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TB is a disease caused by bacterium M. Tuberculosis. India is the highest TB burden country accounting for one fifth of the global incidence.
Source: WHO Geneva; WHO Report 2009

Global annual incidence = 9.4 million India annual incidence = 1.96 million

Signs and Symptoms

India is the highest TB burden country accounting for more than one-fifth of the global incidence
Global annual incidence = 9.4 million India annual incidence = 1.96 million

India 21%
Other countries 20%

India is 17th among 22 High Burden Countries (in terms of TB incidence rate)

Other 13 HBCs 16%

China 14%

Phillipines 3% Pakistan 3% Ethiopia 3% Bangladesh 4%

Indonesia 6% Nigeria South Africa 5% 5%

Source: WHO Geneva; WHO Report 2009: Global Tuberculosis Control; Surveillance, Planning and Financing NTF Presentations for RNTCP Sensitization

Evolution of Programme
1950s-60s Important TB research at TRC and NTI 1962 National TB Programme (NTP) 1992 Programme Review only 30% of patients diagnosed; of these, only 30% treated successfully 1993 RNTCP pilot began 1998 RNTCP scale-up 2001 450 million population covered 2004 >80% of country covered 2006 Entire country covered by RNTCP

Millennium Development Goals

Goal 6: Combat HIV/AIDS, malaria and other diseases
Target 8: By 2015, to have halted and begun to reverse the incidence of malaria and other major diseases
Indicator 23: between 1990 and 2015 to halve prevalence of TB disease and deaths due to TB Indicator 24: to detect 70% of new infectious cases and to successfully treat 85% of detected sputum positive patients

Goal- To reduce mortality and morbidity from TB To interrupt chain of transmission Objectives 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 Organization structure: State level

Health Minister

Health Secretary MD NRHM Director Health Services

Additional / Deputy / Joint Director (State TB Officer)

State Training and Demonstration Center (TB) Director, IRL Microbiologist, MO, Epidemiologist/statistician, IRL LTs etc.,

State TB Cell Deputy STO, MO, Accountant, IEC Officer, SA, DEO, TB HIV Coordinator etc.,

Major activities under RNTCP

Case detection Treatment of TB patients Surveillance and Monitoring TB/HIV collaborative activities DOTS-Plus for management of MDR-TB Public-private-mix (PPM) Advocacy, Communication and Social Mobilization (ACSM)

Unique features of RNTCP

District TB Control Society Modular training Patient wise boxes Sub-district level supervisory staff (STS, STLS)

for treatment & microscopy

Robust reporting and recording system

Recommended by WHO in 2006 Pursue quality DOTS expansion and enhancement Engage people with TB and affected communities Address TB-HIV, MDR-TB and other challenges Contribute to health system strengthening Involve all health care providers Enable and promote research

Directly Observed Treatment, (DOTS) a five point strategy

Political commitment Diagnosis by microscopy Adequate supply of Short Course drugs Directly observed treatment Accountability

Diagnosis of TB in RNTCP: Smear examination

Cough for 3 weeks or More

3 sputum smears
3 or 2 positives 1 positive smear

3 Negative Antibiotics 1-2 weeks Symptoms persist X-ray Negative For TB

X- ray
positive smear Smear-Positive TB negative

Positive Smear-Negative TB Anti-TB Treatment

Anti-TB Treatment Non-TB


DOT PROVIDER at Subcenter

Mechanism of DOT
DOT-provider can be anybody who is accessible and acceptable to the patient and accountable to the health system and who is not a family member . Can be health care workers, ASHA, Anganwadi Workers, NGO workers, private practitioners, community volunteers, shop keepers,cured patients, etc. During intensive phase (first 2-3 months), all doses are given to the patients under the direct observation of the DOT provider During continuation phase (remaining part of treatment),the first dose of the week is given to the patients under direct observation of the DOT provider




An effective quality assurance (QA) system of the RNTCP, sputum smear microscopy network is of crucial importance for the future of the programme. QA is a total system consisting of internal quality control (QC), assessment of performance using external quality assessment (EQA) methods, and continuous quality improvement (QI) of laboratory services

External Quality Assessment (EQA) 1. On Site Evaluation (OSE) 2. Panel Testing 3. Random Blinded Rechecking (RBRC)

Internal Quality Assurance (Quality Control) 1. Instrument checks 2. Reagent quality check

Random Blinded Rechecking of Routine Slides

Effective liaison shall be made with State AIDS Control Society on TB-HIV collaborative activities under District Co-ordination Committee.

RNTCP Supervision and Monitoring Strategy

Programme has a well defined strategy for S&M It has checklists for all levels of staff It has indicators

Essential components of the strategy

1. Supervision Protocol for Supervisory visits/ Check list/ Supervisory register 2. Programme surveillance system Records/ Reports/ Monitoring indicators 3. Review meetings Stated frequency district-state-national level Programme review checklist for CMO/ DM; DHS/ HS 4. Evaluations Internal 2 districts per state per quarter; 1 state per month by Central team External Joint Monitoring Mission; every 3 years

Programme Surveillance System

Peripheral Health Institute (DMC and other PHIs) Monthly PHI Report

Tuberculosis Unit
System electronic From district level upwards District TB Centre (Electronic reports) Quarterly Feedback Central TB Division State TB Cell Quarterly CF, SC, RT, PM Reports Additional Quarterly

Frantic efforts have been made to generate awareness about tuberculosis is amongst masses with special emphasis in slum areas, which include: Broadcasting of Radio Jingles Magic/Puppet Shows Nukkar Nataks Wall Paintings & Installation of Flex Boards at prominent places Community Meeting