Rntcp introduction

TUBERCULOSIS & RNTCPTUBERCULOSIS & RNTCP
INTRODUCTIONINTRODUCTION
1111thth
MarchMarch
DR . PRAJAKTA KADALEDR . PRAJAKTA KADALE
MEDICAL OFFICER,MEDICAL OFFICER,
DISTRICT TB CENTRE PUNE (R)DISTRICT TB CENTRE PUNE (R)

Tuberculos is A HistoricalTuberculos is A Historical
Disease Progress to FutureDisease Progress to Future

HISTORY ofHISTORY of
TuberculosisTuberculosis
Tuberculosis Is anTuberculosis Is an
Ancient DiseaseAncient Disease
Spinal TuberculosisSpinal Tuberculosis
in Egyptianin Egyptian
MummiesMummies
History dates to 1550History dates to 1550
– 1080 BC– 1080 BC
Identified by PCRIdentified by PCR
33

Robert KochRobert Koch
Discoverer ofDiscoverer of
MycobacteriumMycobacterium
44

A tribute to Robert KochA tribute to Robert Koch
 World TB Day isWorld TB Day is
March 24. ThisMarch 24. This
annual eventannual event
commemorates thecommemorates the
date in 1882 when Dr.date in 1882 when Dr.
Robert KochRobert Koch
announced hisannounced his
discovery ofdiscovery of
MycobacteriumMycobacterium
tuberculosistuberculosis, the, the
bacteria that causebacteria that cause
tuberculosis (TB)tuberculosis (TB)

 ““TB" is short form of tuberculosis. TBTB" is short form of tuberculosis. TB
disease is caused by a bacterium calleddisease is caused by a bacterium called
Mycobacterium tuberculosisMycobacterium tuberculosis. The bacteria. The bacteria
usually attacks the lungs, but TB bacteriausually attacks the lungs, but TB bacteria
can attack any part of the body such ascan attack any part of the body such as
the kidney, spine, and brain. If not treatedthe kidney, spine, and brain. If not treated
properly, TB disease can be fatal.properly, TB disease can be fatal.

Tuberculosis can infect any oneTuberculosis can infect any one ??

Poverty and Crowded livingPoverty and Crowded living
spreads Tuberculosisspreads Tuberculosis
Dr.T.V.Rao MDDr.T.V.Rao MD 88

How TB is spreadHow TB is spread
 TB is spread through theTB is spread through the
air from one person toair from one person to
another. The TB bacteriaanother. The TB bacteria
are put into the air whenare put into the air when
a person with active TBa person with active TB
disease of the lungs ordisease of the lungs or
throat coughs, sneezes,throat coughs, sneezes,
speaks, or sings. Peoplespeaks, or sings. People
nearby may breathe innearby may breathe in
these bacteria andthese bacteria and
become infected.become infected.

Multiorgan InvolvementMultiorgan Involvement
in Tuberculosis.in Tuberculosis.
Dr.T.V.Rao MDDr.T.V.Rao MD 1010

SYMPTOMS OF TBSYMPTOMS OF TB
 COUGH MORE THAN 2 WEEKSCOUGH MORE THAN 2 WEEKS
 LOSS OF APPETITELOSS OF APPETITE
 WEAKNESSWEAKNESS
 PAIN IN CHESTPAIN IN CHEST
 RISING FEVER AT EVENINGRISING FEVER AT EVENING

Worldwide Distribution of New TB Cases,Worldwide Distribution of New TB Cases,
20062006

Global burden of TBGlobal burden of TB
 2 billion infected, i.e. 1 in 3 of global2 billion infected, i.e. 1 in 3 of global
populationpopulation
 9.4 million (139/lakh) new cases in 2008,9.4 million (139/lakh) new cases in 2008,
80% in 22 high-burden countries80% in 22 high-burden countries
 4 m new sm+ve PTB (61/lakh) cases4 m new sm+ve PTB (61/lakh) cases inin
20082008
 Global incidence of TB has peaked inGlobal incidence of TB has peaked in
2004 and is declining.2004 and is declining.
 1.77m deaths in 2007, 98% in low-income1.77m deaths in 2007, 98% in low-income
countriescountries
 MDR-TB -prevalence in new casesMDR-TB -prevalence in new cases

05/26/1605/26/16
Magnitude of the ProblemMagnitude of the Problem
Source: WHO Geneva; WHO Report 2008: Global Tuberculosis Control; Surveillance, Planning and Financing
Global annual incidence = 9.1 million
India annual incidence = 1.9 million
India is 17th
among 22
High Burden
Countries (in terms of
TB incidence rate)
1515

Problem of TB in IndiaProblem of TB in India
 Estimated incidenceEstimated incidence
 1.96 million new cases annually1.96 million new cases annually
 0.8 million new smear positive cases annually0.8 million new smear positive cases annually
 75 new smear positive PTB cases/1lakh75 new smear positive PTB cases/1lakh
population per yearpopulation per year
 Estimated prevalence of TB diseaseEstimated prevalence of TB disease
 3.8 million bacillary cases in 20003.8 million bacillary cases in 2000
 1.7 million new smear positive cases in 20001.7 million new smear positive cases in 2000
 Estimated mortalityEstimated mortality
 330,000 deaths due to TB each year330,000 deaths due to TB each year
 Over 1000 deaths a dayOver 1000 deaths a day
 2 deaths every 3 minutes2 deaths every 3 minutes
05/26/1605/26/16 1616

Problem of TB in India (contd)Problem of TB in India (contd)
 Prevalence of TB infectionPrevalence of TB infection
 40% (~400m) infected with40% (~400m) infected with M. tuberculosisM. tuberculosis (with a 10%(with a 10%
lifetime risk of TB disease in the absence of HIV)lifetime risk of TB disease in the absence of HIV)
 Estimated Multi-drug resistant TBEstimated Multi-drug resistant TB
 < 3% in new cases< 3% in new cases
 12% in re-treatment cases12% in re-treatment cases
 TB-HIVTB-HIV
 ~~2.312.31 million people living with HIV (PLWHA)million people living with HIV (PLWHA)
 10-15% annual risk (60% lifetime risk) of developing10-15% annual risk (60% lifetime risk) of developing
active TB disease in PLWHAactive TB disease in PLWHA
 EstimatedEstimated ~~ 5% of TB patients are HIV infected5% of TB patients are HIV infected
1717

Dr.T.V.Rao MDDr.T.V.Rao MD
Social and Economic Burden of TB inSocial and Economic Burden of TB in
IndiaIndia
Estimated burden per yearEstimated burden per year
 Indirect costs to societyIndirect costs to society $3 billion$3 billion
 Direct costs to societyDirect costs to society $300 million$300 million
 Productive work days lost due to TB illnessProductive work days lost due to TB illness 100 million100 million
 Productive work days lost due to TB deathsProductive work days lost due to TB deaths 1.3 billion1.3 billion
 School drop-outs due to parental TBSchool drop-outs due to parental TB 300,000300,000
 Women rejected by families due to TBWomen rejected by families due to TB 100,000100,000
C, Socio-economic impact of TB on patients and family in India, Int J Tub Lung Dis 1999 3: 869-87705/26/1605/26/16 1818

Do You KnowDo You Know
•• That someone in the world is newlyThat someone in the world is newly
infected with TB bacilli every second?infected with TB bacilli every second?
•• That one-third of the world population isThat one-third of the world population is
currently infected by TB?currently infected by TB?
•• That over six lakhs Indians are unawareThat over six lakhs Indians are unaware
that they suffer from TB?that they suffer from TB?
•• That every TB patient infects 10-15 newThat every TB patient infects 10-15 new
persons on an average every year?persons on an average every year?

Tuberculosis – A major cause ofTuberculosis – A major cause of
Morbidity and Mortality in IndiaMorbidity and Mortality in India
 In India today, twoIn India today, two
deaths occur everydeaths occur every
three minutes fromthree minutes from
tuberculosis (TB). Buttuberculosis (TB). But
these deaths can bethese deaths can be
prevented. Withprevented. With
proper care andproper care and
treatment, TB patientstreatment, TB patients
can be cured and thecan be cured and the
battle against TB canbattle against TB can
be wonbe won

Diagnosis ofDiagnosis of
2121

How are TB cases diagnosed?How are TB cases diagnosed?
 Cough for ≥2 weeks (Cough for ≥2 weeks (TB suspectsTB suspects) screened from) screened from
OPD/clinics and referred for sputum microscopyOPD/clinics and referred for sputum microscopy
 Sputum microscopy performed at quality assuredSputum microscopy performed at quality assured
Designated Microscopy Centres (DMCs)Designated Microscopy Centres (DMCs)
 If sputum is initially negative and remains so after aIf sputum is initially negative and remains so after a
course of antibiotic, despite persisting symptoms,course of antibiotic, despite persisting symptoms,
then X-ray chest is donethen X-ray chest is done
 Standard diagnostic algorithm for pulmonary TBStandard diagnostic algorithm for pulmonary TB
 Patients diagnosed as Sputum +ve and Sputum –ve PTBPatients diagnosed as Sputum +ve and Sputum –ve PTB
 Extra-Pulmonary TB is diagnosed based on clinicalExtra-Pulmonary TB is diagnosed based on clinical
evaluation and histopathological evidenceevaluation and histopathological evidence

Why Sputum MicroscopyWhy Sputum Microscopy
 Sputum smear microscopy
is an essential tool of case-
finding in Tuberculosis
control. Tuberculosis
control, aiming at the
prevention of the
transmission of infection,
imparts a clear priority to the
sputum positives which are
the sources of infection in
the community. Hence the
need to detect as many
sputum positives as
possible

Dr.T.V.Rao MDDr.T.V.Rao MD
Evolution of TB Control in IndiaEvolution of TB Control in India
 1950s-60s1950s-60s Important TB research at TRC and NTIImportant TB research at TRC and NTI
 19621962 National TB Programme (NTP)National TB Programme (NTP)
 19921992 Programme ReviewProgramme Review
• only 30% of patients diagnosed;only 30% of patients diagnosed;
• of these, only 30% treated successfullyof these, only 30% treated successfully
 19931993 RNTCP pilot beganRNTCP pilot began
 19981998 RNTCP scale-upRNTCP scale-up
 20012001 450 million population covered450 million population covered
 20042004 >80% of country covered>80% of country covered
 20062006 Entire country covered by RNTCPEntire country covered by RNTCP
05/26/1605/26/16 2525

WHOWHO - Working- Working
 WHO is working toWHO is working to
dramatically reducedramatically reduce
the burden of TB, andthe burden of TB, and
halve TB deaths andhalve TB deaths and
prevalence by 2015,prevalence by 2015,
through its Stop TBthrough its Stop TB
Strategy andStrategy and
supporting the Globalsupporting the Global
Plan to Stop TB.Plan to Stop TB.

WHO - DOTSWHO - DOTS
 The WHO-recommendedThe WHO-recommended
Directly ObservedDirectly Observed
Treatment, Short CourseTreatment, Short Course
(DOTS) strategy was(DOTS) strategy was
launched formally aslaunched formally as
Revised National TBRevised National TB
Control programme inControl programme in
India in 1997 after pilotIndia in 1997 after pilot
testing from 1993-1996.testing from 1993-1996.
Since then DOTS hasSince then DOTS has
been widely advocatedbeen widely advocated
and successfullyand successfully
applied. ....applied. ....

State TB Cell
District TB Centre
Tuberculosis Unit
Microscopy Centre
DOT Centre
STO, Deputy STO
MO, Accountant,
IEC Officer, SA, DEO
DTO, MO-DTC, LT,
DEO, Driver
MO-TC
STS, STLS
MO, LT
DOT Provider – MPW,
NGO, PP, Comm Vol
Nodal point for
TB control
One/ 5 lakh (2.5 lakh
in hilly/ difficult/
tribal area)
One/ lakh (0.5 lakh
in hilly/ difficult/
tribal area)
Structure of RNTCP at State level

Imitation toImitation to Revised National TBRevised National TB
ControlControl
 India had switched over to the RevisedIndia had switched over to the Revised
National TB Control Programme (RNTCP),National TB Control Programme (RNTCP),
which concentrates on the personalwhich concentrates on the personal
attention of the health staff on each TBattention of the health staff on each TB
patient. Thus, India hopes to cut down TBpatient. Thus, India hopes to cut down TB
prevalence and death rate by half, by theprevalence and death rate by half, by the
year 2015.year 2015.
 RNTCP shift responsibility for cureRNTCP shift responsibility for cure
from patient to health system…from patient to health system…

DOTS is a systematic strategyDOTS is a systematic strategy
which has various componentswhich has various components
 Political and administrativePolitical and administrative
commitment.commitment.
 Good quality diagnosis.Good quality diagnosis.
 Good quality drugs. An uninterruptedGood quality drugs. An uninterrupted
supply of good quality anti-TB drugsupply of good quality anti-TB drug
 Directly observed treatment shortDirectly observed treatment short
course chemotherapycourse chemotherapy
 Monitoring and accountabilityMonitoring and accountability

India – DOTS largestIndia – DOTS largest
 India now has the second largest DOTSIndia now has the second largest DOTS
(Directly Observed Treatment, Short(Directly Observed Treatment, Short
course) programme in the world. However,course) programme in the world. However,
India's DOTS programme is the fastestIndia's DOTS programme is the fastest
expanding programme, and the largest inexpanding programme, and the largest in
the world in terms of patients initiated onthe world in terms of patients initiated on
treatment, placing more than 100,000treatment, placing more than 100,000
patients on treatment every month.patients on treatment every month.

DOTS in 2009DOTS in 2009
 By June 2009, more than 10.2 millionBy June 2009, more than 10.2 million
patients have been initiated on treatment,patients have been initiated on treatment,
saving more than 1.9 million additionalsaving more than 1.9 million additional
lives.lives.
 The success of DOTS in India hasThe success of DOTS in India has
contributed substantially to the success ofcontributed substantially to the success of
TB control in the world.TB control in the world.

Concern for TB patients is theConcern for TB patients is the
Backbone of the ControlBackbone of the Control
ProgrammeProgramme

MDR TuberculosisMDR Tuberculosis
 The emergence ofThe emergence of
resistance to drugsresistance to drugs
used to treat TB, andused to treat TB, and
particularly multi-particularly multi-
drug-resistant TBdrug-resistant TB
(MDR TB), has(MDR TB), has
become a significantbecome a significant
public health problempublic health problem
and an obstacle toand an obstacle to
effective TB control.effective TB control.
05/26/1605/26/16 3535

DOTS Can reduce MDRDOTS Can reduce MDR
 DOTS has been proven to prevent theDOTS has been proven to prevent the
emergence of MDRTB, and also toemergence of MDRTB, and also to
reverse the incidence of MDRTB where itreverse the incidence of MDRTB where it
has emerged. MDRTB is a tragedy forhas emerged. MDRTB is a tragedy for
individual patients and a symptom of poorindividual patients and a symptom of poor
TB management. The best way toTB management. The best way to
confront this challenge is to improve TBconfront this challenge is to improve TB
treatment and implement DOTS.treatment and implement DOTS.

DOTS PlusDOTS Plus
 DOTS Plus refers to a DOTS program that addsDOTS Plus refers to a DOTS program that adds
components for MDR TB diagnosis,components for MDR TB diagnosis,
management, and treatment. The WHO-management, and treatment. The WHO-
endorsed DOTS Plus program began in 2000s.endorsed DOTS Plus program began in 2000s.
In 2002, the Global Fund to fight AIDS, TB, andIn 2002, the Global Fund to fight AIDS, TB, and
Malaria (GFATM) started financing TB controlMalaria (GFATM) started financing TB control
programs, including MDR TB, greatly reducingprograms, including MDR TB, greatly reducing
the economic barrier to MDR TB control.the economic barrier to MDR TB control.
 DOTS-Plus programs can and shouldDOTS-Plus programs can and should
strengthen the basic DOTS strategystrengthen the basic DOTS strategy
05/26/1605/26/16 3737

Current Experience withCurrent Experience with
DOTSDOTS
 DOTS is a proven cost-effective TBDOTS is a proven cost-effective TB
treatment strategy. A combination oftreatment strategy. A combination of
technical and managerial components,technical and managerial components,
DOTS quickly makes infectious casesDOTS quickly makes infectious cases
non-infectious and breaks the cycle ofnon-infectious and breaks the cycle of
transmission. Using DOTS also preventstransmission. Using DOTS also prevents
the development of drug-resistant strainsthe development of drug-resistant strains
of TB that are often fatal and veryof TB that are often fatal and very
expensive to cure.expensive to cure.
05/26/1605/26/16

World TB Day celebrated with aWorld TB Day celebrated with a
New Theme Every YearNew Theme Every Year
 The 2014 World TB Day campaign
“Reach the three million,“Reach the three million,
A TB test, treatment and cure for all”A TB test, treatment and cure for all”..
 The key message is that TB is curable..The key message is that TB is curable..
 World TB Day is held each year on 24
March.

Control of TB is a Team WorkControl of TB is a Team Work

“Let us all join hands in transforming the fight
against TB towards elimination of Tuberculosis”

Rntcp introduction

More Related Content

What's hot (20)

Similar to Rntcp introduction (20)

Recently uploaded (20)

Rntcp introduction

Editor's Notes