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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
History 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
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 tuberculosisSputum 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 strategyIsoniazid, 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.
H: Isoniazid (600 mg), R: Rifampicin (450 mg), Z: Pyrazinamide (1500 mg), E: Ethambutol (1200 mg), S: Streptomycin (750 mg)
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/TBThe 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.
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