Download - 7.Rntcp
BYR.SIVAPIYA
72
REVISED NATIONAL TUBERCULOSIS CONTROL PROGRAMME
ORIGIN NATIONAL TB PROGRAM (NTP) 1962
RNTCP IS THE REVIEWED FORM OF NTP
NEED FOR REVISED STRATEGY-OVER EMPHASIS ON X-RAYS FOR DIAGNOSIS-INADEQUATE FUNDING,POOR QUALITY MICROSCOPY-NON-STANDARD TREATMENT REGIMENS-LOW RATES OF TREATMENT COMPLETION-LACK OF SYSTEMATIC INFORMATION ON TREATMENT OUTCOME-ONLY 30% OF ESTIMATED TB PATIENTS WERE DIAGONOSED-ONLY 30% OF THE DIAGONOSED CASES WERE TREATED
SUCCESSFULLY
RNTCP STARTED IN YEAR 1992 (GOVT. OF INDIA,WHO,WORLD BANK)
GOAL TO REDUCE MORTALITY AND MORBIDITY FROM TBTO INTERRUPT CHAIN OF TRANSMISSSION
OBJECTIVES
ACHIEVEMENT OF AT LEAST 85%CURE RATE OF INFECTIOUS CASES DETECTION OF ATLEAST 70%OF ESTIMATED CASESINFORMATION, EDUCATION, COMMUNICATION AND IMPROVED
OPERATIONAL RESEARCH ACTIVITIES.
COMPONENTS
POLITICAL COMMITMENTGOOD QUALITY SPUTUM MICROSCOPYUNINTERRUPTED SUPPLY OF GOOD QUALITY DRUGSDIRECTLY OBSERVED TREATMENTACCOUNTABILITY
ORGANIZATION-PROFILE AT STATE LEVEL
STATE TUBERCULOSIS OFFICE - STATE TUBERCULOSIS
OFFICER
STATE TUBERCULOSIS TRAINING & DEMONSTRATION CENTRE - DIRECTOR
DISTRICT TUBERCULOSIS CENTRE (DTC) - DISTRICT TUBERCULOSIS
OFFICERTUBERCULOSIS UNIT - MEDICAL OFFICER
- SENIOR TREATMENT SUPERVISOR(STS)
- SENIOR TB LAB SUPERVISOR(STLS)
MICROSCOPY CENTRES AND TREATMENT CENTRES
DOTS PROVIDERS
LABORATORY NETWORK
CENTRAL TB DIVISION
NATIONAL REFERENCE LAB
STATE TB CELL
INTERMEDIATE REFERENCE LAB DISTRICT TB CENTRE
TU TU
TU
DMC II
DMC I
DMC III
NATIONAL LEVEL
STATE LEVEL
DISTRICT LEVEL(SPUTUM MICROSCOPY EQA)
(SUPERVISION) (FEEDBACK)
ROLE OF EACH LEVEL OF LABORATORY
NATIONAL REFERENCE LABORATORTY(NRL)
☻3 CENTRES- NEW DELHI, CHENNAI AND BANGALORE☻EACH CENTRE CONTROLS OVER 8-11 STATES☻SUPERVISES SPUTUM MICROSCOPY EQA ACTIVITIES.
INTERMEDIATE REFERENCE LABORATORY(IRL)
☻STATE TB TRAINING AND DEMONSTRATION CENTRES OR
PUBLIC HEALTH LAB/MEDICAL COLLEGE LABORATORY☻CONDUCTS SPUTUM MICROSCOPY EQA FOR THE STATE☻PROVIDES TECHNICAL TRAINING TO THE DISTRICT AND SUB DISTRICT TECHNICIANS AND SENIOR TB LAB SUPERVISORS.☻CONDUCTS ON SITE EVALUATION VISITS OF EACH DTC ATLEAST ONCE A YEAR☻MANUFACTURES SLIDES FOR PANEL TESTING
DISTRICT TB CENTRES
☻ CONDUCTS BLINDED RE-CHECKING OF SMEARS☻MAINTAIN GOOD QUALITY REAGENTS AND EQUIPMENTS AT ALL TB
UNITS
TUBERCULOSIS UNITS
☻AT SUB- DISTRICT LEVEL☻1 TB UNIT PER 5 LAKH POPULATION( IN HILLY AREAS 2.5 LAKH)☻CONDUCTS ON-SITE EVALUATIONS AND BLINDED RE-CHECKING OF SMEARS
DESIGNATED MICROSCOPY CENTRES
☻AT PERIPHERAL LEVEL☻1 PER 1 LAKH POPULATION( IN HILLY AREAS 50000)☻LOCATED AT EITHER IN CHC, PHC, TALUKA HOSP, TB DISPENSARIES☻EACH CENTRE HAS A SKILLED TECHNICIAN☻A SENIOR TB LAB SUPERVISOR(STLS) IS APPOINTED FOR EVERY 5 MICROSCOPY CENTRES
TREATMENT CENTRES
☻PROVIDES DRUGS FREE OF COST☻THREE COMPONENTS
APPROPRIATE MEDICAL TREATMENTSUPERVISION AND MOTIVATIONMONITORING OF THE DISEASE STATUS
DOTS PROVIDERS
☻MAY BE A PERIPHERAL HEALTH STAFF OR VOLUNTARY WORKERS(TEACHERS, SOCIAL WORKERS, ANGANWADI WORKERS, EX-PATIENTS,ETC…)☻THEY ARE KNOWN AS “DOTS AGENT”☻PAID AN INCENTIVE OF RS.150 PER PATIENT COMPLETING THE TREATMENT
SERVICES PROVIDED
SERVICES INC DRUGS – FREE OF COST
HIGH QUALITY SPUTUM MICROSCOPY WITH PROMPT REPORTING OF RESULTS
HIGH QUALITY EVALUATION AND APP. TREATMENT
HIGH QUALITY DRUGS
UNINTERRUPTED SUPPLY OF DRUGS TO THE FULL REQUIREMENT
PROVISION OF DOTS BY THE GENERAL HEALTH SERVICES OR BY COMMUNITY VOLUNTEERS
TECHNICAL ASSISTANCE
DEFAULTER ACTION
IF PATIENT FAILS TO REPORT VISIT HOMEINTENSIVE PHASE -ON NEXT DAYCONTINUATION PHASE - WITHIN A WEEK
RECORDS
TUBERCULOSIS REGISTERLABORATORY REGISTERTREATMENT CARDLABORATORY FORM FOR SPUTUM EXAMINATIONSUPERVISORY REGISTERREFERRAL FOR TREATMENT REGISTER
REPORTS
QUARTERLY REPORTS ON -CASE FINDING-SPUTUM CONVERSION-RESULTS OF TREATMENT
RNTCP REPORT ON PROGRAMME MANAGEMENT & LOGISTICS
RNTCP-PHASES
PHASE I (1992 – 2006) PHASE II ( 2006 – 2011)
PHASE I BY 1993 PILOT PHASE I PILOT PHASE II PILOT PHASE IIIBY THE END OF 1998, ONLY 2 % COVERED.BY 2006 WHOLE POPULATION COVERED.
PHASE II TO CONSOLIDATE, MAINTAIN AND FURTHER IMPROVE THE ACHIEVEMENTS OF THE PHASE I ACTIVITIES
INCREASE ACCESS OF SERVICES TO HARD-TO-REACH AREAS
STRENGHTHENING THE INTER SECTORAL COLLABORATION
SCALLING UP OF THE STATE LEVEL INTERMEDIATE REFERRAL LABORATORIES(IRL) CAPACITY
IMPLEMENTATIOIN OF DOTS-PLUS FOR MDR-TB CASES IN A PHASED MANNER
DISRIBUTION OF PAEDIATRIC DRUG BOXES
INSTITUTIONAL STRENGHTHENING AT NATIONAL, STATE AND DISTRICT LEVEL
INTRODUCTION OF TB-HIV CO-ORDINATOR ,URBAN CO-ORDINATOR AND COMMUNICATION FACILITATOR.
DRUG RESISTANCE SURVEILLANCE
AIMTO DETERMINE THE PREVALENCE OF ANTI-MYCOBACTERIAL DRUG RESISTANCE AMONG
-NEW CASE-TREATED CASE
PLANSSTATE WIDE DRS SURVEYSICMR SURVEYSBY 2010, A NETWORK OF 24 STATE-LEVEL CULTURE AND DRUG SENSITIVITY TESTING LABORATORIES
DOTS-PLUS
STRATEGY CURRENTLY UNDER DEVELOPMENT BY WHOFOR THE MANAGEMENT OF MDR-TB CASES
GOAL
TO PREVENT FURTHER DEVELOPMENT OF MDR-TB
PRE-REQUISITE
AN EFFECTIVE DOTS BASED TB CONTROL PROGRAM
ORGANISATION
DESIGNATED RNTCP DOTS-PLUS SITES ATLEAST 1 IN EACH STATEWITH READY ACCESS TO RNTCP ACCREDITED CULTURE AND DRUG SUSCEPTIBILITY TESTING(DST) LABORATORY
WHO 7-POINT PLAN OF ACTION
SHORT TERM
BASIC TB CONTROL MEASURES MEET INTERNATIONAL STANDARD FOR TB CARERAPID SURVEYS TO ACCESS THE DISTRIBUTION OF MDR-TB AND XDR-TB IN VULNERABLE POPULATIONSTRENGTHEN NATIONAL TB LAB CAPACITYIMPLEMENTING INFECTION CONTROL PRECAUTIONS IN HEALTH CARE FACILITIES
LONG TERM
ESTABLISH CAPACITY FOR CLINICAL AND PUBLIC HEALTH SERVICESPROMOTE UNIVERSAL ACCESS TO ARTs FOR TB-HIV PARIENTS FUNDING FOR RESEARCHES
MANAGEMENT OF PAEDIATRIC TUBERCULOSIS
DIAGNOSIS AND TREATMENT FOR THE PAEDIATRIC PATIENTS
ISSUING DRUGS FOR THE PAEDIATRIC CASES IN THE PATIENT WISE BOXES(PWB)
TREATMENT BASED ON CHILD’S BODY WEIGHT6-10KG WEIGHT BAND11-17KG WEIGHT BAND
CHILDREN WEIGHING 6KG WILL BE TREATED WITH LOOSE ANTI-TB DRUGS
TB HIV CO-ORDINATIONRNTCP AND NACO – “JOINT ACTION PLAN”OBJECTIVETO REDUCE TB ASSOCIATED MORBIDITY AND MORTALITY IN TB-HIV PATIENTSFOR EFFECTIVE PREVETION AND CONTROL OF BOTH THE DISEASES
PHASE I2OOIIN 6 HIGH HIV PREVALENT STATES(AP, KARNATAKA, MAHARASHTRA, MANIPUR,
NAGALAND, TN)
PHASE II20038 ADDITIONAL STATES(DELHI, GUJARAT, HP, KERALA, ORISSA,PUNJAB, RAJASTHAN, WB)PLAN TO BE EXTENDED TO ALL OTHER STATES IN DUE COURSE
ACHIEVEMENTS OF RNTCP
TREATMENT SUCCESS RATE
DEATH RATE
INVOLVEMENT OF NGOs, PRIVATE PRACTITIONERS, MEDICAL COLLEGES, PERIPHERAL LABORATORIES, DESIGNATED MICROSCOPY CENTRES, PUBLIC HEALTH CARE PROVIDERS
4 URBAN DOTS PROJECTS(MUMBAI,HYDERABAD,VARANASI,CHENNAI)
“NATIONAL FRAME WORK FOR JOINT TB-HIV COLLOBORATIVE ACTIVITIES”- BY CENTRAL TB DIVISION & NACO- REPLACES “JOINT ACTION PLAN”
NATIONAL FRAMEWORK FOR JOINT TB-HIV COLLABORATIVE ACTIVITIES
ESTABLISHMENT OF CO-ORDINATION MECHANISMS,JOINT PLANNING AND REVIEW AT NATIONAL,STATE AND DISTRICT LEVELS
SERVICE DELIVERY CO-ORDINATION
INVOLVEMENT OF NGOs
OPERATIONAL RESEARCH
INFECTION CONTROL MEASURES
STOP TB STRATEGY
VISION
A WORLD FREE OF TB
GOAL
TO DRAMATICALLY REDUCE THE GLOBAL BURDEN OF TB BY 2015 IN LINE WITH THE MILLENNIUM DEVELOPMENT GOALS AND THE STOP TB PARTNERSHIP TARGETS
COMPONENTS
☻ HIGH QUALITY DOTS EXPANSION
☻ADDRESSING TB-HIV, MDR-TB AND OTHER CHALLENGES
☻HEALTH SYSTEM STRENGHTHENING
☻ENGAGING ALL CARE PROVIDERS(PUBLIC-PUBLIC AND PUBLIC- PRIVATE MIX APPROACHES)
☻EMPOWERING PEOPLE WITH TB CARE
☻PROMOTING RESEARCH ACTIVITIES
TARGETS -BY 2015
GLOBAL BURDEN OF TB(PREVALENCE AND DEATH RATES) WIL BE REDUCED BY 50 % (INCL TB-HIV CASES)
-BY 2050GLOBAL INCIDENCE OF TB 1 CASE PER 1 MILLION POPULATION PER YEAR
IMPROVED TREATMENT ACCESS
NEW DRUGS
NEW VACCINE - DEVELOP A SAFE, AFFORDABLE VACCINE TO IMPROVE UPON THE EXISTING VACCINE
NEW DIAGNOSTICS- TO DEVELOP EFFICIENT, EFFECTIVE, AND AFFORDABLE DIAGNOSTIC TESTS FOR TB
GLOBAL PLAN TO STOP TUBERCULOSIS
AIMS
ACKNOWLEDGEMENTPROF. HOD. DR. UMADEVI MADAM, SPM
DEPT AND ALL OUR PROFESSORS.TUBERCULOSIS CENTRE, PULIANTHOPE.CHETPET TB HOSPITAL.DOTS CENTRE, KMCH AND ROYAPETTAH.THIRUVOTTESWARAR TB HOSPITAL,
OTTERI.AYNAVARAM DOTS CENTRE.