4) Revised National TB Control Programme ( RNTCP) :-

Revised National TB Control Programme started in Latur dist, in Aug-2001. For programme implementation 4 TB Units (TUs) established with 1 TU catering to 5 Lakh Population. i.e. Latur , Udgir, Nilanga, Ahmedpur. Concerned TB Unit's THO is appointed as Medical Officer TB Unit (MOTU). 21 Microscopy Centers are set up with  1 DMC catering 1 Lakh population. There are  400 DOT Centers functioning throughout the district.

Infrastructure  (NTCP - Regular post)

Sr. No.	Designation	No. of Posts
1	DTO	1
2	MODTC	2
3	Pharmacist	1
4	Lab Technician	2
5	Health Supervisor	1
6	HA (TB)	2
7	Staff Nurse.	6
8	Sr. Clerk	1
8	Jr. Clerk	2
9	Statistical Assistant	1
10	X-ray Technician	1
11	Driver	1
12	Peon	2
13	Ward Servant	12

 

Infrastructure  (RNTCP - Contract based post)

So. No.	Designation	No. of Posts
1	Medical Officer	2
1	Senor Treatment Supervisor (STS)	4
2	Senior TB Laboratory Supervisor	4
3	Lab.Tech	3
4	TB-HV	2
5	Data Entry Operator	1

As per norms and guidelines of RNTCP at least 2-3 % of adult OPD Patients who are chest symptomatic (having Cough of more than 3 weeks duration) are to be subjected for sputum microscopy examination. Now under RNTCP, more emphasis is laid on sputum microscopy rather than Chest X-ray.  PHC's where there is no DMC are supposed to transport sputum sample on weekly basis to nearest DMC.

            Upon sputum microscopy result patient is categorized as Cat-I , II, III. Depending on previous history of treatment by the examining physician, after categorization patient is put on Directly observed Treatment- Short course chemotherapy (DOTS) at DOT Center nearest to his / her residence. The diagnostics & Treatment facilities are available free of cost under RNTCP. The medicines provided are of highest quality.  Treatment is of 6 months duration in category I & III and of 9 months duration in Cat-II. Patients are supplied with Multi blister combi packs with two pouches i.e. one for Intensive Phase (IP) and another for Continuation Phase (CP). The Anti-TB drugs are administered directly under the supervision of AWW, ANM, MPW, HA, Pharmacist. The tri- weekly doses are administered on alternate basis (Monday, Wednesday, Friday OR Tuesday, Thursday, Saturday) during IP. While during CP only first dose (Monday/Tuesday) is under supervision while remaining doses are to be self-administered. The follow-up sputum examination is carried on after 2 months of IP in Cat-I & III and after 3 months in Cat-III. If sputum turns to be positive after 2 months of IP in Cat-I & 3 months of IP in Cat III, the patients are put on additional one month of IP with provision of prolongation pouches.

The pediatric multi- blister combi packs of Anti-TB treatment are also available in Latur district since Apr-07.

TU Wise list of DMC's:

RNTCP is implemented by District Tuberculosis officer (DTO) in the district.  The District TB center (DTC) is the nucleus of all RNTCP activities in the district.  The DTC is situated in the campus of Govt. Medical college & Hospital Latur.

 

Sr. No.	Name of TU	Name of DMC
1	Latur	DTC,Latur
		Municipal Hospital,Latur
		Manjara Ayurvedic  College,Latur
		MIT Medical College,Latur
		R.H. Murud
		R. H. Renapur
		PHC Jawala (Bk)
2	Nilanga	S.D.H. Nilanga
		R.H.Kasar Sirsi
		R.H.Ausa
		R.H.Killari
		PHC Aurad (Sh)
3	Udgir	S.D.H.Udgir
		R.H.Deoni
		PHC Shirur (A)
		PHC Jalkot
		PHC Handarguli
4	Ahmedpur	R.H.Ahmedpur
		R.H.Chakur
		PHC Shirur (T)
		PHC Janval

 

Objectives :

• Cure rate of at least 85% of new sputum positive patient's detected.
• Detection of at least 70% of new sputum positive cases.

Programme Strategy - The RNTCP is based on DOTS (Directly observed Treatment short course chemotherapy) strategy.  Five key elements of DOTS are

• Political commitment to sustain smear microscopy among symptomatic patients.
• Case detection by sputum smear microscopy among symptomatic patients.
• Standardized short course chemotherapy regimen for all TB cases to be given under direct supervision.
• Regular uninterrupted supply of quality anti TB drugs.
• Systematic recording & reports system that allows assessment of treatment results for each & every patient & TB control programme.
• DOTS means Directly Observed Treatment, short course chemotherapy, in which a health worker ( ANM/MPW/AWW etc.) or other trained person who is not a family member of patient observes whether patient swallows anti - TB medicines in his/her presence.
• RNTCP shifts responsibility of cure form patient to the health system.

Organizational set up -

For smooth management of RNTCP activities, RH & PHC are classified as TB unit microscopy center or peripheral  Health Institute (PHI)

TB Unit - 1 TU is established per 5 lakh population.  Following tables show the details:

Name of TB Unit	PHI under TU	Name of MO - TU
Latur	RH Murud & Bhabhalgaon PHC Bori, Bhatangali, Nivali, Jawla Bk. Chikurda, Gangapur, Chincholi Bk, RH Renapur, Janwal, Chapoli, Nalegaon,	Dr. Bhagwat
Nilanga	SDH Nilanga, PHC Aurad (s), Halgara, Kasar Balkunda, Madansuri, Nitur, Ambulga, Panchinhcoli, RH Kasar Shirsi, PHC Shirur (A), Sakol, Bhada, Hasegaon, Lamjana, Jawalga (P), Matola,  Ujani, Belkund, RH Killari	Dr. Nimbalkar
Udgir	SDH Udgir, RH Devani, PHC Her, Handarguli, Wadhaona, Devarjan, Nalgir, Jalkot, Atnoor, Borol, Walandi	Dr. Dange
Ahmarpur	RH A'pur, RH Chakur, , PHC Kingaon, Andhori, Satala, Shirur (T), Hadolti, Pangaon, Karepur, Kharola, Poharegaon	Dr. Sonawane

 

Functions of TB Unit -

• Acting as a referral unit for all MCs, PHIs in the area for diagnostic problems, treatment failure patients.
• Maintaining regular supply of drugs regent & other logistics to all MCs & PHIs.
• Supervision & monitoring of MCs & PHIs for RNTCP activities.
• Monitoring & updating records of RNTCP of TU, MC & PHI.
• THO of a block where TU is located is now days designated as MO-TB unit.  Contract based post like senior Treatment supervisor (STS) & senior to Laboratory Supervisors are responsible for overall supervision of Treatment & diagnosis respectively of TB in TU area.

B) Microscopy center (MC) -

            One MC is established for 1 Lakh population.  There are in all 21 MCs in Latur district.  The main function of MC is to collect & examine 3 sputum of all chest symptomatic (Patient with a cough > 3 wks duration) referred from PHI or directly attending OPD. 

Disease classification & Diagnosis -

            Patients who're sputum negative are subjected for chest, X-ray, USG, Biopsy as the case may be after sputum exam and thereafter another investigations depending on site of involvement, the patients are classified as sputum positive TB case, Sputum Negative TB case or extra pulmonary case. 

Treatment-

Treatment of TB under RNTCP depends on 3 important aspects a) sputum microscopy b) history of post anti TB treatment .c) Nature of illness of patient

The patient is classified in one of 3 categories for treatment called as CAT-I, CAT-II & CAT-III .ATT is available in boxes (one box  is maintained for each patient) with color coding for different categories-Red for CAT-I, Blue for CAT-II & Green for CAT-III. 

DOTS-

In Latur district there are 400 DOTS centers.  A separate treatment card is filled by diagnosing physician for each & every TB case.

ATT is of 6 months duration in cat-I & Cat-III, while its of 8 month period in Cat-II.

A patient swallows medicine on alternate day (tri weekly) in presence of DOTs provider (ANM, MPW, AWW etc.) during intensive phase (first 2 month in cat-I & III) and first 3 month in Cat-II).

During continuation phase (4 Months in cat I & III and 5 month in cat-II) pt is administered in supervision during 1 st dose only (i.e. on Monday/ Thursday) while rest of weeks dose is given at the home of patient for self administration.

A treatment card is ticked, entered appropriately by DOT provider after DOTS day to day .  During 2007-08, new sputum positive patient were 774 while pretreatment cases were 211 sputum negative cases were 556 and in all total TB cases were 1802. The cure rate was 62 percent while sputum conversion was 76 percent during 2008-09.