2. TB disease burden in India
• As per WHO Global TB Report, 2015, out of
the estimated global annual incidence of 9.6
million TB cases, 2.2 million were estimated to
have occurred in India.
TB burden Number
(Millions)
(95% CI)
Rate Per
100,000
Persons (95% CI)
Incidence 2.2 (2.0–2.3) 167 (156–179)
Prevalence 2.5 (1.7–3.5) 195 (131–271)
Mortality 0.22 (0.15–0.35) 17 (12–27)
3. Evolution of TB Control in India
• 1950s-60s Important TB research at TRC and NTI
• 1962 National TB Programme (NTP)
• 1992 Programme Review
• only 30% of patients diagnosed;
• of these, only 30% treated successfully
• 1993 RNTCP pilot began
• 1998 RNTCP scale-up
• 2001 450 million population covered
• 2004 >80% of country covered
• 2006 Entire country covered by RNTCP
4. RNTCP
• RNTCP(1993) is a modification of National Tuberculosis
Programme (NTP) which has been in operation since 1962.
•Large-scale implementation of the RNTCP began in 1997
•Adopted the Directly Observed Treatment Short-
course(DOTS) strategy
•The revised strategy was introduced in the country in a
phased manner.
5. Core elements of Phase I
• The core element of RNTCP in Phase I (1997-
2006)was to ensure high quality DOTS expansion
in the country, addressing the five primary
components of the DOTS strategy
– Political will and administrative commitment
– Diagnosis by quality assured sputum smear
microscopy
– Directly observed treatment
– Systematic Monitoring and Accountability
– Adequate supply of quality assured short
course chemotherapy drugs
6. RNTCP Phase II( 2006-11)
• The RNTCP phase II is envisaged to:
–Consolidate the achievements of phase
I
–Maintain its progressive trend and
effect further improvement in its
functioning
–Achieve TB related MDG goals while
retaining DOTS as its core strategy
7. Early detection & Rx of 90% cases (DR-TB & HIV-TB)
Rx 90% of new TB patients, 85% of previously-treated
Reduce default rate : new TB cases to < 5%
re-treatment TB cases to < 10%
Extend RNTCP services to patients in private sector
Initial screening of all re-treatment smear-positive till 2015, and
all smear positive TB patients by year 2017 for drug-resistant TB
and provision of treatment services for MDR-TB patients.
Offer of HIV counselling and testing for all TB patients and linking
HIV-infected TB patients to HIV care and support
National Strategic Plan/12th Five year plan
(2012-17)
7
8. Organization
The profile of RNTCP in a state is as follows
State Tuberculosis Office State Tuberculosis Officer
State Tuberculosis Office and
Demonstration Centre
Director
District Tuberculosis Centre District Tuberculosis Officer
Tuberculosis Unit •Medical Officer(TB control)
•Senior Treatment Supervisor
•Senior TB Laboratory Supervisor
Designated Microscopy Centre,
Treatment Centers
DOTS Providers
9. Achievements of RNTCP
• National coverage of DOTS strategy was achieved in the year
2006.
• RNTCP is currently the world’s largest DOT programme.
• Since inception RNTCP has treated more than 19 million TB
patients under DOTS by utilizing a network of over 4 lakh
DOT providers.
• In 2015,
– RNTCP covered a population of 1.28 billion.
– A total of 91,32,306 TB suspects were examined by sputum
smear microscopy and 14,23,181 cases were registered for
treatment.
– 79% of all registered TB cases knew their HIV status.
– 93% HIV infected TB patients were initiated on CPT and 92%
were initiated on ART.
10. New Initiatives
• Introduced GeneXpert in RNTCP
(a new molecular test which diagnoses TB by detecting
the presence of Mycobacterium tuberculosis, as well as
testing for resistance to the drug Rifampicin)
• Using CB NAAT for the diagnosis of TB and
MDR-TB in high risk population like HIV
positive and pediatric group
11. Nikshay
• TB surveillance using case based web based IT
system
• Developed by central TB division in
collaboration with NIC
• The software was launched in May 2012
12. TB Notification
• Govt. of India declared Tuberculosis a
notifiable disease on 7th May 2012.
• It is now mandatory for all healthcare
providers to notify every TB case to local
authorities.
13. Ban on TB Serology
• The currently available serological tests are
having poor specificity and should not be used
for the diagnosis of pulmonary or extra-
pulmonary TB.
• Their import, manufacturing, sale,
distribution, and use is banned by GOI.
