National TB Elimination Program (India)

RNTCP or the Revised National Tuberculosis Control Program is the State-run Tuberculosis Control Initiative of the Government of India. It incorporates the principles of Directly observed treatment-Shortcourse (DOTS) - the global TB control strategy of the World Health Organization . The program provides, free of cost, quality Anti-Tubercular drugs across the country through the numerous Primary Health Centres and the growing numbers of the private-sector DOTS-providers

File:DOTS logo English.jpg

DOTS Logo

History

Need for a Revised Strategy - India has had an on-going National TB Program, NTP since 1962. In 1992, the Government of India, together with the World Health Organization (WHO) and Swedish International Development Agency (SIDA), reviewed the National TB Program, and concluded that it suffered from the following

• managerial weakness,
• inadequate funding,
• over-reliance on x-ray,
• non-standard treatment regimens,
• low rates of treatment completion, and
• lack of systematic information on treatment outcomes.

Program reviews showed that only 30% of estimated tuberculosis patients were diagnosed and only 30% of those were treated successfully.

Based on the findings and recommendations of the review in 1992, the GOI evolved a revised strategy and launched the Revised National TB Control Programme (RNTCP) in the country.

Started on a pilot project in 1993, the strategy proved both its technical and operational feasibility. A soft loan of US $ 142 million was negotiated with the World Bank in December 1996 and the credit agreement was signed with IDA in May 1997.

Launch, Expansion and Coverage

The Revised National Tuberculosis Control Programme (RNTCP), based on the DOTS strategy, began as a pilot in 1993 and was launched as a national program in 1997. Rapid RNTCP expansion began in late 1998.

• By the end of 2000, 30%of the country’s population was covered
• By the end of 2002, 50%of the country’s population was covered under the RNTCP
• By the end of 2003, 778 million population was covered
• By the end of 2004, the coverage reached to 997 million
• By December 2005, around 97% (about 1080 million) of the population had been covered
• By 24th March 2006, the entire country was covered under DOTS covering 1114 million people.

Components of RNTCP

The Directly observed treatment, Short-course DOTS strategy along with the other ingrediants of the Stop TB Partnership are implemented as a comprehensive package for TB control.

The five principal components of DOTS are

• Political and administrative commitment
• Case detection by Sputum Smear Microscopy
• Uninterrupted supply of good quality anti-TB drugs
• Standardized treatment regimens with directly observed treatment for at least the first two months
• Systematic monitoring and accountability

Diagnosis of Pulmonary TB under RNTCP

Diagnosis is made primarily based on Sputum Smear Examination. X-rays play a secondary role in the standard diagnostic alogorithm for Pulmonary Tuberculosis

Sputum Smear Microscopy using the Ziehl-Neelsen staining technique is used as the standard case-finding tool. Three sputum samples are collected (as spot-morning-spot) over two days from Chest Symptomatics to arrive at the diagnosis. The use of thrre samples ensures that the procedure has a high (>99%) Sensitivity_(test)

As a national health program, RNTCP pays more attention to the sputum-positive pulmonary tuberculosis patients (who are likely to spread the disease in the community) than people with other, non-pulmonary forms of the disease.

Treatment Categories and Drug Regimens

Standardized Treatment Regimens are one of the pillars of the DOTS strategy

Isoniazid, Rifampicin, Pyrazinamide, Ethambutol, and Streptomycin are the primary Antitubercular drugs used. Most DOTS regimens have thrice-weekly schedules and typicaly last for 6 to 8 months, with an initial Intensive phase and a Continuation phase.

Based on the Nature/severity of the disease and the Patients' exposure to previous anti-tubercular treatments, RNTCP classifies tuberculosis patients in to three Treatment Categories.

Category I	Category II	Category III
New sputum smear-positive Seriously ill sputum smear-negative Seriously ill extra-pulmonary	Sputum smear-positive Relapse Sputum smear-positive Failure Sputum smear-positive Treatment after default	New sputum smear-negative, not seriously ill New extra-pulmonary, not seriously ill
2H3R3Z3E3 + 4H3R3	2H3R3Z3E3S3 + 1H3R3Z3E3 + 5H3R3E3	2H3R3Z3 + 4H3R3
2 months Intensive phase + 4 months continuation phase Four drugs at Thrice-weekly Schedule	3 months Intensive phase + 5 months continuation phase Five drugs at Thrice-weekly Schedule	2 months Intensive phase + 4 months continuation phase Two drugs at Thrice-weekly Schedule

H: Isoniazid (600 mg), R: Rifampicin (450 mg), Z: Pyrazinamide (1500 mg), E: Ethambutol (1200 mg), S: Streptomycin (750 mg)

Second Phase of RNTCP

In the first phase of RNTCP (1998-2005), the programme’s focus was on ensuring expansion of quality DOTS services to the entire country. The future holds a different set of challenges including MDR TB and HIV/TB

The RNTCP has now entered its second phase in which the programme aims to firstly consolidate the gains made to date, to widen services both in terms of activities and access, and to sustain the achievements. These needs to be done in order to achieve the TB-related targets set by the Millennium Development Goals for 2015 and to achieve TB control in the longer term.

See Also

• Tuberculosis

• Tuberculosis treatment

• Tuberculosis diagnosis

• DOTS

• The Global Alliance for TB Drug Development

• Stop TB Strategy

• Global Plan to Stop Tuberculosis

• Multi-drug-resistant tuberculosis

External Links

• TBC-RNTCP Tuberculosis Control India's Homepage on RNTCP

• TRC Chennai Tuberculosis Research Center, Chennai

• NTI Bangalore The National Tuberculosis Institute, Bangalore

• StopTB The Stop Tuberculosis Initiative Website

• History of TB Control in India

• WHO Page on TB WHO's Global TB Programme

Reference

• What is DOTS? A guide to Understanding the WHO-recommended TB Control Strategy -1999

• RNTCP at a Glance

• Tuberculosis Control in India

• RNTCP Annual Report, 2007 Status Reports 2007