Towards Ending TB – India’s Strategic Response & Progress. Key Strategies and Innovations: India’s response has been characterized by prioritizing innovations across various domains.
Tuberculosis (TB) remains a significant public health challenge globally, and India bears the highest burden, accounting for a quarter of cases worldwide. Recognizing the diverse TB epidemiology across its states and the significant role of the private healthcare sector, India adopted a sub-national assessment approach. The National TB Programme has evolved significantly since the introduction of DOTS in 1997, embracing the Stop TB Strategy in 2006 and the End TB Strategy in 2015. A pivotal step was the integration of the TB program into the general health system under the National Health Mission (NHM), facilitating resource optimization and mainstreaming of human resources. The program was renamed the National TB Elimination Program (NTEP) in 2020, underscoring its ambitious goal.
Key Strategies and Innovations: India’s response has been characterized by prioritizing innovations across various domains.
• Diagnostics: Scaling up rapid molecular testing infrastructure with over 8,295 machines, establishing an annual capacity of over 14 million tests. Introduction of digital chest X-ray as a screening tool and exploration of AI-based tools for automated reading. Development and validation of indigenous tools like TrueNAT and Cy-TB.
• Treatment: Introduction of shorter drug regimens and focus on improving outcomes for drug-resistant TB, with treatment success rates reaching 87% for MDR-TB. Expansion of drug susceptibility testing (DST) to all TB patients.
• Digital Health: Development and implementation of Nikshay, a real-time integrated digital surveillance system for patient management and drug logistics. Utilization of digital adherence tools like 99-DOTS and Video DOT, and a multilingual national call centre, Nikshay Sampark, for patient counselling.
• Community Engagement: Decentralized initiatives like TB-Free villages/districts empowered local stakeholders and fostered healthy competition. Active Case Finding (ACF) campaigns are regularly organized to improve case detection and awareness. Engaging TB survivors as “TB champions” and mobilizing community support through initiatives like Nikshay Mitras.
• Socio-economic Support: Implementation of direct benefit transfer schemes to mitigate the socio-economic impact of TB, along with nutritional support initiatives through crowd-sourcing and enhanced financial assistance. Linking TB patients to social welfare schemes for vulnerable populations.
• Research and Development: Establishment of the Indian TB Research Consortium (ITRC) to foster research in diagnostics, drugs, vaccines, and implementation science. Collaboration with institutions like IIT Bombay for disease modelling. Progress in clinical trials for TB vaccine candidates and ongoing study for adult BCG vaccination.
Progress and Impact: India has witnessed a significant reduction in TB burden. TB incidence declined by 18% between 2015 and 2023, and TB-related deaths decreased by 24% during the same period, outpacing global averages. TB case notification rate increased from 1.5 million in 2014 to 2.6 million in 2024, and treatment success rates improved to 89% in 2023. Notably, almost 6 million additional TB patients from the private sector have been notified in the last decade with comparable treatment outcomes to the public sector. Several districts have achieved END TB targets based on sub-national certification.
Remaining Challenges: Despite considerable progress, challenges persist, including the sheer scale of interventions needed and the diverse socio-economic and epidemiological contexts across states. Addressing stigma, improving access to care in rural areas, and ensuring comprehensive implementation of TB Preventive Treatment (TPT) and vaccination programs remain critical. A significant proportion of symptomatic patients still do not seek care, and a considerable number of diagnosed patients are asymptomatic, contributing to missed cases.
Way Forward and Future Directions: The development of a new National Strategic Plan (NSP) aims to consolidate achievements and align with broader national health frameworks. Key priorities include:
• Enhanced Screening and Diagnostics: Deployment of highly sensitive screening tools like finger prick tests and cough AI tools, and further strengthening rapid molecular diagnostics.
• Expanded Prevention Efforts: Rapid scale-up of TB Preventive testing and treatment, and potential nationwide adult vaccination against TB based on ongoing study outcomes. Addressing social determinants like undernutrition and indoor air pollution.
• Strengthened Treatment and Support: Differentiated TB care, post-treatment follow-up, rehabilitation, and augmented DST for all drug-resistant TB patients. Continued research into newer drug regimens and molecules.
• Leveraging Technology: Enhancing digital surveillance tools with AI capabilities and telemedicine networks.
• Multi-sectoral Collaboration: Strengthening inter-ministerial and corporate engagement, and linking with social welfare schemes.
• Focus on Vulnerable Populations: Targeted interventions for high-risk groups identified through prevalence surveys.
Conclusion: India’s journey towards TB elimination showcases the transformative power of strong political will, strategic innovations, community engagement, and increased financial investment. While significant strides have been made, sustained and intensified efforts, focusing on addressing remaining challenges and leveraging emerging opportunities, are crucial to achieve the ambitious goal of a TB-free India by 2025. The lessons learned from India’s experience offer valuable insights for the global fight against this persistent epidemic.
Ending TB India’s Strategic
Reference: Lessons and updates from India’s National TB Elimination Program – bold decisions and innovative ways of fast-tracking progress towards ending TB, IJID Regions (2025), doi: https://doi.org/10.1016/j.ijregi.2025.100599
Dr. Shruti Patel
Senior Medical Advisor , Cadila Pharmaceuticals
