In 1992, the Government of India, together with the World Health Organization (WHO) and Swedish International Development Agency (SIDA), reviewed the national programme and concluded that it suffered from managerial weakness, inadequate funding over-reliance on x-ray, non-standard treatment regimens, low rates of treatment completion, and lack of systematic information on treatment outcomes. As a result, a Revised National Tuberculosis Control Programme (RNTCP) was designed. DOTS is known as the Revised National Tuberculosis Control Programme (RNTCP) in India and is a comprehensive strategy for TB control. India 's Revised National TB Control Programme (RNTCP) now provides access to DOTS for >85% of the population . Countrywide coverage is anticipated in 2006 . This program is the fastest expanding DOTS program in the world and the largest in the world in terms of patients receiving initial treatment . Outside of the RNTCP, India has a large private health sector that is actively involved in providing TB care ; almost half of patients with TB in India initially seek care from the private sector . Thus, because Indian healthcare workers see large numbers of TB patients and because large numbers of TB patients are hospitalized .

In terms of population coverage, India now has the second largest DOTS (Directly Observed Treatment, Short course) programme in the world. However, India 's DOTS programme is the fastest expanding programme, and the largest in the world in terms of patients initiated on treatment, placing more than 100,000 patients on treatment every month. This site provides information about tuberculosis and its control in India . The rapid expansion of RNTCP in India , whilst maintaining quality services and results, has demonstrated that it is operationally feasible to run a technically sound TB control programme based on the DOTS strategy in a populous country, with wide regional and cultural diversities, such as India . However to make an epidemiological impact on the burden of TB in India, the good results obtained to date needs to be both maintained and improved over the coming decades or more. By the end of March 2006, the entire population of the country (1114 million) residing in 632 districts of 35 States and Union Territories have access to DOTS services.

The RNTCP has consistently affected a high treatment success rate since the inception. in the year 2004 a success rate of 86% was achieved under the programme which is treble that achieved in the earlier programme. Death rates under RNTCP have been cut 7-fold from 29% to around 4%. The India's new programme for controlling TB is working, but not yet fast enough for the millions affected.

The Indian treatment default is on two accounts, fault of the patient and , organizational lapses of the services. Inadequate staff and equipment ,irregular drug supply etc. outweighs the lapses on the part of patients. Hence, a patient may be called a defaulter only after he/she does not utilize the optimal services provided. The TB social workers' role in India is to strengthen treatment, organization and whenever possible, provide treatment under supervision. Socio-etiological factors in India , example, rise in standard of living leading to better nutrition, less close contact, increase in the host resistance, genetic selection and attenuating virulence of bacilli could lead to the reduction in the problem of TB. Economics of TB should be evaluated as total suffering, that is, loss of work, cost of treatment, due to death and morbidity leading to a vicious cycle of poverty and sickness in the community.

The RNTCP established a network of RNTCP accredited quality-assured Intermediate Reference Laboratories (IRL), providing culture and DST services for the RNTCP. Concurrently, a network of DOTS Plus sites, as per international guidelines, capable of enrolling and providing care and management for MDR-TB cases would be established. A total of 24 DOTS Plus sites are planned to be established across the country over the next five years, with a view to have in place RNTCP DOTS Plus services that are capable of enrolling for treatment at least 5000 “new” MDR-TB patients every year by 2010. The first DOTS Plus sites will be established in the states of Gujarat and Maharashtra and will be ready to enroll the first patients during 2006. The cost of MDR-TB treatment at US$ 1600 is prohibitive, compared to less than US$ 10 for RNTCP DOTS treatment. Some of the major challenges in providing cost-effective MDR treatment in the field include: provision of daily DOT over an extended period of 24-27 months; ensuring uninterrupted supply of DOTS Plus drugs; provision of services to manage the anticipated frequent, and sometime severe, adverse drug reactions; managing the contacts of MDR-TB patients, provision of social support to the patients and their families during treatment; and ensuring the establishment of long term sustainable DOTS Plus services under the RNTCP. Under RNTCP Phase II, it is planned to first establish a network of RNTCP accredited quality-assured Intermediate Reference Laboratories (IRL), providing culture and DST services for the RNTCP. Concurrently, a network of DOTS Plus sites, as per international guidelines, capable of enrolling and providing care and management for MDR-TB cases would be established. A total of 24 DOTS Plus sites are planned to be established across the country over the next five years, with a view to have in place RNTCP DOTS Plus services that are capable of enrolling for treatment at least 5000 “new” MDR-TB patients every year by 2010. The first DOTS Plus sites will be established in the states of Gujarat and Maharashtra and will be ready to enroll the first patients during 2006.

Links:

1. National Tuberculosis Institute, Banglore

2. Tuberculosis Research Centre, Chennai

3. Ministry of Health and Family Welfare

4. CDC Division of Tuberculosis Elimination