RNTCP at a Glance

Revised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control Programme

Revised National Tuberculosis Control ProgrammeRevised National Revised National

Revised National



Revised National



Revised National



Revised National



Revised National



Revised National



Revised National



Revised National



Revised National



Revised National



Revised National



Revised National

Revised National Tuberculosis Control Programme Revised National

Rev

ised

Nat

iona

l Tub

ercu

losi

s C

ontr

ol P

rogr

amm

e


Revised National Tuberculosis Control Programme


Revised National Tuberculosis Control Programme


Revised National Tuberculosis Control ProgrammeCentral TB DivisionRevised National Tuberculosis Control ProgrammeCentral TB DivisionRevised National Tuberculosis Control Programme

Directorate General of Health ServicesRevised National Tuberculosis Control Programme



Directorate General of Health ServicesRevised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control ProgrammeDirectorate General of Health ServicesRevised National Tuberculosis Control ProgrammeDirectorate General of Health ServicesRevised National Tuberculosis Control Programme

Directorate General of Health ServicesRevised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control ProgrammeDirectorate General of Health ServicesRevised National Tuberculosis Control ProgrammeMinistry of Health and Family WelfareRevised National Tuberculosis Control ProgrammeMinistry of Health and Family WelfareRevised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control Programme

Ministry of Health and Family WelfareRevised National Tuberculosis Control ProgrammeNirman Bhavan, New Delhi - 110 011Revised National Tuberculosis Control ProgrammeNirman Bhavan, New Delhi - 110 011Revised National Tuberculosis Control Programme

RNTCPRevised National Tuberculosis Control Programme

RNTCPRevised National Tuberculosis Control Programme

Revised National Tuberculosis Control ProgrammeRNTCPRevised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control ProgrammeRNTCPRevised National Tuberculosis Control Programme

at a Revised National Tuberculosis Control Programme

at a Revised National Tuberculosis Control Programme

Revised National Tuberculosis Control Programmeat a Revised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control Programmeat a Revised National Tuberculosis Control Programme

GLANCERevised National Tuberculosis Control Programme

GLANCERevised National Tuberculosis Control Programme

Revised National Tuberculosis Control ProgrammeGLANCERevised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control ProgrammeGLANCERevised National Tuberculosis Control Programme

CONTENTSCONTENTSCONTENTS

DEFINITIONS: THE REVISED NATIONAL TUBERCULOSIS DEFINITIONS: THE REVISED NATIONAL TUBERCULOSIS DEFINITIONS: THE REVISED NATIONAL TUBERCULOSIS CONTROL PROGRAMME 5CONTROL PROGRAMME 5CONTROL PROGRAMME 5

DIAGNOSTIC ALGORITHM FOR PULMONARY TB 6DIAGNOSTIC ALGORITHM FOR PULMONARY TB 6DIAGNOSTIC ALGORITHM FOR PULMONARY TB 6

STAINING METHOD 7STAINING METHOD 7STAINING METHOD 7

Key steps in the preparation and staining of smears 7Key steps in the preparation and staining of smears 7Key steps in the preparation and staining of smears 7

Ziehl - Neelsen Staining Method 8Ziehl - Neelsen Staining Method 8Ziehl - Neelsen Staining Method 8

TREATMENT 9TREATMENT 9TREATMENT 9

ZONAL ARTIS AND ESTIMATED NSP CASES PER LAKH ZONAL ARTIS AND ESTIMATED NSP CASES PER LAKH ZONAL ARTIS AND ESTIMATED NSP CASES PER LAKH POPULATION 9POPULATION 9POPULATION 9

TREATMENT CATEGORIES AND SPUTUM EXAMINATION TREATMENT CATEGORIES AND SPUTUM EXAMINATION TREATMENT CATEGORIES AND SPUTUM EXAMINATION SCHEDULE 10SCHEDULE 10SCHEDULE 10

MANAGEMENT OF PATIENTS WHO INTERRUPT TREATMENT 12MANAGEMENT OF PATIENTS WHO INTERRUPT TREATMENT 12MANAGEMENT OF PATIENTS WHO INTERRUPT TREATMENT 12

TREATMENT OF CHILDREN 15TREATMENT OF CHILDREN 15TREATMENT OF CHILDREN 15

Algorithm for clinical monitoring of Pediatric TB 16Algorithm for clinical monitoring of Pediatric TB 16Algorithm for clinical monitoring of Pediatric TB 16

Chemoprophylaxis for Children 17Chemoprophylaxis for Children 17Chemoprophylaxis for Children 17

SYMPTOM-BASED APPROACH TO EVALUATION OF POSSIBLE SIDE SYMPTOM-BASED APPROACH TO EVALUATION OF POSSIBLE SIDE SYMPTOM-BASED APPROACH TO EVALUATION OF POSSIBLE SIDE EFFECTS OF ANTI-TB DRUGS USED IN RNTCP 18EFFECTS OF ANTI-TB DRUGS USED IN RNTCP 18EFFECTS OF ANTI-TB DRUGS USED IN RNTCP 18

MANAGEMENT OF TB PATIENTS ON DOT IN SPECIAL MANAGEMENT OF TB PATIENTS ON DOT IN SPECIAL MANAGEMENT OF TB PATIENTS ON DOT IN SPECIAL SITUATIONS 19SITUATIONS 19SITUATIONS 19

HOSPITALIZATION OF TB PATIENTS 20HOSPITALIZATION OF TB PATIENTS 20HOSPITALIZATION OF TB PATIENTS 20

SUPERVISORY VISITS 21SUPERVISORY VISITS 21SUPERVISORY VISITS 21

SUMMARY OF KEY INDICATORS AND POSSIBLE CORRECTIVE SUMMARY OF KEY INDICATORS AND POSSIBLE CORRECTIVE SUMMARY OF KEY INDICATORS AND POSSIBLE CORRECTIVE ACTIONS 22ACTIONS 22ACTIONS 22

NEW INDICATORS 26NEW INDICATORS 26NEW INDICATORS 26

RNTCP at a Glance 5

DEF

INIT

ION

S: TH

E REV

ISED

NA

TIO

NA

L TU

BER

CU

LOSIS

CO

NTRO

L PR

OG

RA

MM

E

Cas

e de

finiti

ons

Typ

es o

f ca

ses

Tre

atm

ent

outc

omes

Pulm

onar

y Tub

ercu

losi

s, S

mea

r-Po

sitiv

eTB in

a p

atie

nt w

ith

at le

ast

2 in

itia

l spu

tum

sm

ear

exam

inat

ions

(di

rect

sm

ear

mic

rosc

opy)

pos

itiv

e fo

r A

FB.

Or:

TB in

a p

atie

nt w

ith

one

sput

um s

mea

r ex

amin

atio

n po

sitive

for

AFB

and

rad

iogr

aphi

c ab

norm

alitie

s co

nsis

tent

with

active

pul

mon

ary

TB

as d

eter

min

ed b

y th

e tr

eating

MO

.O

r: TB in

a p

atie

nt w

ith

one

sput

um s

mea

r sp

ecim

en p

ositiv

e fo

r A

FB a

nd c

ultu

re p

ositiv

e fo

r M

.tub

ercu

losi

s.Pu

lmon

ary

tube

rcul

osis

, Sm

ear-

nega

tive

TB in

a p

atie

nt w

ith

sym

ptom

s su

gges

tive

of

TB w

ith

at le

ast

3 s

putu

m s

mea

r ex

amin

atio

ns

nega

tive

for

AFB

, an

d ra

diog

raph

ic a

bnor

mal

itie

s co

nsis

tent

with

active

pul

mon

ary

TB a

s de

term

ined

by

the

tre

atin

g M

O f

ollo

wed

by

a de

cisi

on t

o tr

eat

the

patien

t w

ith

a fu

ll co

urse

of

anti-t

uber

culo

sis

ther

apy.

Or:

D

iagn

osis

bas

ed o

n po

sitive

cul

ture

but

neg

ativ

e A

FB s

putu

m s

mea

r ex

amin

atio

ns.

Ex

tra

Pulm

onar

y tu

berc

ulos

isTB o

f an

y or

gan

othe

r th

an t

he lu

ngs,

suc

h as

th

e pl

eura

(TB p

leur

isy)

, ly

mph

nod

es,

inte

stin

es,

geni

tour

inar

y tr

act,

ski

n, jo

ints

and

bon

es,

men

inge

s of

the

bra

in,

etc.

Dia

gnos

is s

houl

d be

bas

ed o

n cu

ltur

e-po

sitive

sp

ecim

en fro

m the

ext

ra-p

ulm

onar

y si

te, hi

stol

ogic

al,

radi

olog

ical

, or

str

ong

clin

ical

evi

denc

e co

nsis

tent

w

ith

active

ext

ra p

ulm

onar

y TB f

ollo

wed

by

deci

sion

of

the

tre

atin

g M

O t

o tr

eat

with

a fu

ll co

urse

of

anti-

TB t

hera

py.

Pleu

risy

is c

lass

ifie

d as

ext

ra p

ulm

onar

y TB.

A p

atie

nt d

iagn

osed

with

both

spu

tum

sm

ear

posi

tive

pul

mon

ary

and

extr

a pu

lmon

ary

TB s

houl

d be

cla

ssifie

d as

pul

mon

ary

TB.

New

A

TB p

atie

nt w

ho h

as n

ever

had

tre

atm

ent

for

tube

rcul

osis

or

has

take

n an

ti-t

uber

culo

sis

drug

s fo

r le

ss t

han

one

mon

th.

Rel

apse

A T

B p

atie

nt w

ho w

as d

ecla

red

cure

d or

tre

atm

ent

com

plet

ed b

y a

phys

icia

n, b

ut w

ho r

epor

ts b

ack

to

the

heal

th s

ervi

ce a

nd is

now

fou

nd t

o be

spu

tum

sm

ear

posi

tive

.Tra

nsfe

rred

inA

TB p

atie

nt w

ho h

as b

een

rece

ived

for

tre

atm

ent

into

a T

uber

culo

sis

Uni

t, a

fter

sta

rtin

g tr

eatm

ent

in

anot

her

unit w

here

s/h

e ha

s be

en r

egis

tere

d.Tre

atm

ent

afte

r de

faul

tA

TB p

atie

nt w

ho r

ecei

ved

anti-t

uber

culo

sis

trea

tmen

t fo

r on

e m

onth

or

mor

e fr

om a

ny s

ourc

e an

d re

turn

s to

tre

atm

ent

afte

r ha

ving

def

aulted

, i.e

., n

ot t

aken

ant

i-TB d

rugs

con

secu

tive

ly f

or t

wo

mon

ths

or m

ore,

and

is f

ound

to

be s

putu

m s

mea

r po

sitive

. Fa

ilure

Any

TB p

atie

nt w

ho is

sm

ear

posi

tive

at

5 m

onth

s or

mor

e af

ter

star

ting

tre

atm

ent.

Fai

lure

als

o in

clud

es a

pat

ient

who

was

tre

ated

with

Cat

egor

y III

reg

imen

but

who

bec

omes

sm

ear

posi

tive

dur

ing

trea

tmen

t.

Chr

onic

A T

B p

atie

nt w

ho r

emai

ns s

mea

r po

sitive

aft

er

com

plet

ing

a re

-tre

atm

ent

regi

men

.O

ther

sTB p

atie

nts

who

do

not

fit

into

the

abo

ve m

ention

ed

type

s. R

easo

ns f

or p

utting

a p

atie

nt in

thi

s ty

pe

mus

t be

spe

cified

.

Cur

edIn

itia

lly s

putu

m s

mea

r-po

sitive

pat

ient

who

has

co

mpl

eted

tre

atm

ent

and

had

nega

tive

spu

tum

sm

ears

, on

tw

o oc

casi

ons,

one

of

whi

ch w

as a

t th

e en

d of

tre

atm

ent

Tre

atm

ent

com

plet

edSpu

tum

sm

ear-

posi

tive

pat

ient

who

has

com

plet

ed

trea

tmen

t, w

ith

nega

tive

sm

ears

at

the

end

of t

he

inte

nsiv

e ph

ase

but

none

at

the

end

of t

reat

men

t.

Or:

Spu

tum

sm

ear-

nega

tive

TB p

atie

nt w

ho h

as

rece

ived

a f

ull c

ours

e of

tre

atm

ent

and

has

not

beco

me

smea

r-po

sitive

dur

ing

or a

t th

e en

d of

tr

eatm

ent.

O

r:

Extr

a-pu

lmon

ary

TB p

atie

nt w

ho h

as r

ecei

ved

a fu

ll co

urse

of

trea

tmen

t an

d ha

s no

t be

com

e sm

ear-

posi

tive

dur

ing

or a

t th

e en

d of

tre

atm

ent.

Die

dPa

tien

t w

ho d

ied

durin

g th

e co

urse

of

trea

tmen

t re

gard

less

of

caus

eFa

ilure

Any

TB p

atie

nt w

ho is

sm

ear

posi

tive

at

5 m

onth

s or

mor

e af

ter

star

ting

tre

atm

ent.

Fai

lure

als

o in

clud

es a

pat

ient

who

was

tre

ated

with

Cat

egor

y III

reg

imen

but

who

bec

omes

sm

ear

posi

tive

dur

ing

trea

tmen

t.

Def

aulte

dA

pat

ient

who

has

not

tak

en a

nti-T

B d

rugs

for

2 m

onth

s or

mor

e co

nsec

utiv

ely

afte

r st

arting

tr

eatm

ent.

Tra

nsfe

rred

out

A p

atie

nt w

ho h

as b

een

tran

sfer

red

to a

noth

er

Tub

ercu

losi

s U

nit/

Dis

tric

t an

d hi

s/he

r tr

eatm

ent

resu

lt (

outc

ome)

is n

ot k

now

n.

RNTCP at a Glance6

DIAGNOSTIC ALGORITHM FOR PULMONARY TB

COUGH FOR 3 WEEKS OR MORECOUGH FOR 3 WEEKS OR MORE

3 Sputum smears3 Sputum smears

2 or 3 Positives2 or 3 Positives 3 Negatives3 Negatives

Antibiotics 10-14 daysAntibiotics 10-14 days

Cough PersistsCough Persists

Repeat 3 Sputum Repeat 3 Sputum Examinations

1 Positive

X-Ray Negative 2 or 3 Positives2 or 3 Positives

Suggestive of TBSuggestive of TB Negative for TBNegative for TB Sputum Positive Sputum Positive TB (Anti-TB Treatment)Treatment)

X-RaySputum Positive Sputum Positive

TB (Anti-TB Treatment)Treatment)

Negative for TBNegative for TB Suggestive of TBSuggestive of TB

Sputum Smear Sputum Smear Negative TB

(Anti-TB Treatment)(Anti-TB Treatment)

Non TB

RNTCP at a Glance 7

STAINING METHODKey steps in the preparation and staining of smears

Step 1

Break a broomstick into two

Pick up the large, yellow purulent portion of sputum Spread evenly onto 2/3 of central portion of the

numbered slide

Step 2

Spread evenly onto 2/3 of central portion of the

numbered slide

Air-dry the slide for 15–30

minutes

Step 3

Fix the dry slide by heating briefly 3–5 times for 3–4

seconds each time

Place the slides in serial order on the

staining rack

Stain the slides with 1% carbol

fuchsin

Step 4

Step 5

Heat the slides from underneath until vapours rise

Let the slides stand for 5 minutes

Rinse the slides with tap water

Step 6 Step 7

Drain off excess water

Decolourize with 25% sulphuric acid and let it stand for 2–4 minutes (repeat, letting

stand for 1–3 minutes, if necessary)

Step 8

Rinse away excess stain with tap water

Drain off the water

Step 9

Step 10

Counterstain with 0.1% methylene blue and let stand for 30 seconds

Gently rinse the slides with tap water, drain the water

off, and allow the slide to dry

Examine the slides under the microscope examine

at least 100 fields.

RNTCP at a Glance8

Ziehl - Neelsen Staining Method1. Select a new unscratched slide and label the slide with the Laboratory Serial

Number with a diamond marking pencil.2. Make a smear from yellow purulent portion of the sputum using a broom stick. A

good smear is spread evenly, 2 cms x 3 cms in size and is neither too thick nor too thin. The optimum thickness of the smear can be assessed by placing the smear on a printed matter. The print should be readable through the smear. Smear preparation should be done near a flame. This is required, as six inches around the flame is considered as a sterile zone which coagulates the aerosol raised during smear preparation.

3. Allow the slide to air dry for 15–30 minutes.4. Fix the slide by passing it over a flame 3–5 times for 3–4 seconds each time.5. Pour 1% filtered carbol fuchsin to cover the entire slide.6. Gently heat the slide with carbol fuchsin on it, until vapours rise. Do not boil.7. Leave carbol fuchsin on the slide for 5 minutes.8. Gently rinse the slide with tap water until all free carbol fuchsin stain is washed

away. At this point, the smear on the slide looks red in colour.9. Pour 25% sulphuric acid onto the slide.10. Let the slide stand for 2–4 minutes.11. Rinse gently with tap water. Tilt the slide to drain off the water.12. A properly decolourised slide will appear light pink in color .If the slide is still red,

reapply sulphuric acid for 1–3 minutes and rinse gently with tap water. Wipe the back of the slide clean with a swab dipped in sulphuric acid,

13. Pour 0.1% methylene blue onto the slide.14. Leave methylene blue on the slide for 30 seconds.15. Rinse gently with tap water.16. Allow the slide to dry.17. Examine the slide under the microscope using x 40 lens to select the suitable area

and then examine under x100 lens using a drop of immersion oil.18. Record the results in the Laboratory Form and the Laboratory Register.

If the slide has: Result Grading No. of fields to be examined

More than 10 AFB per oil immersion field Pos 3+ 20

1-10 AFB per oil immersion field Pos 2+ 50

10-99 AFB per 100 oil immersion fields Pos 1+ 100

1-9 AFB per 100 oil immersion fields Pos Scanty-B* 100

No AFB in 100 oil immersion fields Neg 100

*Record actual number of bacilli seen in 100 fields – e.g. “Scanty 4”

19. Invert the slides on tissue paper till the immersion oil is completely absorbed. Do not use xylene for cleaning the slides, as it may give false results at repeat examination after storage.

20. Store all positive and negative slides serially in the same slide-box until instructed by the supervisor.

21. Disinfect all contaminated material before discarding.

RNTCP at a Glance 9

TREATMENT

Is the patient sputum-smear positive*Is the patient sputum-smear positive*

Does the patient have TB?Does the patient have TB? Has the patient been treated for TB for one month or more

previously

NO YES

NO

YES

No Anti-TB treatment

Is the patient seriously ill?**

NO YES

NO

CAT IICAT II

YES

* Patients with extra-pulmonary TB should receive Category III treatment unless they are seriously ill, in which case they should receive Category I treatment.

** Examples of seriously ill patients are those suffering from meningitis, disseminated TB, tuberculous pericarditis, peritonitis, bilateral or extensive pleurisy, spinal TB with neurological complications, smear-negative pulmonary TB with extensive parenchymal involvement, intestinal, genito-urinary TB and co-infection with HIV. All forms of pediatric smear negative TB except primary complex and pediatric extrapulmonary TB except lymph node TB and unilateral pleural effusion.

ZONAL ANNUAL RISK OF TUBERCULOUS INFECTION (ARTI) AND ESTIMATED NSP CASES PER LAKH POPULATIONZone States/Union Territories Estimated NSP cases

per lakh population

North Haryana, Himachal Pradesh, Jammu & Kashmir, Punjab, Uttar Pradesh, Chandigarh, Delhi, Uttaranchal

95

East* Assam, Bihar, Manipur, Meghalaya, Mizoram, Nagaland, Sikkim, Tripura, West Bengal, Andaman & Nicobar, Arunachal Pradesh, Jharkhand

75

South* Andhra Pradesh, Karnataka, Kerala, Tamil Nadu, Pondicherry, Lakshadweep

75

West Goa, Gujarat, Madhya Pradesh, Maharashtra, Rajasthan, Dadra & Nagar Haveli, Daman & Diu, Chhattisgarh

80

State specific Orissa 85

CAT ICAT ICAT IIICAT III

RNTCP at a Glance10

TREA

TM

ENT C

ATEG

ORIE

S A

ND

SPU

TU

M E

XA

MIN

ATIO

N S

CH

EDU

LE

TREA

TM

ENT R

EGIM

ENSPU

TU

M E

XA

MIN

ATIO

NS F

OR P

ULM

ON

ARY

TB

Cat

egor

y of

Tre

at m

ent

Typ

e of

pat

ient

Reg

imen

*Pr

e-tr

eatm

ent

sput

umTes

t at

m

onth

(e

nd IP)

If r

esul

t is

The

n

Cat

egor

y I

New

spu

tum

sm

ear-

posi

tive

2H

3R

3Z

3E 3

+

4H

3R

3

+2

–Sta

rt c

ontinu

atio

n ph

ase,

tes

t sp

utum

aga

in a

t 2 m

onth

s in

CP

(4 m

onth

s) a

nd a

t th

e en

d of

tr

eatm

ent

(6 m

onth

s)

+C

ontinu

e In

tens

ive

phas

e fo

r on

e m

ore

mon

th,

test

spu

tum

aga

in a

t en

d of

ext

ende

d IP

(3 m

onth

s),

and

then

at

2 m

onth

s in

CP

(5 m

onth

s) a

nd a

t th

e en

d of

tre

atm

ent

(7

mon

ths)

†Ser

ious

ly il

l** s

putu

m s

mea

r-ne

gative

Ser

ious

ly il

l** e

xtra

-pul

mon

ary

–2

–Sta

rt c

ontinu

atio

n ph

ase,

tes

t sp

utum

aga

in a

t th

e en

d of

tre

atm

ent

(6 m

onth

s)

+

Con

tinu

e In

tens

ive

phas

e fo

r on

e m

ore

mon

th,

test

spu

tum

aga

in a

t en

d of

ext

ende

d IP

(3 m

onth

s),

and

then

at

2 m

onth

s in

CP

(5 m

onth

s) a

nd a

t th

e en

d of

tre

atm

ent

(7

mon

ths)

†

Cat

egor

y II

Spu

tum

sm

ear-

posi

tive

Rel

apse

Spu

tum

sm

ear-

posi

tive

Fai

lure

Spu

tum

sm

ear-

posi

tive

Tre

atm

ent af

ter

defa

ult

Oth

ers*

**

2H

3R

3Z

3E 3

S3 +

1H

3R

3Z

3E 3

+

5H

3R

3E 3

+3

–Sta

rt c

ontinu

atio

n ph

ase,

tes

t sp

utum

aga

in a

t 2 m

onth

s in

CP

(5 m

onth

s) a

nd a

t th

e en

d of

tr

eatm

ent

(8 m

onth

s)

+

Con

tinu

e In

tens

ive

phas

e fo

r on

e m

ore

mon

th,

test

spu

tum

aga

in a

t en

d of

ext

ende

d IP

(4 m

onth

s),

and

then

at

2 m

onth

s in

CP

(6 m

onth

s) a

nd a

t th

e en

d of

tre

atm

ent

(9

mon

ths)

Cat

egor

y III

New

spu

tum

sm

ear-

nega

tive

,no

t se

rious

ly il

l2H

3R

3Z

3 +

4H

3R

3

–

2–

Sta

rt c

ontinu

atio

n ph

ase,

tes

t sp

utum

aga

in a

t th

e en

d of

tre

atm

ent

(6 m

onth

s)

New

ext

ra-p

ulm

onar

y, n

ot s

erio

usly

ill

+Re-

regi

ster

the

pat

ient

and

beg

in C

ateg

ory

II tr

eatm

ent†

*

The

num

ber

befo

re t

he le

tter

s re

fers

to

the

num

ber

of m

onth

s of

tre

atm

ent.

The

sub

scrip

t af

ter

the

lett

ers

refe

rs t

o th

e nu

mbe

r of

dos

es p

er w

eek.

The

dos

age

stre

ngth

s ar

e as

fo

llow

s: H

: Is

onia

zid

(600 m

g),

R:

Rifam

pici

n (4

50 m

g),

Z:

Pyra

zina

mid

e (1

500 m

g),

E: E

tham

buto

l (1200 m

g),

S:

Str

epto

myc

in (

750 m

g).

Patien

ts w

ho w

eigh

60 k

g or

mor

e re

ceiv

e ad

dition

al r

ifam

pici

n 150 m

g. P

atie

nts

who

are

mor

e th

an 5

0 y

ears

old

rec

eive

str

epto

myc

in 5

00 m

g. P

atie

nts

who

wei

gh le

ss t

han

30 k

g, r

ecei

ve d

rugs

as

per

body

w

eigh

t. P

atie

nts

in C

ateg

orie

s I an

d II

who

hav

e a

posi

tive

spu

tum

sm

ear

at t

he e

nd o

f th

e in

itia

l int

ensi

ve p

hase

rec

eive

an

addi

tion

al m

onth

of

inte

nsiv

e ph

ase

trea

tmen

t.**

Ser

ious

ly il

l als

o in

clud

es,

any

patien

t, p

ulm

onar

y or

ext

ra-p

ulm

onar

y w

ho is

HIV

pos

itiv

e an

d de

clar

es h

is s

ero-

stat

us t

o th

e ca

tego

rizin

g/ t

reat

ing

med

ical

off

icer

. F

or t

he p

urpo

se

of c

ateg

oriz

atio

n, H

IV t

esting

sho

uld

not

be d

one

*** In

rare

and

exc

eption

al c

ases

, pa

tien

ts w

ho a

re s

putu

m s

mea

r-ne

gative

or

who

hav

e ex

tra-

pulm

onar

y di

seas

e ca

n ha

ve R

elap

se o

r Fa

ilure

. Thi

s di

agno

sis

in a

ll su

ch c

ases

sho

uld

alw

ays

be m

ade

by a

n M

O a

nd s

houl

d be

sup

port

ed b

y cu

ltur

e or

his

tolo

gica

l evi

denc

e of

cur

rent

, ac

tive

TB.

In t

hese

cas

es,

the

patien

t sh

ould

be

cate

goriz

ed a

s ‘O

ther

s’ a

nd

give

n C

ateg

ory

II tr

eatm

ent.

†

Any

pat

ient

tre

ated

with

Cat

egor

y I w

ho h

as a

pos

itiv

e sm

ear

at 5

mon

ths

or la

ter

shou

ld b

e co

nsid

ered

a F

ailu

re a

nd s

tart

ed o

n C

ateg

ory

II tr

eatm

ent

afre

sh.

Any

pat

ient

on

Cat

egor

y III

who

has

a p

ositiv

e sm

ear

anyt

ime

durin

g th

e tr

eatm

ent

is a

lso

cons

ider

ed a

s Fa

ilure

and

sta

rted

on

Cat

egor

y II

trea

tmen

t.

RNTCP at a Glance 11

MEDICATIONMedication Dose (thrice a week)*** Number of pills in

combipackIsonazid 600mg 2Rifampicin 450mg* 1Pyrazinamide 1500mg 2Ethambutol 1200mg 2Streptomycin 0.75g** -

Category Duration (number of doses) TotalIntensive Phase (IP) Continuation Phase (CP)

Category I 8 weeks (24 doses) 18 weeks (54 doses) 26 weeks (78 doses)Category II 12 weeks (36 doses) 22 weeks (66 doses) 34 weeks (102 doses)Category III 8 weeks (24 doses) 18 weeks (54 doses) 26 weeks (78 doses)

Phases and duration of treatment

* Patients who weigh 60kg or more at the start of treatment are given an extra 150mg dose of rifampicin** Patients over 50 years of age and those who weigh less than 30 kg are given 0.5g of streptomycin.*** Adult patients who weigh less than 30kg receive drugs in patient-wise boxes from the weight band

suggested for pediatric patients

Regimen for non-DOTS in RNTCP areasTreatment Type of Patient RegimenNon-DOTS Regimen 1 (ND 1)

New smear-positive pulmonary Seriously ill sputum smear-negativeSeriously ill extra-pulmonary

2 HSE + 10 HE

Non-DOTS Regimen 2 (ND 2)

Smear-negative pulmonary, not seriously illExtra-pulmonary, not seriously ill

12 HE

Duration if sputum is positive at end of Intensive Phase*Category Duration (number of doses) Total

Intensive Phase (IP) Continuation Phase (CP)Category I 12 weeks (36 doses) 18 weeks (54 doses) 26 weeks (90 doses)Category II 16 weeks (48 doses) 22 weeks (66 doses) 34 weeks (114doses)

* Cat I – at the end of 2 months Cat II – at the end of 3 months

In RNTCP areas, less then 5% of patients may get Non-DOTS Treatment

RNTCP at a Glance12

MANAGEMENT OF PATIENTS WHO INTERRUPT TREATMENT

Management of patients who were smear-negative at diagnosis and who interrupt treatment

Treatment received beforeinterruption

Length ofinterruption

Do a sputumSmear examination

Result of sputumSmear examination

Outcome Re-registration

Treatment

Less than1 month

Less than2 months

No __ __ __ ResumeTreatment andComplete All doses

2 months ormore

Yes Neg __ __ ResumeTreatment

Pos Default New Begin CAT Iafresh

More than1 month

Less than2 months

No __ __ __ ResumeTreatment andCompleteAll doses

More than 2 months

Yes Neg __ __ ResumeTreatment andCompleteAll doses

Pos Default Treatment After Default

Begin CAT IITreatmentafresh



Treatment for New smear-positive cases who interrupt treatment (Category I)

Treatment received before interruption


Do a sputum Smear examination?

Result of sputum Smear examination


Treatment

Less than1 month

Less than2 weeks

No __ __ __ Continue CAT I*

2-7 weeks No __ __ __ Start again on CAT I**

8 weeksor more

Yes Positive Default New Start again on CAT I**

Negative __ __ Continue CAT I*

1-2 months Less than2 weeks

No __ __ __ Continue CAT I*

More than2 months

2-7 weeks Yes Positive __ __ 1 extra month of intensive phase of CAT I

8 weeks or more

Yes Negative __ __ Continue CAT I*

Positive Default Treatment After Default

Start on CAT II*

Less than2 weeks

No Negative __ __ Continue CAT I*

__ __ __ Continue CAT I*

2-7 weeks Yes Positive Default*** Other Start on CAT II**

8 weeks or more


Yes Positive Default Treatment After Default

Start on CAT II**


* A patient must complete all 24 doses of the initial intensive phase. For example, if a patient has to continue his previous treatment and he took 1 month of treatment (12 doses) before interrupting. He will have to take 1 more month (12 doses) of the intensive phase treatment. The patient will then start the continuation phase of treatment.

** A patient who must start again will restart treatment from the beginning.*** Although this patient does not strictly fit the definition of default. Default most closely describes the outcome of

this patient. although at re-registration the patient should be categorized as ‘Other’.

RNTCP at a Glance14


Treatment for smear-positive retreatment cases who interrupt treatment (Category II)

Treatment received beforeinterruption


Do a sputumSmear examination

Result of sputum Smear examination


Treatment

Less than1 month

Less than2 weeks

No __ __ __ Continue CAT II*

2-7 weeks No __ __ __ Start again on CAT II**

8 weeksor more


Start again on CAT II**

Negative __ __ Continue CAT II*

1-2 months

Less than2 weeks

No __ __ __ Continue CAT II*

2-7 weeks Yes Positive __ __ 1 extra month of intensive phase of CAT II

8 weeks or more

Yes Negative __ __ Continue CAT II*

Positive Default Treatment After Default

Start again on CAT II**

More than2 months

Less than2 weeks

No Negative __ __ Continue CAT II*

__ __ __ Continue CAT II*

2-7 weeks Yes Positive Default*** Other Start again on CAT II**

8 weeks or more



Start again on CAT II


* A patient must complete all 36 doses of the initial intensive phase.** A patient who must “start again” will restart treatment from the beginning. *** Although this patient does not strictly fit the definition of default. Default most closely describes the outcome of this

patient, although at re-registration the patient should be categorized as ‘Other’.

Is expectoration present?Is expectoration present?

If yes, examine 3 sputum If yes, examine 3 sputum

2 or 3 Positives2 or 3 Positives 3 Negatives3 Negatives

Antibiotics 10-14 daysAntibiotics 10-14 days

Cough PersistsCough Persists

Repeat 3 Sputum Repeat 3 Sputum Examinations

1 Positive

X-Ray Negative 2 or 3 Positives2 or 3 Positives

Suggestive of TBSuggestive of TB Negative for TBNegative for TB Sputum Positive Sputum Positive TB (Anti-TB Treatment)

X-Ray + MantouxSputum Positive Sputum Positive

TB (Anti-TB Treatment)

Negative for TBNegative for TB Suggestive of TBSuggestive of TB

Sputum Smear Negative TB Sputum Smear Negative TB (Anti-TB Treatment)

Refer to PediatricianRefer to Pediatrician

TREATMENT OF CHILDREN

Diagnostic Algorithm for Pediatric Pulmonary TB

Pulmonary TB Suspect Fever and/or cough 3 weeks Loss of wt/ No wt. gain History of contact with suspected or diagnosed case of active TB

If no, refer to PediatricianIf no, refer to Pediatrician

RNTCP at a Glance16

Algorithm for Clinical Monitoring of Pediatric TB

Patient on treatment

Review at 2 months, Review at 2 months, satisfactory response assessed by:– improvement in symptoms– no weight loss and or

weight gain

Review at 2 months, non-Review at 2 months, non-satisfactory response assessed by:– adherence to treatment– weight loss– worsening of symptoms

Follow up clinically Refer to Pediatrician/TB Refer to Pediatrician/TB specialist for assessment (consider sputum examination)

Clinical assessment and Clinical assessment and X-ray at completion of treatment

Sputum positiveSputum positive

Failure

Category IICategory II

Sputum negative or not Sputum negative or not available

– Review diagnosis– extend IP by 1 month

No improvement = Pediatric non-responder


Dosages for children

Drugs Dosage (Thrice a week)Isonoazid 10-15mg/kgRifampicin 10mg/kgPyrazinamide 35mg/kgStreptomycin 15mg/kgEthambutol 30mg/kg

Chemoprophylaxis for Children

Household contacts of smear-positive TB cases, especially those below 6 years of age, must be screened for symptoms of tuberculosis. In case of symptoms being present, the diagnostic algorithm for pediatric TB should be followed and the child should be given a full course of anti TB treatment if s/he is diagnosed as a TB case.

For asymptomatic children and those who are not found to be suffering from TB, chemoprophylaxis with isoniazid (5 mg per kg body wt) should be administered daily for a period of six months.

This is regardless of the BCG vaccination status.

RNTCP at a Glance18

SYMPTOM-BASED APPROACH TO EVALUATION OF POSSIBLE SIDE EFFECTS OF ANTI-TB DRUGS USED IN RNTCP

Symptom Drug (abbreviation) Action to be taken

Gastrointestinal upset

Any oral medication Reassure patient Give drugs with less water Give drugs over a longer period of time (e.g. 20 minutes) Do not give drugs on empty stomach If the above fails, give antiemetic if appropriate

Itching Isoniazid (H) (Other drugs also)

Reassure patientIf severe, stop all drugs and refer patient to MO

Burning in the hands and feet Isoniazid (H) Give pyridoxine 100 mg/day until

symptoms subside

Joint pains Pyrazinamide (Z)If severe, refer patient forEvaluation

Impaired vision Ethambutol (E) STOP ethambutol, refer patient for evaluation

Ringing in the ears Streptomycin (S) STOP streptomycin, refer patient for

evaluation

Loss of hearing Streptomycin (S) STOP streptomycin, refer patient for evaluation

Dizziness and loss of balance Streptomycin (S) STOP streptomycin, refer patient for

evaluation

JaundiceIsoniazid (H)Rifampicin (R)Pyrazinamide (Z)

STOP all drugs, refer patient for evaluation

In cases of jaundice, all anti-TB drugs should be stopped immediately and the patient referred for evaluation.


MANAGEMENT OF TB PATIENTS ON DOT IN SPECIAL SITUATIONS

Situation ManagementHospitalization • Only extremely ill patients need hospitalization during the

treatment • Patients with significant haemoptysis, pneumothorax or large

accumulation of pleural fluid leading to breathlessness need to be hospitalized

• Flow chart for hospitalized patients is given on next pageTuberculous meningitis

• Fatal if untreated• Patient should be referred to the hospital• Total duration of treatment is 8–9 months. The continuation

phase should be given for 6–7 months• Steroids should be given initially and gradually reduced over

6–8 weeksTreatment of TB during pregnancy and postnatal period

• Streptomycin should not be given; other drugs used in RNTCP are safe

• Breast feeding should continue regardless of the mother’s TB status

• Advise the mother to cover her mouth, if she is smear-positive, while breastfeeding the baby

• Chemoprophylaxis for the baby is advisable if mother is sputum smear-positive

Treatment in patients with renal failure

• Rifampicin, isoniazid and pyrazinamide can be safely given• Streptomycin and ethambutol, if given, should be closely

monitored with reduced dosageTreatment in women taking oral contraceptive pills

• Rifampicin decreases the efficiency of oral contraceptives; increase the dosage of the oral contraceptive or switch to another method of contraception

TB and HIV • Anti-TB Treatment is same for HIV-infected people as it is for HIV negative TB patients

• DOT assumes greater importance for HIV infected patients• All new TB cases who are known to be HIV positive based

on voluntary sharing of results and/or history of anti-retroviral therapy are considered to be seriously ill

• Patients with TB-HIV should complete their TB treatment prior to beginning ART (if not already on ART). If patient is already on ART, it should be modified to be rifampicin-friendly

MDR TB • MDR-TB is drug resistant TB caused due to bacilli resistant to Isoniazid and Rifampicin, with or without resistance to other anti TB drugs.

• Management of MDR –TB is very complex• Prevention of MDR–TB rather than its treatment is the priority

under RNTCP

RNTCP at a Glance20

Patient is admittted with tuberculosis for indications Patient is admittted with tuberculosis for indications like significant haemoptysis, pneumothorax or large

accumulation of pleural fluid leading to breathlessnes

Attending physician prescribes RNTCP regimen using Attending physician prescribes RNTCP regimen using prolongation pouches

Inform DOT centre of that hospitalInform DOT centre of that hospital

Register in the TU, where the hospital belongs if the patient

is not already registered

If the patient is already If the patient is already registered, do not re-register. On discharge send back to

treating PHI to continue and complete treatment.

If the patient does not reside If the patient does not reside in the same TU, on discharge

transfer out to PHI/TU nearest to his/her residence, to continue and

complete treatment

If the patient resides in the If the patient resides in the same TU, on discharge send to the PHI nearest to his/her residence to continue and

complete treatment

HOSPITALIZATION OF TB PATIENTSSome TB patients may need hospitalization during their illness. All indoor patients are to be treated with RNTCP regimens. The treatment is given using prolongation pouches which will be supplied by District TB Officer through the STS of that TU. On discharge, patients may be given a maximum of three doses (1 week drug supply) to cover the intervening period prior to their continuation of treatment at their respective DOT Centre, which may/not be in the same district, hence ensuring no interruption in treatment. All indoor patients treated under RNTCP, should be registered under the local TU in which the hospital is located.

Management of Hospitalized patients


SUPERVISORY VISITS

Category of supervisor

Methodology of supervision Number of supervisory visits

DTO/MO –DTC

Interview the MO-TC, MO I/C of PHC-CHC, STS, STLS, LT and DOT-provider, health personnel of other sectors (NGO, private etc.) and the person in-charge of anti-TB drug & consumable storage.

Interact with community and local opinion leaders

Randomly interview patients and community leaders.

Inspect records of the TU, PHC and CHC, and stock of anti-TB drugs and laboratory consumables.

Randomly check the microscopy centre and treatment observation centres.

Visit all TUs every month and all DMCs every quarter. Visit all CHCs and Block PHCs in the district every quarter, one sub-centre from each Block PHC area and a proportion of treatment observation centres every quarter. Conduct supervisory visit at least 3-5 days a week. Visit at least three patients at their homes per visit

MO-TC

Interview the MO I/C BPHC/CHC/PHC.

Randomly interview patients and community leaders.

Interact with community and local opinion leaders

Randomly check the microscopy centre and treatment observation centre; stock of anti-tuberculosis drugs and laboratory consumables.

Visit all DMCs every month. Visit all CHCs/BPHCs/ PHCs and a proportion of treatment observation centres at least once every quarter. Conduct supervisory visits 7days a month. Visit at least three patients at their homes per visit.

STS

Interview MPHS and MPWs at the PHC sub-centre.

Inspect records, Tuberculosis Treatment Cards and Tuberculosis Laboratory Register.

Randomly interview patients.

Visit all PHIs at least once every month and all treatment observation centres once every quarter. Visit all new sputum positive patients at their home within one month of treatment initiation. Conduct supervisory visits at least 5 days a week.

STLS

Inspect all microscopy centres and laboratory records.

Visit all microscopy centres in the jurisdiction of the TU at least once a month. Visit all sputum collection centres at least once a month.

RNTCP at a Glance22

SU

MM

ARY

OF

KEY

IND

ICA

TO

RS A

ND

PO

SSIB

LE C

ORREC

TIV

E A

CTIO

NS

Cas

e Fi

ndin

g In

dica

tors

and

pos

sibl

e re

spon

ses

to p

robl

ems

Qua

rter

ly R

epor

tIn

dica

tor

Poss

ible

Act

ions

Expe

cted

: N

ew s

mea

r-po

sitive

cas

es ca

se

dete

ctio

n of

≥ 7

0%

Ann

ualiz

edre

gist

ered

num

ber

of

new

sm

ear-

posi

tive

ca

ses

is <

50%

Ensu

re t

hat

ever

y TB s

uspe

ct in

all

perip

hera

l hea

lth

faci

litie

s un

derg

o sp

utum

sm

ear

exam

inat

ion

(in a

t le

ast

2%

of

new

adu

lt o

utpa

tien

ts).

Ensu

re t

hat

3 s

putu

m s

mea

r ex

amin

atio

ns a

re d

one

for

TB s

uspe

cts.

Ensu

re t

hat

sput

um s

mea

r m

icro

scop

y is

don

e co

rrec

tly

(5%

–15%

pos

itiv

ity

is e

xpec

ted

amon

g pa

tien

ts

exam

ined

for

dia

gnos

is).

Int

ensi

fy r

evie

w o

f sl

ides

rea

d as

sm

ear-

nega

tive

, pa

rtic

ular

ly t

hose

of

patien

ts

plac

ed o

n tr

eatm

ent.

Ensu

re t

hat

all s

mea

r-po

sitive

s in

the

Lab

orat

ory

Reg

iste

r ar

e st

arte

d on

tre

atm

ent

and

regi

ster

ed in

the

TB R

egis

ter.

Ensu

re t

hat

sput

um s

mea

r m

icro

scop

y is

acc

essi

ble

to p

atie

nts,

and

the

labo

rato

ry t

echn

icia

n is

tra

ined

.

Ann

ualiz

edre

gist

ered

num

ber

of

new

sm

ear-

posi

tive

ca

ses

is >

100%

Ensu

re t

hat

no a

ctiv

e ca

se-f

indi

ng is

bei

ng d

one

in a

ny a

rea.

Ensu

re t

hat

sput

um s

mea

r m

icro

scop

y is

acc

urat

e.

Ensu

re r

evie

w o

f sl

ides

of

smea

r-po

sitive

pat

ient

s.En

sure

tha

t on

ly p

atie

nts

who

res

ide

in t

he a

rea

are

star

ted

on t

reat

men

t, a

nd n

on-r

esid

ent

patien

ts a

re

refe

rred

for

tre

atm

ent

to h

ealth

faci

litie

s in

the

are

as t

hat

they

res

ide

in.

Expe

cted

: Re-

trea

tmen

t sm

ear-

posi

tive

cas

es

are

abou

t 30%

of

all

smea

r-po

sitive

cas

es in

in

itia

l yea

rs o

f RN

TC

P im

plem

enta

tion

Re-

trea

tmen

t ca

ses

are

<20%

of

all

smea

r -p

ositiv

e ca

ses

Ensu

re t

hat

accu

rate

his

tory

tak

ing

is d

one

at a

ll le

vels

. Pa

tien

ts m

ust

be a

sked

car

eful

ly a

bout

any

pr

ior

trea

tmen

t ta

ken

for

TB f

rom

any

sou

rce.

It

shou

ld b

e ex

plai

ned

to p

atie

nts

that

onl

y if t

hey

prov

ide

accu

rate

info

rmat

ion

can

the

mos

t ef

fect

ive

trea

tmen

t be

giv

en.

Mak

e su

re t

hat

defini

tion

s ar

e ap

plie

d co

rrec

tly.

Any

sm

ear-

posi

tive

pat

ient

tre

ated

in t

he p

ast

for

mor

e th

an o

ne m

onth

and

has

def

aulted

for

mor

e th

an t

wo

mon

ths,

sho

uld

rece

ive

the

re-t

reat

men

t (C

ateg

ory

II) r

egim

enRe-

trea

tmen

t ca

ses

are

>40%

of

all

smea

r-po

sitive

cas

es

Ensu

re t

hat

active

cas

e-find

ing

is n

ot b

eing

res

orte

d to

. W

ith

active

cas

e-find

ing,

man

y ‘o

ld’ TB c

ases

are

re

port

ed.

Ensu

re t

hat

hist

ory-

taki

ng is

acc

urat

e an

d de

fini

tion

s ar

e be

ing

corr

ectly

appl

ied.

Ensu

re t

hat

new

sym

ptom

atic

pat

ient

s un

derg

o th

ree

sput

um s

mea

r ex

amin

atio

ns f

or a

cid-

fast

bac

illi

(AFB

).Ex

pect

ed: 50%

of

all n

ew

pulm

onar

y ca

ses

will

be

smea

r-po

sitive

Am

ong

new

pu

lmon

ary

case

s,

prop

ortion

of

smea

r-po

sitive

is <

45%

Ensu

re t

hat

over

-dia

gnos

is o

f sp

utum

sm

ear-

nega

tive

pat

ient

s is

not

hap

peni

ng d

ue t

o ov

er r

elia

nce

on

radi

ogra

phy.

No

patien

t sh

ould

beg

in t

reat

men

t w

itho

ut t

he m

anda

tory

thr

ee s

putu

m s

mea

r ex

amin

atio

ns.

Ensu

re t

hat

3 s

putu

m s

mea

rs a

re e

xam

ined

for

all

TB s

uspe

cts.

Ensu

re t

hat

repe

at s

putu

m s

mea

r ex

amin

atio

ns a

re d

one

for

patien

ts w

ho c

ontinu

e to

hav

e sy

mpt

oms

afte

r a

cour

se o

f an

tibi

otic

s.En

sure

tha

t sp

utum

sm

ear

mic

rosc

opy

is d

one

corr

ectly.

Rev

iew

slid

es o

f sm

ear

nega

tive

pat

ient

s pl

aced

on

tre

atm

ent.

Expe

cted

: N

ot m

ore

than

20%

of

smea

r-ne

gative

and

ex

tra-

pulm

onar

y pa

tien

ts

are

cons

ider

ed s

erio

usly

ill

and

plac

ed u

nder

Cat

egor

y I

Prop

ortion

of

smea

r-ne

gative

or

extr

a-pu

lmon

ary

serio

usly

ill

pat

ient

s gi

ven

Cat

egor

y I re

gim

en is

>

25%

Ensu

re t

hat

only

ser

ious

ly il

l pat

ient

s ar

e gi

ven

Cat

egor

y I t

reat

men

t. N

on-s

erio

usly

ill N

ew s

mea

r-ne

gative

pa

tien

ts s

houl

d re

ceiv

e C

ateg

ory

III t

reat

men

t.En

sure

tha

t sp

utum

mic

rosc

opy

is d

one

corr

ectly.

Arr

ange

rev

iew

of

slid

es o

f sm

ear-

nega

tive

pat

ient

s pl

aced

on

trea

tmen

t.


Spu

tum

Con

vers

ion

Indi

cato

rs a

nd p

ossi

ble

resp

onse

s to

pro

blem

sQ

uart

erly

Rep

ort

Indi

cato

rPo

ssib

le A

ctio

ns

Expe

cted

:C

onve

rsio

n ra

te is

>90%

of

new

sm

ear-

posi

tive

pat

ient

s at

3

mon

ths

Less

tha

n 85%

of

New

sm

ear-

posi

tive

pa

tien

ts a

re d

ocum

ente

d to

bec

ome

sput

um s

mea

r-ne

gative

at

3 m

onth

s

Ensu

re t

hat

Med

ical

Off

icer

s, t

reat

men

t su

perv

isor

s, a

nd a

ll ot

her

staf

f in

volv

ed in

the

pr

ogra

mm

e at

per

iphe

ral c

entr

es u

nder

stan

d th

e im

port

ance

of fo

llow

-up

sput

um e

xam

inat

ions

. Fo

llow

-up

sput

um e

xam

inat

ions

are

the

bes

t m

easu

re o

f pa

tien

t re

spon

se t

o tr

eatm

ent.

C

onve

rsio

n of

spu

tum

at

the

end

of IP

incr

ease

s pa

tien

t co

nfid

ence

and

is c

ritic

al t

o pr

ogra

mm

e ev

alua

tion

.V

isit a

ll ce

ntre

s w

ith

low

spu

tum

con

vers

ion

rate

and

res

olve

any

pro

blem

with

the

help

of

the

staf

f.M

ake

sure

def

ault r

ates

in t

he f

irst

two

mon

ths

are

<5%

, an

d th

e nu

mbe

r of

pat

ient

s w

ho d

ie

or t

rans

ferr

ed o

ut a

re m

inim

ized

.En

sure

tha

t ac

cura

te h

isto

ry-t

akin

g ta

kes

plac

e at

all

leve

ls.

Patien

ts m

ust

be a

sked

car

eful

ly

abou

t an

y pr

ior

trea

tmen

t fo

r TB f

rom

any

sou

rce.

It

shou

ld b

e ex

plai

ned

to p

atie

nts

that

onl

y if t

hey

prov

ide

accu

rate

info

rmat

ion

can

effe

ctiv

e tr

eatm

ent

be g

iven

. If p

revi

ousl

y tr

eate

d pa

tien

ts a

re n

ot p

lace

d on

the

re-

trea

tmen

t re

gim

en,

they

may

not

res

pond

wel

l to

trea

tmen

t.M

ake

sure

tha

t de

fini

tion

s ar

e ap

plie

d co

rrec

tly.

Any

sm

ear-

posi

tive

pat

ient

tre

ated

for

mor

e th

an o

ne m

onth

in t

he p

ast

and

with

a de

faul

t of

mor

e th

an t

wo

mon

ths,

sho

uld

rece

ive

the

re-t

reat

men

t (C

ateg

ory

II) r

egim

en.

Ensu

re t

hat

sput

um m

icro

scop

y is

acc

urat

e. E

nsur

e re

view

of

slid

es o

f pa

tien

ts w

ho r

emai

ned

smea

r po

sitive

at

the

end

of t

he in

tens

ive

phas

e.En

sure

tha

t ev

ery

dose

of

med

icat

ion

is o

bser

ved

durin

g th

e in

tens

ive

phas

e of

tre

atm

ent.

O

bser

vation

sites

sho

uld

be c

onve

nien

t to

the

pat

ient

. The

qua

lity

of D

OTS s

houl

d be

che

cked

at

the

tim

e of

sup

ervi

sion

, in

clud

ing

chec

king

of

entr

ies

in t

he T

reat

men

t C

ards

with

the

drug

s av

aila

ble

in p

atie

nt-w

ise

boxe

s.

RNTCP at a Glance24

Res

ult

of T

reat

men

t In

dica

tors

and

pos

sibl

e so

lutio

n to

pro

blem

s

Qua

rter

ly R

epor

tIn

dica

tor

Poss

ible

Act

ions

Expe

cted

: C

ure

rate

fo

r ne

w s

mea

r-po

sitive

ca

ses

is ≥

85%

Cur

e ra

te o

f

new

sm

ear-

posi

tive

pa

tien

ts

is <

80%

Vis

it c

entr

es w

ith

low

cur

e ra

tes

to d

iscu

ss w

ith

patien

ts a

nd s

taff

the

rea

sons

for

low

cur

e ra

te a

nd

poss

ible

sol

utio

ns.

Ensu

re t

hat

accu

rate

his

tory

-tak

ing

take

s pl

ace

at a

ll le

vels

. Pa

tien

ts m

ust

be a

sked

car

eful

ly a

bout

any

prio

r tr

eatm

ent

for

tube

rcul

osis

tak

en f

rom

any

sou

rce.

It

shou

ld b

e ex

plai

ned

to p

atie

nts

that

onl

y if t

hey

prov

ide

accu

rate

info

rmat

ion

can

the

mos

t ef

fect

ive

trea

tmen

t be

giv

en.

If p

revi

ousl

y tr

eate

d pa

tien

ts a

re n

ot g

iven

th

e re

-tre

atm

ent

regi

men

, th

ey m

ay n

ot r

espo

nd w

ell t

o tr

eatm

ent.

Mak

e su

re t

hat

defini

tion

s ar

e ap

plie

d co

rrec

tly.

Any

sm

ear-

posi

tive

pat

ient

tre

ated

for

mor

e th

an o

ne m

onth

in

the

pas

t, w

ith

defa

ult

of m

ore

than

tw

o m

onth

s, s

houl

d re

ceiv

e th

e re

-tre

atm

ent

(Cat

egor

y II)

reg

imen

.

Ensu

re t

hat

ever

y do

se o

f m

edic

atio

n is

obs

erve

d du

ring

the

inte

nsiv

e ph

ase

of t

reat

men

t, a

nd a

t le

ast

one

dose

per

wee

k in

the

con

tinu

atio

n ph

ase.

Ens

ure

retu

rn o

f em

pty

blis

ter

pack

s du

ring

wee

kly

colle

ctio

n of

dr

ugs.

Obs

erva

tion

sites

sho

uld

be c

onve

nien

t fo

r th

e pa

tien

t.

Ensu

re t

hat

heal

th w

orke

rs a

re d

ispe

nsin

g m

edic

atio

n pr

oper

ly a

s pe

r te

chni

cal g

uide

lines

.

Ensu

re t

hat

follo

w-u

p sp

utum

sm

ear

exam

inat

ions

are

don

e ac

cord

ing

to g

uide

lines

.

Cur

e ra

te o

f ne

w

smea

r- p

ositiv

e C

AT I

patien

ts is

>95%

Che

ck f

or t

he a

ccur

acy

of t

he r

epor

t. M

ake

sure

tha

t Res

ult

of T

reat

men

ts a

re c

orre

ctly

rec

orde

d an

d re

port

ed.

All

diag

nose

d sm

ear-

posi

tive

pat

ient

s st

arte

d on

tre

atm

ent

shou

ld b

e re

gist

ered

.

Expe

cted

: N

ot m

ore

than

3%

of

new

sm

ear-

posi

tive

pat

ient

s ar

e gi

ven

the

Prop

ortion

of

new

sm

ear-

pos

itiv

e pa

tien

ts w

ho a

re

clas

sified

as

havi

ng

‘com

plet

ed’

trea

tmen

t is

>5%

Ensu

re t

hat

follo

w-u

p sp

utum

exa

min

atio

ns a

re d

one

as p

er p

olic

y. C

aref

ully

tra

ck t

his

at a

ll tr

eatm

ent

units.

Sen

sitize

the

Med

ical

Off

icer

s an

d ot

her

heal

th s

taff

abo

ut t

he im

port

ance

of

follo

w-u

p sp

utum

ex

amin

atio

ns.

Loca

te p

atie

nts

who

hav

e re

cent

ly c

ompl

eted

tre

atm

ent

and

obta

in s

putu

m s

ampl

es f

or e

xam

inat

ion.

Car

eful

ly r

evie

w t

he p

atie

nt d

ata

for

accu

racy

and

to

ensu

re t

hat

trea

tmen

t is

bei

ng g

iven

und

er d

irect

ob

serv

atio

n as

per

pol

icy.

Expe

cted

: N

ot m

ore

than

4%

of

new

sm

ear-

posi

tive

pat

ient

s di

e du

ring

trea

tmen

t

Prop

ortion

of

new

sm

ear-

posi

tive

pat

ient

s w

ho

die

durin

g tr

eatm

ent

is

>5%

Ensu

re t

hat

ever

y do

se o

f m

edic

atio

n is

obs

erve

d du

ring

the

inte

nsiv

e ph

ase

of t

reat

men

t, a

nd a

t le

ast

one

dose

per

wee

k in

the

con

tinu

atio

n ph

ase.

Obs

erva

tion

sites

sho

uld

be c

onve

nien

t to

the

pat

ient

.

Rev

iew

info

rmat

ion

on p

atie

nts

who

die

d to

det

erm

ine

reas

ons.

If p

atie

nts

are

pres

enting

for

tre

atm

ent

whe

n al

read

y m

orib

und,

con

side

r w

ays

and

mea

ns t

o en

cour

age

mor

e pr

ompt

ref

erra

l and

dia

gnos

is s

o th

at p

atie

nts

can

be t

reat

ed e

arlie

r in

the

cou

rse

of t

heir

TB il

lnes

s.

In-s

pite

of

all

the

abo

ve, if t

he d

eath

rat

e is

still

mor

e th

an 5

%, co

nsid

er e

valu

atio

n of

the

pre

vale

nce

of H

IV

infe

ctio

n am

ong

TB p

atie

nts,

to

be d

one

stric

tly

as p

er p

olic

y w

ith

safe

guar

ds o

f co

nfid

ential

ity.


Expe

cted

:

Failu

re:

Not

m

ore

than

4%

of

new

sm

ear-

posi

tive

pat

ient

s

cont

inue

to

be sm

ear-

posi

tive

at

5 m

onth

s o

r la

ter

from

the

sta

rt o

f tr

eatm

ent

Prop

ortion

of

new

sm

ear-

posi

tive

pat

ient

s

who

fai

l tre

atm

ent

is

>5%

Ensu

re t

hat

accu

rate

his

tory

-tak

ing

is d

one

at a

ll le

vels

. Pa

tien

ts m

ust

be a

sked

car

eful

ly a

bout

prio

r tr

eatm

ent

for

tube

rcul

osis

fro

m a

ny s

ourc

e. It

shou

ld b

e ex

plai

ned

to p

atie

nts

that

onl

y if t

hey

prov

ide

accu

rate

info

rmat

ion

can

the

mos

t ef

fect

ive

trea

tmen

t be

giv

en.

If p

revi

ousl

y tr

eate

d pa

tien

ts a

re n

ot g

iven

th

e re

-tre

atm

ent

regi

men

, th

ey m

ay n

ot r

espo

nd w

ell t

o tr

eatm

ent.

Mak

e su

re t

hat

defini

tion

s ar

e ap

plie

d co

rrec

tly.

Any

sm

ear-

posi

tive

pat

ient

tre

ated

for

mor

e th

an o

ne m

onth

in

the

pas

t, w

ith

defa

ult

of m

ore

than

tw

o m

onth

s, s

houl

d re

ceiv

e th

e re

-tre

atm

ent

(Cat

egor

y II)

reg

imen

.

Ensu

re t

hat

ever

y do

se o

f m

edic

atio

n is

obs

erve

d du

ring

the

inte

nsiv

e ph

ase

of t

reat

men

t an

d at

leas

t on

e do

se p

er w

eek

in t

he c

ontinu

atio

n ph

ase.

Ens

ure

retu

rn o

f em

pty

blis

ter

pack

s du

ring

wee

kly

colle

ctio

n of

dr

ugs

in t

he c

ontinu

atio

n ph

ase.

Obs

erva

tion

sites

sho

uld

be c

onve

nien

t to

the

pat

ient

.

Ensu

re t

hat

heal

th w

orke

rs a

re d

ispe

nsin

g m

edic

atio

n pr

oper

ly a

s pe

r te

chni

cal g

uide

lines

.

Ensu

re t

hat

drug

s ar

e of

acc

epta

ble

qual

ity,

sto

red

in a

ppro

pria

te c

ondi

tion

s an

d ar

e us

ed b

efor

e th

e ex

piry

pe

riod.

In-s

pite

of

all t

he a

bove

, if t

he f

ailu

re rat

e re

mai

ns h

ighe

r th

an 5

%, co

nsid

er e

valu

atio

n of

the

leve

l of

prim

ary

drug

res

ista

nce

in t

he c

omm

unity.

Expe

cted

Def

ault r

ate

is <

5%

Def

ault r

ate

of s

mea

r-

posi

tive

Cat

egor

y I

patien

ts is

>8%

Vis

it c

entr

es w

hich

hav

e re

port

ed t

he h

ighe

st d

efau

lt r

ates

and

inte

rvie

w s

taff

and

pat

ient

s to

det

erm

ine

the

effo

rts

mad

e to

ret

rieve

pat

ient

s, t

he r

easo

ns f

or d

efau

lt a

nd p

ossi

ble

solu

tion

s. M

ake

sure

tha

t ce

ntre

s ar

e aw

are

of t

heir

defa

ult

rate

so

that

the

y ca

n ta

ke s

teps

to

redu

ce it

.

Ensu

re t

hat

patien

t hi

stor

y is

car

eful

ly a

scer

tain

ed,

incl

udin

g th

e ad

dres

s. A

vis

it t

o pa

tien

ts’

hom

e sh

ould

be

mad

e to

ver

ify

addr

ess

and

land

mar

ks n

ear

the

hous

e sh

ould

be

reco

rded

in t

he T

reat

men

t C

ard.

Ser

vice

s sh

ould

be

conv

enie

nt t

o th

e pa

tien

t in

ter

ms

of d

ista

nce,

tim

e an

d st

aff

attitu

des.

Dur

ing

the

visi

t to

the

hou

se f

or v

erific

atio

n of

add

ress

, no

te t

he n

ame

and

addr

ess

of a

per

son

who

can

be

cont

acte

d in

the

eve

nt t

he p

atie

nt d

efau

lts.

Ensu

re t

hat

dire

ctly

obs

erve

d tr

eatm

ent

is g

iven

to

patien

ts in

the

inte

nsiv

e ph

ase

and

at le

ast

one

dose

per

w

eek

is d

irect

ly o

bser

ved

durin

g th

e co

ntin

uation

pha

se.

Expe

cted

:

Tra

nsfe

rred

out

is <

3%

Prop

ortion

of

patien

ts

who

are

‘Tra

nsfe

rred

out’

is >

5%

Tra

nsfe

r ou

t ca

n be

a w

ay o

f di

sgui

sing

def

ault.

Patien

ts s

houl

d be

cat

egor

ized

as

‘Tra

nsfe

rred

out

’ on

ly if

th

ey h

ave

been

giv

en a

Tra

nsfe

r Fo

rm t

o be

tak

en t

o th

e fa

cilit

y w

here

the

y ar

e tr

ansf

erre

d to

.

Ensu

re t

he r

ecei

pt o

f re

sults

of f

ollo

w u

p sp

utum

exa

min

atio

ns a

nd t

reat

men

t

RNTCP at a Glance26

New

Indi

cato

rsIn

dica

tors

Form

ula

Com

men

ts

% n

ew s

mea

r po

sitive

out

of

tota

l new

pul

mon

ary

case

sN

os.

of N

SP

case

s re

gist

ered

in t

he q

uart

er /

Tot

al N

os.

of n

ew p

ulm

onar

y (N

SP+

NSN

) ca

ses

regi

ster

ed in

the

sam

e qu

arte

r X

100

Expe

cted

val

ue is

50%

.

% o

f ne

w e

xtra

pul

mon

ary

case

s ou

t of

all

new

cas

esN

os.

of n

ew e

xtra

pulm

onar

y ca

ses

regi

ster

ed /

Nos

. of

new

ca

ses

regi

ster

ed (

NSP+

NSN

+ne

w

extr

a pu

lmon

ary)

X 1

00

Expe

cted

val

ue is

10-

15%

% o

f re

trea

tmen

t ca

ses

out

of

all s

mea

r po

sitive

cas

esTot

al N

os.

of s

mea

r po

sitive

ret

reat

men

t ca

ses

(Rel

apse

, Fa

ilure

, Tre

atm

ent

afte

r de

faul

t, O

ther

s)

regi

ster

ed /

Tot

al N

os.

of s

mea

r po

sitive

cas

es (

new

sm

ear

posi

tive

pul

mon

ary

case

s +

sm

ear

posi

tive

ret

reat

men

t ca

ses)

X

100

% o

f pe

diat

ric c

ases

out

of

all

new

cas

esTot

al N

os. of

new

ped

iatr

ic c

ases

reg

iste

red

(new

sm

ear po

sitive

pul

mon

ary

pedi

atric

cas

es +

new

sm

ear

nega

tive

pul

mon

ary

pedi

atric

cas

es +

new

ext

ra p

ulm

onar

y pe

diat

ric c

ases

) /

Tot

al N

os.

of

new

cas

es r

egis

tere

d (N

SP+

NSN

+ n

ew e

xtra

pulm

onar

y)

X 1

00

% s

mea

r po

sitive

pat

ient

s liv

ing

in t

he d

istr

ict

plac

ed o

n D

OTS

Nos

. of

spu

tum

pos

itiv

e pa

tien

ts p

ut o

n RN

TC

P D

OTS d

urin

g th

e qu

arte

r in

the

dis

tric

t /

(Nos

. of

spu

tum

pos

itiv

e pa

tien

ts d

iagn

osed

dur

ing

the

resp

ective

qua

rter

– N

os.

of s

putu

m p

ositiv

e pa

tien

ts r

efer

red

for

trea

tmen

t ou

tsid

e th

e di

stric

t) X

100

Expe

cted

val

ue >

95%

% o

f sm

ear

posi

tive

pat

ient

s pl

aced

on

Non

-DO

TS tre

atm

ent

regi

men

Nos

. of

spu

tum

pos

itiv

e pa

tien

ts p

ut o

n RN

TC

P N

on-D

OTS d

urin

g th

e qu

arte

r in

the

dis

tric

t / (N

os.

of s

putu

m p

ositiv

e pa

tien

ts d

iagn

osed

dur

ing

the

resp

ective

qua

rter

– N

os.

of s

putu

m p

ositiv

e pa

tien

ts r

efer

red

for

trea

tmen

t ou

tsid

e th

e di

stric

t) X

100

Expe

cted

val

ue le

ss t

han

5%

% o

f in

itia

l def

aulter

sN

os.

of s

putu

m p

ositiv

e pa

tien

ts d

iagn

osed

who

are

nei

ther

put

on

RN

TC

P D

OTS o

r RN

TC

P N

on-D

OTS in

the

dis

tric

t, o

r re

ferr

ed f

or t

reat

men

t ou

tsid

e th

e di

stric

t /

(Nos

. of

spu

tum

pos

itiv

e pa

tien

ts d

iagn

osed

dur

ing

the

resp

ective

qua

rter

– N

os.

of s

putu

m p

ositiv

e pa

tien

ts r

efer

red

for

trea

tmen

t ou

tsid

e th

e di

stric

t) X

100

% o

f ne

w s

mea

r po

sitive

cas

es

star

ted

on R

NTC

P D

OTS w

ithi

n 7 d

ays

of d

iagn

osis

Nos

. of

spu

tum

pos

itiv

e pa

tien

ts d

iagn

osed

sta

rted

on

trea

tmen

t w

ith

in 7

day

s of

dia

gnos

is / T

otal

N

os.

of s

putu

m p

ositiv

e pa

tien

ts d

iagn

osed

X 1

00

Dat

a ob

tain

ed f

rom

TB

regi

ster

% o

f ne

w s

mea

r po

sitive

cas

es

regi

ster

ed w

ithi

n on

e m

onth

of

diag

nosi

s

Nos

. of

spu

tum

pos

itiv

e pa

tien

ts d

iagn

osed

and

sta

rted

on

trea

tmen

t un

der

RN

TC

P, w

ho a

re

regi

ster

ed w

ithi

n 1 m

onth

of

diag

nosi

s /

Tot

al N

os.

of s

putu

m p

ositiv

e pa

tien

ts d

iagn

osed

X 1

00

Dat

a ob

tain

ed f

rom

TB

regi

ster

% o

f in

terv

iew

ed n

ew s

mea

r po

sitive

cas

es w

ho r

ecei

ved

DO

T d

urin

g In

tens

ive

Phas

e as

pe

r gu

idel

ines

Nos

. of

inte

rvie

wed

NSP

case

s w

ho r

ecei

ved

DO

T a

s pe

r gu

idel

ines

(>

21/2

4 d

oses

)/ T

otal

Nos

. of

N

SP

case

s in

terv

iew

ed X

100

Dat

a ob

tain

ed f

rom

Pa

tien

ts in

terv

iew

s du

ring

supe

rvis

ory

fiel

d vi

sits

% o

f cu

red

NSP

case

s ha

ving

en

d of

tre

atm

ent

follo

w-u

p sp

utum

don

e w

ithi

n 7 d

ays

of

last

dos

e

Nos

. of

NSP

case

s re

gist

ered

dur

ing

the

quar

ter

havi

ng a

n ou

tcom

e cu

red,

who

had

the

ir en

d of

tr

eatm

ent

sput

um e

xam

ined

withi

n 7 d

ays

of la

st d

ose/

Tot

al N

os.

of N

SP

case

s re

gist

ered

dur

ing

the

resp

ective

qua

rter

with

trea

tmen

t ou

tcom

e as

cur

ed X

100

Dat

a ob

tain

ed f

rom

TB

regi

ster

NSP-

New

Sm

ear

Posi

tive

; N

SN

- N

ew S

mea

r N

egat

ive

Due dates for reports from Tuberculosis Units to DTC in the year 2006

Due On Quarterly Report on Period Covered

7 January 2006

Case Finding 1 October – 31 December 2005

Programme Management 1 October – 31 December 2005

Sputum Conversion 1 July – 30 September 2005

Results of Treatment 1 October – 31 December 2004

7 April 2006

Case Finding 1 January – 31 March 2006

Programme Management 1 January – 31 March 2006

Sputum Conversion 1 October – 31 December 2005

Results of Treatment 1 January – 31 March 2005

7 July 2006

Case Finding 1 April – 30 June 2006

Programme Management 1 April – 30 June 2006

Sputum Conversion 1 January – 31 March 2006

Results of Treatment 1 April – 30 June 2005

7 October 2006

Case Finding 1 July – 30 September 2006

Programme Management 1 July – 30 September 2006

Sputum Conversion 1 April – 30 June 2006

Results of Treatment 1 July – 30 September 2005

The District TB Officer is to retain one copy of records and send the quarterly reports to the state TB Officer. All reports to reach Central TB Division by the 24th of the month. Reports to be sent to [email protected]

RNTCP at a Glance

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Transcript of RNTCP at a Glance