8
million new infectious cases ). Highest
in the world .
About 370 , 000 deaths .
Substantial socio - economic impact
since incidence highest in
economically productive age groups .
REVISED
NATIONAL
TUBERCULOSIS
CONTROL PROGRAMME
GROUP MEMBERS
Dr . Abhay Dahiya
Dr . Amit Murarka
Mr . Anant Kumar
Mr . Anup Lakra
Ms . Doyir eshi
Ms . Neha Asthana
Mr . Netra Risal
Dr . Raj Rishi Meena
Dr . Ranvir Singh Saluja
Mr . Renthungo Patton
OVERVIEW
Tuberculosis has been present in
humans since antiquity .
Was known as “ Consumption ” in the
past .
Tuberculosis is an infectious
disease caused by Mycobacterium
tuberculosis .
The bacteria was discovered by
Sir Robert Koch , hence T . B also
known as Koch ’ s disease .
Tuberculosis is the world's
greatest infectious killer of
women of reproductive age and the
leading cause of death among
people with HIV / AIDS
India is the highest TB burden country
globally
accounting for one fifth of the global
incidence
Globally ~9
million new TB India
cases occur 20%
Non-HBCs
annually 20%
China
15%
Other 13 HBCs
18%
Indonesia
South Africa
6%
4%
Nigeria
Philippines 4%
3% Bangladesh
Ethiopia Pakistan
4%
3% 3%
Source: WHO Geneva; WHO Report 2006: Global Tuberculosis Control; Surveillance, Planning and Financing
STATISTICS
One third of the world population infected
with TB bacilli.
75 % of which are pulmonary cases
90% of the infected population
asymptomatic
50 % mortality Rate in rest 10% if
untreated
Most common mode of transmission via
aerosol droplets
22% infection rate
10-15 secondary cases from a active but
untreated pt./year
Aetiology
Problem of TB in India
Incidence of TB disease: 1.8 million new TB cases annually
(0.8 million new infectious cases).Highest in the world.
2 peaks in incidence are observed
o1-4 yr age group
North
West East
National 75
North Zone 95
East Zone 75
West Zone 80
South Zone 75
South
NATIONAL TUBERCULOSIS
CONTROL PROGRAMME
NTCP started by the Indian government
in 1962
No change in prevalence of disease
Mortality declined from 80 lakh in
1971 to 53 lakh in 1993
Achievements
Shortfalls
Shift in age trends from an Drastic rise in Multi drug
extensive disease among the resistant tuberculosis .
young to a more chronic and As per a WHO surveillance .
less severe disease in the 3 to 5 % new case and 12 %
elderly . of the treated patients had
Marked reduction in MDR - TB
complications e . g . Only 30 % of existing cases
Tubercular being diagnosed with
enteritis , laryngitis , amyloid accuracy , of which only 30
disease etc . % completed their
Shift in age at first treatment .
infection to later decades . Mortality rate 29 % amongst
infectious patients
Re vie w
WasDone in 1992
Key problems identified were :
Is a systemic strategy having 5 components :
1 . 1 . Political and administrative commitment .
2 . 2 . Good quality Diagnosis , primarily by sputum
smear
3. microscopy .
4 . 3 . Uninterrupted supply of quality drugs
ORGANIZATION
DOT centre
Team at district Tuberculosis
centre
1 . District Tuberculosis officer
2 . Medical officer
3 . Laboratory Technician
4 . X - ray technician
5 . Treatment organiser
6 . Statistical assistant
7 . Data entry operator
Fu n ct ion s of D ist r ict
t ub e r cu losis of f ice r
%
as with risk of death from 80
TB
60
q
Ø Lower cure rates and increased spread of TB
qA systematic evaluation of 100
well-functioning District TB
%
centres by the National TB
Institute, Bangalore found 80
that nearly 70% of the cases
diagnosed and put on
treatment on the basis of x- 60
ray, did not have
tuberculosis at all
q 40
qThe proportion of cases
diagnosed on the basis of x-
ray alone and put on 20
treatment unnecessarily is
likely to be even higher in
many centres 0
D ia g n o s e d Abcyt u a l c a s e
x - r a y a lo n e
NTI, IJT, 1974
Three sputum Samples collected - SPOT –
Early Morning – SPOT
Three sputum smears are
optimal
100%
100% 93%
81%
Cumulative Positivity
50%
0%
First Second Third
Diagnosis of
tuberculosis
Tools
Tuberculin test Merits
Can identify infection Demerits
Cannot differentiate
Good epidemiological tool infection & disease
Culture for MTB Highly sensitive & specific Costly, not freely available
long waiting period
E NT
AT M
TRE
Objectives of
Chemotherapy
qTo achieve a cure rate of atleast 85 %
in all new smear positive cases .
qTo achieve at least 90 % treatment
completion rate of all retreatment
case and sputum negative cases
qTo decrease mortality , long - term
morbidity and transmission
qTo effect a permanent cure , prevent
relapses and decrease transmission
qTo minimize development of drug
resistance
qTo achieve the above while minimizing
drug side effects
Need for standardized
treatment
qTo treat smear positive TB patients as
priority
qTo prevent under - treatment of smear
positive cases
o prevent spread of TB in the
community
o prevent acquired drug resistance
qTo avoid over - treatment
qTo minimize side effects
qTo be able to monitor and compare
treatment outcomes
Smear positive Case Smear negative case
qRelapse :
A TB patient who was declared cured or treatment
completed by a physician , but who reports back to the
health service and is now found to be sputum smear -
positive .
qTransferred in :
A TB patient who has been received for treatment in
one Tuberculosis
unit , after starting treatment in another unit ( TU )
where ( s ) he has been
registered .
qTreatment after default :
A TB patient who received anti TB treatment for
one month or
more from any source and returns to treatment
after having
defaulted , i . e ., not taken anti TB drugs
consecutively for two
months or more , and who is found to be sputum
smear positive .
qFailure :
Any TB patient who is smear positive at 5
months or more after starting treatment . Failure
also includes a patient who was treated with
category III regimen but who becomes smear
positive during treatment .
qChronic :
A TB patient who remains smear positive after
completing a re -
treatment regimen .
In t e nsive Ph a se
Aims for a rapid killing of bacilli
A state of non-infectiousness within 2 weeks
Quick relief of symptoms
Smear negativity by 2 months
Prevent development of drug resistance
Multi-drug regimens and DOT
Continuation Phase
Aims to eliminate remaining bacilli
Killing of “persisters” prevents relapses
Multi-drug regimens and DOT necessary even
though risk of emergence of drug resistance is
less as fewer bacilli remain
Treatment Regimens
Cat I New smear positive; seriously ill 2H3R3Z3E3 /
smear negative; seriously ill extra-
4H3R3
pulmonary
1 . DFID
2 . Global TB drug facility ( GDF )
3 . Global fund to fight AIDS ,
Tuberculosis and malaria ( GFATM )
4 . United states agency for international
development ( USAID )
Con clusion