SFT

Orientation
8th Feb 2008
RNTCP
Revised National TB
Control Programme
(RNTCP)

Central TB Division
Directorate General of Health Services
Ministry of Health & Family Welfare
Nirman Bhawan, New Delhi 110 011
 India is the highest TB burden country globally
accounting for one fifth of the global incidence

Global annual
incidence = 8.9 million

Source: WHO Geneva; WHO Report 2006: Global Tuberculosis Control; Surveillance, Planning and Financing
 TB Burden in India
• Incidence of TB disease: 1.8 million new TB cases annually
(0.8 million new infectious cases)
• Prevalence of TB disease: 3.8 million bacteriologically
positive (2000)
• Deaths: about 370,000 deaths due to TB each year
• TB/HIV: ~2.5 million people with HIV; >1 million co-infected
with HIV & TB
– About 5% of TB patients estimated to be HIV positive
• MDR-TB in new TB cases ≤3% and ~12% in Re-treatment
cases
• Substantial socio- economic impact
DOTS Coverage by District,
India
31st March 2006

Nation wide DOTS coverage

632 districts – 1114 million
people covered under RNTCP
 RNTCP – Goal and Objectives
• Goal
– The goal of TB control Programme is to decrease
mortality and morbidity due to TB and cut
transmission of infection 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
– To achieve and maintain a cure rate of at least 85%
in such patients
 RNTCP Performance
• National network of Diagnostic facilities
– 12,500 designated microscopy centres
– External quality assurance protocol in place
– Intermediate reference laboratories at State level
for culture and drug sensitivity tests
• More than 8 million patients put on treatment
– NSP case detection rate for 3Q07 was 70%
– Treatment success rate maintained over 85%
– Death rate has fallen from 42/lakh pop (1990) to
29/lakh pop (2005)
 Annualized New Smear-Positive Case Detection Rate
and Treatment Success Rate in DOTS Areas, India, 1999-2007*

•Population projected from 2001 census

•Estimated no. of NSP cases - 75/100,000 population per year (based on recent ARTI report)
 Structure of RNTCP at State level
STO, Deputy STO
State TB Cell MO, Accountant,
IEC Officer, SA, DEO

Nodal point for District TB Centre DTO, MO-DTC, LT,

TB control DEO, Driver

One/ 5 lakh (2.5 lakh

in hilly/ difficult/ Tuberculosis Unit MO-TC
tribal area) STS, STLS

One/ lakh (0.5 lakh

in hilly/ difficult/ Microscopy Centre MO, LT
tribal area)

DOT Provider – MPW,

DOT Centre NGO, PP, Comm Vol
 RNTCP Laboratory Network

3 NRLs
24 IRLs
~12,000 DMCs
(one per 50,000-100,000
population)
 Lab Quality Assurance
• Senior TB Laboratory Supervisor (STLS) was
provided to monitor quality of lab microscopy

• EQA protocol developed in 2001

• In 2004, based on new international guidelines,

External Quality Assessment (EQA) protocol
was revised and implemented
 Quality of treatment
• All patients initiated on treatment are monitored individually
and treatment outcomes are reported through a system of
cohort analysis
• DOT ensures that patients receive
– the right drugs
– in the right doses
– for the right duration of treatment
• All RNTCP patients receive drugs under direct observation by a
accessible, acceptable and accountable DOT provider
– DOT provider may be health worker or community based
volunteer, but not the family member
 Patient-wise drug boxes
•A unique feature of RNTCP are the patient-wise drug boxes (for
adult and paediatric cases), which improve patient care,
adherence, and drug supply and drug stock management.
•Paediatric patient wise boxes introduced in 2006

M&E
•Monitoring through routine surveillance data, review meetings,
– Supervision at every level of programme
– Evaluation by the state, central level and 3 yearly joint
monitoring missions
– All states are implementing the Supervision and Monitoring
Strategy
 Programme Surveillance
System
Peripheral Health
Institute (DMC and other PHIs)

Monthly PHI Report

Tuberculosis Unit
System electronic
from district level
Quarterly CF, SC, RT, PM Reports
upwards
Additional District TB Centre Quarterly
Feedback Electronic reports) Feedback

Quarterly Reports
CF, SC, RT, PM

Central TB Division State TB Cell

 M&E
• Monitoring through routine surveillance
data, review meetings,
–Supervision at every level of programme
–Evaluation by the state, central level
and 3 yearly joint monitoring missions
–All states are implementing the
Supervision and Monitoring Strategy
 RNTCP “Supervision and
Monitoring strategy”
• Strategy document developed and
published in March 2005
• All states and districts implementing the
strategy
• All state/district programme staff trained
in the strategy
 RNTCP initiatives…1
• DOTS Plus for MDR TB
– DOTS Plus services rolled out in Gujarat and
Maharashtra in March 2007. Total of 74 patients put
on DOTS Plus treatment.
– By 2010, programme plans to establish 24 DOTS
Plus sites across the country
• Public private mix
– Over 2400 NGOs, 17,000 private practitioners and
120 corporate houses involved in RNTCP
– 246 Medical colleges involved and contributing 10-
15% of case detection in their districts
 RNTCP initiatives…2
• TB HIV coordination
– National framework of joint TB HIV collaborative activities
developed in 2007
– Expansion of TB-HIV collaboration to all states will be done
in 2008
– 6 fold increase in number of TB suspects referred from
ICTCs to RNTCP since 2005
• IEC (ACSM activities)
– Well defined communication strategy based on audience
research and other aspects
– Web based IEC resource centre
– IEC baseline document has been developed in 2007
– Communication facilitators appointed to support districts in
planning and executing ACSM activities
 RNTCP in NRHM State PIP

• In the NRHM “Programme Implementation

Plan” (PIP), the states have to incorporate
the various TB control activities and budget in
Part ‘D’ of the PIP.
• The existing District Annual Action Plan/ State
Annual Action Plan formats of RNTCP have to
be incorporated in the NRHM State PIP.
 ASHA for RNTCP
• The Accredited Social Health Activist (ASHA) -
These community health volunteers have to be
trained for DOT provision to provide affordable,
accessible and quality treatment services near
to patient’s home.
• These volunteers would be provided
honorarium of Rs 250/- per patient on
treatment completion.