Prime Minister Narendra Modi’s clarion call to eliminate tuberculosis (TB) from India laid the foundation for a new model of TB care and management. India pioneered several innovative approaches and brought a paradigm shift in TB prevention, diagnosis and treatment. The World Health Organization (WHO) Global TB Report 2024 acknowledges the efficacy of these novel approaches and reports a 17.7% decline in TB incidence in India from 2015 to 2023 — double the rate of global decline. The country diagnosed 251,000 patients and marked a significant rise in treatment coverage from 53% (2015) to 85% (2023). India has a unique universal nutritional support scheme — the Ni-kshay Poshan Yojana for TB patients. To date, ₹3,202 crore have been disbursed to over 11.3 million beneficiaries. The monthly support under Ni-kshay Poshan Yojana was doubled to 1,000 per month from November 1, 2024, to reinforce India’s commitment to end TB.
Besides, India has introduced a new initiative to provide Energy Dense Nutritional Supplementation (EDNS) for undernourished patients. These critical policy shifts are based on the rich evidence from the RATIONS trial conducted by the Indian Council for Medical Research (ICMR) between 2019 to 2022, which noted that improved nutrition in contacts of TB patients can reduce TB incidence and mortality by 40% and 60%, respectively. Additionally, EDNS was reported to improve treatment success, reduce unfavorable outcomes and arrest relapses.
The TB Mukt Bharat Abhiyaan created a mass movement to increase awareness and provide nutritional, vocational, and psychological support to TB patients. This government-citizen symphony has ensured over 160,000 Ni-kshay Mitras distributing over 1.9 million food baskets to TB patients.
Several innovations have helped develop efficient screening and testing methods to reduce delays. India has also made consistent efforts to provide quality TB diagnostic and treatment options on par with global standards. India has introduced newer drugs such as bedaquiline and delamanid to improve treatment success rates. Considering the challenges in treatment completion for patients with the drug-resistant variant, a WHO-recommended shorter and more effective BPaLM regimen was rolled out. While one has a shorter nine- to 11-month regimen available alongside the conventional 19- to 20-month regimen, with the BPaLM regimen patients will complete treatment in just six months! With a lesser number of daily pills, BPaLM will ensure better treatment adherence.
From a few hundred molecular diagnostic machines in 2014-15, India now has over 7,700 machines. The ongoing procurement of ultraportable and Artificial Intelligence-enabled handheld X-ray machines would significantly boost India’s TB screening capacity in future.
Truenat, an indigenous molecular diagnostic machine, has drastically reduced the costs of testing, and the time taken to diagnose a patient at district/block levels. WHO’s endorsement of Truenat for global use has positioned India as a leader in TB response. Research and innovations are ongoing to develop and roll out newer tools, including more efficient point-of-care diagnostics further reduce testing costs and time, and most importantly make the process easier for both patients and health care workers. From pioneering research that has led to advanced treatments, to the introduction of universal social support provisions, India stands at the forefront of the global TB response. By proactively identifying at-risk populations, investing in and leveraging innovative diagnostic technologies, India will continue to improve TB detection rates, reduce delays, and enhance treatment outcomes. One is confident that we will defeat this enemy and provide a healthier future for all.
Randeep Guleria is a pulmonologist and former director, AIIMS. The views are personal
