3. TB- BAROMETER OF SOCIAL WELFARE
Discovered by Robert koch.
Mycobacterium tuberculosis- acid and
alcohol fast.
Demonstrated by ZN staining.
Persists as an important public health
problem seeking attention.
4. BURDEN OF TB
Prevalence of TB infection 30%
Incidence of TB infection 1.5%
Incidence of sputum positive TB 75/lac/year
TB mortality 33/lac cases
Prevalence of sputum positive TB 0.4%
MDR TB 3.5%
Resistance to 4 drugs in new cases 1%
4
Ref: WHO Global Report, 2006
5. DIFFERENCE B/W NTP & RNTCP
CRITERIA NTP(1962) RNTCP(1992)
Objective- early diagnosis
and treatment.
Operational target –not
defined.
diagnosis-more emphasis
on x-ray
Breaking chain of
transmission.
Cure rate->85%,case
finding->70%
mainly sputum microscopy
6. EVOLUTION OF TB CONTROL IN
INDIA
1962 National TB Programme (NTP)
1992 Programme Review
1993 RNTCP pilot began
2001 450 million population covered
2004 >80% of country covered
2006 Entire country covered by RNTCP
2007 DOTS plus for MDR TB
launched
2006-2010 RNTCP Phase 2
6
7. RNTCP ORGANIZATION
CENTRAL TB DIVISION (DGHS)
STATE TB CELL
DISTRICT TB CENTRE
TUBERCULOSIS UNIT
MICROSCOPY CENTRE
PERIPHERAL HEALTH INSTITUTIONS
8. REVISED NATIONAL TB CONTROL
PROGRAM (RNTCP)
Launched in 1997 based on WHO DOTS
Strategy
Entire country covered in March’06 through
rapid expansion of DOTS
Implemented as 100% centrally sponsored
programme
Govt. of India is committed to continue the
support till TB ceases to be a public health
problem in the country
All components of the STOP TB Strategy-
2006 are being implemented
9. OBJECTIVES OF RNTCP
To achieve and maintain a cure rate
of at least 85% among newly
detected infectious (new sputum
smear positive) cases
To achieve and maintain detection
of at least 70% of such cases in the
population
10. RNTCP STRATEGY
1. Case finding – passive
2. Two sputum smear
3. Case holding and treatment – directly
observed
4. TB UNIT at sub district level per every 5 lac
population
5. Microscopy centre per every 1 lac population
6. Present coverage is 100% , achieved in 2005
11. CORE ELEMENTS OF RNTCP
PHASE I(1997-2006)
To ensure high quality DOTS expansion in
the country, addressing the five primary
components of the DOTS strategy
Political and administrative commitment
Good Quality Diagnosis through sputum
Microscopy
Directly observed treatment
Systematic Monitoring and Accountability
Addressing stop TB strategy under RNTCP
12. RNTCP PHASE II( 2006-11)
The RNTCP phase II aims to
Consolidate the achievements of
phase I
Maintain its progressive trend and
effect further improvement in its
functioning
Achieve TB related MDG goals
while retaining DOTS as its core
strategy
13. DIAGNOSIS OF TB IN RNTCP: SMEAR
EXAMINATION
13
Cough for 2 weeks or More
2 sputum smears 2 Negative
Antibiotics
1-2 weeks
Symptoms
persist
X-ray
Negative
For TB
Positive
Smear-Negative TB
Anti-TB Treatment
Smear-Positive
TB
Anti-TB Treatment
1 or 2 positives
Repeat 2 sputum
Any +ve
-ve
15. CATEGORY TYPE OF PT. REGIMEN DURATION
Cat-1 new ss+ve 2(HRZE)3 +4(HR)3
6 months
Cat-2 relapse,failure,default 2(HRZES)3+1(HRZE)3; 5(HRE)3
8months
Cat-4 MDR-TB 6(KOCZEEt)+ 12-18(OCEEt) 18-
24months
16. PEDIATRIC TREATMENT
6-11 kg – PC 13
12-17 kg – PC 14
18-25 kg – PC 13+14
26-30 kg – PC 14+14
PC 13 has IP[ H-75 mg, R-75mg,Z-250mg,
E-200mg ]and CP [H-75 mg, R-75mg.]
PC 14 has IP[H-150 mg, R-150 mg, Z-
500mg,
E-400 mg] and CP[H-150 mg, R -150
mg] 16
17. DEFINITIONS
RELAPSE –A TB patient who was declared cured but now comes
back with sputum smear positive.
FAILURE – Any TB patient who is sputum smear positive at 5
months or more after starting treatment or has become sputum smear
positive during treatment.
CURED – Initially sputum smear positive , has completed treatment
, had sputum smear negative on two occasions one of which was at the
end of treatment.
DEFAULTER - Any patient who has not taken TB treatment for
two months or more consecutively after starting treatment for atleast 1
month.
17
18. MDR TB
MDR TB CASE - Any suspect who is sputum culture
positive and whose TB is due to Mycobacterium tuberculosis that
are resistant in vitro to ISONIAZID and RIFAMPICIN with or without
other ATT drugs .
CAUSES OF MDR TB - Incorrect prescription
Irregular supply
Non compliance
Lack of supervision and follow up
18
MDR SUSPECTS - Any TB patient who fails category 1 .
- Any category 2 patient sputum positive at
4th month of treatment
- Close contact of MDR TB patient found
to have smear positive TB
19. TREATMENT OF MDR IN PREGNANCY
First trimester – kanamycin and ethionamide are contraindicated ,
PAS is used instead.
Second and Third trimester- kanamycin is contraindicated.
11/8/2015
19
Pregnancy with MDR
<20 weeks
Advised MTP
Start cat 4
>20weeks
Start modified cat 4 -
-omit kanamycin, add PAS till delivery.
-replace PAS with kanamycin after delivery
And continue till end of IP
20. TREATMENT OF MDR DEFAULTER
11/8/2015
20
RETURNS IN <6 MONTHS
Treatment duration prior to default
<3 months 3 month to end of IP During CP
Re register
Restart category 4
Last culture result Re register
Continue CP
Do culture
- if –ve continue CP
- if +ve do DST+ ve - ve
Re register
Re start category 4
Re register continue cat. 4 IP
Do culture if –ve switch to CP
after completing IP
21. RETURN IN > 6 MONTHS
11/8/2015
21
Do culture
+ ve - ve
No treatment
required
Do 1st and 2nd line DST
MDR
Re register
Start cat. 4
XDR
Start cat. 5
22. XDR TUBERCULOSIS
Extensive drug resistant TB –
Resistance to Rifampicin and Isoniazid and
to any member of quinolones family and to
one of the injectable second line
drug[Kanamycin , Capreomycin, Amikacin]
Priciple for treatment of MDR and XDR are
same
XDR do not transmit easily in healthy
population,yet is capable of causing
epidemics in HIV populations.
11/8/2015
22
23. STOP TB STRATEGY
In 2006 WHO launched STOP TB strategy. It
is implemented over the next 10 years as
described in the global plan to STOP TB 2006-
2015.
11/8/2015
23
Vision A world free of TB
Goal To reduce dramatically the global burden of TB by 2015 in line
with the Millennium Development Goals .
Objectives To achieve universal high quality diagnosis and treatment
To reduce the suffering and socioeconomic burden
To protect poor and vulnerable
Targets By 2005 detect at least 70% of new sputum +ve cases and cure
at least 85% .
By 2015 reduce TB prevalence and death rates by 50% of 1990
By 2050, eliminate TB as a public health problem.[<1/million]
24. CURRENT EXPERIENCE WITH
DOTS
DOTS is a proven cost-effective TB
treatment strategy.
DOTS quickly makes infectious cases non-
infectious and breaks the cycle of
transmission.
prevents the development of drug-resistant
strains of TB that are often fatal and very
expensive to cure.
25. REFERENCE
Text Book of Preventive & Social Medicine
(By - K. PARK) 22nd Edition
(Page 166 to 181)
Harrison’s Principles of Internal Medicine
18th Edition, Volume 1
(Page 1340 to 1359)
