- 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.
