Revised National Tuberculosis Control Programme

Introduction

Tuberculosis is a major health problem in India caused by a Mycobacterium tuberculosis. One sputum positive patient can infect 10-15 persons in a year, if left untreated. Everyday, more than 1000 persons die from TB in India, 4 lakh per year, 2 persons every 3 minutes. To fight with TB, The Revised National Tuberculosis Control Programme (RNTCP), based on the internationally recommended DOTS strategy has been initiated in Haryana in 2000 in three Districts. The entire State of Haryana has been covered under RNTCP by the end of April, 2004.

Goal

The goal of TB Control programme is to decrease mortality and morbidity due to TB and cut the transmission of infection until TB ceases to be a major public health problem.

Objectives

•         To achieve and maintain 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 once the cure rate of 85 % is achieved.

RNTCP is centrally sponsored scheme. The funding of the RNTCP-Phase II is being done by GFATM from 1^st April 2009. Previously it was from World Bank.

Achievements under RNTCP

•         Wide spread network of Tuberculosis unit =47, Designated Microscopy Centres (DMC) = 220, DOT Centres/ providers =   6896.

•         In 1Q2010, total 8831 TB cases were diagnosed and put on treatment, out of which 3257 are new sputum positive cases.

•         In 2009, total 38241 TB cases were diagnosed and put on treatment, out of which 13790 are new sputum positive cases.

•         New sputum positive cases conversion rate is 90.4% has been achieved and success rate of 85.2% has been achieved in accordance with Govt. of India objectives.

•         DOTS PLUS activities for the diagnosis and treatment of Multi Drug Resistant TB cases has been launched successfully in 7 districts (Bhiwani, Jind, Jhajjar, Karnal, Panipat, Sonepat and Rohtak) of the State since July, 2008 and treatment  activities have been stated from Dec,08. At present, 54 multi drug resistant TB cases have been put on treatment on CAT-IV regimen in these seven districts against the target of registration of 50 MDR cases given by GOI in first year of implementation of DOTS PLUS.

•          Intermediate Reference Laboratory (IRL) - Public health laboratory at Karnal has been upgraded to state level intermediate reference laboratory for testing Multi drug resistant TB cases. It will provide free diagnostic services to Multi drug resistant cases after its accreditation by National Reference Lab. At present, its role is in monitoring the quality of microcopy in all the districts of the State. The IRL ensures the proficiency of staff performing RNTCP smear microscopy activities by providing technical training to district and sub- district level laboratory technicians and STLS. The IRL undertakes on – site evaluation and panel testing to each district in the state, at least once a year for quality maintenance and improvement.

•         Involvement of Medical Colleges- All the three Medical Colleges of state (Rohtak, Mullana & Agroha) have been involved in RNTCP and are providing free diagnostic and treatment services to TB cases as per RNTCP guidelines.

•         TB-HIV Collaborative activities- TB-HIV coordination has been established. Cross referral activities from ICTC to RNTCP and RNTCP to ICTC have been started.  Effective RNTCP regimens are being used for the treatment of HIV infected TB cases. From April 09 to January 2010,  5832 cases have been referred from ICTC to RNTCP and 6996 cases have been referred from RNTCP to ICTC and 435 cases have been diagnosed co-infected with TBHIV

•         IMA- GFATM -RNTCP-PPM Project - IMA head quarter has signed a MOU with GOI, to involve 6 State and Haryana is the one of the States involved under this project. Funding agency is GFATM. Project is running successfully in Haryana since last two years to provide impetus to the private health care sector to join and participate in RNTCP by using the DOTS strategy for patients suffering from TB. IMA has conducted 37 sensitization workshops and 13 District Training Programme                                                                                        district training programmes of private Doctors in various districts of Haryana and opened 13 DOT Centres in coordination with the District Health societies.

•         In the Year 2009, under RNTCP 12 new Designated Microscopy Centers have been sanctioned by State TB Cell in 6 districts of Haryana to strengthen the diagnostic services

New Initiatives and their Impact

•         There is plan to extend DOTS PLUS services to other districts of Haryana in phased manner by 2010.

•         Stress will be given to strengthen TB-HIV collaborative activities and 30 facility  integrated counselling and testing centre will be opened in the designated microscopy centres  under RNTCP where ICTC facility is not existing in the same premises to improve the TB-HIV cross referral activities. 30LT of DMCs have been trained in HIV Testing and 30 Para Medical workers have been trained as FICTC counsellors and 12 FICTC are functional at present.

•         IMA- RNTCP-PPM Project:- Services of private practitioners will be utilized for creating designated microscopy centres and DOT Centres in their clinics , who are interested in RNTCP and fulfil the criteria  of establishing a DMC. 

•         21 New microscopy centres will be opened in Haryana in the year 2010-2011

Physical achievement of State Haryana under RNTCP