TB-Free India: Achievements, challenges and the way forward

India’s dedicated journey towards tuberculosis (TB) elimination has been recognised globally, with a noteworthy 17.7 per cent decline in TB incidence from 2015 to 2023, a rate that is over twice the global average decline of 8.3 per cent, as reported by the World Health Organization (WHO) in its Global Tuberculosis Report 2024. This milestone highlights the impact of India’s National Tuberculosis Elimination Programme (NTEP), a comprehensive strategy that combines cutting-edge diagnosis, preventive care, patient support, and cross-sector partnerships to meet the ambitious goal of TB elimination by 2025.

Strategies and goals for ending tuberculosis in India

The SDG target 3.3 aims to “End the epidemics of AIDS, tuberculosis, malaria, and neglected tropical diseases, and combat hepatitis, water-borne diseases, and other communicable diseases by 2030.” India, as a signatory to the United Nations Sustainable Development Goals (UN-SDGs), has pledged to achieve the “End TB” targets by 2025, five years ahead of the SDG deadline of 2030.

The indicators for TB under this target include:

• An 80 per cent reduction in the TB incidence rate (new cases per lakh population) compared to 2015 levels.
• A 90 per cent reduction in the TB mortality rate compared to 2015 levels.
• Zero TB-affected households experiencing catastrophic expenses due to the disease.

The Government’s commitment to End TB by 2025 was first articulated by Prime Minister Narendra Modi during the End TB Summit held in New Delhi in March 2018 and was reaffirmed at the One World TB Summit in Varanasi on World TB Day 2023. At this summit, the Prime Minister emphasised the need for a decisive and revitalised response to TB.  Additionally, India is a signatory to the Gandhinagar Declaration, the joint declaration by the Health Ministers and WHO South-East Asian Regional Office (SEARO), which was signed at the high-level ministerial meeting on “Sustain, Accelerate and Innovate to End TB” in the South-East Asia Region by 2030 in August 2023.

In line with the strong political commitment shown by the Government of India, the National Tuberculosis Elimination Program (NTEP) has been implementing the National Strategic Plan (NSP) for TB Elimination. The NSP 2017–2025 has made significant progress in narrowing the gap between targets and achievements, and India is one of the first countries to develop a mathematical model for burden estimation.

India’s approach: National tuberculosis elimination programme (NTEP)

Following the COVID-19 pandemic, India intensified its efforts to eliminate TB through the NTEP, a programme aligned with the National Strategic Plan (NSP) 2017–25. Key achievements in 2023 include around 1.89 crore sputum smear tests and 68.3 lakh nucleic acid amplification tests, which reflect the programme’s commitment to expanding access to diagnosis at all healthcare levels.

In response to evolving medical insights, the National Tuberculosis Elimination Programme (NTEP) introduced comprehensive care packages and decentralised TB services, which include an expanded rollout of shorter oral regimens for patients with drug-resistant TB (DR-TB). The program prioritised minimising treatment delays and enhancing the quality of TB care, with a specific focus on addressing coexisting health conditions such as malnutrition, diabetes, HIV, and substance abuse through a differentiated care approach and by encouraging early diagnosis. Preventive measures remain a central focus of the NTEP’s approach, as the program significantly expanded access to TB preventive treatment (TPT). A strong commitment from various states demonstrated a collective resolution to prevent the emergence of TB disease in vulnerable populations. This led to an overall increase of approximately 15 lakh beneficiaries being provided with TPT including the shorter regimen.

Acknowledging the impact of additional health issues on TB outcomes, the NTEP launched initiatives to tackle these conditions particularly malnutrition, diabetes, HIV, and substance abuse by collaborating with other ministries and departments. These efforts aimed to provide TB patients with more holistic support, thereby improving their overall treatment outcomes.

Strengthening patient care through supportive services

Direct Benefit Transfer (DBT) under the Ni-kshay Poshan Yojana provides financial support for TB patients by disbursing nearly Rs 2,781 crores to around 1 crore beneficiaries. New initiatives, including incentivising treatment supporters and ASHA (Accredited Social Health Activist) workers, TB Vijeta’s (TB champions) and Ni-kshay SAATHI (Family caregiver model) were aimed to further enhance patient support systems.

The launch of the Pradhan Mantri TB Mukt Bharat Abhiyaan (PMTBMBA) in September 2022 marked a pivotal step toward strengthening community involvement and ownership in the fight against tuberculosis. This initiative received extensive support, with political leaders, government officials, and NGOs actively participating in awareness campaigns and events to amplify its reach. Notably, over 1.5 lakh Ni-kshay Mitras have committed to supporting individuals affected by TB. Advocacy, communication, social mobilisation, and community engagement continue to be fundamental aspects of the National Tuberculosis Elimination Programme (NTEP), which has been further solidified through PMTBMBA to drive community-based efforts in TB elimination.

The way forward: Advancing towards TB elimination

To sustain the momentum in the fight towards TB elimination, a variety of interventions are being implemented and are in development for the coming years, including:

• Conducting studies on adult BCG vaccination
• Expanding and rapidly scaling up Tuberculosis Preventive Therapy (TPT), including new and shorter treatment regimens
• Increasing access to molecular diagnostic testing for all individuals suspected of having TB, along with comprehensive recording and reporting mechanisms
• Decentralising TB service delivery to “Ayushman Arogya Mandirs”
• Enhancing community-based patient support systems through the PMTBMBA initiative

Conclusion

India’s comprehensive TB elimination approach is showing positive results, with significant declines in incidence and a strengthened health response framework. With continued emphasis on cross-sector partnerships, innovative care solutions, and community engagement, India is well-positioned to meet its goal of a TB-free nation by 2025. This progress underscores the country’s commitment to global health initiatives and the power of collaborative, innovative, and patient-centred healthcare strategies in tackling TB on a national scale.