DIRECTORATE GENERAL OF HEALTH SERVICES

Revised National Tuberculosis Control Programme

Introduction:

The Revised National TB Control Programme (RNTCP), based on the internationally recommended Directly Observed Treatment Short-course (DOTS) strategy, was launched in 1997 expanded across the country in a phased manner with support from World Bank and other development partners. Full nation-wide coverage was achieved in March 2006. In terms of treatment of patients, RNTCP has been recognized as the largest and the fastest expanding TB control programme in the world. RNTCP is presently being implemented throughout the country.

Under the programme, diagnosis and treatment facilities are provided free of cost to all TB patients. For quality diagnosis, designated microscopy centers have been established for every one lac population in the general areas and for every 50,000 population in the tribal, hilly and difficult areas. More than 13000 microscopy centers have been established in the country. Free treatment services are available for TB at all Government hospitals, Community Health Centers (CHC), Primary Health Centers (PHCs). DOT centers have been established near to residence of patients to the extent possible. All public heatlh facilties, subs centres, Community Volunteers, ASHA, Women Self Groups etc. also function as DOT Providers/DOT Centers.

Estimated TB Burden in India (as per Global TB report 2015)

• Incidence: 2.2 million new TB cases annually - 167 cases per 100,000 population
• Prevalence: 2.5 million cases - 195 cases per 100,000 population
• Deaths: About 220,000 deaths each year - 17 deaths per 100,000 population
• Approximately 5% of TB patients estimated to be HIV +ve
• DR-TB (Drug resistant-TB)

• 2.2% in New cases and
• 15% in previously treated cases

India is highest TB burden country in the world, accounting for nearly 23% of the global incidence. In 2014, out of the estimated global annual incidence of 9.6 million TB cases; 2.2 million were estimated to have occurred in India.

Goal of the programme: The goal of TB control Programme is to decrease mortality and morbidity due to TB and cut transmission of infection until TB ceases to be a major public health problem in India.

Objectives of the programme:

• To reduce the incidence of and mortality due to TB
• To prevent further emergence of drug resistance and effectively manage drug-resistant TB cases
• To improve outcomes among HIV-infected TB patients
• To involve private sector on a scale commensurate with their dominant presence in health care services
• To further decentralize and align basic RNTCP management units with NRHM block level units within general health system for effective supervision and monitoring

Financial Allocation to RNTCP

Proposed budget for the RNTCP under the 12^th Five year plan is Rs 4500.15 crores. The year-wise allocation of the funds under the aforesaid plan is following:

The year-wise actual allocation from the Ministry of Health & family welfare has been as per details given below:

Performance of RNTCP

Basic TB case finding and treatment services

In 2005, 1.29 million TB patients, in 2006, 1.39 million; in 2007, 1.48 million, in 2008, 1.51 million, in 2009, 1.53 million, in 2010, 1.52 million, in 2011, 1.51 million patients, in 2012, 1.46 million, in  2013, 1.44 million TB patients, in 2014 and 1.42 million TB patients  have been registered for treatment. For the first time in 2015, the programme screened more than 9 million suspects for Tuberculosis.

Treatment success rates have tripled from 25% in pre-RNTCP era to 87% presently (2014) and TB death rates have been reduced from 29% to 4% during the same period.

Since 2007, RNTCP has achieved the NSP case detection rate of more than 70% in line with the global targets for TB control while maintaining the treatment success rate of >85%.

TB HIV Coordination:

• The TB-HIV collaborative activities which were being undertaken in 14 states in 2006 were scaled up to all the states in 2007. NACP (National AIDS Control Programme) & RNTCP have developed “National framework of Joint TB/HIV Collaborative activities” in 2007 and revised it in 2015. The framework articulates the policy of TB/HIV collaborative activities in the country. 
• At the country level, as in 2015, 79% of the total registered TB patients, were tested for HIV, which has increased from 11% in 2008; 3% of those tested  were diagnosed as HIV positive and were offered access to HIV care.  Similarly, among HIV-infected TB patients diagnosed in 2015 , 93% were put on co-trimoxazole preventive therapy (CPT). The coverage of Anti-Retroviral Treatment (ART) among TB patients who were known to be HIV-positive, reached 92% in patients registered in 2015, up from 49% in 2008.

Programmatic Management of Drug Resistant TB (PMDT) services:

• Nationwide coverage of services for programmatic management of drug resistant TB has been achieved in March 2013.
• Diagnosis of Drug Resistant TB is undertaken through quality assured drug susceptibility testing at 64 Culture & drug susceptibility testing (C-DST) laboratories, of which 51 laboratories are also equipped with rapid molecular test named Line Probe Assay (LPA). Additionally, Cartridge Based Nucleic Acid Amplification (CBNAAT) Test Machines have been installed at 121 sites for early detection of Rifampicin resistance among TB cases. Additional 300 CBNAAT machines are being installed and 200 more machines will be functional in this year.
• Initial hospitalization for pre-treatment evaluation, treatment initiation and monitoring is undertaken at 136 specialized DR TB Centres, which is followed by ambulatory care at the DOT providers in the districts.
• In 2015, 26,977 MDR-TB patients and 2130 XDR TB patients were initiated on treatment.
• The programme is now moving towards universal access to quality diagnosis and treatment of MDR TB patient by gradually extending the opportunity to diagnose early during the treatment of TB.
• To improve outcome amongst DR-TB patients, the newer anti TB drug Bedaquiline is introduced under the Conditional Access programme (CAP) initially in six referral sites.

Ban on Commercial serology tests for TB diagnosis

Vide the Gazette of India, Ministry of Health and Family Welfare (Department of Health and Family Welfare) has notified G.S.R. 432 (E) for prohibiting the import of the commercial sero-diagnostic test kits for tuberculosis  and G.S.R. 433  (E)  for prohibiting the manufacture , sale, distribution and use of the sero-diagnostic test kits for tuberculosis on 7th June 2012.

TB Notification:

In order to ensure proper TB diagnosis and case management, reduce TB transmission and address the problems of emergence and spread of Drug Resistant-TB, it is essential to have complete information of all TB cases. Towards the same, a Government Order No Z-28015/2/2012-TB dated 7th May 2012 has been issued by the Government of India mandating all healthcare providers to notify every TB case diagnosed &/or treated to local authorities i.e. District Health Officer / Chief Medical Officer of a district and Municipal health Officer of a Municipal Corporation / Municipality or to the Nodal Public Health Authority (for this purpose) or officials designated by the States/UTs for this purpose every month in a given format. For the purpose of this notification, healthcare providers will include clinical establishments run or managed by the Government (including local authorities), private or NGO sectors and/or individual practitioners.

Case based web based Reporting System: Nikshay

• The database of Revised National Tuberculosis Control Program (RNTCP) was conventionally on Epi-info based software for reporting with electronic data transmission from district level upwards. The digitization of information being an ongoing process; the generation of data in aggregated form and report submission is currently being done on quarterly basis.  This causes a delay of more than 3 months and loss of case based data.
• To address this gap, Central TB Division in collaboration with National Informatics Centre developed a case based web based platform- ‘Nikshay’, which has been now scaled up nationally.
• Since implementation, over 4 million patients including MDR cases have been registered in Nikshay. More than 87,000 private health facilities have been registered and more than 3.82 lakh TB patients notified by these private health facilities have been registered in Nikshay. Details of more than 8,000 contractual staff have also been entered in Nikshay.
• The NIKSHAY case based web based TB case management system was awarded “Gold-Specific Sectoral National Award” (Focus Sector for 2013-14_ Health Care) for e-Governance 2013-14. Further developments and enhancement on the platform are ongoing,

Partnerships

• 364 medical colleges (including private ones) have been involved in RNTCP.  Health facilities in government sectors outside Health Ministry have been involved viz. ESI, Railways, Ports and the ministries of Mines, Steel, coal, etc.
• TB care services are provided through engagement of private provider and NGOs. More than 1800 NGOs collaborations and 13,000 Private practitioners are involved in the programme in different signed schemes under NGO/PP schemes.
• Intensified Public Private Mix project was being undertaken with Indian Medical Association (IMA) in 16 states and with Catholic Bishop Conference of India (CBCI), a faith based organization (FBO), in 19 States under the Global Fund supported Single Stream Funding Project.
• Under the Global Fund Round 9 project civil society organizations are undertaking activities in 374 districts across 23 states to enhance the visibility and reach of the programme and engage with communities and community based care providers to improve TB care and control.

           For more information link to:  http://www.tbcindia.gov.in