Tuberculosis Programme

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TB was declared as a global Health emergency in 1993. In the same year, India established the RNTCP as a small pilot project. This project was scaled up nationwide between 1998–2006.
The overall vision of RNTCP is “A TB free India”—a situation in which TB is no longer a major public health problem.
Over the last 15 years, the RNTCP became one of India’s largest and greatest public health achievements.
By 2006, decentralized basic TB control Services had been established nationwide. In 2006–11, in its second phase RNTCP sought to improve the quality and reach of services, and reach global case detection and cure targets.
These targets were achieved by 2007-08, and from 2006–10 alone more than 27 million chest symptomatic have been examined and 6 million treated.
In the process, the programme implemented activities effectively, delivering Rs. 1545 crores (as of March 2012) expenditure against Rs.1447 crores planned expenditure in the 11th five year plan. There is compelling evidence that the tide has turned for TB.
The burden of TB has begun to fall, and there are now fewer TB-related deaths each year than the year before.
Despite these achievements, undiagnosed and mistreated cases continue to drive the epidemic such that TB remains an enormous public health problem for India. In 2011 alone an estimated 1.2 million TB cases occurred, and 60,000 people died of TB – nearly 165 deaths per day. Nearly 1 in 6 deaths among adults aged 15–49 are due to TB. More adult Women die of TB every year than from peri-partum complications or HIV/AIDS. TB remains the leading cause of illness and death among persons living with HIV/AIDS. Nearly 100,000 cases of serious multidrug resistant TB (MDR-TB) are estimated to occur in the country every year, mostly attributable to prior inadequate treatment, and each MDR TB case costs more than Rs 1 lakh to diagnose and treat. TB affects anyone, but predominantly the poor and marginalized, perpetuating POVERTY through health and economic shocks to families least able to cope.

History of TB Control:

Despite the National TB Programme (NTP) being in existence since 1962, no appreciable change in the epidemiological situation of TB in the country had been observed. The HIV-AIDS epidemic and the spread of multi-drug resistance TB were threatening to further worsen the situation. In view of this, in 1992, GOI, with WHO and SIDA reviewed the TB situation and identified the following limitations:

NTP, was managerially weak
Inadequate funding for program activities
Over-reliance on x-ray for diagnosis
Frequently interrupted drug supply
Low rates of treatment compliance

In order to overcome these limitations, in 1993 the GoI decided to reenergize the NTP, with assistance from international agencies.

The Revised National TB Control Programme

The Revised National TB Control Programme (RNTCP) thus formulated, adopted the internationally recommended Directly Observed Treatment Short-course (DOTS) strategy, as the most systematic and cost-effective approach for TB control in India. Political and administrative commitment, to ensure the provision of organised and comprehensive TB control services was obtained. Adoption of smear microscopy for reliable and early diagnosis was introduced in the general health services. DOTS was adopted as a strategy for provision of treatment to increase the treatment completion rates.
The supply of drugs was also strengthened to meet the requirements of the system.
The key objectives of the RNTCP were to achieve and maintain at least 85 per cent cure rate among the new smear-positive cases initiated on treatment, and thereafter a case detection rate of at least 70 per cent of such cases

RNTCP (Revised National TB Control Programme Growth) & Innovations:

The RNTCP built on the Infrastructure-2/”>INFRASTRUCTURE and systems built through the NTP. A key focus area was strengthening the recording and reporting systems.
An addition to the RNTCP was the establishment of a subdistrict supervisory unit, known as a TU (Tuberculosis Unit), with dedicated RNTCP supervisors. This led to Decentralization of both diagnostic and treatment services, with treatment given under the support of DOT providers.
The quality of diagnosis of TB patients under RNTCP improved by giving the highest priority to the provision of quality assured sputum smear microscopy services.
Another key innovation under RNTCP has been the development of Patient-Wise Boxes, which contain the full course of treatment for an individual patient.
This ensures that treatment of that patient cannot be interrupted due to a lack of drugs. The RNTCP has effectively decentralized supervision via the sub-district TB Units, with in-built systems for monitoring and evaluation.

RNTCP (The Revised National TB Control Programme) II

RNTCP II was developed based on the lessons learnt from the implementation of the programme over a 12-year period (1993-2005).
RNTCP II was designed to consolidate the gains achieved in RNTCP I and to initiate services to address TB/HIV, MDR-TB and extend RNTCP to private sector.
Systematic research and evidence building to inform the programme for better design was also an important component of the programme. The emerging needs of Advocacy, Communication and Social Mobilization were addressed in the new phase.
The challenges imposed by the structures under NRHM were also taken into account for RNTCP II.
Since 2007, the programme has been consistently achieving a treatment success rate of >85% and a NSP case detection rate (CDR) of >70%.
In 2011, RNTCP achieved the NSP CDR of 72% and treatment success rate of 88%, which is in line with the global targets for TB control.

Monitoring, supervision and evaluation:

The RNTCP’s ‘Supervision and Monitoring strategy’ includes detailed guidelines, tools and indicators for monitoring the performance from the PHI level to the national level.
The quality programme implementation is ensured by frequent Internal and external evaluations.
The programme is focusing on the reduction in the default rates among all new and re-treatment cases.
Quality assured sputum smear microscopy facilities are available nationwide through about 13,000 sputum microscopy laboratories in the health system.
As a result, chest symptomatic examined has increased from 397 to 642 per 100,000 Population per annum over the last 10 years.
Quality assured anti-TB drugs for the full course of treatment are provided to the patients through patient wise boxes.
Decentralized treatment is provided through a Network of more than 6,40,000 DOTS providers, to provide treatment to the patients as near to their home as possible

National Strategic Plan 2012-17/ The National Strategic Plan for TB Control 2012-17 (NSP-RNTCP)

The vision of the Government of India is for a “TB-free India” with reduction of the burden of the disease until it is no longer a major public health problem.
To achieve this vision, the programme has now adopted the new objective of Universal Access for quality diagnosis and treatment for all TB patients in the community.
This entails sustaining the achievements of the programme to date, and extending the reach and quality of services to all persons diagnosed with TB.
With the GOI vision as a long term guide, the programme defined objectives for 2012–2017 are:

To ensure early and improved diagnosis of all TB patients including drug resistant and HIV-associated TB
To provide access to high-quality treatment for all diagnosed cases of TB
To scale-up access to effective treatment for drug-resistant TB
To decrease the morbidity and mortality of HIV-associated TB
To extend RNTCP services to patients diagnosed and treated in the private sector.

Thrust areas and Strategies

Strengthening and improving the quality of basic DOTS services
Further strengthening and aligning with health system under NRHM
Deploying improved rapid diagnostics to the field level
Expanding efforts to engage all care providers
Strengthening urban TB Control
Expanding diagnosis and treatment of drug resistant TB
Improving communication, outreach, and social mobilization
Promoting research for development and implementation of improved tools and strategies

Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis (MTB). It is spread through the air when an infected person coughs, sneezes, or talks. TB can affect any part of the body, but it most commonly affects the lungs.

TB is a serious disease that can be fatal if not treated. However, TB is curable with a combination of antibiotics.

Table of Contents

Epidemiology

TB is a global health problem. In 2019, there were an estimated 10.0 million new cases of TB and 1.4 million deaths from TB.

The highest burden of TB is in low- and middle-income countries. In 2019, 95% of new cases and 99% of deaths from TB occurred in these countries.

Pathogenesis

TB is caused by infection with Mycobacterium tuberculosis (MTB). MTB is a rod-shaped bacterium that is spread through the air when an infected person coughs, sneezes, or talks.

After inhalation, MTB is deposited in the lungs. The bacteria then multiply and spread to other parts of the body, including the lymph nodes, brain, and kidneys.

Clinical Features

The most common symptom of TB is a cough that lasts for more than two weeks. Other symptoms may include fever, night sweats, weight loss, and fatigue.

TB can also cause symptoms in other parts of the body, depending on the site of infection. For example, TB of the brain can cause headache, seizures, and confusion.

Diagnosis

TB is diagnosed with a chest X-ray and a sputum test. The sputum test is used to look for the presence of MTB.

If TB is suspected, a doctor may order other tests, such as a blood test or a biopsy.

Treatment

TB is treated with a combination of antibiotics. The treatment regimen typically lasts for six to nine months.

It is important to complete the full course of treatment, even if symptoms improve. Stopping treatment early can lead to the development of drug-resistant TB.

Prevention

The best way to prevent TB is to get vaccinated with the BCG vaccine. The BCG vaccine is not 100% effective, but it can reduce the risk of developing TB by up to 80%.

Other preventive measures include avoiding contact with people who have TB, practicing good hygiene, and getting tested for TB if you have been exposed to the disease.

Surveillance

TB surveillance is the process of monitoring the incidence of TB in a population. This information is used to track the progress of TB control programs and to identify areas where there is a need for additional intervention.

TB surveillance is conducted through a variety of methods, including case reporting, contact tracing, and laboratory testing.

Evaluation

TB evaluation is the process of assessing the effectiveness of TB control programs. This information is used to improve the programs and to ensure that they are meeting their objectives.

TB evaluation is conducted through a variety of methods, including review of program data, surveys, and interviews.

Challenges

There are a number of challenges to TB control, including:

Drug resistance: Drug-resistant TB is a major challenge to TB control. Drug-resistant TB is more difficult to treat and can be more expensive to treat.
Poverty: Poverty is a major risk factor for TB. People who are living in poverty are more likely to be exposed to TB and less likely to have access to quality health care.
HIV/AIDS: HIV/AIDS is a major co-infection with TB. People who are living with HIV/AIDS are more likely to develop TB and more likely to die from TB.
Stigma: TB is a stigmatized disease. People who have TB may be afraid to seek treatment because they fear being stigmatized.

Future Directions

The future directions of TB control include:

Developing new drugs and Vaccines for TB: New drugs and vaccines are needed to treat and prevent TB.
Improving access to quality health care: People who have TB need to have access to quality health care, including diagnosis, treatment, and support.
Reducing poverty: Poverty is a major risk factor for TB. Reducing poverty will help to reduce the burden of TB.
Addressing HIV/AIDS: HIV/AIDS is a major co-infection with TB. Addressing HIV/AIDS will help to reduce the burden of TB.
Reducing stigma: TB is a stigmatized disease. Reducing stigma will help people who have TB to seek treatment.

What is tuberculosis?

Tuberculosis (TB) is a bacterial infection that most commonly affects the lungs. It can also affect other parts of the body, such as the brain, kidneys, and spine. TB is spread through the air when an infected person coughs, sneezes, or talks.

What are the symptoms of tuberculosis?

The symptoms of TB can vary depending on the part of the body that is infected. However, some common symptoms include:

Coughing that lasts for 2 or more weeks
Chest pain
Fatigue
Weight loss
Loss of appetite
Fever
Night sweats

How is tuberculosis treated?

TB is treated with a combination of antibiotics. The treatment usually lasts for 6 to 9 months. It is important to take all of the antibiotics as prescribed, even if you start to feel better. Stopping the treatment early can allow the TB bacteria to become resistant to antibiotics, which can make the infection more difficult to treat.

How can I prevent tuberculosis?

The best way to prevent TB is to get vaccinated. The TB vaccine, called BCG, is given to children at birth in many countries. BCG can help protect against TB, but it is not 100% effective.

You can also reduce your risk of getting TB by:

Avoiding close contact with people who have TB
Getting tested for TB if you have been exposed to someone who has TB
Taking the TB vaccine if you are at high risk of getting TB

What is the prognosis for people with tuberculosis?

The prognosis for people with TB is good if they are treated properly. However, if TB is not treated, it can be fatal.

What are the complications of tuberculosis?

Complications of TB can occur if the infection is not treated properly. These complications can include:

Spread of the infection to other parts of the body
Lung damage
Death

What is the cost of treating tuberculosis?

The cost of treating TB varies depending on the country and the type of treatment that is used. However, in general, the cost of treating TB is relatively low.

What is the impact of tuberculosis on Society?

TB has a significant impact on society. It is a major cause of death and disability, particularly in low- and middle-income countries. TB also has a negative impact on the economy, as it can lead to lost productivity and increased health care costs.

What is being done to control tuberculosis?

There are a number of things that are being done to control TB, including:

Vaccination: The TB vaccine, called BCG, is given to children at birth in many countries. BCG can help protect against TB, but it is not 100% effective.
Early diagnosis and treatment: Early diagnosis and treatment of TB is essential to prevent the spread of the infection and to reduce the risk of complications.
Prevention: There are a number of things that can be done to prevent TB, including avoiding close contact with people who have TB, getting tested for TB if you have been exposed to someone who has TB, and taking the TB vaccine if you are at high risk of getting TB.
Research: There is a lot of research being done to find new ways to prevent, diagnose, and treat TB.

Question 1

Tuberculosis is a disease that affects the lungs. It is caused by a bacterium called Mycobacterium tuberculosis.

True or False?

Answer

True.

Question 2

Tuberculosis can be spread through the air when an infected person coughs or sneezes.

True or False?

Answer

True.

Question 3

The symptoms of tuberculosis can include:

Coughing that lasts for more than two weeks
Chest pain
Fatigue
Loss of appetite
Weight loss
Fever
Night sweats

True or False?

Answer

True.

Question 4

Tuberculosis can be treated with antibiotics.

True or False?

Answer

True.

Question 5

If you are at risk for tuberculosis, you should get a TB test.

True or False?

Answer

True.

Question 6

The TB test is a skin test that is used to see if you have been infected with the TB bacteria.

True or False?

Answer

True.

Question 7

The TB test is usually given on the inside of your forearm.

True or False?

Answer

True.

Question 8

A small amount of tuberculin is injected into your skin.

True or False?

Answer

True.

Question 9

The area around the injection site will be checked for a reaction 48 to 72 hours later.

True or False?

Answer

True.

Question 10

A red, raised bump at the injection site means that you have been infected with the TB bacteria.

True or False?

Answer

False. A red, raised bump at the injection site does not necessarily mean that you have been infected with the TB bacteria. A positive TB test result means that you have been infected with the TB bacteria, but it does not mean that you have active TB disease. Active TB disease is a serious illness that can be fatal. If you have a positive TB test result, you will need to see a doctor to determine if you have active TB disease.

Question 11

There are several things you can do to prevent tuberculosis, including:

Getting vaccinated against TB
Avoiding close contact with people who have TB
Getting tested for TB if you are at risk
Taking your medication as prescribed if you are diagnosed with TB

True or False?

Answer

True.

Question 12

The TB vaccine is called BCG.

True or False?

Answer

True.

Question 13

The TB vaccine is given to children in many countries.

True or False?

Answer

True.

Question 14

The TB vaccine is not 100% effective.

True or False?

Answer

True.

Question 15

The TB vaccine can prevent severe forms of TB disease.

True or False?

Answer

True.

Question 16

If you have been exposed to TB, you should get a TB test.

True or False?

Answer

True.

Question 17

If you have a positive TB test result, you will need to see a doctor to determine if you have active TB disease.

True or False?

Answer

True.

Question 18

If you have active TB disease, you will need to take medication for several months.

True or False?

Answer

True.

Question 19

It is important to take your medication for TB as prescribed.

True or False?

Answer

True.

Question 20

If you do not take your medication for TB as prescribed, you can develop drug-resistant TB.

True or False?

Answer

True.

Question 21

Drug-resistant TB is more difficult to treat than regular TB.

True or False?

Answer

True.

Question 22

Drug-resistant TB can be fatal.

True or False?