1. Presentation 1 Introduction
Contents
• Global Tuberculosis Scenario
Burden of Tuberculosis in India
•RNTCP- Evolution, objectives, structure, achievements
NTF Presentations for RNTCP Sensitization First edition 10th Nov 06

2. NTF Presentations for RNTCP Sensitization First edition 10th Nov 06
Global burden of TB
2 billion infected, i.e. 1 in 3 of global population
9.4 million (139/lakh) new cases in 2008, 80% in 22 high-burden countries
4 m new sm+ve PTB (61/lakh) cases in 2008
Global incidence of TB has peaked in 2004 and is declining.
1.77m deaths in 2007, 98% in low-income countries
MDR-TB -prevalence in new cases around 3.6%
Source of information (2006 report)
NTF Presentations for RNTCP Sensitization First edition 10th Nov 06
Ref: WHO Global Report, 2006 3

3. Estimated TB incidence rate, 2007
:Source: WHO Geneva; WHO Report 2009: Global Tuberculosis Control; Surveillance, Planning and Financing

4. Millennium Development Goals
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…”
Indicator 23: between 1990 and 2015 to halve prevalence of TB disease and deaths due to TB
Indicator 24: to detect 70% of new infectious cases and to successfully treat 85% of detected sputum positive patients
NTF Presentations for RNTCP Sensitization First edition 10th Nov 06

5. Stop TB Partnership Targets
By 2005:
At least 70% people with sputum smear positive TB will be diagnosed.
At least 85% cured.
By 2015:
Global burden of TB (prevalence and death rates) will be reduced by 50% relative to 1990 levels.
Reduce prevalence to <150 per lakh population
Reduce deaths to <15 per lakh population
Number of people dying from TB in 2015 should be less than 1 million, including those co-infected with HIV
By 2050:
Global incidence of TB disease will be less than or equal to 1 case per million population per year
NTF Presentations for RNTCP Sensitization First edition 10th Nov 06

6. NTF Presentations for RNTCP Sensitization First edition 10th Nov 06
Stop TB Strategy, 2006
Vision: A world free of TB
Goal: To dramatically reduce the global burden of TB by 2015 in line with Millennium Development Goals and the Stop TB Partnership targets
NTF Presentations for RNTCP Sensitization First edition 10th Nov 06

7. Components of Stop TB Strategy, 2006
Pursuing high-quality DOTS expansion and enhancement
Addressing TB/HIV, MDR-TB and other challenges
Contributing to health system strengthening
Engaging all health providers
Empowering people with TB, and communities
Enabling and promoting research
NTF Presentations for RNTCP Sensitization First edition 10th Nov 06

8. Directly Observed Treatment, Short-course strategy (DOTS), 1994
Government commitment to TB control
Diagnosis by smear microscopy mostly on self-reporting symptomatic patients
Standardised short course chemotherapy (SCC) with direct observation of treatment (DOT)
Efficient system of drug supply
Efficient recording and reporting system with assessment of treatment results
Five components were expanded in 2002
Stop TB Strategy and DOTs is part of it (SEARO AIIMS meeting)
NTF Presentations for RNTCP Sensitization First edition 10th Nov 06

9. NTF Presentations for RNTCP Sensitization First edition 10th Nov 06
Global Situation
Since 1995,over 21 million patients have been diagnosed and treated in DOTS programmes
In 2007, 5.5 million new and relapse TB cases were initiated on treatment under DOTS strategy
Of 2.5 million new smear positive patients registered in 2006, 85% were successfully treated under DOTS
NTF Presentations for RNTCP Sensitization First edition 10th Nov 06

10. NTF Presentations for RNTCP Sensitization First edition 10th Nov 06

11. International Standards for TB Care-2006-revised in 2009
Developed by Tuberculosis Coalition for Technical Assistance
Members of TCTA
American Thoracic Society
WHO (World Health Organisation)
CDC (Center for Disease Control and Prevention)
KCNV(Dutch Tuberculosis Foundation),
IUATLD (The International Union Against Tuberculosis and Lung Disease)
Part of the new STOP TB Strategy and global plan to Stop TB
NTF Presentations for RNTCP Sensitization First edition 10th Nov 06

12. International Standards for TB Care
The ISTC is designed to address the care of patients of all ages with any manifestation of the disease, including multi-drug resistant and extra-pulmonary tuberculosis and tuberculosis combined with HIV infection.
The ISTC is also designed to guide providers everywhere, regardless of the circumstances of their practice.
Consists of 21 standards for Public Health Responsibility
NTF Presentations for RNTCP Sensitization First edition 10th Nov 06

13. NTF Presentations for RNTCP Sensitization First edition 10th Nov 06
INDIA
NTF Presentations for RNTCP Sensitization First edition 10th Nov 06

14. Problem of TB in India Estimated incidence
1.96 million new cases annually
0.8 million new smear positive cases annually
75 new smear positive PTB cases/1lakh population per year
Estimated prevalence of TB disease
3.8 million bacillary cases in 2000
1.7 million new smear positive cases in 2000
Estimated mortality
330,000 deaths due to TB each year
Over 1000 deaths a day
2 deaths every 3 minutes
Divide into two slides
Gopi P et al (TRC), IJMR, Sep 2005
NTF Presentations for RNTCP Sensitization First edition 10th Nov 06

15. Problem of TB in India (contd)
Prevalence of TB infection
40% (~400m) infected with M. tuberculosis (with a 10% lifetime risk of TB disease in the absence of HIV)
Estimated Multi-drug resistant TB
< 3% in new cases
12% in re-treatment cases
TB-HIV
~2.31 million people living with HIV (PLWHA)
10-15% annual risk (60% lifetime risk) of developing active TB disease in PLWHA
Estimated ~ 5% of TB patients are HIV infected
NTF Presentations for RNTCP Sensitization First edition 10th Nov 06

16. NTF Presentations for RNTCP Sensitization First edition 10th Nov 06
India is the highest TB burden country accounting for more than one-fifth of the global incidence
Global annual incidence = 9.4 million
India annual incidence = 1.96 million
India is 17th among 22 High Burden Countries (in terms of TB incidence rate)
However, in terms of absolute numbers, India accounts for one fifth of the global Tuberculosis burden. Every year 1.9 million people in India develop tuberculosis (TB), of which 0.8 million are sputum positive cases that are infectious. Tuberculosis is unique among the main disease killers of the developing world in that it afflicts nearly all age groups. Tuberculosis has devastating social costs as well. This continued burden of disease is particularly tragic because TB is nearly 100% curable. Untreated patients can infect persons each year; poorly treated patients develop drug resistant and potentially incurable TB.
NTF Presentations for RNTCP Sensitization First edition 10th Nov 06
Source: WHO Geneva; WHO Report 2009: Global Tuberculosis Control; Surveillance, Planning and Financing

17. Estimated Incidence of TB in India. (No
Estimated Incidence of TB in India* (No. of NSP Cases per 100,000 population, per year)
* Estimated from recent ARTI survey
North
West
East
National 75
North Zone 95
East Zone
75**
West Zone 80
South Zone
Legend to have same colour as map. Ref to be added
South
** For programme monitoring purpose estimated cases in East & South zones have been kept at the national level of 75 and this is within the upper limit of CI or ARTI in these zones
NTF Presentations for RNTCP Sensitization First edition 10th Nov 06
Source: Module 9, Managing the RNTCP in your area

18. Social and Economic Burden of TB in India
Estimated burden per year
Indirect costs to society $3 billion
Direct costs to society $300 million
Productive work days lost due to TB illness 100 million
Productive work days lost due to TB deaths 1.3 billion
School drop-outs due to parental TB 300,000
Women rejected by families due to TB 100,000
Estimates made in
TRC, Socio-economic impact of TB on patients and family in India, Int J Tub Lung Dis :
NTF Presentations for RNTCP Sensitization First edition 10th Nov 06

19. NTF Presentations for RNTCP Sensitization First edition 10th Nov 06

20. Evolution of TB Control in India
1950s-60s Important TB research at TRC and NTI
National TB Programme (NTP)
Programme Review
only 30% of patients diagnosed;
of these, only 30% treated successfully
RNTCP pilot began
RNTCP scale-up
million population covered
>80% of country covered
2006 Entire country covered by RNTCP
Formattiing required..TURN 450 INTO PERCENTAGE
NTF Presentations for RNTCP Sensitization First edition 10th Nov 06

21. NTF Presentations for RNTCP Sensitization First edition 10th Nov 06
Objectives of RNTCP
To achieve and maintain a cure rate of at least 85% among newly detected infectious (new sputum smear positive) cases
To achieve and maintain detection of at least 70% of such cases in the population
Explanatory notes (brief and carefully written)
NTF Presentations for RNTCP Sensitization First edition 10th Nov 06

22. RNTCP Organization structure: State level
Organizational Chart Ministry of Health and Family Welfare Directorate General of Health Services Central TB Division
RNTCP Organization structure: State level
Health Minister
Health Secretary
MD NRHM
Director Health Services
Additional / Deputy / Joint Director
(State TB Officer)
State TB Cell
Deputy STO, MO, Accountant,
IEC Officer, SA,
DEO, TB HIV Coordinator etc.,
State Training and Demonstration
Center (TB)
Director, IRL Microbiologist, MO,
Epidemiologist/statistician, IRL LTs etc.,
NTF Presentations for RNTCP Sensitization First edition 10th Nov 06

23. Structure of RNTCP at district levels
District Magistrate/
District Collector
District Administration
Chief Medical Officer and
other supporting staff
District Health Services
DTO, MO-DTC (15%), LT, DEO,
Driver, Urban TB Coordinators,
TBHVs, Communication Facilitators
Nodal point for TB control
District TB Centre
One/ 500,000
(250,000 in hilly/
difficult/ tribal area)
Medical officer-TB Control,
Senior Treatment supervisor(STS),
Senior TB Laboratory Supervisor(STLS)
Tuberculosis Unit
Medical Officer, paramedical staff
And Laboratory Technician (20-50%)
One/ 100,000
(50,000 in hilly/ difficult/
tribal area)
Microscopy Centre
TB Health Visitors (TBHV),
DOT Provider
(MPW, NGO, PP, ASHA,
Community Volunteers)
DOT Centre
NTF Presentations for RNTCP Sensitization First edition 10th Nov 06

24. Unique features of RNTCP
District TB Control Society
Modular training
Patient wise boxes
Sub-district level supervisory staff (STS, STLS) for treatment & microscopy
Robust reporting and recording system
NTF Presentations for RNTCP Sensitization First edition 10th Nov 06

25. Annualized New Smear-Positive Case Detection Rate
and Treatment Success Rate in DOTS Areas, India, *
Treatment success has recently exceeded the global target of 85%
Case Detection in DOTS areas has recently attained global target of 70%
Population projected from 2001 census
Estimated no. of NSP cases - 75/100,000 population per year (based on recent ARTI report)
NTF Presentations for RNTCP Sensitization First edition 10th Nov 06 25

26. NTF Presentations for RNTCP Sensitization First edition 10th Nov 06
Impact of RNTCP
Cure rate more than doubled compared with earlier NTP, 85% global target consistently achieved 2003 onwards
Case detection rate is more than 70%
Case fatality reduced from 29% to 4% in NSP cases, and deaths due to TB from 500,000 to <330,000 a year
Over 11 million patients initiated on DOTS, and over 2 million additional lives saved
Add slide of graphs (differential mortality) with reference
NTF Presentations for RNTCP Sensitization First edition 10th Nov 06