Revised National TB Control Programme


RNTCP In India today, two deaths occur every three minutes from tuberculosis (TB). But these deaths can be prevented. With proper care and treatment, TB patients can be cured and the battle against TB can be won.

Entire Country covered under DOTS in March 2006 :

Tuberculosis (TB) is an infectious disease caused by a Bacterium, Mycobacterium tuberculosis. It is spread through the air by a person suffering from TB. A single patient can infect 10 or more people in a year.
 

Year

Total Number of Registered Patients in a year

Annualized case detection rate per lakh (Target – 190/lakh)

NSP case detection Rate per lakh (target-70%)

Success rate in %

(Target- >85%)

2008

2645

189

52

76

2009

2872

205

66

85

2010

2874

205

62

82

2011

2863

168*

51*

85

* The calculation is done as per the new population census (2011). Dehradun District Population – 17 lakhs (new census), 14.98 lakhs (old census)

India has a long and distinguished tradition of research in TB. Studies from the Tuberculosis Research Centre in Chennai and the National Tuberculosis Institute in Bangalore provided key knowledge to improve treatment of TB patients all around the world.

Modern anti-TB treatment can cure virtually all patients. It is, however, very important that treatment be taken for the prescribed duration, which in every case is a minimum of 6 months. Because treatment is of such a long duration and patients feel better after just 1-2 months, and because many TB patients face other problems such as poverty and unemployment, treatment is often interrupted.

Therefore, just providing anti-TB medication is not sufficient to ensure that patients are cured. The DOTS strategy ensures that infectious TB patients are diagnosed and treated effectively till cure, by ensuring availability of the full course of drugs and a system for monitoring patient compliance to the treatment.

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Directly Observed Treatment, Short-course (DOTS) :

The DOTS strategy along with the other components of the Stop TB strategy, implemented under the Revised National Tuberculosis Control Programme (RNTCP) in India, is a comprehensive package for TB control.

The DOTS strategy is cost-effective and is today the international standard for TB control programmes. To date, more than 180 countries are implementing the DOTS strategy. India has adapted and tested the DOTS strategy in various parts of the country since 1993, with excellent results, and by March 2006 nationwide DOTS coverage has been achieved.

DOTS is a systematic strategy which has five components :

  • Political and administrative commitment. TB is the leading infectious cause of death among adults. TB kills more men than women, yet more women die of TB than all causes associated with childbirth combined. Since TB can be cured and the epidemic reversed, it warrants the topmost priority, which it has been accorded by the Government of India. This priority must be continued and expanded at the state, district and local levels.

  • Good quality diagnosis. Good quality microscopy allows health workers to see the tubercle bacilli and is essential to identify the infectious patients who need treatment the most.

  • Good quality drugs. An uninterrupted supply of good quality anti-TB drugs must be available. In the RNTCP, a box of medications for the entire treatment is earmarked for every patient registered, ensuring the availability of the full course of treatment the moment the patient is initiated on treatment. Hence in DOTS, the treatment can never interrupt for lack of medicine.

  • Supervised treatment to ensure the right treatment, given in the right way. The RNTCP uses the best anti-TB medications available. But unless treatment is made convenient for patients, it will fail. This is why the heart of the DOTS programme is "directly observed treatment" in which a health worker, or another trained person who is not a family member, watches as the patient swallows the anti-TB medicines in their presence.

  • Systematic monitoring and accountability. The programme is accountable for the outcome of every patient treated. This is done using standard recording and reporting system, and the technique of ‘cohort analysis’. The cure rate and other key indicators are monitored at every level of the health system, and if any area is not meeting expectations, supervision is intensified. The RNTCP shifts the responsibility for cure from the patient to the health system.

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