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Tuberculosis (TB) remains a major public health challenge in India, which accounts for 27% of the global TB burden (WHO Global TB Report 2023). The National TB Elimination Programme (NTEP), launched under the Nikshay Poshan Yojana and PM TB Mukt Bharat Abhiyan, aims to eliminate TB by 2025, but progress is hindered by drug resistance, stigma, and healthcare gaps.

Significant Strides Made by the National TB Elimination Programme (NTEP)

• Universal Drug Susceptibility Testing (UDST): NTEP has expanded molecular diagnostic facilities, ensuring early detection and drug resistance profiling for TB patients.
  For example: The introduction of CBNAAT and TruNat machines has enabled faster and more accurate TB detection in primary healthcare settings.
• Nikshay Poshan Yojana (NPY): Direct Benefit Transfer (DBT) scheme providing ₹1,000 per month to TB patients for nutritional support, addressing a key determinant of treatment adherence.
  For example: As of now, 1.13 crores TB patients have benefited from the scheme, reducing malnutrition-related complications.
• TB Preventive Therapy (TPT) Expansion: The government has promoted preventive treatment for household contacts of TB patients, reducing new infections.
• Private Sector Engagement: NTEP has integrated private clinics, hospitals, and NGOs to report and treat TB cases, bridging gaps in underreporting.
  For example: The Joint Effort for Elimination of Tuberculosis (JEET) program has increased TB case notifications from private practitioners.
• AI & Digital Health Integration: The adoption of Nikshay 2.0, a real-time TB tracking system, enhances treatment monitoring and surveillance.
  For example: AI-based 99DOTS and MERM have been deployed for patient adherence tracking, reducing dropouts in TB treatment.

Systemic Challenges Hindering India’s TB Elimination Progress

• Diagnostic Gaps: Despite advancements, rural areas still lack access to molecular diagnostics, delaying early TB detection.
• Drug Stock Outs & Resistance: Inconsistent drug supply and rising multidrug-resistant TB (MDR-TB) complicate treatment success rates.
  For example: Multiple states reported shortages of Rifampicin and Bedaquiline, affecting TB treatment continuity.
• Social Stigma & Mental Health: TB patients face ostracization, leading to mental health issues and reluctance in seeking timely treatment.
• Weak Public-Private Coordination: Private sector notifications remain incomplete, leading to underreporting and unregulated TB treatment practices.
• Poor Nutritional & Economic Support: Financial hardships force many TB patients to discontinue treatment, worsening health outcomes.

Key Obstacles in TB Control

• Inadequate Community Awareness: Low health literacy leads to delayed health-seeking behavior and non-adherence to treatment.
• Limited Mental Health Support: TB patients suffer from depression and anxiety, affecting their ability to complete treatment.
• Overcrowding & Poor Living Conditions: Slums, prisons, and labor camps serve as TB hotspots due to poor ventilation and hygiene.
• Multidrug-Resistant TB (MDR-TB) Crisis: MDR-TB cases are rising due to poor treatment adherence and irrational antibiotic use.
• Slow Adoption of New TB Drugs & Vaccines: Regulatory delays hinder the introduction of effective, shorter drug regimens and vaccines.
  For example: The rollout of BPaL (Bedaquiline-Pretomanid-Linezolid) regimen, a game-changer for MDR-TB, is still limited.

Multi-Sectoral Approach for TB Elimination in India

• Strengthening Primary Health Care: Expand molecular diagnostic facilities to all districts and integrate TB services with Ayushman Bharat Health & Wellness Centers.
  For example: Mobile TB diagnostic units can improve access in remote tribal and rural areas.
• Nutritional & Economic Support: Scale up direct cash transfers, ration support, and community kitchens for TB patients.
  For example: Doubling Nikshay Poshan Yojana benefits can improve treatment adherence and recovery.
• Private Sector Accountability: Mandate strict reporting protocols for private doctors and ensure quality-assured treatment regimens.
  For example: Linking private TB case notifications to incentives can improve reporting rates.
• Tackling Social Stigma: Nationwide awareness campaigns, survivor-led advocacy, and community TB champions can fight discrimination.
  For example: Incorporating TB awareness in school curriculums can reduce stigma from an early age.
• Technological Innovation: AI-driven telemedicine, smart pill boxes, and automated adherence tracking can improve treatment success.

Achieving a TB-free India demands a synergistic approach integrating robust healthcare infrastructure, social support, and technological innovation. Strengthening active case detection, nutrition support, and AI-driven diagnostics can accelerate progress. Public-private partnerships, community engagement, and one-health strategies must align with Ayushman Bharat and Nikshay Poshan Yojana, ensuring a resilient, patient-centric TB elimination roadmap by 2025.

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