Revised National Tuberculosis Control Programme -An Overview pptx

Revised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control Programme
An OverviewAn Overview
Central TB DivisionCentral TB Division
Ministry of Health & Family WelfareMinistry of Health & Family Welfare
Ministry of Health & Family WelfareMinistry of Health & Family Welfare
New DelhiNew Delhi
Overview of the presentation
Overview

of

the

presentation
• Introduction
• The problem of TB- Indian Scenario
•
Evolution of TB Control Programme in India
Evolution

of

TB

Control

Programme

in

India

• RNTCP- Objectives, structure and key activities
•
Programme surveillance supervision &
•
Programme

surveillance
,
supervision

&

monitoring
•
Achievements of RNTCP
•
Achievements

of

RNTCP
• Linkages with NRHM
Challenges
•
Challenges
• Future plans
Introduction
Introduction
•
TB is a disease caused by bacterium M tb

TB

is

a

disease

caused

by

bacterium

M
.
tb
• Airborne transmission
– Any individual can be infected
• An individual infected with M. tb has only 10% life time risk
to develop active TB disease
C
i f ti ith HIV i
dfii t diti i
–
C
o-
i
n
f

ec
ti
on w
ith

HIV
or any
i
mmuno-
d
e
fi
c
i
en
t
con
diti
on
i
ncreases
this risk
• More than 80% TB affects the lun
g
s
g
– About 50% are sputum smear positive and are infectious
• Any other organ of the body (except hair and nails) can be
affected
Extra

Pulmonary TB
affected
-
Extra
-
Pulmonary

TB
• The best way to control TB is early detection and cure of
infectious pulmonary TB cases
infectious

pulmonary

TB

cases
The
p
roblem of TB in India
p
India is the highest TB burden country accounting for one fifth of the
global incidence
global

incidence
Global annual incidence = 9.1 million
Non-HBCs
20%
India

20%
India annual incidence = 1.9 million
20%
Chi
India is 17
th
among 22
High Burden
Countries (in terms of
TB i id t )
Chi
na
14%
Other 13 HBCs
16%
TB

i
nc
id
ence ra
t
e
)
Philippines
3%
Indonesia
6%
Pakistan
3%

Ethiopia
3%
South Africa
Bangladesh
Nigeria
5%
6%
3%
5%
Bangladesh
4%
Source: WHO Geneva; WHO Report 2008: Global Tuberculosis Control; Surveillance, Planning and Financing
Wh
y
TB Control is a
p
riorit
y
?
ypy
• Incidence: 1.9 million new TB cases annually
Iid i th di b
–
I
nc
id
ence more
i
n nor
th

an
d

i
n ur
b
an areas
•
Prevalence:
3 8 million bacteriologically positive (2000)
Prevalence:
3
.
8

million

bacteriologically

positive

(2000)
•
Deaths:
about 325 000 deaths due to TB each year
Deaths:
about

325
,

000

deaths

due

to

TB

each

year
•
2.6 million people living with HIV;
~
1.2 million co
-
infected with HIV and TB
2.6

million

people

living

with

HIV;

1.2

million

co
infected

with

HIV

and

TB
– ~5% of TB patients estimated to be HIV positive
• MDR-TB in new TB cases is ~3% and in previously treated cases is ~12%
• TB affects predominantly economically productive age group leading to
huge socio-economic impact
Evolution of RNTCP
Piloting of RNTCP
• In 1992, NTP (started in 1962) was jointly reviewed
by GOI SIDA and WHO and they concluded that:
by

GOI
,
SIDA

and

WHO
,
and

they

concluded

that:
– NTP suffered from managerial weakness,
inadequate funding
–
inadequate

funding
,
– over-reliance on x-ray with low case detection,
low rates of treatment completion and
–
low

rates

of

treatment

completion
,

and

– lack of systematic information on treatment outcomes
• Following 1992 review, RNTCP designed based on
i t ti ll d d DOTS t t
i
n
t
erna
ti
ona
ll
y recommen
d
e
d

DOTS
s
t
ra
t
egy
• Started on a pilot scale in 1993
Directly Observed Treatment, Short-course
(DOTS)
fi i
(DOTS)
–a
fi

ve

po
i
nt

strategy
z Political commitment
z Diagnosis by microscopy
Adequate supply of Short
z
Adequate

supply

of

Short

Course drugs
z Directly observed treatment
TB Register
z Accountability
From pilot project to National Programme
• RNTCP launched as a national programme in 1997
•
Expansion was planned in a phased manner
•
Expansion

was

planned

in

a

phased

manner
• Prior to starting service delivery, the preparatory activities
in the district were certified by an appraisal mechanism
E ti t d d RNTCP b M h’06
•
E
n
ti
re coun
t
ry covere
d
un
d
er
RNTCP

b
y
M

arc
h’06
Operational structure of RNTCP in the state
State TB Cell
STO, Deputy STO
MO, Accountant,
IEC Officer, SA, DEO
Desi
g
nated IRL and
Di t i t TB C t
DTO, MO-DTC, LT, DEO,
Driver
Ndl itf
g
DOTS-Plus site
TB-HIV Coordinator
Di
s
t
r
i
c
t

TB

C
en
t

re
Driver
N
o
d
a
l
po
i
n
t

f
or
TB control
Urban TB Coordinators,
Communication Facilitator
Tuberculosis Unit
MO-TC
STS, STLS
One/ 5 lakh (2.5
lakh in hilly/
difficult/ tribal area)
Communication

Facilitator
Microscopy Centre
MO
,
LT

One/ lakh (0.5 lakh
in hilly/ difficult/
Microscopy

Centre
,
DOT P id
MPW
in

hilly/

difficult/

tribal area)
DOT Centre
DOT

P
rov
id
er –
MPW
,
NGO, PP, Comm Vol
TBHV
Implementation of RNTCP
ii lh i
DEO/ Accountant
District TB Officer

D
i
str
i
ct Hea
l
t
h
Soc
i
ety
STS/STLS
TBHVs (Urban)
TB Unit (Sub-district Hospital/ CHC)
District

TB

Officer
TB Unit for every 250,000/ 500,000
population
Contractual LTs
(20-50%)
(MO-TC)
DMC for every 50,000/ 100,000 population
DMC
(PHC/ CHC)
DMC
(PHC/ CHC)
DMC

(PHC/ CHC)
DMC
(PHC/ CHC)
DMC
(PHC/ CHC)
PHC PHCPHC
SCSC SC SCSC
Community Volunteers – AWW; ASHA; PPs; NGOs etc
WHOWHO recommended Stop TB Strategy (2006)recommended Stop TB Strategy (2006)
to Reach the 2015 MDGsto Reach the 2015 MDGs
to

Reach

the

2015

MDGsto

Reach

the

2015

MDGs
Com
p
onents of STOP TB Strate

gy
Com
p
onents of STOP TB Strate
gy
pgypgy
1
Pursuing quality DOTS expansion and enhancement
1
.
Pursuing

quality

DOTS

expansion

and

enhancement
Additional components
2 Addressing TB/HIV and MDR-TB
3
Contributing to health system strengthening
3
.
Contributing

to

health

system

strengthening
4. Engaging all care providers
5. Empowering patients and communities
6. Enablin
g
and
p
romotin
g
research
(
dia
g
nosis, treatment, vaccine, OR
)
gp g (g )
RNTCP
–
Goal and Objectives
RNTCP

–
Goal

and

Objectives
• Goal
– The goal of TB control Programme is to decrease
mortality and morbidity due to TB and cut transmission
ff
o
f
in
f
ection until TB ceases to be a major public health
problem in India.
• Objectives:
–
To achieve and maintain a case detection of at least
70% of new sputum positive TB patients
T hi d i t i t f t l t 85% i
–
T
o ac
hi
eve an
d
ma
i
n
t
a
i
n a cure ra

t
e o
f
a
t

l
eas
t

85%

i
n
such patients
Major activities under RNTCP
Major activities under RNTCP
• Case detection
• Treatment of TB patients
• Surveillance and Monitoring
• TB/HIV collaborative activities
DOTS
Pl f t f MDR
TB
•
DOTS
-
Pl
us
f

or managemen
t
o
f

MDR
-
TB
•
Public
-
private
-
mix (PPM)
•
Public
-
private
-
mix

(PPM)
•
A
dvocac
y
, Communication and Social Mobilization
(
ACSM
)

y()
RNTCP provides free and quality assured
di i b t i
di
agnos
i
s
b
y spu
t
um m
i
croscop
y
12 500 DMCs established
~
12
,
500

DMCs

established
27 State level IRLs
4 National Reference Labs
Case detection
• Sputum microscopy is the primary tool for diagnosis
• Diagnosis using standard diagnostic algorithms
Pulmonary TB
–

Pulmonary

TB
– Pediatric TB
Guidance on some forms of Extra
pulmonary TB
–
Guidance

on

some

forms

of

Extra
-
pulmonary

TB
• Guidelines for Laboratory quality assurance
developed and implemented
RNTCP Laboratory Network
RNTCP

Laboratory

Network

4 NRLs
27 IRLs
>12,000 DMCs
(one per 50,000
-
100,000
(one

per

50,000
100,000

population)
Quality Assurance (QA)
Quality

Assurance

(QA)
External Quality
Assessment (EQA)
Internal Quality
Assurance
(Quality Control)
Quality
Improvement
(QI)
(Quality

Control)
(QI)
1
On Site Evaluation
1
.
On

Site

Evaluation

(OSE)
2. Panel Testin
g
1. Instrument
checks
1. Data
Collection
g
3. Random Blinded
Rechecking
(RBRC)
2. Reagent
quality check
2. Data Analysis
3. Solvin
g

(RBRC)

g
problems
RNTCP Treatment Regimens and
RNTCP

Treatment

Regimens

and

Quality of drugs
Patient flow
TB suspect (Cough > 2 weeks)
Diagnosis
Categorization
Start of treatment
Re
g
istration
g
Follow-up and outcome reporting
RNTCP Categories and Regimens
RNTCP

Categories

and

Regimens

Patient
-
wise drug boxes
Patient
-
wise

drug

boxes

A unique feature of RNTCP are the patient-wise drug boxes (for
dlt d diti ) hihi ti t
a
d
u
lt
an
d
pae
di
a
t
r
i
c cases
)
, w
hi
c

h

i
mprove pa
ti
en
t
care,
adherence, and drug supply and drug stock management
Directly Observed Treatment
Directly

Observed

Treatment