Status of Revised National
Tuberculosis Control Program (RNTCP)
in India
Dr Jitendra
Framework
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TB burden
RNTCP implementation
RNTCP performance
Achievements Under RNTCP
- Case Detection Rate
- Cure Rate
Progress Towards MDGs
Cost Effectiveness of Program
RNTCP- DOTS-Plus
Changes in RNTCP policy
Challenges
Estimated epidemiological burden of TB
Global India
Annual incidence 9.3
of TB (million)
1.9
HIV + among TB
5%
15%
India is Highest TB Burden Country
India is 17th among 22 High
Burden Countries (in terms
of TB incidence rate)
National ARTI- 75 NSP
PTB cases/100,000
population
Source: WHO Report 2008: Global Tuberculosis Control; Surveillance, Planning and Financing
Revised National TB Control Program (RNTCP)
• Launched in 1997 based on WHO DOTS Strategy
– Entire country covered in March’06
Largest & fastest
(632 districts/reporting units)
expanding program
• Implemented as 100% centrally sponsored program
– GoI is committed to continue support till TB ceases to be a
public health problem in country
RNTCP…
All components of STOP TB Strategy-2006 are being implemented
1.
Pursuing high-quality DOTS expansion and enhancement
2.
Addressing TB/HIV, MDR-TB and other challenges
3.
Contributing to health system strengthening
4.
Engaging all health providers
5.
Empowering people with TB, and communities
6.
Enabling and promoting research
RNTCP performance- 2009
Continue to achieve twin objectives of NSP case
detection and cure rate at the national level
 New Sputum Positive Case Detection Rate ≥ 70%
 Cure rate≥ 85%
RNTCP performance…
Suspects Examined/
lakh pop
Annualized new
sm+ CDR (%)
Cure rate of
new Sm+ pt
T/t success rate
of new Sm+ pt
India
154
59(78)
85%
87%
MH
137
48(60)
83%
85%
WR
147
40(50)
67%
82%
Achievements Under RNTCP
TB Suspects Examined per 100,000 Population(2000-2009)
Achievements …
Case Detection Rate and Treatment Success Rate
CDR- 72% 78%
Treatment success rate- 85%  87%
Achievements in line with the global targets
Annualized new smear (+) case detection rate and T/t success rate
Achievements since implementation
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> 40 million TB suspects examined
> 9 million patients placed on treatment
> 1.6 million lives saved (deaths averted)
Progress Towards MDGs
Goal 6: “Combat HIV/AIDS, malaria and other diseases”
- Target 8: “By 2015, to have halted and begun to reverse the incidence of
malaria and other major diseases…”
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Indicator 23: between 1990 & 2015 to halve prevalence of TB disease and deaths
due to TB
47%
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33%
?
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Indicator 24: to detect 70% of new infectious cases and to successfully treat 85%
of detected sputum positive patients
Global (2006)
India
NSP CDR
61%
70% (2007 onwards)
T/t success rate
85%
85% (2003 onwards)
WHO Global TB Report 2008
Cost Effectiveness of Program in India
• Total cost of TB control per capita is US $ 0.1 (2007)
• Cost of first line drugs per patient treated in India is US
$ 14 compared to US $ 30 (median) for High Burden
Countries (HBCs)
• India remains the country with lowest cost per patient
treated (US $ 84) compared to US $ 274 (median) for
HBCs
Source: WHO Report 2008, Global Tuberculosis Control; pg 71 &112
RNTCP- DOTS-Plus
• RNTCP regimens highly effective, with low failure rates (2%
in CAT I , 6% in CAT II cases)
India- Highest burden country in world
On verge of MDR-TB epidemic
MDR-TB: 3% in new cases
12-17% in retreatment cases
• Failure cases- previously not been well addressed by RNTCP,
now have been addressed in RNTCP under DOTS-Plus
DOTS-Plus…
Strategy to prevent MDR-TB
1. Through sustained high-quality DOTS implementation (DOTSPlus)
- MH and GJ: 2007
- AP, DL, HR, KE and WB: 2008
- Remaining states: 2009-2010
2. Improve lab capacity- 27 Accredited culture and DST IRLs
are being established across country in a phased manner
3. Effective t/t of MDR-TB
DOTS-Plus in MH:
Nagpur circle- 7district (2007)
Akola circle- 6 district (2008)
100% coverage across MH state by 2012
RNTCP- DOTS-Plus Vision
• By 2010 DOTS-Plus services available in all states
• By 2012, universal access under RNTCP to laboratory based
quality assured MDR-TB diagnosis for all retreatment TB
cases and new cases who have failed treatment
• By 2012, free and quality assured treatment to all MDR-TB
cases diagnosed under RNTCP (~30,000 annually)
• By 2015, universal access to MDR diagnosis and treatment
for all smear positive TB cases under RNTCP
Changes in RNTCP policy on diagnosis of smear
positive pulmonary TB
1. Number of sputum specimen required for diagnosis
is 2, with one of them being a morning sputum
2. Diagnosis of PTB suspect- One smear specimen
positive out of the two is enough to declare a patient
as Sm+ PTB
3. Definition of PTB suspect- any person with cough
for 2 weeks, or more
Challenges…
• Wide variation in capacity of health systems in
states
• Burden due to TB-HIV co-infection
• Ensure adherence of treatment
• Large & unregulated private system
References
• Global tuberculosis control : epidemiology, strategy, financing :
WHO report 2009.
• TB INDIA 2009. RNTCP Status Report. Central TB Division.
Directorate General of Health Services. Ministry of Health and
Family Welfare. New Delhi.
• RNTCP Performance Report, India. Second Quarter, 2009. Central TB
Division. Directorate General of Health Services. Ministry of Health
and Family Welfare. New Delhi.
• RNTCP Performance Report, India. Second Quarter, 2008. Central TB
Division. Directorate General of Health Services. Ministry of Health
and Family Welfare. New Delhi.
• Global Tuberculosis Control: Surveillance, Planning and Financing:
WHO Report 2008.
• TBC India. Directorate General of Health Services. Ministry of Health
and Family Welfare. New Delhi. [Online]. 2009. [cited 2009 Dec 7];
Available from: URL: http://www.tbcindia.org.
THANK YOU