective DOT Centre, which may/not be in the same district, hence ensuring no interruption in treatment. All indoor patients treated under RNTCP, should be registered under the local TU in which the hospital is located.
Management of Hospitalized patients
RNTCP at a Glance 21
SUPERVISORY VISITS
Category of supervisor
Methodology of supervision Number of supervisory visits
DTO/MO –DTC
Interview the MO-TC, MO I/C of PHC-CHC, STS, STLS, LT and DOT-provider, health personnel of other sectors (NGO, private etc.) and the person in-charge of anti-TB drug & consumable storage.
Interact with community and local opinion leaders
Randomly interview patients and community leaders.
Inspect records of the TU, PHC and CHC, and stock of anti-TB drugs and laboratory consumables.
Randomly check the microscopy centre and treatment observation centres.
Visit all TUs every month and all DMCs every quarter. Visit all CHCs and Block PHCs in the district every quarter, one sub-centre from each Block PHC area and a proportion of treatment observation centres every quarter. Conduct supervisory visit at least 3-5 days a week. Visit at least three patients at their homes per visit
MO-TC
Interview the MO I/C BPHC/CHC/PHC.
Randomly interview patients and community leaders.
Interact with community and local opinion leaders
Randomly check the microscopy centre and treatment observation centre; stock of anti-tuberculosis drugs and laboratory consumables.
Visit all DMCs every month. Visit all CHCs/BPHCs/ PHCs and a proportion of treatment observation centres at least once every quarter. Conduct supervisory visits 7days a month. Visit at least three patients at their homes per visit.
STS
Interview MPHS and MPWs at the PHC sub-centre.
Inspect records, Tuberculosis Treatment Cards and Tuberculosis Laboratory Register.
Randomly interview patients.
Visit all PHIs at least once every month and all treatment observation centres once every quarter. Visit all new sputum positive patients at their home within one month of treatment initiation. Conduct supervisory visits at least 5 days a week.
STLS
Inspect all microscopy centres and laboratory records.
Visit all microscopy centres in the jurisdiction of the TU at least once a month. Visit all sputum collection centres at least once a month.
RNTCP at a Glance22
SU
MM
ARY
OF
KEY
IND
ICA
TO
RS A
ND
PO
SSIB
LE C
ORREC
TIV
E A
CTIO
NS
Cas
e Fi
ndin
g In
dica
tors
and
pos
sibl
e re
spon
ses
to p
robl
ems
Qua
rter
ly R
epor
tIn
dica
tor
Poss
ible
Act
ions
Expe
cted
: N
ew s
mea
r-po
sitive
cas
es ca
se
dete
ctio
n of
≥ 7
0%
Ann
ualiz
edre
gist
ered
num
ber
of
new
sm
ear-
posi
tive
ca
ses
is <
50%
Ensu
re t
hat
ever
y TB s
uspe
ct in
all
perip
hera
l hea
lth
faci
litie
s un
derg
o sp
utum
sm
ear
exam
inat
ion
(in a
t le
ast
2%
of
new
adu
lt o
utpa
tien
ts).
Ensu
re t
hat
3 s
putu
m s
mea
r ex
amin
atio
ns a
re d
one
for
TB s
uspe
cts.
Ensu
re t
hat
sput
um s
mea
r m
icro
scop
y is
don
e co
rrec
tly
(5%
–15%
pos
itiv
ity
is e
xpec
ted
amon
g pa
tien
ts
exam
ined
for
dia
gnos
is).
Int
ensi
fy r
evie
w o
f sl
ides
rea
d as
sm
ear-
nega
tive
, pa
rtic
ular
ly t
hose
of
patien
ts
plac
ed o
n tr
eatm
ent.
Ensu
re t
hat
all s
mea
r-po
sitive
s in
the
Lab
orat
ory
Reg
iste
r ar
e st
arte
d on
tre
atm
ent
and
regi
ster
ed in
the
TB R
egis
ter.
Ensu
re t
hat
sput
um s
mea
r m
icro
scop
y is
acc
essi
ble
to p
atie
nts,
and
the
labo
rato
ry t
echn
icia
n is
tra
ined
.
Ann
ualiz
edre
gist
ered
num
ber
of
new
sm
ear-
posi
tive
ca
ses
is >
100%
Ensu
re t
hat
no a
ctiv
e ca
se-f
indi
ng is
bei
ng d
one
in a
ny a
rea.
Ensu
re t
hat
sput
um s
mea
r m
icro
scop
y is
acc
urat
e.
Ensu
re r
evie
w o
f sl
ides
of
smea
r-po
sitive
pat
ient
s.En
sure
tha
t on
ly p
atie
nts
who
res
ide
in t
he a
rea
are
star
ted
on t
reat
men
t, a
nd n
on-r
esid
ent
patien
ts a
re
refe
rred
for
tre
atm
ent
to h
ealth
faci
litie
s in
the
are
as t
hat
they
res
ide
in.
Expe
cted
: Re-
trea
tmen
t sm
ear-
posi
tive
cas
es
are
abou
t 30%
of
all
smea
r-po
sitive
cas
es in
in
itia
l yea
rs o
f RN
TC
P im
plem
enta
tion
Re-
trea
tmen
t ca
ses
are
<20%
of
all
smea
r -p
ositiv
e ca
ses
Ensu
re t
hat
accu
rate
his
tory
tak
ing
is d
one
at a
ll le
vels
. Pa
tien
ts m
ust
be a
sked
car
eful
ly a
bout
any
pr
ior
trea
tmen
t ta
ken
for
TB f
rom
any
sou
rce.
It
shou
ld b
e ex
plai
ned
to p
atie
nts
that
onl
y if t
hey
prov
ide
accu
rate
info
rmat
ion
can
the
mos
t ef
fect
ive
trea
tmen
t be
giv
en.
Mak
e su
re t
hat
defini
tion
s ar
e ap
plie
d co
rrec
tly.
Any
sm
ear-
posi
tive
pat
ient
tre
ated
in t
he p
ast
for
mor
e th
an o
ne m
onth
and
has
def
aulted
for
mor
e th
an t
wo
mon
ths,
sho
uld
rece
ive
the
re-t
reat
men
t (C
ateg
ory
II) r
egim
enRe-
trea
tmen
t ca
ses
are
>40%
of
all
smea
r-po
sitive
cas
es
Ensu
re t
hat
active
cas
e-find
ing
is n
ot b
eing
res
orte
d to
. W
ith
active
cas
e-find
ing,
man
y ‘o
ld’ TB c
ases
are
re
port
ed.
Ensu
re t
hat
hist
ory-
taki
ng is
acc
urat
e an
d de
fini
tion
s ar
e be
ing
corr
ectly
appl
ied.
Ensu
re t
hat
new
sym
ptom
atic
pat
ient
s un
derg
o th
ree
sput
um s
mea
r ex
amin
atio
ns f
or a
cid-
fast
bac
illi
(AFB
).Ex
pect
ed: 50%
of
all n
ew
pulm
onar
y ca
ses
will
be
smea
r-po
sitive
Am
ong
new
pu
lmon
ary
case
s,
prop
ortion
of
smea
r-po
sitive
is <
45%
Ensu
re t
hat
over
-dia
gnos
is o
f sp
utum
sm
ear-
nega
tive
pat
ient
s is
not
hap
peni
ng d
ue t
o ov
er r
elia
nce
on
radi
ogra
phy.
No
patien
t sh
ould
beg
in t
reat
men
t w
itho
ut t
he m
anda
tory
thr
ee s
putu
m s
mea
r ex
amin
atio
ns.
Ensu
re t
hat
3 s
putu
m s
mea
rs a
re e
xam
ined
for
all
TB s
uspe
cts.
Ensu
re t
hat
repe
at s
putu
m s
mea
r ex
amin
atio
ns a
re d
one
for
patien
ts w
ho c
ontinu
e to
hav
e sy
mpt
oms
afte
r a
cour
se o
f an
tibi
otic
s.En
sure
tha
t sp
utum
sm
ear
mic
rosc
opy
is d
one
corr
ectly.
Rev
iew
slid
es o
f sm
ear
nega
tive
pat
ient
s pl
aced
on
tre
atm
ent.
Expe
cted
: N
ot m
ore
than
20%
of
smea
r-ne
gative
and
ex
tra-
pulm
onar
y pa
tien
ts
are
cons
ider
ed s
erio
usly
ill
and
plac
ed u
nder
Cat
egor
y I
Prop
ortion
of
smea
r-ne
gative
or
extr
a-pu
lmon
ary
serio
usly
ill
pat
ient
s gi
ven
Cat
egor
y I re
gim
en is
>
25%
Ensu
re t
hat
only
ser
ious
ly il
l pat
ient
s ar
e gi
ven
Cat
egor
y I t
reat
men
t. N
on-s
erio
usly
ill N
ew s
mea
r-ne
gative
pa
tien
ts s
houl
d re
ceiv
e C
ateg
ory
III t
reat
men
t.En
sure
tha
t sp
utum
mic
rosc
opy
is d
one
corr
ectly.
Arr
ange
rev
iew
of
slid
es o
f sm
ear-
nega
tive
pat
ient
s pl
aced
on
trea
tmen
t.
RNTCP at a Glance 23
Spu
tum
Con
vers
ion
Indi
cato
rs a
nd p
ossi
ble
resp
onse
s to
pro
blem
sQ
uart
erly
Rep
ort
Indi
cato
rPo
ssib
le A
ctio
ns
Expe
cted
:C
onve
rsio
n ra
te is
>90%
of
new
sm
ear-
posi
tive
pat
ient
s at
3
mon
ths
Less
tha
n 85%
of
New
sm
ear-
posi
tive
pa
tien
ts a
re d
ocum
ente
d to
bec
ome
sput
um s
mea
r-ne
gative
at
3 m
onth
s
Ensu
re t
hat
Med
ical
Off
icer
s, t
reat
men
t su
perv
isor
s, a
nd a
ll ot
her
staf
f in
volv
ed in
the
pr
ogra
mm
e at
per
iphe
ral c
entr
es u
nder
stan
d th
e im
port
ance
of fo
llow
-up
sput
um e
xam
inat
ions
. Fo
llow
-up
sput
um e
xam
inat
ions
are
the
bes
t m
easu
re o
f pa
tien
t re
spon
se t
o tr
eatm
ent.
C
onve
rsio
n of
spu
tum
at
the
end
of IP
incr
ease
s pa
tien
t co
nfid
ence
and
is c
ritic
al t
o pr
ogra
mm
e ev
alua
tion
.V
isit a
ll ce
ntre
s w
ith
low
spu
tum
con
vers
ion
rate
and
res
olve
any
pro
blem
with
the
help
of
the
staf
f.M
ake
sure
def
ault r
ates
in t
he f
irst
two
mon
ths
are
<5%
, an
d th
e nu
mbe
r of
pat
ient
s w
ho d
ie
or t
rans
ferr
ed o
ut a
re m
inim
ized
.En
sure
tha
t ac
cura
te h
isto
ry-t
akin
g ta
kes
plac
e at
all
leve
ls.
Patien
ts m
ust
be a
sked
car
eful
ly
abou
t an
y pr
ior
trea
tmen
t fo
r TB f
rom
any
sou
rce.
It
shou
ld b
e ex
plai
ned
to p
atie
nts
that
onl
y if t
hey
prov
ide
accu
rate
info
rmat
ion
can
effe
ctiv
e tr
eatm
ent
be g
iven
. If p
revi
ousl
y tr
eate
d pa
tien
ts a
re n
ot p
lace
d on
the
re-
trea
tmen
t re
gim
en,
they
may
not
res
pond
wel
l to
trea
tmen
t.M
ake
sure
tha
t de
fini
tion
s ar
e ap
plie
d co
rrec
tly.
Any
sm
ear-
posi
tive
pat
ient
tre
ated
for
mor
e th
an o
ne m
onth
in t
he p
ast
and
with
a de
faul
t of
mor
e th
an t
wo
mon
ths,
sho
uld
rece
ive
the
re-t
reat
men
t (C
ateg
ory
II) r
egim
en.
Ensu
re t
hat
sput
um m
icro
scop
y is
acc
urat
e. E
nsur
e re
view
of
slid
es o
f pa
tien
ts w
ho r
emai
ned
smea
r po
sitive
at
the
end
of t
he in
tens
ive
phas
e.En
sure
tha
t ev
ery
dose
of
med
icat
ion
is o
bser
ved
durin
g th
e in
tens
ive
phas
e of
tre
atm
ent.
O
bser
vation
sites
sho
uld
be c
onve
nien
t to
the
pat
ient
. The
qua
lity
of D
OTS s
houl
d be
che
cked
at
the
tim
e of
sup
ervi
sion
, in
clud
ing
chec
king
of
entr
ies
in t
he T
reat
men
t C
ards
with
the
drug
s av
aila
ble
in p
atie
nt-w
ise
boxe
s.
RNTCP at a Glance24
Res
ult
of T
reat
men
t In
dica
tors
and
pos
sibl
e so
lutio
n to
pro
blem
s
Qua
rter
ly R
epor
tIn
dica
tor
Poss
ible
Act
ions
Expe
cted
: C
ure
rate
fo
r ne
w s
mea
r-po
sitive
ca
ses
is ≥
85%
Cur
e ra
te o
f
new
sm
ear-
posi
tive
pa
tien
ts
is <
80%
Vis
it c
entr
es w
ith
low
cur
e ra
tes
to d
iscu
ss w
ith
patien
ts a
nd s
taff
the
rea
sons
for
low
cur
e ra
te a
nd
poss
ible
sol
utio
ns.
Ensu
re t
hat
accu
rate
his
tory
-tak
ing
take
s pl
ace
at a
ll le
vels
. Pa
tien
ts m
ust
be a
sked
car
eful
ly a
bout
any
prio
r tr
eatm
ent
for
tube
rcul
osis
tak
en f
rom
any
sou
rce.
It
shou
ld b
e ex
plai
ned
to p
atie
nts
that
onl
y if t
hey
prov
ide
accu
rate
info
rmat
ion
can
the
mos
t ef
fect
ive
trea
tmen
t be
giv
en.
If p
revi
ousl
y tr
eate
d pa
tien
ts a
re n
ot g
iven
th
e re
-tre
atm
ent
regi
men
, th
ey m
ay n
ot r
espo
nd w
ell t
o tr
eatm
ent.
Mak
e su
re t
hat
defini
tion
s ar
e ap
plie
d co
rrec
tly.
Any
sm
ear-
posi
tive
pat
ient
tre
ated
for
mor
e th
an o
ne m
onth
in
the
pas
t, w
ith
defa
ult
of m
ore
than
tw
o m
onth
s, s
houl
d re
ceiv
e th
e re
-tre
atm
ent
(Cat
egor
y II)
reg
imen
.
Ensu
re t
hat
ever
y do
se o
f m
edic
atio
n is
obs
erve
d du
ring
the
inte
nsiv
e ph
ase
of t
reat
men
t, a
nd a
t le
ast
one
dose
per
wee
k in
the
con
tinu
atio
n ph
ase.
Ens
ure
retu
rn o
f em
pty
blis
ter
pack
s du
ring
wee
kly
colle
ctio
n of
dr
ugs.
Obs
erva
tion
sites
sho
uld
be c
onve
nien
t fo
r th
e pa
tien
t.
Ensu
re t
hat
heal
th w
orke
rs a
re d
ispe
nsin
g m
edic
atio
n pr
oper
ly a
s pe
r te
chni
cal g
uide
lines
.
Ensu
re t
hat
follo
w-u
p sp
utum
sm
ear
exam
inat
ions
are
don
e ac
cord
ing
to g
uide
lines
.
Cur
e ra
te o
f ne
w
smea
r- p
ositiv
e C
AT I
patien
ts is
>95%
Che
ck f
or t
he a
ccur
acy
of t
he r
epor
t. M
ake
sure
tha
t Res
ult
of T
reat
men
ts a
re c
orre
ctly
rec
orde
d an
d re
port
ed.
All
diag
nose
d sm
ear-
posi
tive
pat
ient
s st
arte
d on
tre
atm
ent
shou
ld b
e re
gist
ered
.
Expe
cted
: N
ot m
ore
than
3%
of
new
sm
ear-
posi
tive
pat
ient
s ar
e gi
ven
the
Prop
ortion
of
new
sm
ear-
pos
itiv
e pa
tien
ts w
ho a
re
clas
sified
as
havi
ng
‘com
plet
ed’
trea
tmen
t is
>5%
Ensu
re t
hat
follo
w-u
p sp
utum
exa
min
atio
ns a
re d
one
as p
er p
olic
y. C
aref
ully
tra
ck t
his
at a
ll tr
eatm
ent
units.
Sen
sitize
the
Med
ical
Off
icer
s an
d ot
her
heal
th s
taff
abo
ut t
he im
port
ance
of
follo
w-u
p sp
utum
ex
amin
atio
ns.
Loca
te p
atie
nts
who
hav
e re
cent
ly c
ompl
eted
tre
atm
ent
and
obta
in s
putu
m s
ampl
es f
or e
xam
inat
ion.
Car
eful
ly r
evie
w t
he p
atie
nt d
ata
for
accu
racy
and
to
ensu
re t
hat
trea
tmen
t is
bei
ng g
iven
und
er d
irect
ob
serv
atio
n as
per
pol
icy.
Expe
cted
: N
ot m
ore
than
4%
of
new
sm
ear-
posi
tive
pat
ient
s di
e du
ring
trea
tmen
t
Prop
ortion
of
new
sm
ear-
posi
tive
pat
ient
s w
ho
die
durin
g tr
eatm
ent
is
>5%
Ensu
re t
hat
ever
y do
se o
f m
edic
atio
n is
obs
erve
d du
ring
the
inte
nsiv
e ph
ase
of t
reat
men
t, a
nd a
t le
ast
one
dose
per
wee
k in
the
con
tinu
atio
n ph
ase.
Obs
erva
tion
sites
sho
uld
be c
onve
nien
t to
the
pat
ient
.
Rev
iew
info
rmat
ion
on p
atie
nts
who
die
d to
det
erm
ine
reas
ons.
If p
atie
nts
are
pres
enting
for
tre
atm
ent
whe
n al
read
y m
orib
und,
con
side
r w
ays
and
mea
ns t
o en
cour
age
mor
e pr
ompt
ref
erra
l and
dia
gnos
is s
o th
at p
atie
nts
can
be t
reat
ed e
arlie
r in
the
cou
rse
of t
heir
TB il
lnes
s.
In-s
pite
of
all
the
abo
ve, if t
he d
eath
rat
e is
still
mor
e th
an 5
%, co
nsid
er e
valu
atio
n of
the
pre
vale
nce
of H
IV
infe
ctio
n am
ong
TB p
atie
nts,
to
be d
one
stric
tly
as p
er p
olic
y w
ith
safe
guar
ds o
f co
nfid
ential
ity.
RNTCP at a Glance 25
Expe
cted
:
Failu
re:
Not
m
ore
than
4%
of
new
sm
ear-
posi
tive
pat
ient
s
cont
inue
to
be sm
ear-
posi
tive
at
5 m
onth
s o
r la
ter
from
the
sta
rt o
f tr
eatm
ent
Prop
ortion
of
new
sm
ear-
posi
tive
pat
ient
s
who
fai
l tre
atm
ent
is
>5%
Ensu
re t
hat
accu
rate
his
tory
-tak
ing
is d
one
at a
ll le
vels
. Pa
tien
ts m
ust
be a
sked
car
eful
ly a
bout
prio
r tr
eatm
ent
for
tube
rcul
osis
fro
m a
ny s
ourc
e. It
shou
ld b
e ex
plai
ned
to p
atie
nts
that
onl
y if t
hey
prov
ide
accu
rate
info
rmat
ion
can
the
mos
t ef
fect
ive
trea
tmen
t be
giv
en.
If p
revi
ousl
y tr
eate
d pa
tien
ts a
re n
ot g
iven
th
e re
-tre
atm
ent
regi
men
, th
ey m
ay n
ot r
espo
nd w
ell t
o tr
eatm
ent.
Mak
e su
re t
hat
defini
tion
s ar
e ap
plie
d co
rrec
tly.
Any
sm
ear-
posi
tive
pat
ient
tre
ated
for
mor
e th
an o
ne m
onth
in
the
pas
t, w
ith
defa
ult
of m
ore
than
tw
o m
onth
s, s
houl
d re
ceiv
e th
e re
-tre
atm
ent
(Cat
egor
y II)
reg
imen
.
Ensu
re t
hat
ever
y do
se o
f m
edic
atio
n is
obs
erve
d du
ring
the
inte
nsiv
e ph
ase
of t
reat
men
t an
d at
leas
t on
e do
se p
er w
eek
in t
he c
ontinu
atio
n ph
ase.
Ens
ure
retu
rn o
f em
pty
blis
ter
pack
s du
ring
wee
kly
colle
ctio
n of
dr
ugs
in t
he c
ontinu
atio
n ph
ase.
Obs
erva
tion
sites
sho
uld
be c
onve
nien
t to
the
pat
ient
.
Ensu
re t
hat
heal
th w
orke
rs a
re d
ispe
nsin
g m
edic
atio
n pr
oper
ly a
s pe
r te
chni
cal g
uide
lines
.
Ensu
re t
hat
drug
s ar
e of
acc
epta
ble
qual
ity,
sto
red
in a
ppro
pria
te c
ondi
tion
s an
d ar
e us
ed b
efor
e th
e ex
piry
pe
riod.
In-s
pite
of
all t
he a
bove
, if t
he f
ailu
re rat
e re
mai
ns h
ighe
r th
an 5
%, co
nsid
er e
valu
atio
n of
the
leve
l of
prim
ary
drug
res
ista
nce
in t
he c
omm
unity.
Expe
cted
Def
ault r
ate
is <
5%
Def
ault r
ate
of s
mea
r-
posi
tive
Cat
egor
y I
patien
ts is
>8%
Vis
it c
entr
es w
hich
hav
e re
port
ed t
he h
ighe
st d
efau
lt r
ates
and
inte
rvie
w s
taff
and
pat
ient
s to
det
erm
ine
the
effo
rts
mad
e to
ret
rieve
pat
ient
s, t
he r
easo
ns f
or d
efau
lt a
nd p
ossi
ble
solu
tion
s. M
ake
sure
tha
t ce
ntre
s ar
e aw
are
of t
heir
defa
ult
rate
so
that
the
y ca
n ta
ke s
teps
to
redu
ce it
.
Ensu
re t
hat
patien
t hi
stor
y is
car
eful
ly a
scer
tain
ed,
incl
udin
g th
e ad
dres
s. A
vis
it t
o pa
tien
ts’
hom
e sh
ould
be
mad
e to
ver
ify
addr
ess
and
land
mar
ks n
ear
the
hous
e sh
ould
be
reco
rded
in t
he T
reat
men
t C
ard.
Ser
vice
s sh
ould
be
conv
enie
nt t
o th
e pa
tien
t in
ter
ms
of d
ista
nce,
tim
e an
d st
aff
attitu
des.
Dur
ing
the
visi
t to
the
hou
se f
or v
erific
atio
n of
add
ress
, no
te t
he n
ame
and
addr
ess
of a
per
son
who
can
be
cont
acte
d in
the
eve
nt t
he p
atie
nt d
efau
lts.
Ensu
re t
hat
dire
ctly
obs
erve
d tr
eatm
ent
is g
iven
to
patien
ts in
the
inte
nsiv
e ph
ase
and
at le
ast
one
dose
per
w
eek
is d
irect
ly o
bser
ved
durin
g th
e co
ntin
uation
pha
se.
Expe
cted
:
Tra
nsfe
rred
out
is <
3%
Prop
ortion
of
patien
ts
who
are
‘Tra
nsfe
rred
out’
is >
5%
Tra
nsfe
r ou
t ca
n be
a w
ay o
f di
sgui
sing
def
ault.
Patien
ts s
houl
d be
cat
egor
ized
as
‘Tra
nsfe
rred
out
’ on
ly if
th
ey h
ave
been
giv
en a
Tra
nsfe
r Fo
rm t
o be
tak
en t
o th
e fa
cilit
y w
here
the
y ar
e tr
ansf
erre
d to
.
Ensu
re t
he r
ecei
pt o
f re
sults
of f
ollo
w u
p sp
utum
exa
min
atio
ns a
nd t
reat
men
t
RNTCP at a Glance26
New
Indi
cato
rsIn
dica
tors
Form
ula
Com
men
ts
% n
ew s
mea
r po
sitive
out
of
tota
l new
pul
mon
ary
case
sN
os.
of N
SP
case
s re
gist
ered
in t
he q
uart
er /
Tot
al N
os.
of n
ew p
ulm
onar
y (N
SP+
NSN
) ca
ses
regi
ster
ed in
the
sam
e qu
arte
r X
100
Expe
cted
val
ue is
50%
.
% o
f ne
w e
xtra
pul
mon
ary
case
s ou
t of
all
new
cas
esN
os.
of n
ew e
xtra
pulm
onar
y ca
ses
regi
ster
ed /
Nos
. of
new
ca
ses
regi
ster
ed (
NSP+
NSN
+ne
w
extr
a pu
lmon
ary)
X 1
00
Expe
cted
val
ue is
10-
15%
% o
f re
trea
tmen
t ca
ses
out
of
all s
mea
r po
sitive
cas
esTot
al N
os.
of s
mea
r po
sitive
ret
reat
men
t ca
ses
(Rel
apse
, Fa
ilure
, Tre
atm
ent
afte
r de
faul
t, O
ther
s)
regi
ster
ed /
Tot
al N
os.
of s
mea
r po
sitive
cas
es (
new
sm
ear
posi
tive
pul
mon
ary
case
s +
sm
ear
posi
tive
ret
reat
men
t ca
ses)
X
100
% o
f pe
diat
ric c
ases
out
of
all
new
cas
esTot
al N
os. of
new
ped
iatr
ic c
ases
reg
iste
red
(new
sm
ear po
sitive
pul
mon
ary
pedi
atric
cas
es +
new
sm
ear
nega
tive
pul
mon
ary
pedi
atric
cas
es +
new
ext
ra p
ulm
onar
y pe
diat
ric c
ases
) /
Tot
al N
os.
of
new
cas
es r
egis
tere
d (N
SP+
NSN
+ n
ew e
xtra
pulm
onar
y)
X 1
00
% s
mea
r po
sitive
pat
ient
s liv
ing
in t
he d
istr
ict
plac
ed o
n D
OTS
Nos
. of
spu
tum
pos
itiv
e pa
tien
ts p
ut o
n RN
TC
P D
OTS d
urin
g th
e qu
arte
r in
the
dis
tric
t /
(Nos
. of
spu
tum
pos
itiv
e pa
tien
ts d
iagn
osed
dur
ing
the
resp
ective
qua
rter
– N
os.
of s
putu
m p
ositiv
e pa
tien
ts r
efer
red
for
trea
tmen
t ou
tsid
e th
e di
stric
t) X
100
Expe
cted
val
ue >
95%
% o
f sm
ear
posi
tive
pat
ient
s pl
aced
on
Non
-DO
TS tre
atm
ent
regi
men
Nos
. of
spu
tum
pos
itiv
e pa
tien
ts p
ut o
n RN
TC
P N
on-D
OTS d
urin
g th
e qu
arte
r in
the
dis
tric
t / (N
os.
of s
putu
m p
ositiv
e pa
tien
ts d
iagn
osed
dur
ing
the
resp
ective
qua
rter
– N
os.
of s
putu
m p
ositiv
e pa
tien
ts r
efer
red
for
trea
tmen
t ou
tsid
e th
e di
stric
t) X
100
Expe
cted
val
ue le
ss t
han
5%
% o
f in
itia
l def
aulter
sN
os.
of s
putu
m p
ositiv
e pa
tien
ts d
iagn
osed
who
are
nei
ther
put
on
RN
TC
P D
OTS o
r RN
TC
P N
on-D
OTS in
the
dis
tric
t, o
r re
ferr
ed f
or t
reat
men
t ou
tsid
e th
e di
stric
t /
(Nos
. of
spu
tum
pos
itiv
e pa
tien
ts d
iagn
osed
dur
ing
the
resp
ective
qua
rter
– N
os.
of s
putu
m p
ositiv
e pa
tien
ts r
efer
red
for
trea
tmen
t ou
tsid
e th
e di
stric
t) X
100
% o
f ne
w s
mea
r po
sitive
cas
es
star
ted
on R
NTC
P D
OTS w
ithi
n 7 d
ays
of d
iagn
osis
Nos
. of
spu
tum
pos
itiv
e pa
tien
ts d
iagn
osed
sta
rted
on
trea
tmen
t w
ith
in 7
day
s of
dia
gnos
is / T
otal
N
os.
of s
putu
m p
ositiv
e pa
tien
ts d
iagn
osed
X 1
00
Dat
a ob
tain
ed f
rom
TB
regi
ster
% o
f ne
w s
mea
r po
sitive
cas
es
regi
ster
ed w
ithi
n on
e m
onth
of
diag
nosi
s
Nos
. of
spu
tum
pos
itiv
e pa
tien
ts d
iagn
osed
and
sta
rted
on
trea
tmen
t un
der
RN
TC
P, w
ho a
re
regi
ster
ed w
ithi
n 1 m
onth
of
diag
nosi
s /
Tot
al N
os.
of s
putu
m p
ositiv
e pa
tien
ts d
iagn
osed
X 1
00
Dat
a ob
tain
ed f
rom
TB
regi
ster
% o
f in
terv
iew
ed n
ew s
mea
r po
sitive
cas
es w
ho r
ecei
ved
DO
T d
urin
g In
tens
ive
Phas
e as
pe
r gu
idel
ines
Nos
. of
inte
rvie
wed
NSP
case
s w
ho r
ecei
ved
DO
T a
s pe
r gu
idel
ines
(>
21/2
4 d
oses
)/ T
otal
Nos
. of
N
SP
case
s in
terv
iew
ed X
100
Dat
a ob
tain
ed f
rom
Pa
tien
ts in
terv
iew
s du
ring
supe
rvis
ory
fiel
d vi
sits
% o
f cu
red
NSP
case
s ha
ving
en
d of
tre
atm
ent
follo
w-u
p sp
utum
don
e w
ithi
n 7 d
ays
of
last
dos
e
Nos
. of
NSP
case
s re
gist
ered
dur
ing
the
quar
ter
havi
ng a
n ou
tcom
e cu
red,
who
had
the
ir en
d of
tr
eatm
ent
sput
um e
xam
ined
withi
n 7 d
ays
of la
st d
ose/
Tot
al N
os.
of N
SP
case
s re
gist
ered
dur
ing
the
resp
ective
qua
rter
with
trea
tmen
t ou
tcom
e as
cur
ed X
100
Dat
a ob
tain
ed f
rom
TB
regi
ster
NSP-
New
Sm
ear
Posi
tive
; N
SN
- N
ew S
mea
r N
egat
ive
RNTCP at a Glance 27
Due dates for reports from Tuberculosis Units to DTC in the year 2006
Due On Quarterly Report on Period Covered
7 January 2006
Case Finding 1 October – 31 December 2005
Programme Management 1 October – 31 December 2005
Sputum Conversion 1 July – 30 September 2005
Results of Treatment 1 October – 31 December 2004
7 April 2006
Case Finding 1 January – 31 March 2006
Programme Management 1 January – 31 March 2006
Sputum Conversion 1 October – 31 December 2005
Results of Treatment 1 January – 31 March 2005
7 July 2006
Case Finding 1 April – 30 June 2006
Programme Management 1 April – 30 June 2006
Sputum Conversion 1 January – 31 March 2006
Results of Treatment 1 April – 30 June 2005
7 October 2006
Case Finding 1 July – 30 September 2006
Programme Management 1 July – 30 September 2006
Sputum Conversion 1 April – 30 June 2006
Results of Treatment 1 July – 30 September 2005
The District TB Officer is to retain one copy of records and send the quarterly reports to the state TB Officer. All reports to reach Central TB Division by the 24th of the month. Reports to be sent to quarterlyreports@tbcindia.org