Dr. Kumar Khagendra Singh
Hon'ble CMO
Haridwar, Uttarakhand.
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RNTCP (Revised National Tuberculosis Control Programme)
Tuberculosis (TB) is an infectious disease caused by Mycobacterium Tuberculosis bacteria. It spreads through air when a person suffering from tuberculosis cough, sneeze or spit. TB remains to be major public health problem in India. TB control efforts are initiated countrywide since 1962 with inception of National TB Control Programme. The programme was reviewed and revised strategy was pilot testedin 1993. The Revised National TB Control Programme (RNTCP) was launched in 1997 with implementation of Directly Observed Treatment, Short Course Strategy. The DOTS strategy is based on five components:
  • Political and administrative commitment
  • Good quality diagnosis, primarily by sputum smear microscopy
  • Uninterrupted supply of quality drugs
  • Directly observed treatment (DOT)
  • Systematic monitoring and accountability

Goals and Objectives of RNTCP
The goal of RNTCP is to decrease the mortality and morbidity due to tuberculosis and cut down the chain of transmission of infection until TB ceases to be a public health problem.

The goal is achieved through the following objectives :
To achieve and maintain :
  • Cure rate of at least 85% among newly detected smear-positive (infectious) pulmonary tuberculosis cases; and
  • Case detection of at least 70% of the expected new smear positive PTB cases in a community.

The state is achieving twin objectives of RNTCP since 2006. The current focus is on ensuring universal access to quality assured TB diagnosis and treatment services under the programme.

Strategic vision to move towards universal access
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 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.

Organization of RNTCP services in Haridwar
The goal of TB control Programme is to decrease mortality and morbidity due to TB and cut transmission of infection until TB ceases to be a major public health problem in India.

RNTCP was launched in the state of Uttarakhand with implementation of pilot in Haridwar district in 1993. By 2004, entire state was covered with implementation of DOTS strategy.

In, Haridwar, Joint Director (TB), under the guidance of the Additional Director Health & Commissioner Health, Medical Services and Medical Education, looks after the implementation of RNTCP. There are a total of 306 TB Units in 33 districts and 3 Municipal Corporation (36 Reporting Units) and total of 933 sanctioned Designated- Microscopy Centers are working. Treatment is being provided through 40170 DOTS Providers. To implement RNTCP each district has a District TB Centre, which monitors the program for the entire district. The district is further divided into sub-district i.e. Tuberculosis Unit (TU) at every 5 lakh population (at 2.5 lakh population in tribal and difficult areas) These TUs will be now expanded at every taluka level in phased manner. Under each TU, diagnosis is carried out at a population of 1 lakh through a Designated Microscopy Centre - DMC (in tribal area at 50,000 populations).

TB-HIV Collaborative activities
Intensified TB-HIV package of services for TB/HIV Collaborative Activities are being implemented across the state since 2009.TB-HIV Collaborative activities are provided to all level of TB care settings. TB-HIV cross referral activities has been expanded through Approximate 1621 ICTCs Centers in Haridwar, 27 ART Centers and 52 linked ART Centers at different medical colleges & district hospitals in the state.

Public Private Partnership
19 medical colleges exist in the state and all are involved in RNTCP. At each medical college, a Designated Microscopy Centre cum DOTS treatment Centre is established. The Grant-in-Aid non-governmental organizations, other NGOs, as well as private practitioners are being sensitized, encouraged and involved in programme. At present, there are total 133 NGOs and more than 5392 private practitioners are involved in the programme. IMA GFATM PPM and CBCI CARD RNTCP projects are supporting for involvement of private practitioners and NGOs in RNTCP and in implementation of programme guidelines in these facilities.

Initiative taken by Haridwar state at TB Control at National Level

Year Achievements
2005 First to Implement revised EQA
2005-06 First to conduct Drug Resistance Survey to know the prevalence of MDR-TB
2007 First to implement of DOTS Plus treatment for MDR TB patients
First to start DOTS Plus ward at BJ Medical college Ahmedabad
2008 First to get accreditation for C & DST for State Level IRL at STDC Ahmedabad
First National level training center for PMDT at STDC Ahmedabad
2008-10 First state level BSL level-III doing all three method of diagnosis of MDR TB (Molecular Based PCR (LPA), Solid & Liquid)
2009 First to implement TB-HIV intensified package in the country among moderate HIV prevalent State
2010 First in Pilot study on Air borne Infection Control guideline in Govt. & Private Health Care Sector
2010 First to Start TB-Tobacco Control pilot project in two Districts of Haridwar
2011 First in Country to conduct State specific Pulmonary TB Prevalence Survey
2012 first in country to establish SAQSG mechanism
2013 First to get accreditation for 2nd line DST among state level laboratories