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National TB Elimination Program (India)
The National Tuberculosis Elimination Programme (NTEP), earlier known as the Revised National Tuberculosis Control Programme (RNTCP), is the Public Health initiative of the Government of India that organizes its anti-Tuberculosis efforts. It functions as a flagship component of the National Health Mission (NHM) and provides technical and managerial leadership to anti-tuberculosis activities in the country. As per the National Strategic Plan 2017–25, the program has a vision of achieving a "TB free India", with a strategies under the broad themes of "Prevent, Detect, Treat and Build pillars for universal coverage and social protection". The program provides, various free of cost, quality tuberculosis diagnosis and treatment services across the country through the government health system.
The program is managed through a four-level hierarchy from the national level down to the sub-district (Tuberculosis Unit) level. At the country level the program is led by the Central TB Division under the Ministry of Health and Family Welfare. The State TB Cell and the District TB Office govern the activities of the program at the state and district level respectively. At the sub-district/ Block level activities are organized under the Tuberculosis Unit (TB Unit). The Central TB Division is headed by a Deputy Director General - TB (DDG-TB) and is the National Program Manager. The administrative command falls to the Additional Secretary and Director General (NTEP and NACO) and the Joint Secretary-TB. Under the Central TB Division, a number of National Level Expert Committees and National Institutes for Tuberculosis, advise and assist in various programmatic functions. At the State level, a State TB Officer and at District level a District TB Officer manages the program.
Diagnostic services under the program are provided through a network of various types of laboratories operating in a three tier fashion. At the service/ facility level there are microscopy and rapid molecular tests, constituting the first tier. The second tier is constituted by Intermediate Reference Laboratories(IRL) and Culture and Drug Susceptibility Testing (C&DST) Labs, which provide advanced DST facilities and supervisory support to the first tier. The National Reference Laboratories constitute the third tier, and provide quality assurance and certification services for C&DST labs and co-ordinate with WHO Supra National Reference Laboratory Network. In addition to the above, Chest Radiography, available at tertiary and secondary healthcare levels, also play an important role in screening for Tuberculosis signs and clinical diagnosis.
Sputum smear microscopy, using the Ziehl–Neelsen staining technique, is conducted at the DMCs. This is the most widely available test with over 20,000 quality controlled laboratories across India. For diagnosis, two sputum samples are collected over two days (as spot-morning/morning-spot) from chest symptomatic (patients with presenting with a history of cough for two weeks or more) to arrive at a diagnosis. In addition to the test's high specificity, the use of two samples ensures that the diagnostic procedure has a high (>99%) test sensitivity as well.[citation needed]
Cartridge Based Nucleic Acid Amplification Test (CBNAAT) using the GeneXpert Platform, and TruNat are rapid molecular tests for TB diagnosis and Rifampicin resistance detection . This test is the first choice of diagnostic test for high risk population, children, contacts of drug resistant cases and PLHA(Patient Living With HIV AIDS) . Currently there are about 1200 CBNAAT and 200 TruNat laboratories in the country, at the district and in some cases at a sub-district level[citation needed].
Advanced tests such as the Line Probe Assay, Liquid and Solid Culture, and Drug Susceptibility Testing are available at C&DST(Culture and Drug Sensitivity Testing) Labs are located at a few select places in the state, often within the IRL; these provide additional drug resistance/ susceptibility testing services for a number of Anti-TB drugs.[citation needed]
Standardized treatment regimen composed of multiple anti-Tuberculosis drugs are provided through the program. Typically, drug regimen consist of an intensive phase of about two to six months and a longer continuation phase of four to one and half years.[citation needed]
Based on the nature of anti-microbial resistance to the disease different treatment regimen are offered through the program. New Cases and those which exhibit no resistance are offered a six-month, short course of the four first line drugs; Isoniazid-H: Rifampicin-R, Pyrazinamide-Z, and Ethambutol-E. The drugs are administered through daily weight band based doses of Fixed Dose Combinations, consisting of HRZE for the intensive phase of two months and HRE for the continuation phase of four months. For drug resistant cases, depending upon the pattern of drug resistance a number of regimen are available composed of a combination of 13 drugs.[citation needed]
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National TB Elimination Program (India)
The National Tuberculosis Elimination Programme (NTEP), earlier known as the Revised National Tuberculosis Control Programme (RNTCP), is the Public Health initiative of the Government of India that organizes its anti-Tuberculosis efforts. It functions as a flagship component of the National Health Mission (NHM) and provides technical and managerial leadership to anti-tuberculosis activities in the country. As per the National Strategic Plan 2017–25, the program has a vision of achieving a "TB free India", with a strategies under the broad themes of "Prevent, Detect, Treat and Build pillars for universal coverage and social protection". The program provides, various free of cost, quality tuberculosis diagnosis and treatment services across the country through the government health system.
The program is managed through a four-level hierarchy from the national level down to the sub-district (Tuberculosis Unit) level. At the country level the program is led by the Central TB Division under the Ministry of Health and Family Welfare. The State TB Cell and the District TB Office govern the activities of the program at the state and district level respectively. At the sub-district/ Block level activities are organized under the Tuberculosis Unit (TB Unit). The Central TB Division is headed by a Deputy Director General - TB (DDG-TB) and is the National Program Manager. The administrative command falls to the Additional Secretary and Director General (NTEP and NACO) and the Joint Secretary-TB. Under the Central TB Division, a number of National Level Expert Committees and National Institutes for Tuberculosis, advise and assist in various programmatic functions. At the State level, a State TB Officer and at District level a District TB Officer manages the program.
Diagnostic services under the program are provided through a network of various types of laboratories operating in a three tier fashion. At the service/ facility level there are microscopy and rapid molecular tests, constituting the first tier. The second tier is constituted by Intermediate Reference Laboratories(IRL) and Culture and Drug Susceptibility Testing (C&DST) Labs, which provide advanced DST facilities and supervisory support to the first tier. The National Reference Laboratories constitute the third tier, and provide quality assurance and certification services for C&DST labs and co-ordinate with WHO Supra National Reference Laboratory Network. In addition to the above, Chest Radiography, available at tertiary and secondary healthcare levels, also play an important role in screening for Tuberculosis signs and clinical diagnosis.
Sputum smear microscopy, using the Ziehl–Neelsen staining technique, is conducted at the DMCs. This is the most widely available test with over 20,000 quality controlled laboratories across India. For diagnosis, two sputum samples are collected over two days (as spot-morning/morning-spot) from chest symptomatic (patients with presenting with a history of cough for two weeks or more) to arrive at a diagnosis. In addition to the test's high specificity, the use of two samples ensures that the diagnostic procedure has a high (>99%) test sensitivity as well.[citation needed]
Cartridge Based Nucleic Acid Amplification Test (CBNAAT) using the GeneXpert Platform, and TruNat are rapid molecular tests for TB diagnosis and Rifampicin resistance detection . This test is the first choice of diagnostic test for high risk population, children, contacts of drug resistant cases and PLHA(Patient Living With HIV AIDS) . Currently there are about 1200 CBNAAT and 200 TruNat laboratories in the country, at the district and in some cases at a sub-district level[citation needed].
Advanced tests such as the Line Probe Assay, Liquid and Solid Culture, and Drug Susceptibility Testing are available at C&DST(Culture and Drug Sensitivity Testing) Labs are located at a few select places in the state, often within the IRL; these provide additional drug resistance/ susceptibility testing services for a number of Anti-TB drugs.[citation needed]
Standardized treatment regimen composed of multiple anti-Tuberculosis drugs are provided through the program. Typically, drug regimen consist of an intensive phase of about two to six months and a longer continuation phase of four to one and half years.[citation needed]
Based on the nature of anti-microbial resistance to the disease different treatment regimen are offered through the program. New Cases and those which exhibit no resistance are offered a six-month, short course of the four first line drugs; Isoniazid-H: Rifampicin-R, Pyrazinamide-Z, and Ethambutol-E. The drugs are administered through daily weight band based doses of Fixed Dose Combinations, consisting of HRZE for the intensive phase of two months and HRE for the continuation phase of four months. For drug resistant cases, depending upon the pattern of drug resistance a number of regimen are available composed of a combination of 13 drugs.[citation needed]