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Editorial
Recent Changes in Technical and Operational Guidelines for
Tuberculosis Control Programme in India – 2016: A Paradigm Shift
in Tuberculosis Control
The national tuberculosis programme of India (NTP)
was initiated in 1962 and was originally designed
for domiciliary treatment, using self‑administered
standard drug regimen. In 1992, the Government of
India with  World Health Organization (WHO) and
Swedish International Development Corporation Agency
(SIDA) reviewed the tuberculosis (TB) situation and
the performance of NTP which revealed that the NTP,
though technically sound, suffered from managerial
weakness, inadequate funding, over‑reliance on X‑ray
for diagnosis, frequent interrupted supplies of drugs
and low rate of treatment completion. In 1997, Revised
TB Control Programme (RNTCP) was launched which
formulated and adopted the internationally recommended
Directly Observed Short Course (DOTS) strategy as the
most systemic and cost‑effective approach to revitalize
the TB control programme in India.
The objectives of RNTPCP were to achieve at least 85%
cure rate among the new smear‑positive cases initiated
on treatment and thereafter a case detection rate of at
least 70% of such cases. The major addition of RNTCP
was the establishment of a sub‑district supervisory
unit known as TB Unit, with RNTCP supervisor and
decentralization of diagnostic and treatment services
with treatment given under the support of DOT
provider (DP).
The first technical and operational guidelines for
RNTCP were developed during the initial years of
implementation of the programme and were updated in
2005. The current document outlines the guidelines on
TB care in line with RNTCP national strategic plan for
TB control 2012–2017. Experts from National Institute,
National and Intermediate Laboratories, Medical
Colleges and Partners were involved in the process
of preparing it. The documents covered strategies and
guidelines for diagnosis and treatment for all forms
of TB including pulmonary TB, extra‑pulmonary TB,
drug‑resistant TB (DRTB), TB with comorbidity and
paediatric TB. The programme management aspect
covering patients support system, human resource
management, partnership for TB control, advocacy,
communications and social mobilization, infection
control measures, planning and finance are also
incorporated.
The goal of the national strategic plan is to achieve
universal access of quality of TB diagnosis and treatment
© 2017 The Journal of Association of Chest Physicians | Published by Wolters Kluwer ‑ Medknow
of all TB patients in the community. The objectives of
the national strategic plan are:
1. To achieve 90% notification rate for all cases
2. To achieve 90% success rate for all new and 85% for
re‑treatment cases
3. To significantly improve the successful outcome of
treatment for DRTB cases
4. To achieve decreased morbidity and mortality for
HIV‑associated TB cases
5. To improve the outcome of TB care in the private
sectors.
A government order issued by the Government of India
in May 2012 mandates all health care providers to notify
every TB case and/or treated to the local authorities. To
support TB notification and strengthen TB surveillance
in general, a case‑based, web‑based TB notification
system NIKSHAY was established to provide platform
for notification from both public and private sectors.
The major change in the organization structure
of RNTCP is the formation of one TB Unit per
block/1.5–2.5 lakh population in urban areas in contrast
to previous RNTCP guidelines, where there was one TB
Unit per 5 lakh population/1 per 2.5 lakh in tribal, hilly
and difficult areas.
Presumptive TB cases
As per the previous guidelines, a pulmonary TB suspect
was defined as:
• An individual having cough for 2 weeks or more
• Contacts of smear‑positive TB patients having cough
for any duration
• Suspected/confirmed extra‑pulmonary TB having
cough for any duration
• HIV‑positive patient having cough for any duration.
But according to the new guidelines –
Presumptive pulmonary TB refers to a person with any
of the symptoms or signs suggestive of TB:
• cough >2 weeks,
• fever >2 weeks,
• significant weight loss,
• haemoptysis,
• any abnormalities in chest radiography.
In addition, contact of microbiologically confirmed
TB patients, PL HIV, diabetics, malnourished, cancer
patients, patients on immunosuppressive therapy or
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Chaudhuri: RNTCP 2016
steroid should be regularly screened for signs and
symptoms of TB.
There is no change in the definition of presumptive
extra‑pulmonary TB cases.
There are few additions in the definition of presumptive
TB cases in paediatric patients, where loss of body
weight is defined that loss of  >5% body weight as
compared to highest weight recorded in the last
3  months. The history of unexplained or no weight gain
in the past 3 months and symptomatic child contact
with any form of active TB in the last 2 years may be
significant.
There have been changes in the definition of presumptive
DRTB cases as follows:
• TB patients who have failed treatment with first‑line
anti‑tubercular drugs (ATD)
• Paediatric TB non‑responder
• TB patients who are contacts of DRTB
• TB patients who are found positive on any follow‑up
sputum smear examination during treatment with
first‑line ATD
• Previously treated TB cases
• TB patients with HIV co‑infection.
Diagnostic algorithm of pulmonary TB has been
completely changed from the previous guidelines
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• All presumptive TB will undergo sputum smear
examination (spot–early morning or spot–spot). If the
first sputum is positive and not at risk for DRTB, it
is categorized as microbiologically confirmed TB
• Smear‑positive and presumptive multi‑drug resistance
TB (MDR TB): A Cartridge‑Based Nucleic Acid
Amplification Test  (CBNAAT) will be performed
to rule out Rifampicin resistance and categorized as
microbiologically confirmed drug‑sensitive TB or
RIF‑resistant TB
• If the first smear is negative and chest X‑ray  (CXR)
is suggestive of TB, 2nd sample will be subjected to
smear and CBNAAT simultaneously
• On the basis of the CBNAAT result, patients will
be categorized as microbiologically confirmed
drug‑sensitive TB or RIF‑resistant TB
• A RIF indeterminate result will get an additional
CBNAAT to get a valid result and in case of
indeterminate on second occasion, the specimen
will be sent to the Intermediate Reference
Laboratory (IRL) or Culture and Drug Sensitivity
Test (C and DST) centre for Line Probe Assay (LPA)
or Liquid Culture and Drug Sensitivity Test
(LC and DST)
• Whenever facilities are available, effort should be
made to obtain DST results of all drugs
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• If both the sputum smear and CXR are negative, the
patient should be referred to a pulmonologist
• All key population  (PLHIV, children, EPTB, etc.)
will preferentially get a CBNAAT
• All diagnostic health care facilities should have TB
(2) Clinically diagnosed TB case refers to a presumptive
lab that are quality assured by competent authority.
Diagnostic algorithm of extra‑pulmonary TB has
been completely changed:
positive for acid‑fast bacilli, or positive for
mycobacterium TB on culture, or positive for
TB through Quality Assured Rapid Diagnostic
molecular test.
TB patient who is not microbiologically confirmed,
but has been diagnosed with active TB by a clinician
on the basis of X‑ray abnormalities, histopathology

Diagnostic algorithm of paediatric TB has also been

completely changed from the previous guidelines:

Case definition: There are significant changes in the or clinical signs with a decision to treat the patient
definition of cases as per New Guidelines: with a full course of anti‑TB treatment.
(1) Microbiologically confirmed TB case refers to a Microbiologically confirmed or clinically diagnosed
presumptive TB patient with biological specimen cases of TB are classified according to

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1. Anatomical site of disease
2. History of previous TB
3. Drug resistance.
There are significant changes in the definition while
the classification is done on the basis of history of the
previous treatment.
1. New case – A TB patient who has never had treatment
for TB or has taken ATD for <1 month. (No change
in new guidelines.)
2 Previously treated patients have received one month
or more ATD in the past. This may be:
(a) Recurrent TB case – A TB patient previously
declared as successfully treated (cured/treatment
completed) and who is subsequently found to be
microbiologically confirmed TB case is a recurrent
TB case. (Previously called relapse.)
(b) Treatment after failure – Patients are those who
have previously been treated for TB and whose
treatment failed at the end of their most recent
course of treatment.
Previously, it was called failure where a TB patient is
sputum‑positive at 5 months or more after initiation of
treatment.
3. 
Treatment after loss to follow‑up – A TB patient
previously treated for TB for one month or more
and who was declared lost to follow‑up in their
most recent course of treatment and subsequently
found microbiologically confirmed TB cases.
Previously called treatment after default – a patient
who has received treatment for TB for a month or more
from any source and return for treatment after having
defaulted, that is, not taking ATD consecutively for
2 months or more and found to have smear‑positive.
There are significant additions in the definition while
classification was done on the basis of drug resistance.
1. Mono resistance (MR) – A TB patient whose
biological specimen is resistant to one first‑line
anti‑TB drug only.
2. Poly resistance (PDR) – A TB patient whose biological
specimen is resistant to more than one first‑line
anti‑TB drug, other than both INH and Rifampicin.
3. Multi‑drug resistance (MDR) – A TB patient whose
biological specimen is resistant to both INH and
Rifampicin with or without resistance other first‑line
ATD, based on results from a Quality Assured
Laboratory. (No changes.)
4. Rifampicin resistance (RR) – Resistance to
Rifampicin detected by phenotypic or genotypic
methods with or without resistant to other ATD
excluding INH. Patient with RR should be managed
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as if they are in MDR TB case.
5. E
 xtensive drug resistance  (XDR)  –  MDR TB
case whose biological specimen was resistant to a
Fluroquinolone (FQ) and a second‑line injectable ATD
from a Quality Assured Laboratory. (No changes.)
According to the previous guidelines, drug regimen
for drug‑sensitive TB was as follows:
• Standard intermittent regimen with 2 categories of
treatment
• Treatment under direct observation of DP
• Category decided by MO (category I/II)
• Drugs to be taken three times a week under direct
observation of the DP
• Intensive phase (IP) for 2–3 months – all doses given
under supervision
• Continuation phase  (CP) for 4–5  months  –  first dose
of the week given under supervision.
But there are significant changes in the drug regimen
in the new guidelines:
• Principle of treatment of TB has been shifted towards
daily regimen with administration of daily fixed dose
combination of first‑line ATD as per appropriate
weight bands.
For new TB cases
• Treatment in IP will consist of 8  weeks of INH,
Rifampicin, Pyrazinamide and Ethambutol in daily
dosages as per four weight bands categories
• There will be no need for extension of IP
• Only Pyrazinamide will be stopped in CP while
the other three drugs will be continued for another
16 weeks as daily dosages.
For previously treated cases:
• IP will be of 12  weeks, where injection Streptomycin will
be stopped after 8 weeks and the remaining four drugs in
daily dosages as per weight band for another 4 weeks
• No need of extension of IP
• At the start of CP, Pyrazinamide will be stopped
while rest of the drugs will be continued for another
20 weeks as daily dosages.
Type of TB Case Treatment regimen in IP Treatment
regimen CP
New (2) HRZE (4) HRE
Previously treated (2) HRZES + (1) HRZE (5) HRE
Management of extra‑pulmonary TB  (new guidelines)  –
There is only one change as follows:
• The CP in both new and previously treated cases
may be extended 3–6  months in certain TB such as
CNS, skeletal, disseminated TB, and so on based on
clinical decision of the treating physicians
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• Extension beyond 3  months will only be on Long‑term follow‑up

recommendation of experts of concerned field.
(In the previous guidelines, extension of ATD in case
of CNS and skeletal TB was maximum 3 months).
According to the new guidelines, ATD are to be given
in fixed dose combination as daily doses; drug doses for
adult TB is as follows:
After completion of treatment, the patient should be
followed up at the end of 6, 12, 18 and 24 months. Any
clinical symptoms and/or cough, sputum microscopy
and/or culture should be considered. (New addition)
However, there was no provision of long‑term follow‑up
in the previous guidelines.

Drug Dosage for Adult TB Difference of RNTCP regimen between new and
previous guidelines
Weight Number of tablets (FDCs) lnj.
category Intensive phase Continuation phase Streptomycin New guidelines Previous guidelines
HRZE HRE Daily regimen Intermittent regimen
75/150/400/275 75/150/275 gm Ethambutol in CP of both Ethambutol in CP of
25‑39 kg 2 2 0.5 categories I and II regimen category II regimen only
40‑54 kg 3 3 0.75 Fixed dose combination as per No fixed dose, limited
weight band weight band
55‑69 kg 4 4 1
No need of extension of IP Extension of IP for 1 month
>=70 5 5 1
if sputum is positive at the
end of IP
In patients above 50  years of age, maximum dose of
Follow‑up-clinical, laboratory Follow‑up-laboratory only
Streptomycin should be 0.75 g. investigation
Drug Dosage for Pediatric TB Long‑term follow‑up up to 2 years No long‑term follow‑up

Weight Number of tablets (dispersible FDCs) lnj.

Treatment outcomes
category Intensive phase Continuation phase Streptomycin
Cured
HRZ E HRE
50/75/150 100 50/75/100 mg A microbiologically confirmed TB at the beginning of
4‑7 kg 1 1 1 100 the treatment who was smear‑ or culture‑negative at the
8‑11 kg 2 2 2 150 end of complete treatment. (Changed).
12‑15 kg 3 3 3 200
Treatment success
16‑24 kg 4 4 4 300
25‑29 kg 3+1A 3 3+1A 400
TB patients either cured or treatment completed are
30‑39 kg 2+2A 2 2+2A 500 accounted in the treatment success. (New addition).
A = Adult FDC (HRZE = 75/ 150/400/275; HRE = 75/150/275) Failure
Follow‑up of treatment: There are some changes in A TB patient whose biological specimen is positive by
the new guidelines: smear or culture at the end of the treatment. (Changed).
Clinical follow‑up – (new addition) Failure to respond
Should be at least monthly – the patient may visit the For paediatric TB patients. (New addition).
clinical facility, or the medical officer may conduct Lost to follow‑up
the review when she/he visits the house of the patient A TB patient whose treatment was interrupted for one
to observe improvement of chest symptoms, weight consecutive month or more. (New addition).
gain, control the co‑morbid conditions such as HIV and
diabetes and to monitor any adverse reaction to ATD. Not evaluated
A TB patient for whom no treatment outcome is
Follow‑up laboratory investigation
assigned. (Former transfer out).
For PTB cases  –  sputum smear examination at the end of
IP and at the end of treatment. (In the previous guidelines, Treatment regimen changed
follow‑up sputum smear to be done at 2, 4 and 6 months for Previously, it was called as switched over to MDR treatment.
new cases and 3, 5 and 8 months in previously treated cases.)
There are some additions of chapter in the new
• In case of clinical deterioration, the Medical Office
guidelines like
may consider repeat sputum smear even during
CP. (New addition.) Management of TB patients with liver disorder
• At the completion of treatment, sputum smear and If the serum alanine amino transferase level is more than
culture should be done for every patient three times normal before initiation of treatment, the
• CXR – to be offered whenever required and available. regime should be:

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(a) Containing two hepatotoxic drugs: INH  + • It has no cross‑resistance with first‑  and
Rifampicin + Ethambutol for 9 months second‑line ATD
or • Significant benefit in improving the time to
(b) INH + Rifampicin + Ethambutol + Streptomycin for culture conversion in MDR TB patients
2 months followed by INH and Rifampicin for 7 months • RNTCP introducing BDQ at six sites in the
or country initially
(c) Rifampicin + Ethambutol + Pyrazinamide for • Basic criterion  –  Adult aged  ≥18  years having
6–9 months. pulmonary MDR TB
(d) Containing one hepatotoxic drug: • Female should not be pregnant.
INH + Ethambutol + Streptomycin for 2 months
followed by INH + Ethambutol for 10 months.
(e) Containing no hepatotoxic drugs:
Streptomycin + Ethambutol + FQ for 18–24 months.
Initiation of first‑line ART in relation to ATD
Clinical CD4 cell Timing of ART ART
staging count in relation to Recommendati ons
(cells/ initiation of
mm3) TB treatment
Start ART CD4 Start ATT first Start ART Regimen
irrespective count of Start ART as TLE for patients not
of any any soon as TB on ART.
clinical value treatment Forpatients already
stage is tolerateon 151 line ART,
(between2 ZLN, shift to ZLE
weeks and 2& continue ZLE
months) even after ATT is
stopped.
T = Tenofovir 300MG + L = Lamivudine 300MG + E = Efavirenz
600MG (FDC) Z= Zidovudine + L = Lamivudine 300MG + N =
Nevirapine E = Efavirenz 600MG

Isoniazid Preventive Therapy (IPT) for PLHIVs

(a) Adult and adolescents living with HIV should be MDR/RR TB cases (without additional resistance)
screened for TB and those who are unlikely to have Treatment regimen for MDR TB contains 6–9 months
active TB should be offered IPT of IP with Kanamycin, Levofoxacin, Ethambutol,
(b) Children with HIV who have no TB symptoms and Pyrazinamide, Ethionamide and Cycloserine and
who are unlikely to have active TB on symptom‑based 18  months of CP with Levofoxacin, Ethambutol,
screening should be offered IPT regardless of their age Ethionamide and Cycloserine (no change).
(c) All children with HIV who have successfully
But if INH resistance is not known or DST result
completed treatment for TB disease should receive IPT.
shows sensitivity to INH, then addition of INH in the
Dosage of INH preventive therapy: above‑mentioned regimen of ATD is to be done. (New
• Adult and adolescent: INH 300  mg  +  Pyridoxine addition)
50 mg per day for 6 months. Type of TB Case Treatment regimen Treatment
• Children above 12  months: INH 10  mg/kg  + in IP regimen CP
Pyridoxine 25 mg per day for 6 months. Rifampicin resistant (6‑9) Km LfxEto Cs (18) LfxEto Cs E H
+ Isoniazid sensitive Z E H
Changes in the DRTB (DRTB guidelines):
or unknown
Introduction of new ATD under RNTCP MDRTB (6‑9) Km LfxEto Cs Z (18) LfxEto Cs E
• Bedaquiline (BDQ): E (Modify treatment
based on the level of
• New class of drug, diarylquinoline that targets
INH resistance as per
mycobacterial ATP synthase, and enzyme essential the footnote)
for supply of energy to mycobacterium TB
• Strong bactericidal and sterilizing activities All MDR TB cases would be subjected to LC and
against MTB DST at baseline for Kanamycin and Levofloxacin.

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Appropriate modification of the treatment regimen can • In case of reported baseline additional resistance to
be done in case of additional resistance. other first‑line drugs  (FLD) the regime is  –  injection
SLD + FQ + Rifampicin + any FLD to which the
If isoniazid resistance is found, the use of isoniazid
patient is sensitive + one of the remaining group four
depends on:
drugs (Ethionamide, Cycloserine, PAS)
1. If high‑level resistance detected by liquid
• In addition, high dose INH is to be added if LPA
culture – omit INH.
shows inhA mutation or culture shows low‑level INH
2. If low‑level resistance detected by LC – add high
resistance
dose INH.
• Total duration of treatment will be 9–12 months
3. If LPA reports INH resistance by Kat G
• IP for 3  months with extension to a maximum
mutation – omit INH.
6 months and CP for 6 months depending on
4. If LPA reports INH resistance by INH A
follow‑up sputum reports
mutation – add high dose INH.
• Treatment initiated at DRTB centre.
There are some new additions
• If  RR by CBNAAT, then add INH in the standard Type of TB Case Treatment regimen Treatment
dose till result of LPA or LC and DST. in IP regimen CP
• For new patients diagnosed as TB and RR by Rifampicin Sensitive INH (3‑6) Km Lfx R E Z (6) Lfx R E Z
CBNAAT – repeat CBNAAT and send the sample Resistant1TB & DST of (modify treatment treatment of
SEZ not known based on baseline MDR/RR with
for liquid culture
DST report to E, Z, Additional
• If  second CBNAAT shows RR then start KM, CM, Lfx, Mfx) Resistance
standard MDR till result for culture DST
available. Perform DST to INH and SLDST on
liquid culture. Type of TB Case Treatment Treatment
regimen in IP regimen CP
• If second CBNAAT shows R sensitiveness,
MDR or Rifampicin (6‑9) Km Lfx (18) Lfx Eto
continue regimen for new TB cases and wait for Resistant TB Eto Cs Z Cs
LC and DST. As soon as LC result is available, + Ethambutol
modify the regimen as follows: resistance
• If LC shows R sensitiveness  –  continue MDR or Rifampicin (6‑9) Km Lfx (18) Lfx Eto
regimen for new TB cases Resistant TB + Eto Cs E Cs E
• If LC shows R resistance – refer the patients Pyrazinamide
resistance
to DRTB centre for decision regarding
MDR or Rifampicin (6‑9) Km Lfx (18) Lfx Eto
starting MDR or continuing regimen for Resistant TB + Eto Cs PAS Cs PAS
new TB cases depending on the response to Ethambutol +
treatment given so far. Pyrazinamide
• For mixed resistance pattern, consider oral drug in the resistance
sequence of preference – Pyrazanamide, Ethambutol, MDR or Rifampicin (6‑9) Km Mfx (18) Mfx
Ethionamide, Cycloserine, PAS, Clofazimine, Linezolide, Resistant TB + Eto Cs Z E Eto Cs E
Levofloxacin PAS Cfz PAS Cfz
Coamoxyclave, high dose INH, Clarythromycin
• Regimen designing or modification will be MDR or Rifampicin (6‑9) Km Lfx (18) Lfx Eto
prerogative of the DRTB centre committee only. Resistant TB + Eto Cs Z E Cs E PAS
Moxifloxacin PAS Cfz Cfz
Treatment of mono/poly drug resistance TB MDR or Rifampicin (6‑12) Km (18) Eto Cs
• On receiving reports showing mono/poly Resistant Eto Cs Z E E PAS Cfz
TB+Resistance PAS Cfz Lzd Lzd
DRTB from the quality assured C and DST laboratory, to all
the patients and the family members are counselled Fluoroquinolones
• Pre‑treatment evaluation by the DRTB centre MDR or Rifampicin (6‑9) Cm Lfx (18) Lfx Eto
committee Resistant TB + Eto Cs Z E Cs E
• Mono drugs resistance TB. Resistance
• Injectable second‑line drug  (SLD) + FQ + to Km only
Rifampicin + two out of the first‑line drugs MDR or Rifampicin (6‑12) Lfx (18) Lvx
(from H, E, Z) to which the patient is sensitive Resistant TB + Eto Cs Z E Eto Cs E
to make a total five effective drugs given Resistance to all SL PAS Cfz Lzd PAS Cfz
daily. Injectable Lzd

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Follow‑up: for permanent regimen change of at least two or

more ATD in CP because of lack of microbiological
(1) For MDR TB patients – conversion by the end of IP or microbiological
Schedule for sputum culture examination for MDR reversion in the CP after conversion to negative or
TB (no change): evidence of additional acquired resistance FQ or
IP extension Intensive Extension of IP Continuation
second‑line injectable drugs, or adverse drug reaction.
phase (1‑3 rronths) phase Outcomes for mono/poly drug‑resistant TB
No 3 4 5 6 ‑ ‑ ‑ 9 12 15 18 21 24 patients
1month 3 4 5 6 7 10 13 16 19 22 25 • Cure  –  A microbiologically confirmed TB at the
2 months 3 4 5 6 7 8 11 14 17 20 23 26
beginning of treatment who was culture‑negative
3 months 3 4 5 6 7 8 9 12 15 18 21 24 27
in the last month of treatment and on at least one
(2) For mono DR and poly DRTB patients – previous occasion
• Treatment completed  – A patient who has completed
Schedule for sputum culture examination: treatment according to the guidelines but does not
Microbiological: Sputum smear and culture at second meet the definition for cure or treatment failure due
and third months and then culture examination at to lack of microbiological results
three monthly interval till completion of the treatment. • Failure – Treatment terminated or need for permanent
regimen change of at least two or more anti‑TB
• Formono/poly DRTB patients – drugs in CP because of:
• IP should given for at least 3 months • Evidence of additional acquired resistance to
• After this, the patient will be reviewed Rifampicin, Rluroquinolone or second‑line
• If after the 3  months the smear result remains injectable during treatment
positive, the sputum sample is sent for • Severe ADR
genotypic DST to Rifampicin for CBNAAT or • Culture‑positive during CP or at end of
LPA and liquid/solid culture and DST to see for treatment
resistance amplification • Died  – A patient who dies for any reason during the
• Shifting from IP to CP will be based on the course of M/X DRTB treatment
result of culture • Loss to follow‑up – A patient whose
• The IP can be extended maximum 3 months treatment was interrupted for one month or more for
• Duration of CP is 6 months any reasons
(3) MDR TB patients with additional drugs resistance • Not evaluated  –  A DRTB patient for whom no
including XDR TB patients treatment outcome is assigned, and this included
• Change from IP to CP will be done after former ‘transfer out’.
achievement of culture conversion, that is, two
consecutive negative cultures taken at least one Therefore, there are mammoth and comprehensive
month apart changes in the new RNTCP guidelines for both
• In case of delay in culture conversion, IP can be drug‑sensitive and DRTB in regard to:
extended from 6 months to maximum 12 months. • The objectives, organizational structure, definition
of presumptive TB cases, case definition, drug
Outcome for RR/MDR and/or XDR TB patients (new
regimen, follow‑up, treatment outcome and also in
guidelines)
the management of DRTB cases
• Cure – Treatment completed as recommended by the • Introduction of daily regimen  –  the Government of
National Policy without evidence of failure and three India has taken a decision to introduce daily regimen
or more consecutive cultures taken at least 30 days for treatment of drug‑sensitive TB patients under
apart are negative after IP Revised National TB Control Programme in a phased
• Treatment completed – Treatment completed manner. Initially, it is going to be introduced for all
as recommended by the National Policy without TB patients in five states, that is, Bihar, Maharashtra,
evidence of failure but no record that three or more Sikkim, Himachal Pradesh and Kerala. In addition,
consecutive cultures taken at least 30 days apart are all HIV‑infected TB patients and paediatric TB cases
negative after IP in entire country will be provided daily regimen
• Treatment success – The sum of cured and treatment under the programme
completed • Modification of ART regimen in TB‑HIV co‑infected
• Treatment failed – Treatment terminated or need patients

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Chaudhuri: RNTCP 2016

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Arunabha D. Chaudhuri
Department of Pulmonary Medicine, R.G. Kar Medical College, DOI:
10.4103/2320-8775.196644
Kolkata, West Bengal, India

Address for correspondence:

Dr. Arunabha D. Chaudhuri,
Professor R.G. Kar Medical College,
BF‑130, Sector‑I, Salt Lake City, Kolkata - 700 064,
West Bengal, India.
E‑mail: arunabhadc@rediffmail.com
How to cite this article: Chaudhuri AD. Recent changes in technical
and operational guidelines for tuberculosis control programme in
India - 2016: A paradigm shift in tuberculosis control. J Assoc Chest
Physicians 2017;5:1-9.

The Journal of Association of Chest Physicians  ¦  Jan-Jun 2017  ¦  Volume 5  ¦  Issue 1 9