TB Elimination Targets and Public Health Strategies in India

India’s Fight Against Tuberculosis: Targets and Public Health Strategies

India bears the world’s largest burden of Tuberculosis (TB), making its elimination a critical public health priority. With an ambitious goal to end TB by 2025, five years ahead of the global Sustainable Development Goals (SDG) target, the nation has launched a robust National Strategic Plan (NSP) underpinned by multifaceted public health strategies. This comprehensive approach aims not only to reduce incidence and mortality but also to eradicate the socio-economic impact of this ancient disease, crucial for national development and public health well-being.

Understanding Tuberculosis (TB) in India

• Tuberculosis is an infectious disease primarily affecting the lungs, caused by the bacterium Mycobacterium tuberculosis. India accounts for a significant proportion of global TB cases, experiencing immense health and economic ramifications due to lost productivity and healthcare costs.

• The disease presents in various forms, including pulmonary TB (most common), extra-pulmonary TB (affecting other organs), and drug-resistant TB (DR-TB). DR-TB, particularly Multi-Drug Resistant TB (MDR-TB) and Extensively Drug-Resistant TB (XDR-TB), poses a severe challenge due to its complex, longer treatment regimens and higher mortality rates.

• Challenges in India extend beyond timely diagnosis and effective treatment to include low public awareness, persistent social stigma associated with the disease, and the difficulty in reaching marginalized and vulnerable populations, necessitating a holistic and community-centric approach for effective elimination.

India’s National Strategic Plan for TB Elimination (NSP) 2017-2025

• The NSP 2017-2025 outlines a clear vision for a ‘TB-Free India,’ aiming to achieve a 90% reduction in TB incidence and a 95% reduction in TB deaths by 2025, compared to 2015 baseline levels. This target is ambitious but reflects India’s strong political will.

• It operates on four strategic pillars: Detect (finding all cases), Treat (providing appropriate therapy), Prevent (offering preventive care), and Build (strengthening health systems and capacity). This framework ensures a comprehensive response covering every aspect from early diagnosis to post-treatment follow-up and system strengthening.

• The plan emphasizes universal access to quality diagnosis and treatment for all TB patients, including those with drug-resistant forms, by integrating advanced technologies and patient-centric care models across both public and private sectors.

Key Public Health Strategies in Action

Early Diagnosis and Treatment

• Improved diagnostic tools like Nucleic Acid Amplification Tests (NAATs), including CBNAAT (Cartridge-Based Nucleic Acid Amplification Test) and TrueNat, have significantly reduced diagnosis time and improved accuracy, enabling quicker initiation of treatment across all levels of healthcare facilities.

• Universal Drug Susceptibility Testing (UDST) is now mandated for all diagnosed TB cases, particularly for presumptive DR-TB, to identify drug resistance patterns early. This prevents the spread of DR-TB and ensures that patients receive the most effective, personalized treatment regimen from the outset.

• Active Case Finding (ACF) campaigns involve systematic screening in high-risk populations, vulnerable communities, and underserved areas through door-to-door surveys, mobile health units, and special camps, uncovering hidden cases that might otherwise remain undiagnosed and continue transmission.

Patient-Centric Care and Support

• The Directly Observed Treatment, Short-course (DOTS) strategy, now integrated under the National TB Elimination Programme (NTEP, formerly Revised National TB Control Programme or RNTCP), ensures adherence through supervised drug intake, significantly improving treatment success rates and reducing default.

• Nikshay Poshan Yojana provides direct benefit transfers (DBT) of INR 500 per month to all notified TB patients for nutritional support. This addresses malnutrition, a key risk factor for TB progression and recurrence, thereby helping improve treatment outcomes and overall patient well-being.

• The Nikshay platform serves as a comprehensive web-enabled IT system for surveillance, monitoring, and program management, tracking every TB patient from diagnosis to treatment completion and facilitating timely interventions and resource allocation.

Drug-Resistant TB (DR-TB) Management

• Decentralized DR-TB treatment centers and increased accessibility to specialized care ensure that patients with drug-resistant forms of TB can receive treatment closer to their homes, improving retention rates and reducing treatment interruptions and associated travel burdens.

• The introduction of newer anti-TB drugs like Bedaquiline and Delamanid, along with shorter all-oral regimens, has revolutionized DR-TB treatment, offering more effective, less toxic, and patient-friendly options compared to older, injectable-heavy regimens.

• Robust surveillance mechanisms are in place to monitor the emergence and spread of drug resistance, allowing for prompt adaptation of national treatment guidelines and public health responses to evolving epidemiological patterns.

Preventive Interventions

• TB Preventive Treatment (TPT) is actively promoted for household contacts of pulmonary TB patients, individuals living with HIV (PLHIV), and other vulnerable groups (e.g., diabetics, immunocompromised individuals). This intervention significantly reduces the risk of developing active TB disease from latent infection.

• Bacillus Calmette-Guérin (BCG) vaccination for infants remains a crucial public health measure, primarily protecting against severe forms of TB in children, such as TB meningitis and disseminated TB, though its efficacy against adult pulmonary TB varies.

• Strict infection control measures in healthcare settings, correctional facilities, and other public spaces are emphasized to prevent airborne transmission of the Mycobacterium tuberculosis bacteria, protecting both patients and healthcare workers.

Private Sector Engagement

• Engagement with the vast private healthcare sector is a cornerstone of India’s strategy. Mandatory notification of TB cases by private practitioners to the government’s Nikshay platform ensures comprehensive data collection, patient tracking, and linkage to public sector support.

• Public-Private Mix (PPM) models are actively implemented to bridge gaps in service delivery, offering incentives and technical support to private providers to ensure adherence to national treatment protocols, improve diagnostic practices, and enhance patient outcomes.

Community Engagement and Social Support

• Awareness campaigns and ‘Jan Andolan’ (people’s movement) initiatives aim to educate the public about TB symptoms, prevention, and treatment, encouraging early seeking of care, fostering community ownership, and reducing stigma associated with the disease.

• Involvement of community health workers like Accredited Social Health Activists (ASHAs) and other frontline workers is vital for reaching remote communities, supporting patients through treatment, and ensuring treatment adherence at the grassroots level through direct engagement and follow-up.

Challenges and Way Forward

• Despite significant progress, challenges persist, including persistent funding gaps, the large number of undetected cases, and the high burden of malnutrition and co-morbidities like diabetes and HIV which exacerbate TB risk and outcomes.

• The socio-economic determinants of health, such as poverty, inadequate housing, limited access to healthcare, and migration, continue to fuel TB transmission, requiring a multi-sectoral approach involving various government departments beyond health.

• The COVID-19 pandemic significantly disrupted TB services, leading to delays in diagnosis and treatment and potential increases in case fatalities. Restoring and strengthening TB services, integrating them with other primary health programs, is crucial for getting back on track towards the 2025 target.

Frequently Asked Questions (FAQs)

1. What is India’s target year for TB elimination?
India aims to eliminate Tuberculosis by 2025, five years ahead of the global Sustainable Development Goal (SDG) target of 2030. This ambitious goal underscores the nation’s strong commitment to public health and disease eradication.

2. What is the Nikshay Poshan Yojana?
The Nikshay Poshan Yojana is a scheme providing financial support of INR 500 per month to all notified TB patients through Direct Benefit Transfer (DBT) for nutritional assistance. It aims to improve treatment outcomes by addressing malnutrition among patients.

3. How is drug-resistant TB managed in India?
Drug-resistant TB (DR-TB) is managed through decentralized treatment centers, Universal Drug Susceptibility Testing (UDST), and the use of newer, more effective drugs like Bedaquiline and Delamanid. Shorter, all-oral regimens are also increasingly implemented for improved patient experience.

4. What role does BCG vaccination play in TB elimination?
BCG (Bacillus Calmette-Guérin) vaccination is a crucial part of India’s strategy, primarily protecting infants and young children from severe forms of TB, such as TB meningitis and disseminated TB. It does not completely prevent pulmonary TB in adults but significantly reduces severe outcomes.

Stay Updated with Daily Current Affairs 2026