The status and prospects of tuberculosis control in India

SETTING: India, where much of the global strategy for tuberculosis control was established, but where, every year, there are an estimated 2 million ca ses of tuberculosis. OBJECTIVE: TO describe the policies, initial results, and lessons learned f rom implementation of a Revised National Tuberculosis Control Programme usi ng the principles of DOTS (Directly Observed Treatment, Short-course). DESIGN: A Revised National Tuberculosis Control Programme (RNTCP) was desig ned and implemented starting in 1993. With funding from the Government of I ndia, State Governments, the World Bank and bilateral donors, regular suppl y of drugs and logistics was ensured. Persons with chest symptoms who atten d health facilities are referred to microscopy centres for diagnosis. Diagn osed cases are categorized as per World Health Organization guidelines, and treatment is given by direct observation Systematic recording and cohort r eporting is done. RESULTS: From October 1993 through mid-1999, 146012 patients were put on tr eatment in the programme. The quality of diagnosis was improved, with the r atio of smear-positive to smear-negative patients being maintained at 1:1. Case detection rates varied greatly between project sites and correlated wi th the percentage of patients who were smear-positive among those examined for diagnosis, suggesting heterogeneous disease rates. Treatment success wa s achieved in 81% of new smear-positive patients, 82% of new smear-negative patients, 89% of patients with extra-pulmonary tuberculosis, and 70% of re -treatment patients. CONCLUSION: The RNTCP has successfully treated approximately 80% of patient s in 20 districts of 15 states of India. Treatment success rates are more t han double and death rates are less than a seventh those of the previous pr ogramme. Starting in late 1998, the programme began to scale up and now cov ers more than 130 million people. Maintaining the quality of implementation during the expansion phase is the next challenge.