The NTP was under implementation in most parts of the country during the past 4 decades and a large number of key personnel have been trained in tuberculosis (TB) control. To rectify the organizational and administrative shortcomings, the NTP was revised in 1993. The Revised National Tuberculosis Control Programme (RNTCP) has Directly Observed Treatment Short course (DOTS) as the main theme. About 50% of the population of India is now covered under RNTCP. The RNTCP has been found to be effective in curing people and saving lives. Sputum microscopy is the mainstay for diagnosis of TB cases in RNTCP. Systems have been put into operation under the programme for ensuring Quality Assurance in Sputum Microscopy and ensuring cure of diagnosed TB cases by providing Directly Observed treatment and providing anti TB drugs in blister packs.
The National Sample Survey to estimate the Annual Risk of Tuberculous Infection (ARI) in different parts of India in collaboration with Tuberculosis Research Centre (TRC), Chennai is almost complete and the survey findings are awaited. These investigations are critical in estimating the extent of TB problem in the country and for evaluating the programme performance. It has also been proposed to repeat the survey in some of the states where the RNTCP is fully implemented, to assess the future trends.
The Directorate General of Health Services (DteGHS), New Delhi, has given priority to short and long term operations research. What are the future plans of NTI? With the revised strategy firmly in place, what type of operational research NTI will undertake? NTI intends to focus on operational research to improve the performance of the RNTCP. Some of the problem areas taken up for study include identification alternative DOT providers from the community more accessible and acceptable to the patients, and studying relapses and deaths among TB patients after completion of treatment. A study has also been undertaken to bring out the Current Status of functioning of TB and Chest Diseases Hospitals (Sanatoria) in Karnataka. The results of the study would enable a review of the infrastructure, manpower and treatment practices for better utilization of this services. The Institute is also planning to study the status of DOTS Implementation in RNTCP Districts and the impact of the programme on deaths among TB patients in rural areas. The findings of these studies should help the programme managers in improving the functioning of the RNTCP.
The rapid expansion of RNTCP will necessitate the training of a large number of field staff at various levels. The Institute is gearing up for this challenge. The training curriculum is being reviewed to meet the emerging needs of the programme. Few of the training programmes which will be taken up shortly are Revised regular training for all the key staff of RNTCP; Training for state programme managers and staff working in the State TB Demonstration Centres and Training of Trainers (TOT). In addition CMEs, Workshops, Seminars and trainings will be organised for Postgraduate students, NGO's, the Private Sector and Medical College faculty. The Institute has also been training the fellows deputed by the World Health Organization. Expanded implementation of RNTCP will also bring in the need for 'Re-Training'. The Institute is ready to take up this challenge also.
NTI is also not immune to absorption of latest laboratory techniques and environment. The opportunities opened up with the establishment of a Bio-safety level: PIII lab for animal experimentation, involving a low dose aerosol infection system, which simulates the conditions of TB in humans, will be utilized optimally.
The NTI will work with commitment to reduce the burden of Tuberculosis in India and the world.
26th August 2002 DR PRAHLAD KUMAR