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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 numbers of the private-sector DOTS-providers
Need for a Revised Strategy - India has had an on-going National TB Program, NTP since 1962. In 1992, the Government of India, together with the World Health Organization (WHO) and Swedish International Development Agency (SIDA), reviewed the National TB Program, and concluded that it suffered from the following
Program reviews showed that only 30% of estimated tuberculosis patients were diagnosed and only 30% 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.
Started on a pilot project in 1993, the strategy proved both its technical and operational feasibility. A soft loan of US $ 142 million was negotiated with the World Bank in December 1996 and the credit agreement was signed with IDA in May 1997.
Launch, Expansion and Coverage
The Revised National Tuberculosis Control Programme (RNTCP), based on the DOTS strategy, began as a pilot in 1993 and was launched as a national program in 1997. Rapid RNTCP expansion began in late 1998.
Components of RNTCP
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
Diagnosis of Pulmonary TB under RNTCP
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 used as the standard case-finding tool. Three sputum samples are collected over two days (as spot-morning-spot) from Chest Symptomatics to arrive at the diagnosis. In addition to the test's high specificity, the use of three samples ensures that the diagnostic procedure has a high (>99%) test Sensitivity also.
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
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 8 months, with an initial Intensive phase and a Continuation phase.
Based on the Nature/severity of the disease and the Patients' exposure to previous anti-tubercular treatments, RNTCP classifies tuberculosis patients in to three Treatment Categories.
PPP - Public Private Patrnership under RNTCP
In India, a sizeble 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.
Second Phase of RNTCP
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 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. These 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.
|This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "RNTCP". A list of authors is available in Wikipedia.|