Rntcp park

Reading File

Finding Sources

Reading File

Loading Image

Here is a thorough summary of RNTCP as covered in Park's Textbook of Preventive and Social Medicine:

RNTCP - Revised National Tuberculosis Control Programme

(Now renamed NTEP - National Tuberculosis Elimination Programme)

Background and Origin

India's National Tuberculosis Programme (NTP) had been in operation since 1962, but treatment success rates were unacceptably low with high death and default rates. Spread of multidrug-resistant TB further worsened the situation.

In 1993, the Government of India revitalized the NTP with assistance from international agencies, launching the Revised National TB Control Programme (RNTCP). It adopted the internationally recommended DOTS (Directly Observed Treatment Short-course) strategy as the most systematic and cost-effective approach.

RNTCP expanded rapidly and since March 2006 covers the entire country.

Objectives of RNTCP

Achievement of at least 85% cure rate of infectious TB cases through DOTS
Augmentation of case finding through quality sputum microscopy to detect at least 70% of estimated cases

Five Original DOTS Components

Political will and administrative commitment
Diagnosis by quality-assured sputum smear microscopy
Adequate supply of quality-assured short-course chemotherapy drugs
Directly Observed Treatment (DOT)
Systematic monitoring and accountability

STOP TB Strategy (adopted 2006)

WHO announced the STOP TB strategy in 2006, which RNTCP adopted. Its components:

Pursuing quality DOTS - expansion and enhancement
Addressing TB/HIV and MDR-TB
Contributing to health system strengthening
Engaging all care providers
Empowering patients and communities
Enabling and promoting research (diagnosis, treatment, vaccine)

Renamed to NTEP

In 2014, the World Health Assembly approved the End TB Strategy (a 20-year programme aiming for zero TB deaths, disease, and suffering). In line with these End TB targets, RNTCP was renamed to National Tuberculosis Elimination Programme (NTEP).

NTEP Organizational Structure

Fig. 2 - Organization structure of NTEP (Source: Park's)

The structure has 5 levels:

Level	Key Body	Details
National	Central TB Division (CTD)	Under AS&DG (RNTCP & NACO); supported by 6 NRLs
State	State TB Cell (STC) + State TB Officer (STO)	37 states/UTs; each has STDC with IRL
District	District TB Centre (DTC) + District TB Officer (DTO)	767 districts
Sub-district	TB Unit (TU)	One per 1.5-2.5 lakh population
Peripheral	Designated Microscopy Centre (DMC)	One per 50,000-1 lakh population; also PHIs

Supporting facilities:

3 National Institutes (NTI Bengaluru, NIRT Chennai, NITRD Delhi)
6 National Reference Laboratories (NRLs)
29 Intermediate Reference Laboratories
26 State TB Training and Demonstration Centres (STDCs)
42 Culture & DST Labs
154 Nodal DR-TB Centres
1,180 CBNAAT Laboratories

NTEP-Endorsed Diagnostics

Smear microscopy for AFB (Ziehl-Neelsen or Fluorescence staining)
Culture - Solid (LJ media) or Liquid (Middlebrook, BACTEC, MGIT)
Rapid molecular tests - Line Probe Assay (LPA) or NAAT/GeneXpert (CBNAAT)
Radiography (where available)
Tuberculin skin test

New Initiatives under NTEP

1. NIKSHAY (IT Surveillance System)

Case-based web application launched May 2012 by CTD + National Informatics Centre
"NI-KSHAY" = eradication of TB (Hindi words)
Functions: patient registration, diagnosis details, DOT provider tracking, HIV status, follow-up, outcome recording, DR-TB registration, referral/transfer, private sector notification, mobile app

2. Universal Drug Susceptibility Testing (DST)

1,180 CBNAAT machines expanded across all districts
~55% of all notified TB cases offered universal DST (Q3 2019)

3. Shorter Regimen and Bedaquiline (2018)

Shorter regimen and Bedaquiline expanded for DR-TB
46,129 DR-TB patients on shorter regimen; >7,973 on newer drug-containing regimens

4. Campaign Mode - Active Case Finding

Systematic screening of high-risk populations: tribal areas, slums, old age homes, prisons, orphanages, transit camps

5. Drug Packaging

Drugs supplied in patient-wise boxes with full course in blister packs
Intensive phase: one blister pack per day
Continuation phase: one blister pack per week
Color coding: Red = Category I; Blue = Category II

6. TB-HIV Coordination

NACP and RNTCP adopted Isoniazid Prophylaxis Therapy (IPT) for prevention of TB among PLHIV
HIV testing of TB patients jointly implemented since 2007-08

7. Integration with NPCDCS

Integration for national strategy on TB and diabetes co-morbidities

Drug Resistance Surveillance (DRS, 2014-2016)

MDR-TB prevalence: ~2.84% in new cases and ~11.60% in retreatment cases
DR-TB management services started in 2007 (Gujarat and Maharashtra); scaled up nationally by March 2013
DRTB Centres: Nodal DRTB Centres (NDRTBC) for seriously ill/new drug regimens; District DRTB Centres (DDRTBC) for MDR-TB and H mono/poly resistance

National Strategic Plan (NSP) 2017-2025

Vision: TB-free India with zero deaths, disease, and poverty due to TB

Objectives:

Find all DS-TB and DR-TB cases (emphasis on private sector and high-risk undiagnosed)
Initiate and sustain all patients on appropriate treatment with patient-friendly systems
Prevent TB in susceptible populations
Build enabling policies, empowered institutions, enhanced capacities

Key strategies:

Private sector engagement
Active case finding
DR-TB case management
Addressing social determinants including nutrition
Robust surveillance
Community engagement and multi-sectoral approach

Targets by 2025 (5 years ahead of SDG goal):

80% reduction in TB incidence (from 211/lakh to 43/lakh)
90% reduction in TB mortality (from 32/lakh to 3/lakh)
0% patients with catastrophic expenditure due to TB

Strategic pillars: DTPB - Detect - Treat - Prevent - Build

Financial Support

The programme receives support from the World Bank, DFID (via WHO), and the Global TB Drug Facility (GDF).

Public vs. Private Sector

	Public Sector	Private Sector
Advantages	Free diagnosis, free treatment, standardized regimen, referral system, supervision, accountability	Wide choices (>5 lakh practitioners), better access, convenient timings, personal attention
Disadvantages	Staff non-response to symptoms, delays in results, travel expenditure, perceived low quality	High costs, irrational prescriptions, no adherence tracking, fear of losing patient if involved in RNTCP

~70% of patients in India seek care from private clinics and hospitals (NSSO data).

Source: Park's Textbook of Preventive and Social Medicine, Chapter on National Health Programmes

This is a shared conversation. Sign in to Orris to start your own chat.