Revised National TB Control Program

Tuberculosis (TB) is an infectious disease caused by the bacterium Mycobacterium tuberculosis. It primarily affects the lungs (pulmonary TB) but can also affect other parts of the body (extrapulmonary TB). TB spreads through the air when an infected person coughs, sneezes, or speaks.

Etiology & Pathogenesis:

• Caused by Mycobacterium tuberculosis.
• Spread mainly through airborne droplets.
• Affects lungs (pulmonary TB) and other organs (extrapulmonary TB).
• Risk factors: HIV, malnutrition, diabetes, smoking, poor living conditions.

2. Signs & Symptoms:

• Persistent cough (>2 weeks)
• Weight loss
• Fever, night sweats
• Chest pain, blood in sputum

3. Diagnosis:

• Sputum microscopy, CBNAAT (GeneXpert)
• Chest X-ray
• Tuberculin Skin Test (TST)
• Drug-resistance testing (especially Rifampicin)

4. Prevention:

• BCG vaccination at birth
• Infection control (cough etiquette, ventilation)
• Contact tracing and preventive therapy
• Addressing social factors (poverty, overcrowding)

5. Treatment:

·        New TB Cases:

• IP: 8 weeks - HRZE (Isoniazid, Rifampicin, Pyrazinamide, Ethambutol)
• CP: 16 weeks - HRE (Isoniazid, Rifampicin, Ethambutol)

·        Previously Treated TB Cases:

• IP: 12 weeks - HRZE + Streptomycin (8 weeks), then HRZE (4 weeks)
• CP: 20 weeks - HR daily

·        Special Cases:

• Extension of treatment by 12-24 weeks for complicated TB.

6. Drug-Resistant TB:

• MDR-TB: Resistant to INH and Rifampicin.
• Treatment includes Bedaquiline under special programs.

7. Supportive Schemes:

• Nikshay Poshan Yojana:
• Rs. 500/month for nutritional support to TB patients.
• Nikshay App:
• Digital tracking of TB patients and their treatment.

8. Key Programs:

• National Strategic Plan 2017-2025: Goal to eliminate TB by 2025.
• DTPB Strategy: Detect, Treat, Prevent, Build.

Quick Memory Tip:

• Think "4 D's" — Detect early, Diagnose properly, Drug treatment directly observed, Defeat TB by 2025!

Evolution of TB Control Program in India:

• 1962: National TB Programme (NTP) started with BCG vaccination and TB treatment.
• 1992: Programme review showed poor success — only 30% of diagnosed patients were treated successfully.
• 1993: Revised National TB Control Programme (RNTCP) pilot began.
• 1997: RNTCP officially launched with DOTS (Directly Observed Treatment, Short-course) strategy.
• 2001: 450 million people covered under RNTCP.
• 2004: 90% of the country was covered (Phase I of RNTCP completed).
• 2006: Entire country covered (Phase II of RNTCP).
• 2012: National Strategic Plan for TB Control was documented to achieve universal access to TB care.

National Strategic Plan (NSP) for Tuberculosis Elimination 2017–2025

Goal:

• Eliminate TB in India by 2025.

Strategy (DTPB):

• Detect: Find all TB cases (including drug-resistant) early, especially among high-risk groups.
• Treat: Start and maintain patients on proper anti-TB treatment with good support.
• Prevent: Stop TB spread among vulnerable people.
• Build: Strengthen policies, institutions, and human resources.

Key Services of the Program:

• Free TB diagnosis and treatment.
• Rapid diagnostic testing.
• Testing TB patients for drug resistance and HIV.
• Management of other associated diseases.
• Support to help patients stick to treatment.
• Nutrition support (like Nikshay Poshan Yojana).
• Preventive actions to avoid TB spread.
• Special focus on private sector patients:
• Incentives for private doctors to report TB cases.
• Free medicines even through private healthcare.
• Use of modern MIS (management information system) systems for tracking cases.
• SMS reminders to patients for better treatment compliance.

TB Vulnerability and Control Activities:

• Special focus on high-risk groups:
• HIV patients
• Smokers, alcoholics, and drug addicts
• Poor, malnourished, marginalized groups
• Remote and hilly areas
• Sexual minorities and pregnant women
• Children (pediatric TB)
• Prison inmates
• Patients with extra-pulmonary TB

Airborne Infection Control Measures:

• Early diagnosis and proper management of TB cases.
• Cough hygiene: Cover mouth with tissue/elbow while sneezing/coughing.
• Good ventilation in houses and hospitals.
• Use airborne infection control practices in health centers.
• Evaluate contacts of TB patients (even during treatment).
• Reverse contact tracing for pediatric TB cases.

Isoniazid Preventive Therapy (IPT):

• For children under 6 years old who are close contacts of TB patients.
• TB active disease must be ruled out before starting IPT.
• Also given to HIV-infected children exposed to TB but without active disease.

Treatment of TB:

• Daily Fixed Dose Combinations (FDCs) are given for all TB cases, supervised through Directly Observed Treatment (DOT).
• Rifampicin resistance screening (and other drugs if needed) is done before starting treatment.

Treatment Regimens:

·        New TB cases:

• Intensive Phase (IP): 8 weeks with 4 drugs — Isoniazid (INH), Rifampicin, Pyrazinamide, Ethambutol (HRZE).
• Continuation Phase: 16 weeks with 3 drugs — INH, Rifampicin, Ethambutol (HRE).

·        Previously treated cases:

• IP: 12 weeks with streptomycin + HRZE.
• Continue for 4 more weeks with HRZE.
• Continuation Phase: 20 weeks with HR drugs (daily doses).

·        Extended treatment (by 12–24 weeks) may be needed for complicated TB cases like skeletal or disseminated TB.

Special Notes:

• Bedaquiline introduced for MDR-TB under special programs from 2016 onward.
• Nikshay Poshan Yojana:
• Financial support of Rs. 500/month to each TB patient for nutritional needs during treatment.

ICT-based Treatment Adherence Support Mechanisms:

• Mobile-based "Pill-in-Hand" tool.
• Interactive Voice Response (IVR) and SMS reminders.
• Special electronic pill boxes with GSM connection.
• Mobile apps for patients to report treatment compliance.
• Automated pill loading systems.
• ICT-enabled smart cards and SMS gateway.

Outcomes of the TB Elimination Programme (NSP 2017-2025):

• Over 22 lakh (94.4%) of drug-sensitive TB patients started on treatment.
• Core populations screened across 23 states leading to 62,958 TB cases identified.
• 1180 CBNAAT centers set up; 35.31 lakh tests performed (47% rise).
• 66,359 MDR/RR-TB cases notified, 85% started on treatment.
• New injection-free oral regimens introduced for MDR TB patients.
• 94% of People Living with HIV (PLHIV) screened for TB symptoms.
• 2.4 lakh PLHIV got rapid NAAT testing; 3 lakh+ PLHIV started on TB preventive therapy.
• Blood sugar testing done for over 60% of notified TB patients in the public

Tuberculosis (TB) – One-Page Revision
National Strategic Plan (NSP) 2017–2025 Goals:
• Eliminate TB in India by 2025.
• Strategy: Detect – Treat – Prevent – Build (DTPB).

Key Services:
• Free diagnosis and treatment.
• Rapid diagnostics and HIV testing.
• Management of drug resistance and associated diseases.
• Nutrition support (e.g., Nikshay Poshan Yojana - ₹500/month).
• Digital monitoring (MIS systems, ICT tools).

Treatment Regimen:
• New TB Cases:
◦ Intensive Phase (8 weeks): 4 drugs (HRZE) daily.
◦ Continuation Phase (16 weeks): 3 drugs (HRE) daily.
• Previously Treated Cases:
◦ Intensive Phase (12 weeks): 4 drugs + Streptomycin.
◦ Continuation Phase (20 weeks): HRZE continuation.
• MDR/RR-TB:
◦ Special oral regimens and Bedaquiline treatment started under conditional access.

ICT-Based Adherence Support:
• SMS Reminders, Mobile Apps (compliance reporting).
• Smart Cards, Electronic Pillboxes with GSM.
• Automated pill loading systems.

Achievements (Outcomes):
• Over 22 lakh TB cases treated in a year.
• 62,985 TB cases identified from vulnerable groups.
• 66,359 MDR/RR-TB cases notified; 85% started on treatment.
• 94% PLHIV screened for TB symptoms; over 3 lakh started preventive therapy.
• Blood sugar screening integrated for TB-diabetes.

Important Initiatives:
• Nikshay App: Case tracking and nutrition support.
• Nikshay Poshan Yojana: Nutritional financial support.
• Integrated Disease Surveillance Program (IDSP): Early disease outbreak detection.

Quick Abbreviations:
• DS-TB: Drug Sensitive TB
• DR-TB: Drug Resistant TB
• MDR-TB: Multi-Drug Resistant TB
• HRZE: Isoniazid, Rifampicin, Pyrazinamide, Ethambutol
• PLHIV: People Living with HIV
• CBNAAT/NAAT: Rapid molecular TB diagnosis methods

Reference 

Malviya K, Sahoo S, Dasadiya D, Acharya V. Social and Preventive Pharmacy. 1st ed. Pee Vee (Regd.); 2021