Revised National Tuberculosis Control Program. Revised National Tuberculosis Control Program (RNTCP) is the state- run tuberculosis (TB) control initiative of the Government of India. As per the National Strategic Plan 2. The Revised National TB Control Programme (RNTCP) thus formulated, adopted the internationally recommended Directly Observed Treatment Short- course (DOTS) strategy, as the most systematic and cost- effective approach to revitalise the TB control programme in India.
Political and administrative commitment, to ensure the provision of organised and comprehensive TB control services was obtained. Adoption of smear microscopy for reliable and early diagnosis was introduced in a decentralized manner in the general health services. DOTS was adopted as a strategy for provision of treatment to increase the treatment completion rates. Supply of drugs was also strengthened to provide assured supply of drugs to meet the requirements of the system. Large- scale implementation of the RNTCP began in 1. Int J Tuberc Lung Dis. India's Revised National Tuberculosis Control Programme: looking beyond detection and cure. Kelkar-Khambete A(1), Kielmann K, Pawar S, Porter J, Inamdar V, Datye A, Rangan S. Author information: (1. National TB Control Program UPDATED 2010–2016 PHILIPPINE PLAN OF ACTION TO CONTROL TUBERCULOSIS5. This resulted in a revised version a month later. This revised document became the basis for the development of a concept note submitted to. ![]() Expansion of the programme was undertaken in a phased manner with rigid appraisals of the districts prior to starting service delivery. The initial 5- year project plan was to implement the RNTCP in 1. Short Course Chemotherapy (SCC) districts for introduction of the revised strategy at a later stage. The Government of India took up the massive challenge of nationwide expansion of the RNTCP and covering the whole country under RNTCP by the year 2. TB control on case detection and treatment success. The structural arrangements for funds transfer and to account for the resources deployed were developed and thus the formation of the State and District TB Control Societies was under- taken. The systems were further strengthened and the programme was scaled up for national coverage in 2. This was followed up with RNTCP Phase II, developed based on the lessons learnt from the implementation of the programme over a 1. The design of the RNTCP II remained almost the same as that of RNTCP I but additional requirements of quality assured diagnosis and treatment were built in through schemes to increase the participation of private sector providers and also inclusion of DOTS+ for MDR TB and also offering treatment for XDR TB. Systematic research and evidence building to inform the programme for better de- sign was also included as an important component. The Advocacy, Communication and Social Mobilization were also addressed in the design. The challenges imposed by the structures under NRHM were also taken into account. India achieved country wide coverage under RNTCP in March 2. The RNTCP was built on the infrastructure and systems built through the NTP. Major additions to the RNTCP, over and above the structures established under the NTP, was the establishment of a sub- district supervisory unit, known as a TB Unit, with dedicated RNTCP supervisors posted, and decentralization of both diagnostic and treatment services, with treatment given under the support of DOT (directly observed treatment) providers. Program strategy. The program initially adopted the WHO- DOTS strategy which consisted of the five components of strong political will and administrative commitment, diagnosis by quality assured sputum smear microscopy, uninterrupted supply of quality assured Short Course chemotherapy drugs, Directly Observed Treatment (DOT) and systematic monitoring and Accountability. The DOTS strategy achieved and sustained the target detection rate of 7. TB in the country. With progress in achieving objectives outlined in the DOTS Strategy of the 1. Five year Plan, the program defined the new targets of Universal Access to TB care. Under the 1. 2th Five Year Plan of Government of India as the National Strategic Plan for 2. The plan hopes to achieve detection of at- least 9. Improved integration with the general health system, and leverage field staff for home- based case finding. Improve communication and outreach. Screening clinically and socially vulnerable risk groups for TB. Develop improved sputum collection and transportation systems. Deployment of higher- sensitivity diagnostic tests for TB suspects (and incorporate new tests) and decentralized DST services. Catch patients already diagnosed through notification from all sources, improved referral for treatment mechanisms, and deployment of laboratory and private provider notification. Patient friendly treatment services: Promptly and appropriately treating TB, increasingly guided by DST. Making DOTS more patient friendly through increased communitization of DOT; pilot incentives/offsets for patient costs to help patients complete treatment and better monitoring through information technology. Improving partnerships between public and private sector. X- rays play a secondary role in the standard diagnostic algorithm for pulmonary tuberculosis. Sputum smear microscopy, using the Ziehl- Neelsen staining technique, is employed as the standard case- finding tool. Two sputum samples are collected over two days (as spot- morning/morning- spot) from chest symptomatics (patients with presenting with a history of cough for two weeks or more) to arrive at a diagnosis. In addition to the test's high specificity, the use of two samples ensures that the diagnostic procedure has a high (> 9. As a national health program, RNTCP pays more attention to the sputum- positive pulmonary tuberculosis patients (who are likely to spread the disease in the community) than people with other, non- pulmonary forms of the disease. Treatment categories and drug regimens. Based on results from a recent study, RNTCP has issued guidelines to states on daily treatment for tuberculosis. The daily regimen will replace the existing alternate day (thrice weekly) regimen from January - February 2. The daily regimen has shown to be effective in reducing relapse rates and drug- resistance. Standardized treatment regimens are one of the pillars of the DOTS strategy. Isoniazid, Rifampicin, Pyrazinamide, Ethambutol, and Streptomycin are the primary antitubercular drugs used. Most DOTS regimens have thrice- weekly schedules and typically last for six to nine months, with an initial intensive phase and a continuation phase. Based on the nature/severity of the disease and the patient's exposure to previous anti- tubercular treatments, RNTCP classifies tuberculosis patients into two treatment categories. New*Previously treated**New sputum smear- positive,New sputum smear- negative,New extrapulmonary tuberculosis,others. Sputum smear- positive relapse,Sputum smear- positive failure,Sputum smear- positive treatment after default,others#2. H3. R3. Z3. E3 + 4. H3. R3. 2H3. R3. Z3. E3. S3 + 1. H3. R3. Z3. E3 + 5. H3. R3. E3. 2 months intensive phase + 4 months continuation phase. Four drugs at Thrice- weekly Schedule for 2 months Intensive phase Two drugs at Thrice- Weekly Schedule for remaining 4 months continuation phase. Five drugs at thrice- weekly Schedule for initial 2 months followed by Four drugs for next 1 month Intensive phase. Three drugs at Thrice- weekly Schedule for remaining 5 months continuation phase. H: Isoniazid (3. 00 mg), R: Rifampicin (4. Z: Pyrazinamide (1. E: Ethambutol (1. S: Streptomycin (7. Patients who weigh 6. Rifampicin 1. 50 mg. Patients who are more than 5. Streptomycin 5. 00 mg. Patients who weigh less than 3. Pediatric weight band boxes according to body weight. Notes*New categories includes former Categories I & III**Previously treated is former Category II# Others include patients who are Sputum Smear- Negative or who have Extra- pulmonary disease who can have recurrence or resonance. Public private partnership under RNTCPIn India a sizable proportion of the people with symptoms suggestive of pulmonary tuberculosis approach the private sector for their immediate health care needs. There is need for regularizing the varied anti- tubercular treatment regimens used by general practitioners and other private sector players. The treatment carried out by the private practitioners vary from that of the RNTCP treatment. Once treatment is started in the usual way for the private sector, it is difficult for the patient to change to the RNTCP panel. Studies have shown that faulty anti- TB prescriptions in the private sector in India ranges from 5. TB currently being provided by the largely unregulated private sector in India. Second phase of RNTCPIn the first phase of RNTCP (1. The future holds a different set of challenges including MDR TB and HIV/TBThe RNTCP has now entered its second phase, approved for a period of five years from October 2. September 2. 01. 1, in which the programme aims to firstly consolidate the gains made to date, to widen services both in terms of activities and access, and to sustain the achievements. The second phase aims to maintain at least a 7. This needs to be done in order to achieve the TB- related targets set by the Millennium Development Goals for 2. TB control in the longer term. Today India's TB control program needs to update itself with the international TB guidelines as well as provide an optimal anti TB treatment to the patients enrolled under it or it will land up being another factor in the genesis of drug resistant tuberculosis.
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