Tuberculosis Control

NTEP - TB Warriors Unite

The National Tuberculosis Elimination Program (NTEP) is India's comprehensive strategy to combat TB.

• Primary Goal: Achieve TB elimination by 2025.

  ⭐ India's commitment to eliminate TB by 2025, five years ahead of the global SDG target.

• Strategic Pillars (DTPB): 📌 Detect (early & accurate diagnosis), Treat (patient-centric care), Prevent (transmission & new infections), Build (strengthen health systems & community engagement).
• Organizational Framework:
  • National: Central TB Division
  • State: State TB Cell
  • District: District TB Centre (DTC)
  • Peripheral: TB Units (TU) & PHIs
• Key Initiatives:
  • Nikshay: Real-time, web-based monitoring & patient management.
  • Active Private Sector Engagement (PSE).
  • Intensified Community Participation ("Jan Andolan").

Diagnosis - Spotting the Culprit

⭐ CBNAAT is the initial diagnostic test for all presumptive TB cases under NTEP.

• Microscopy (ZN stain): Detects AFB (e.g., sputum smear). For follow-up or if NAAT unavailable.
• NAAT (CBNAAT/TrueNat): Rapid (<2 hrs), detects MTB & Rif-resistance simultaneously. High sensitivity. NTEP's choice.
• Culture: Gold standard. LJ medium (4-8 wks), MGIT (liquid, 10-14 days). For diagnosis, speciation & full DST.
• Drug Susceptibility Testing (DST): Crucial for DR-TB. LPA (1st/2nd line drugs), phenotypic (culture-based) methods.
• LTBI (Latent TB): TST (Mantoux, induration ≥5/10/15mm by risk), IGRA (blood test, specific, preferred in BCG vax). Not for active TB.

Treatment - Kicking Out TB

• Directly Observed Treatment, Short-course (DOTS): Ensures adherence & support.
• Drug-Sensitive TB (DS-TB): 📌 RIPE (Rifampicin, Isoniazid, Pyrazinamide, Ethambutol). Fixed-Dose Combinations (FDCs) preferred.

-   H-mono/poly DR-TB: Regimens like **6(Lfx)RZE** for H-mono; others individualized.
-   **MDR-TB:** Shorter oral Bedaquiline (Bdq)-containing regimen (**9-11** months). Longer oral regimens (**18-20** months).
-   **XDR-TB:** Individualized; newer drugs (Bdq, Pretomanid, Delamanid).

• Key ADRs & Management:
  • Hepatotoxicity (H,R,Z): Monitor LFTs.
  • Optic neuritis (E): Monitor visual acuity.
  • Peripheral neuropathy (H): Pyridoxine (B6) prophylaxis.
  • Rifampicin: Orange-red secretions.

⭐ Rifampicin is a potent enzyme inducer, affecting metabolism of many other drugs.

Prevention - Shielding the Masses

• BCG Vaccination:
  • Strain: Danish 1331.
  • Dose: 0.05ml at birth; 0.1ml if given between 1 month - 1 year.
  • Route: Intradermal, left deltoid.
  • Timing: At birth, or up to 1 year of age.
  • Scar: Develops in 2-3 weeks, indicates successful vaccination.

  ⭐ BCG vaccine primarily protects against severe forms of TB in children (e.g., TB meningitis, miliary TB).

• TB Preventive Treatment (TPT):
  • For close contacts & high-risk groups (e.g., PLHIV).
  • Regimens:
    • 6H: Daily Isoniazid for 6 months.
    • 3HP: Weekly Isoniazid + Rifapentine for 3 months.
• Airborne Infection Control (AIC):
  • Crucial in healthcare settings.
  • Measures: N95 respirators for staff, patient segregation, adequate ventilation, Upper Room Germicidal UV (UVGI).

High‑Yield Points - ⚡ Biggest Takeaways

• NTEP (National TB Elimination Program) targets TB elimination by 2025.
• CBNAAT is preferred initial diagnostic; sputum smear microscopy for active case finding.
• DOTS strategy with daily regimen Fixed-Dose Combinations (FDCs) is standard treatment.
• BCG vaccine (intradermal) at birth protects against severe childhood TB forms.
• MDR-TB means resistance to at least Isoniazid (H) and Rifampicin (R).
• Nikshay portal for case notification; Nikshay Poshan Yojana for nutritional support.
• Isoniazid Preventive Therapy (IPT) for 6 months is vital for eligible contacts.