RNTCP

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RNTCP or the Revised National Tuberculosis Control Program is the state-run tuberculosis control initiative of the Government of India. It incorporates the principles of directly observed treatment-shortcourse (DOTS), the global TB control strategy of the World Health Organization. The program provides, free of cost, quality anti-tubercular drugs across the country through the numerous Primary Health Centres and the growing number of private-sector DOTS-providers

History[edit]

Need for a Revised Strategy[edit]

India has had an on-going National TB Program, NTP since 1962.

Program reviews showed that only 30% of estimated tuberculosis patients were diagnosed and only 30 percent of those were treated successfully.

Based on the findings and recommendations of the review in 1992, the GOI evolved a revised strategy and launched the Revised National TB Control Programme (RNTCP) in the country.

Components of RNTCP[edit]

The directly observed treatment, short-course DOTS strategy along with the other ingredients of the Stop TB Partnership are implemented as a comprehensive package for TB control.

The five principal components of DOTS are:

  • Political and administrative commitment
  • Case detection by sputum smear microscopy
  • Uninterrupted supply of high-quality anti-TB drugs
  • Standardized treatment regimens with directly observed treatment for at least the first two months
  • Systematic monitoring and accountability

Diagnosis of Pulmonary TB under RNTCP[edit]

Diagnosis is made primarily based on sputum smear examination. X-rays play a secondary role in the standard diagnostic algorithm for pulmonary tuberculosis

Sputum smear microscopy, using the Ziehl-Neelsen staining technique, is employed as the standard case-finding tool. Two sputum samples are collected over two days (as spot-morning/morning-spot) from chest symptomatics (patients with presenting with a history of cough for two weeks or more) to arrive at a diagnosis. In addition to the test's high specificity, the use of two samples ensures that the diagnostic procedure has a high (>99%) test sensitivity as well.

As a national health program, RNTCP pays more attention to the sputum-positive pulmonary tuberculosis patients (who are likely to spread the disease in the community) than people with other, non-pulmonary forms of the disease.

Treatment Categories and Drug Regimens[edit]

Standardized treatment regimens are one of the pillars of the DOTS strategy

Isoniazid, Rifampicin, Pyrazinamide, Ethambutol, and Streptomycin are the primary antitubercular drugs used. Most DOTS regimens have thrice-weekly schedules and typically last for 6 to 9 months, with an initial intensive phase and a continuation phase.

Based on the nature/severity of the disease and the patient's exposure to previous anti-tubercular treatments, RNTCP classifies tuberculosis patients into two treatment categories.

New* Previously treated**

New sputum smear-positive,

New sputum smear-negative,

New extrapulmonary tuberculosis,

others

Sputum smear-positive relapse,

Sputum smear-positive failure,

Sputum smear-positive treatment after default,

others#

2H3R3Z3E3 + 4H3R3 2H3R3Z3E3S3 + 1H3R3Z3E3 + 5H3R3E3
2 months Intensive phase + 4 months continuation phase

Four drugs at Thrice-weekly Schedule for 2 months Intensive phase & Two drugs at Thrice-Weekly Schedule for remaining 4 months continuation phase.

3 months Intensive phase + 5 months continuation phase

Five drugs at Thrice-weekly Schedule for initial 2 months followed by Four drugs for next 1 month Intensive phase.Three drugs at Thrice-weekly Schedule for remaining 5 months continuation phase.

H: Isoniazid (300 mg), R: Rifampicin (450 mg), Z: Pyrazinamide (1500 mg), E: Ethambutol (1200 mg), S: Streptomycin (750 mg)

  1. Patients who weigh 60kg or more receive additional Rifampicin 150mg.
  2. Patients who are more than 50 years old receive Streptomycin 500mg. Patients who weigh less than 30kg receive drugs as per Pediatric weight band boxes according to body weight.

Notes

*New categories includes former Categories I & III

**Previously treated is former Category II

# Others include patients who are Sputum Smear-Negative or who have Extra-pulmonary disease who can have recurrence or resonance.

Public private partnership under RNTCP[edit]

In India, a sizable proportion of the people with symptoms suggestive of pulmonary tuberculosis approach the private sector for their immediate health care needs. There is need for regularizing the varied anti-tubercular treatment regimens used by general practitioners and other private sector players. The treatment carried out by the private practitioners vary from that of the RNTCP treatment. Once treatment is started in the usual way for the private sector, it is difficult for the patient to change to the RNTCP panel. Studies have shown that faulty anti-TB prescriptions in the private sector in India ranges from 50% to 100% and this is a mater of concern for the healthcare services in TB currently being provided by the largely unregulated private sector in India.

Second Phase of RNTCP[edit]

In the first phase of RNTCP (1998–2005), the programme’s focus was on ensuring expansion of quality DOTS services to the entire country. The future holds a different set of challenges including MDR TB and HIV/TB

The RNTCP has now entered its second phase, approved for a period of five years from October 2006 to September 2011, in which the programme aims to firstly consolidate the gains made to date, to widen services both in terms of activities and access, and to sustain the achievements. The second phase aims to maintain at least a 70% case detection rate of new smear positive cases as well as maintain a cure rate of at least 85%. This needs to be done in order to achieve the TB-related targets set by the Millennium Development Goals for 2015 and to achieve TB control in the longer term. Today India's TB control program needs to update itself with the international TB guidelines as well as provide an optimal anti TB treatment to the patients enrolled under it or it will land up being another factor in the genesis of drug resistant tuberculosis.[1]

See also[edit]

External links[edit]

References[edit]

  1. ^ Gyanshankar Mishra, S V Ghorpade, Jasmin Mulani (2014) XDR-TB: An outcome of programmatic management of TB in India. Indian Journal of Medical Ethics 11: 1. 47-52 Jan-Mar.Available online at http://216.12.194.36/~ijmein/index.php/ijme/article/download/932/2179