Revised National TB Control Programme (RNTCP) / NTEP

Historical Evolution

• 1962 - National Tuberculosis Programme (NTP) launched. However, treatment success rates were unacceptably low, death and default rates remained high, and MDR-TB was spreading.
• 1993 - The Government of India decided to revitalize the NTP with assistance from international agencies, launching the Revised National Tuberculosis Control Programme (RNTCP), based on the DOTS strategy.
• 2006 - RNTCP achieved full national coverage across the entire country (all districts).
• 2020 (January 1) - RNTCP was renamed National Tuberculosis Elimination Programme (NTEP), reflecting India's ambitious goal of eliminating TB by 2025 - five years ahead of the global SDG target of 2030.

Objectives of RNTCP

1. Achievement of at least 85% cure rate of infectious (sputum-positive) TB cases through DOTS, involving peripheral health functionaries.
2. Augmentation of case-finding through quality sputum microscopy to detect at least 70% of estimated cases.

DOTS Strategy - Five Core Components

STOP TB Strategy (2006)

• 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)

Organisational Structure (NTEP Organogram)

1. National Level

• Central TB Division (CTD) manages the programme under AS&DG (RNTCP & NACO), headed by the Deputy Director General TB (DDG-TB).
• Supported by: National TB Institute (NTI), Bengaluru; 6 National Reference Laboratories (NRLs) including NIRT Chennai, NITRD Delhi, JALMA Agra.
• National Task Force coordinates medical college activities.

2. State Level

• States have full ownership and accountability.
• State Tuberculosis Officer (STO) heads the State TB Cell (STC).
• Supported by State TB Training and Demonstration Centre (STDC) - with training unit, supervision/monitoring unit, and an Intermediate Reference Laboratory (IRL).
• Each state has one State Drug Store (SDS) per 5 crore population, ensuring uninterrupted supply of 1st and 2nd line anti-TB drugs.

3. District Level

• District Tuberculosis Centre (DTC) is the nodal point.
• Headed by a full-time District Tuberculosis Officer (DTO).
• Chief District Health Officer (CDHO) / Civil Surgeon oversees all activities.

4. Sub-District / PHC Level

• All PHCs function as DOTS centres.
• Deliver treatment per RNTCP guidelines through DOTS providers.
• Manage common complications and drug side effects.

5. Peripheral / Village Level

• ANMs, MPWs, ASHAs serve as DOTS providers.
• ASHA workers conduct DOT activities, motivate patients, and identify defaulters.

Treatment Regimens

Drug Categories (Earlier Classification)

• Category I (New sputum-positive / seriously ill new cases): Intensive phase: 2 months HRZE; Continuation phase: 4 months HR (2HRZE / 4HR).
• Category II (Previously treated / re-treatment): Intensive phase: 2 months HRZES + 1 month HRZE; Continuation phase: 5 months HRE.

Drug Resistant TB (DR-TB)

• PMDT (Programmatic Management of Drug-Resistant TB) services were initiated in 2007 in Gujarat and Maharashtra; scaled up nationally by March 2013.
• Drug Resistance Surveillance (DRS 2014-16) found:
  • MDR-TB prevalence: ~2.84% in new cases; ~11.60% in retreatment cases.
• DR-TB Centres: 147 centres established across India by 2017 (one per ~10 million population), as 20-30 bedded tertiary facilities for treatment initiation, monitoring, and ADR management.

NIKSHAY Portal

TB-HIV Collaborative Activities

1. Intensified TB case finding at all ICTCs (Integrated Counselling and Testing Centres) and ART centres.
2. HIV testing of TB patients is routine via Provider-Initiated Testing and Counselling (PITC).
3. HIV-positive TB patients receive free ART at ART centres (536 ART centres, 1120 link-ART centres as of 2017).
4. HIV-infected TB patients on protease inhibitor-based second-line ART receive rifabutin in place of rifampicin.
5. Isoniazid Prophylaxis Therapy (IPT) adopted as policy for prevention of TB among PLHIV (People Living with HIV).
6. Priority use of Xpert MTB/RIF rapid diagnostic tool for HIV-positive presumptive TB cases.

National Strategic Plan (NSP) 2017-2025 for TB Elimination

• 90% reduction in TB incidence
• 95% reduction in TB mortality
• Zero TB-affected families facing catastrophic costs

New/Key Initiatives

• Integration of RNTCP with NPCDCS (National Programme for Cancer, Diabetes, CVD and Stroke) for management of TB-diabetes co-morbidities.
• Nikshay Poshan Yojana - nutritional support (₹500/month) for all TB patients during treatment.
• Pradhan Mantri TB Mukt Bharat Abhiyaan - community support for TB patients.
• End TB Strategy (WHO 2014) targets: 90% reduction in TB deaths, 80% reduction in TB incidence by 2030 vs. 2015 baseline.

Key Performance Indicators

• At least 85% treatment success rate for new sputum-positive cases.
• At least 70% case detection rate of estimated TB cases.
• Monitoring via quarterly cohort analysis and NIKSHAY data.