RNTCP-ASHUTOSH.pdf

MODERATOR : PRESENTER:
Mr. ROHITASH KUMAR ASHUTOSH SHARMA
ASSISTANT PROFESSOR MSc. NURSING IInd YEAR
KGMU, COLLEGE OF NURSING KGMU, COLLEG OF NURSING
REVISED NATIONAL TUBERCULOSIS
CONTROL PROGRAMME

OUTLINES
✓Tuberculosis, its risk factors, signs symptoms, Diagnostic methods
✓DOTS therapy (Adult & paediatric dose)
✓Tuberculosis profile India (2022)
✓National Tuberculosis Program
✓Revised National Tuberculosis Control Programme
✓National Tuberculosis Elimination Programme
✓Nikshay Poshan Yojna
✓Development of Tuberculosis programmes
✓Organizational structure
03-06-2023
RNTCP, KGMU, COLLEGE OF NURSING
2

ABOUT TUBERCULOSIS
✓Caused by Mycobacterium Tuberculosis bacteria
✓Spreads through droplets from person to person
✓Usually affects lungs but also affects other body parts
✓Patient may not survive if doesn’t get treatment.
✓Three stages: exposure, latent & active disease.
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RISK FACTORS
✓Poverty.
✓HIV infection.
✓Homelessness.
✓Being in jail or prison (where close
contact can spread infection)
✓Substance abuse.
✓Taking medication that weakens the
immune system.
✓Kidney disease and diabetes.
✓Organ transplants.
✓Working in healthcare
✓Exposure to air pollution
✓Cancer
✓Smoking tobacco
✓Pregnancy
✓Age, specifically babies, young
children, and elderly people
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SIGNS & SYMPTOMS
Exposure/ Primary infection
✓Sometimes may not show any symptom
✓Fever
✓Minor symptoms of infection
Latent TB infection
✓Bacteria is in the body, can be detected with investigations
✓But is not active.
✓No symptoms in patient.
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SIGNS & SYMPTOMS Contd..
Active disease
✓Feeling of unwell
✓Coughing
✓Hemoptysis
✓Weight loss
✓Fatigue
✓Chestpain
✓Dysponea
✓Anorexia
✓Fever: starting with chills, rigors,
high grade fever, followed by
sweating as the fever declines.
✓Bodyache
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DIAGNOSTIC METHODS
✓Mantoux Text
✓Sputum Sample
✓Biopsy: lymph nodes, lung or other body tissues.
✓Radiological examination: X ray, CT scan, MRI
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INTENSIVE PHASE CONTINUATION PHASE
( First 2 months) (After 2 months, 2-6 month)

TREATMENT (ADULT DOSAGE)
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Weight
Category
(kg)
Number of Tablets (FDCs)
(FOR ADULTS)
Inj.
Streptomycin
(When used)
Intensive phase Continuation phase
HRZE HRE
75/150/400/275 75/150/275 (gm)
25-34 2 2 0.5
35-49 3 3 0.75
50-64 4 4 1
65-75 5 5 1
>75 6 6

✓H= Isoniazid,
✓ R= Rifampin,
✓ Z= Pyrazinamide,
✓E= Ethambutol.
✓Adult weighing less than 25 kg will be given loose drugs as per body
weight.
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INTENSIVE PHASE
( First 2 months)
CONTINUATION PHASE
(After 2 months, 2-6 month)

TREATMENT (PAEDIATRIC DOSAGE)
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Weight
Category
(kg)
Number of Tablets (FDCs)
Intensive phase Continuation phase
HRZ E HR E
50/75/150 100 50/75 100
4-7 1 1 1 1
8-11 2 2 2 2
12-15 3 3 3 3
16-24 4 4 4 4
25-29 3+1A 3 3+1A 3
30-39 2+2A 2 2+2A 2

Tuberculosis Profile (India)
✓As per annual TB report 2022
(24, March 2023)
*Lesbian, Gay, Bisexual,
Transgender, Intersex,
Queer/questioning, Asexual,
Pansexual
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S.No. Number
1. Total TB incidence 23,58,664
Male 14,33,922
(60.8%)
Female 9,22,649
(39.1%)
*LGBTQIA++ 1023 (<1%)
Children (>14 yrs) 1,34,001 (5.7%)
2. Mortality 99,063 (4.2%)
3. MDR/ RR TB incidence 63,801
4. HIV +ve TB incidence 54,000
5. HIV +ve TB mortality 11,000

TUBERCULOSIS RESEARCH CENTER
✓The Tuberculosis Chemotherapy Centre (now known as NIRT) was set
up in 1956 as a 5-year project, under the joint auspices of the Indian
Council of Medical Research (ICMR), World Health
Organization (WHO) and the British Medical Research
Council (BMRC).
✓The National Institute for Research in Tuberculosis (NIRT) is a
tuberculosis research organization located in Chennai, Tamil Nadu.
✓NIRT carries out research on clinical, bacteriological as well as
behavioural and epidemiological aspects of tuberculosis
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NATIONAL TUBERCULOSIS PROGRAMME
✓Started in 1962.
✓In 1978, BCG vaccination was shifted under Expanded programme on
immunization.
✓Central Govt. supported states financially on 50:50 basis.
✓UTs & voluntary organizations were given 100% financial support.
✓This prgramme was implemented through District Tuberculosis Centre
(DTC)
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STRATEGIES OF NATIONAL TUBERCULOSIS
PROGRAMME
Early detection and treatment thereby converting infectious cases to
non-infectious and preventing non-infectious cases from becoming
infectious.
1. Diagnosis through radiology and sputum microscopy.
2. Free domiciliary treatment through primary health care services.
3. Establishing district tuberculosis Centre in every district.
4. Extend coverage under short course chemotherapy (SCC).
5. Strengthen state TB training and Demonstration centres.
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NEED FOR REVISED STRATEGY
In 1992, a nationwide review was conducted with the assistance of SIDA
and WHO, it was observed that the program has not made any
improvement in the disease status. Following evaluation reasons were
highlighted.
1. Completion rate of treatment was 30% only;
2. Inadequate Budgetary outlay;
3. Shortage and irregular supply of anti-tubercular drugs;
4. Undue emphasis on X-rays diagnosis;
5. Poor quality of sputum microscopy;
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NEED FOR REVISED STRATEGY Contd..
6. More emphasis on case detection rather than cure;
7. Poor organizational setup and support for tuberculosis;
8. Multiplicity of treatment regimens;
9. Poor acceptability of principles of integration of NTP into general
health services, and resistance from medical fraternity; and
10. Poor awareness of TB patients about the disease causation,
prevention, duration of treatment, and availability of TB treatment in
general hospital.
11. Non-availability of trained staff.
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REVISED NATIONAL TUBERCULOSIS
CONTROL PROGRAMME
✓In 1993, WHO adopted DOTS strategy for its control.
✓In 1997, GOI also revised national strategy as RNTCP with support
from world bank.
✓Full nation wide coverage was achieved in March 2006.
✓Second phase started in 2006 with improved quality & reach of
services, case detection, cure targets etc.
✓RNTCP is the largest & fastest expanding TB programme in the world.
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RNTCP Contd..
✓Under RNTCP diagnosis & treatment is free of cost.
✓Designated Microscopy Centers (DMC) for one lac population in
general areas and for 50,000 population in remote areas.
✓For treatment services available at all Govt hospitals, CHC, PHC
DOTS centers.
✓All public health facilities, sub centers, Community volunteers, ASHA,
women self group etc. function as DOTS providers.
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GOAL & OBJECTIVES
✓The goal of RNTCP is to reduce morbidity & mortality due to
Tuberculosis.
Objectives-
✓To Emphasize the cure of infectious & seriously ill TB patients.
✓To achieve a cure rate of at least 85%.
✓To expand case finding activities.
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STRATEGY OF RNTCP
✓Enhancement of organizational support at central & state levels.
✓Stardardized treatment regimens.
✓Ensuring a regular, uninterrupted supply of drugs.
✓Emphasis on training, IEC, research & NGO involvement.
✓Improve TB case finding & treatment services.
✓CBNAAT (Cartridge based nucleic acid amplification) test machines
installation at 121 sites to find out DRTB cases. (at present 20,356)
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STRATEGIES contd..
✓Long term vision of “TB free India” was documented in ‘National
Strategic Plan 2012-17’
✓In 2015, TB drug Bedaquiline was introduced for DRTB patients.
✓In 2015, 26,977 MDR TB patients and 2130 XDR TB patients were on
treatment.
✓Treatment success of TB patients reached upto 87% which was higher
than global targets >85%.
✓To upgrade electronic database of TB patients NIKSHAY portal was
introduced.
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NATIONAL TUBERCULOSIS ELIMINATION
PROGRAMME
✓GOI formulated National Strategic Plan for Tuberculosis Elimination
2017-25 to eliminate TB in India by 2025, five year ahead of global
target.
✓The goal was “Universal access to quality TB diagnosis and treatment
for all TB patients in the community.”
✓Mandatory notification of all TB cases, integration with NHM,
diagnostic services, management of DRTB.
✓Single window service for TB HIV cases, drug resistance surveillance.
✓NSP TB elimination has been integrated into the four strategic pillars of
“Detect – Treat – Prevent – Build. ”
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1. DETECT
✓Objective is to find all drug sensitive TB cases (DSTB & DRTB).
✓Early diagnosis and treatment is important step to decrease the risk of
transmission of disease to others.
✓Notification of all TB cases is made mandatory of MoHFW since 2012.
✓All public-private hospitals/laboratories, NGO, individual practitioner
are bound to notify TB cases to district health officer/ Chief Medical
officer every month.
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✓To facilitate TB notification case based web based surveillance system
was developed as NIKSHAY portal. (https://nikshay.gov.in)
✓It is for both government and private health care facilities.
✓It works for patients support, logistic management, direct date
transfers, adherence support, support for agencies.
✓TB patients diagnosed in Private health care facility centers are also
entitled for incentives.
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The incentives to private sector TB care provider are as follows:
✓Rs 250/- on notification of a TB case diagnosed as per Standards for
TB Care in India (STCI)
✓Rs 250/- on completion of every month of treatment
✓Rs 500/- on completion of entire course of TB treatment
✓Rs 2750/ for notification and management of a drug-sensitive patient
over 6-9 months as per STCI
✓Rs 6750/-for notification and correct management of a drug-resistant
case over 24 months as per STCI
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2. TREAT
✓Provision of free TB drugs in the form of daily fixed dose combination
✓Screening of all patients for Rifampin resistance (or other drugs also if
required.)
✓Drugs of Intensive phase for initial two months (8 weeks) is given as per
FDC.
✓Thereafter drugs of Continuation phase for 3-6 months (16 weeks) is
given as per FDC.
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TREAT contd..
For new TB cases:
✓Intensive phase consists of eight weeks & continuation phase of 16
weeks as per FDC.
For previously treated TB cases:
✓Intensive phase consists of 12 weeks where inj. Streptomycin is given
for 8 weeks along with drugs according to FDC while continuation
phase is for 20 weeks.
✓Continuation phase can be extended by 12 to 24 weeks in some other
TBs like skeletal and based on clinical decision.
✓USA based most effective Bedaquiline drug for MDR TB was
introduced in 2015.
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NIKSHAY POSHAN YOJNA
✓NPY was introduced on April 2018 by central government under
National Health Mission (NHM).
✓Financial incentive of Rs. 500/- per month for plain areas and 750/- for
difficult areas is provided to TB patients.
✓Incentive is provided for nutritional support to each notified TB patient
for duration of anti TB treatment.
✓Amount is transferred in patient’s bank account through DBT.
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3. PREVENT
✓Scale up airborne infection control measures at community & health
centers.
✓Treatment for latent TB infection in contacts with bacteriologically
confirmed cases.
✓ Contact tracing & treatment.
✓BCG vaccination at birth or as early as possible till one year of age.
✓Addressing social factors for TB like poverty, malnutrition,
urbanization, indoor air pollution etc.
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4. BUILD
✓Health system strengthening for TB control under National Strategic
Plan 2017- 2025.
✓Building and strengthening enabling policies
✓Empowering institutions and human resources with enhanced
capacities.
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PRADHAN MANTRI TB MUKT BHARAT ABHIYAN &
NIKSHAY 2.0
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PRADHAN MANTRI TB MUKT BHARAT ABHIYAN &
NIKSHAY 2.0
✓The goal is to eliminate tuberculosis from India by 2025.
✓Any individual, self help group, industrial unit, cooperative society,
political party can adopt TB patient to ensure proper treatment & active
involvement of society.
✓These community elements can become “Nikshay Mitra” by
registering on Nikshay platform.
✓Minimum duration of being a NikshayMitra is one year, and the
maximum period is three years.
✓Total number of patients on treatment as on 1 january 2023 are 13.21
lakh.
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1950-60s Important TB research at Tuberculosis Research Centres.
1962 National TB Program (NTP)
1992 Programme Review
✓ Only 30% of patients diagnosed
✓ Of these, only 30% treated successfully
1993 Revised National TB Control Program (RNTCP) pilot began
1997 RNTCP Scale up, Phase I started.
2000 >30% of country covered
2004 >80% of country covered
2006 Entire country covered by RNTCP, Phase II started
2007 DOTS plus centres for MDR patients started. First state was Gujarat.
2012-17 National Strategic Plan (NSP) for Tuberculosis control
2017-25 National Strategic Plan (NSP) for Tuberculosis Elimination (NTEP)
2018 Nikshay Poshan Yojna
2022 Pradhan Mantri TB Mukt Bharat Abhiyan (PMTBMBA)
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DEVELOPMENT OF TB PROGRAMMES IN INDIA

ORGANIZATIONAL STRUCTURE FOR TUBERCULOSIS
CENTRAL TB
DIVISION, DGHS,
MoH&FW
STATE TB CELL
DISTRICT TB CELL
TUBERCULOSIS
UNIT
DMC
DOTS
CENTRE
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NIKSHAY DIWAS
15th of every month

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WORLD TUBERCULOSIS DAY
24 MARCH 2023

RESPIRATORY MEDICINE DEPARTMENT KGMU
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RESEARCH INPUT
Published Online: 27 February 2020, Indian Journal of tuberculosis,
www.journals.Elsevier.com
Nikshay Poshan Yojana (NPY) for tuberculosis patients: Early implementation
challenges in Delhi, India
Researchers: Rajesh Kumar, Neeta Singla, Tanu Anand, Sharath Burugina Nagaraja,
Karuna Sagili, Khalid Umer Khayyam, Rohit Sarin (2019)
Method: It was a cross sectional study and the data were collected from RNTCP
record/reports and interviews of patients and health care providers using structured
questionnaire. Study was conducted in National capital Territory (NCT) Delhi. Objective
was to determine the number of TB patients who received the benefits and to explore the
challenges faced by the health care providers in delivering NPY through DBT.
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RESEARCH INPUT
Results: Out of 119 patients registered, we interviewed 57 (47.9%) patients. Of which, 30
(52.6%) had received NPY for 2 months in the fourth and fifth month of treatment. The
health providers reported increased workload, lack of training and complex reporting
formats as main hurdles in implementation of the scheme. While, the patients cited non
availability of bank accounts and unlinked bank account with Aadhar card as difficulties to
receive NPY through DBT.
Conclusion: : Non-availability of bank accounts and unlinked bank accounts were some
challenges faced by both health providers and patient. It is recommended to address these
implementation on time in order to reap the benefit of scheme in improving nutritional status
of TB patients. Further studies are needed to determine the effect of nutrition support on TB
patients.
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HEALTH EDUCATION ON TB
By, Dr. Suryakant, Head of the Department, Respiratory Medicine,
KGMU, Lucknow UP
https://www.youtube.com/watch?v=kP03wuiO3uc&t=31s
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ANY QUESTION ?
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REFERENCES
1. Top 10 Most Dangerous Diseases in India 2023: Diseases Signs, Causes & Prevention [Internet]. Paybima Blogs. 2022 [cited 2023 Apr 9]. Available from:
https://www.paybima.com/blog/health-insurance/10-dangerous-and-deadliest-diseases-in-india/
2. India TB Report 2023 :: Central TB Division [Internet]. [cited 2023 Apr 9]. Available from: https://tbcindia.gov.in/index1.php?lang=1&level=1&sublinkid=5613&lid=3658
3. Directorate General Of Health Services [Internet]. [cited 2023 Feb 23]. Available from: https://dghs.gov.in/content/1358_3_RevisedNationalTuberculosisControlProgramme.aspx
4. Guidelines for Programmatic Management of Tuberculosis Preventive Treatment in India.pdf [Internet]. [cited 2023 Feb 23]. Available from:
https://tbcindia.gov.in/WriteReadData/l892s/Guidelines%20for%20Programmatic%20Management%20of%20Tuberculosis%20Preventive%20Treatment%20in%20India.pdf
5. National Tuberculosis Elimination Programme | National Health Portal Of India [Internet]. [cited 2023 Feb 23]. Available from: https://www.nhp.gov.in/revised-national-
tuberculosis-control-programme_pg
6. NSP Draft 20.02.2017 1.pdf [Internet]. [cited 2023 Feb 23]. Available from: https://tbcindia.gov.in/WriteReadData/NSP%20Draft%2020.02.2017%201.pdf
7. India: number of certified TB laboratories by type 2020 [Internet]. Statista. [cited 2023 May 17]. Available from: https://www.statista.com/statistics/1187650/india-number-of-
certified-tb-laboratories/
8. TBcindia module 6. Pdf [internet] [cited 2023 May 18]. Available from:https://tbcindia.gov.in/WriteReadData/l892s/030920201430Module6140120CTD.PDF
9. Nikshay Poshan Yojna - Details, Benefits and Performance UPSC [Internet]. Testbook. [cited 2023 May 18]. Available from: https://testbook.com/ias-preparation/nikshay-poshan-
yojana
10.National Institute for Research in Tuberculosis. In: Wikipedia [Internet]. 2022 [cited 2023 May 24]. Available from:
https://en.wikipedia.org/w/index.php?title=National_Institute_for_Research_in_Tuberculosis&oldid=1105665089
11.Kumar R, Khayyam KU, Singla N, Anand T, Nagaraja SB, Sagili KD, et al. Nikshay Poshan Yojana (NPY) for tuberculosis patients: Early implementation challenges in Delhi,
India. Indian J Tuberc. 2020 Apr;67(2):231–7.
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