Revised National

Tuberculosis Control Programme (RNTCP) implementation in CHC/PHC/SC

RNTCP implementation in CHC/PHC/SC 1

Guided by:- Dr. PR SodaniPresented by:- Shayoni SenShekha D DasShelly SinghShraddha ShettyShravan KumarShree Yadav

INTRODUCTIONRevised National Tuberculosis Control Programme (RNTCP) is a state run TB control initiative of Govt. of India as per the National Strategy Plan 2012-2017. The programme has a vision of achieving a “TB free India”. It aims to achieve universal access to TB control services.

EVOLUTION OF TB CONTROL IN INDIA1950s‐60s Important TB research at TRC and NTI

1962 National TB Programme (NTP)1992

1996 RNTCP pilot began1998 RNTCP scale up2000 >30% of country covered2004 >80% of country covered

2006 Entire country covered by RNTCP

NEED FOR REVISED STRATEGY• In 1992, nation wise review was conducted with assistance of WHO &

ICMR. NTP suffered from managerial weakness• Inadequate funding• Over‐reliance on X‐rays for diagnosis• Frequent interrupted supplies of drugs• Low rates of treatment completion.

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.

REVISED STRATEGY• Augmentation of organizational support at center and state level.

• Use sputum testing as primary method of diagnosis• Standardized treatment regimen• Ensuring regular, uninterrupted supply of drugs• Emphasis on training, IEC, operational research & NGO involvement.

• Increased budget outlay.FIVE COMPONENTS OF DOTS

• Political and administrative commitment.• Good quality diagnosis, primarily by sputum smear microscopy.

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• Uninterrupted supply of good quality drugs.• Directly observed treatment • Systemic monitoring and accountability.

RNTCP ACHIEVEMENTS IN INDIA• In 2005 alone, 1.29 million TB patients were initiated on treatment. In 2006, 1.39 million and in 2007, 1.48 million patients have been enrolled for treatment. In 2008 over 1.51 million patients have been initiated on treatment.

• Treatment success rates have tripled from 25% to 86%. TB death rates have been cut 7-fold from 29% to 4%.

• The Programme has initiated over 10 million patients on treatment, thus saving more than 1.8 million additional lives.

• The programme has consistently maintained the treatment success rate >85%.

• In 2008, RNTCP has achieved the new sputum positive case detection rate of 72% and treatment success rate of 87%, which is in line with the global targets for TB control.

INDIAN PUBLIC HEALTH STANDARDS (IPHS) GUIDELINES FOR RNTCP

As per the guidelines in CHC:• Diagnostic Services- A Microscopy Centre (MC) is established for 1, 00,000 populations. For hilly, tribal and difficult areas MC is established for 50,000 populations.

• Inputs- • RNTCP has provided inputs to upgrade the infrastructure of the existing laboratories to carry out sputum microscopy.

• Manpower: Laboratory Technicians (LTs) are provided by RNTCP on contractual basis.

• Equipment: Binocular Microscopes• Laboratory Consumables: Funds are provided to the District TB Control Societies for procurement and supply of all the consumables required to carry out sputum microscopy.

• Treatment Services • Medical Officers: - detect chest symptoms, collect samples, patient categorization & managing side effects

• DOTS Centers: all sub-centers, CHCs, PHCs and district hospitals.

• DOTS Providers: The Multi Purpose Workers (MPWs), Pharmacists and Staff Nurses

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As per the guidelines in PHC• All PHCs to function as DOTS Centers through DOTS providers• Treatment of common complications of TB• Treatment of common side effects of drugs• Record and report• Collection and transport of sputum samples

As per the guidelines in SC• Essential : Referral of suspected symptomatic cases • DOTS• Ensure compliance and completion of treatment in all cases.• Diagnosis : The diagnostic services are supervised by Senior TB Laboratory Supervisor (STLS) for all the Microscopy Centers at the sub-district level.

Quality Assurance of RNTCP• Diagnosis: The diagnostic services are supervised by Senior TB Laboratory Supervisor (STLS) for all the Microscopy Centers at the sub-district level.

• Treatment : All major drugs are procured at the DOTS Centers through World Bank recommended procedures and provided to the States, thereby assuring quality of the drugs.

NIKSHAY• A web enabled and case based monitoring application to monitor and control RNTCP effectively.

• Has been developed by National Informatics Centre (NIC). • Health functionaries at various levels use this across the country in association with Central TB Division (CTD), MoHFW. RNTCP implementation in CHC/PHC/SC 4

• SMS services are also used effectively for day-to-day communication with patients.

Conclusion• RNTCP is one of the successfully running health programmes in India to achieve TB free India.

• There are some points that in our opinion that can improve the implementation of the programme like increasing more awareness regarding TB affecting people, its complications and its treatment.

• It is also important to create awareness about the importance of DOTS and continuing the course and the side effects of possible relapse if discontinued.

• Moreover, improved diagnostic services like chest X-ray should be used. Documentation should be more emphasized. Patients should have regular follow-ups.

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