RNTCPRevised National

TB Control Programme

TB statistics in India■India is the highest TB burden

country■Accounts for 1/5th (21%) of the

global incidence of TB■WHO statistics for 2014 –Incidence figure of 2.2

million cases of TB for India out of a global incidence of 9 million.

Prevalence figure 2.5 million

 Every day in Indianearly 1,000 deaths due to TB 

Two people die in every three minutes

History of TB control in India■1900 - First open-air sanatorium for treatment and isolation of TB patients founded in 1906 in Tiluania , near Ajmer and two years later one was opened in Almora

■1940 -1960 - anti TB drugs like streptomycin, INH,PAS■1948 – work with BCG started as pilot project ; 1949

extended to cover schools in almost all states.■1962 - National TB Control Programme (NTP) ■1993 - RNTCP pilot project

NTP - National TB Control Programme ■Based on research in the 1950s and early 1960s

by the TRC at Chennai and the NTI at Bangalore, a National Tuberculosis Programme (NTP) was implemented by Government of India in 1962.

WHY DID NTP FAIL?■Inadequate budget and lack of political commitment■Shortage of drugs■Low rates of treatment completion

Only 30% patients diagnosed Of these only 30% treated successfully

■Emphasis on x-ray diagnosis resulting in false diagnosis

■Inadequate microbiology labs leading to unreliable sputum microscopy

RNTCP

■RNTCP based on the WHO recommended DOTS strategy was launched in 1993 as pilot project

■RNTCP: 1997 launched as national programme■By end of 1998 only 2% of total Indian population

was covered. Since March 2006 ,it covers the whole country

Objectives■To achieve and maintain cure rate of at least 85%

among New Sputum Positive (NSP) patients.■To achieve and maintain case detection of at least

70% of the estimated NSP cases in the community.

• Political will and Administrative commitment• Diagnosis by quality assured sputum smear

microscopy• Adequate supply of quality assured short course

chemotherapy drugs• Directly observed treatment• Systemic monitoring and accountability

WEAKNESSIn 2014 Joint TB Monitoring mission (JMM) report

■Additional funding■Use of a thrice weekly intermittent  regimen and

starting treatment without knowing the resistance profile of the patients contributes to the amplification of resistance.

■Delays in supply chain management, bad storage conditions of drugs continue to be a problem

■Integration of HIV-TB departments is still very slow.■The lack of engagement of RNTCP with the massive

private sector■Actual implementation of the policy revisions in

RNTCP is not being done