• TB is an airborne bacterial disease caused by Mycobacterium tuberculosis.
• It mainly affects the lungs, but can also affect other organs.
• It is preventable and curable with timely diagnosis and full treatment.
• Around 25% of the global population is infected, but only about 5–10% develop active TB.

Transmission and Prevention

• Spreads through the air when an infected person coughs, sneezes, or spits.
• BCG vaccine is given to infants for protection against severe forms of TB.

Risk Factors

• Weak immunity
• Diabetes
• Malnutrition
• Tobacco use
• Alcohol use

Diagnosis

• Rapid molecular tests are recommended as initial tests for suspected TB.
• Other tools include sputum smear microscopy and chest X-rays.

Treatment and Drug Resistance

• Standard treatment typically lasts 4–6 months.
• Incomplete treatment can lead to drug-resistant TB.
• MDR-TB is resistant to isoniazid and rifampicin and needs longer, costlier treatment.
• Extensively drug-resistant TB is more severe with fewer effective options.
• TB-HIV link: People with HIV are about 16 times more vulnerable to TB; TB is a major cause of death among them

National TB Elimination Programme (NTEP)

Background and Target

• In 2020, the Revised National Tuberculosis Control Programme (RNTCP) was renamed as the National TB Elimination Programme (NTEP).
• India’s target is to eliminate TB by 2025, earlier than the commonly stated global target of 2030.

Global TB Targets (SDG-linked)

• 80% reduction in TB incidence
• 90% reduction in TB deaths
• Zero TB-affected households facing catastrophic costs

Strategy Framework

• Guided by National Strategic Plan (2017–2025) with four pillars:
  • Detect
  • Treat
  • Prevent
  • Build

Core Focus Areas

• Early diagnosis and faster case detection
• Quality-assured treatment and adherence support
• Private sector engagement for notifications and treatment continuity
• Contact tracing and targeted screening in high-risk settings
• Addressing social determinants through multi-sectoral action

Recent Programme Highlights

• Highest-ever case notifications reported:
  • 25.5 lakh cases in 2023
  • 26.07 lakh cases in 2024
• Drug-resistant TB care improvements:
  • Safer, shorter all-oral regimens using Bedaquiline
  • Treatment success improved from 68% (2020) to 75% (2022)
  • mBPaL regimen (Bedaquiline, Pretomanid, Linezolid) reported around 80% success for MDR-TB, with treatment duration reduced to about 6 months

Pradhan Mantri TB Mukt Bharat Abhiyaan (PMTBMBA)

What It Does

• Launched in 2022 as part of the TB elimination effort.
• Focuses on strengthening treatment outcomes through:
  • Nutritional support
  • Diagnostic support
  • Vocational and social support

Key Components

• Large-scale crowd-sourced nutrition support for TB patients
• Ni-kshay Mitra initiative:
  • Encourages individuals, NGOs, and corporates to support TB patients for six months
  • Support can be nutritional, social, or economic
• Ni-kshay Portal:
  • Digital system to manage cases, track treatment, and enable real-time surveillance

Progress Under NTEP

Decline in Incidence and Mortality

• TB incidence in India declined by 18% from 2015 to 2023
• Global decline during a comparable period was around 8%
• TB mortality reduced by 21% from 28 to 22 deaths per lakh population
• India accounted for over 26% of global TB cases and deaths in 2023

Treatment Coverage and Decentralised Care

• TB treatment coverage has reached about 85%
• Strengthened through decentralised care using around 1.7 lakh Ayushman Arogya Mandirs

Campaign-Based Detection

• 100-Day TB Mukt Bharat Abhiyaan:
  • 12.97 crore screened in high-focus districts
  • 7.19 lakh cases detected
  • 2.85 lakh asymptomatic cases identified

Community Participation

• 2.55 lakh Ni-kshay Mitras supported patients
• 29.4 lakh nutrition baskets distributed to TB patients

Nutrition Support via DBT

• Ni-kshay Poshan Yojana:
  • DBT support provided to 1.28 crore TB patients since 2018
  • Nutritional support amount enhanced to Rs 1,000 in 2024

Diagnostic Network Expansion

• Expansion of NAAT labs and drug susceptibility testing
• Deployment of AI-enabled X-ray units
• Screening expanded to high-risk settings:
  • Mines
  • Construction sites
  • Tea gardens
  • Urban slums

Challenges for Vulnerable Groups

Undernutrition and Poor Recovery

• Undernutrition increases risk of TB and worsens treatment outcomes.
• Leads to higher mortality, greater toxicity, and relapse risk.
• Nutritional schemes exist, but coverage and effectiveness can remain uneven.

Delayed or Missed Diagnosis

• Symptoms often get ignored or mistaken for common illness.
• Women, especially homeless women, may face longer delays due to stigma, low awareness, and limited access.
• Sputum collection can be difficult due to cultural and practical barriers.

Stigma and Social Exclusion

• TB stigma discourages timely testing and treatment, particularly for women.
• Homelessness is often under-recognised as a vulnerability category, leading to gaps.
• Lack of documents (Aadhaar, bank account) blocks access to benefits and continuity of care.

Childhood TB Gaps

• Diagnosis is harder due to low bacterial load and inability to produce sputum.
• Reliance on less sensitive methods and limited resistance screening.
• Only 12% of molecular tests in children confirmed TB bacteriologically in 2022.

Mental Health and Psychosocial Stress

• Anxiety, stigma, and treatment fatigue affect adherence.
• Psychosocial support is often inadequate despite its direct impact on treatment success.

How Targeted Interventions Can Help

Better Targeting of High-Risk Groups

• Use urban-rural and occupational data to find hidden clusters.
• Prioritise high-risk work sectors: construction, mining, textiles, etc.

Recognise and Reach Homeless Populations

• Explicitly treat homelessness as a vulnerability group for priority screening and support.
• Reduce barriers created by lack of ID, stigma, and low facility access.

Strengthen Community Participation

• Expand volunteer and local community involvement to reduce stigma and improve adherence.

Break Transmission Hotspots

• Focus resources in high-incidence areas and congregate settings to interrupt spread.

Faster Detection Tools in Vulnerable Areas

• Deploy molecular tests and AI-based X-ray screening to reduce missed cases, including childhood and drug-resistant TB.