Much of the global strategy for TB control was established in India, but every year, there are an estimated 2 million cases of TB. To describe the policies, initial results and lessons learnt from implementation of a RNTCP using the principles of DOTS is the objective of this study. The RNTCP was designed and implemented starting in 1993. With funding from Government of India, State Governments, the World Bank and bilateral donors, regular supply of drugs and logistics was ensured. Persons with chest symptoms who attend health facilities are referred to microscopy centres for diagnosis. Diagnosed cases are categorized as per WHO guidelines and treatment is given by direct observation. Systematic recording and cohort reporting is done. From October 1993 through mid-1999, 146012 patients were put on treatment in the programme. The quality of diagnosis was improved, with the ratio of smear-positive to smear-negative patients being maintained at 1:1. Case detection rates varied greatly between project sites and correlated with the percentage of patients who were smear-positive among those examined for diagnosis, suggesting heterogeneous disease rates. Treatment success was achieved in 81% of new smear-positive patients, 82% of new smear-negative patients, 89% of patients with extra-pulmonary TB and 70% of re-treatment patients.

The RNTCP has successfully treated approximately 80% of patients in 20 districts of 15 states of India. Treatment success rates are more than double and death rates are less than a seventh those of the previous programme. Starting in late 1998, the programme began to scale up and now covers more than 130 million people. Maintaining the quality of implementation during the expansion phase is the next challenge.