India’s Battle Against Tuberculosis: A Race Against Time
India’s Battle Against Tuberculosis: A Race Against Time
Tuberculosis (TB) remains one of the gravest public health challenges in India, despite decades of policy interventions and medical advancements. Accounting for nearly 28% of the global TB burden, India faces a critical task ahead — the elimination of TB by 2025, five years ahead of the global target set by the World Health Organization (WHO). While progress has been made in expanding access to free diagnosis and treatment, a combination of rising drug-resistant strains, uneven healthcare delivery, and social stigma continues to hinder the nation’s mission.
What is Tuberculosis and How Does It Spread?
Tuberculosis is a communicable disease caused by the bacterium Mycobacterium tuberculosis. While it most frequently targets the lungs (pulmonary TB), it can also affect other parts of the body such as the spine, lymph nodes, kidneys, and even the brain, leading to what is known as extrapulmonary TB. TB spreads through the air, primarily when an infected person expels bacteria by coughing, sneezing, or speaking. Prolonged exposure in closed, poorly ventilated environments increases the risk of transmission.
There are three main forms of TB: Latent TB, where the infection remains dormant and non-contagious; Active TB, where symptoms appear and the disease can spread; and Pulmonary TB, the most infectious form. Symptoms typically include chronic cough, weight loss, night sweats, fever, and fatigue. Importantly, someone with latent TB may not exhibit symptoms but can develop active disease if their immune system weakens.
India’s Alarming TB Burden and the 2025 Goal
India reports the highest number of TB cases globally, with millions affected each year. Despite government reports indicating a slow decline in incidence rates, the sheer scale of the disease makes its elimination a monumental task. According to the India TB Report 2024, over 24 lakh (2.4 million) cases were notified, a sign of improved surveillance but also a reflection of the disease’s persistence.
India’s elimination strategy, declared in 2018, involves reducing TB incidence to less than one case per lakh population by 2025. This ambition, however, is met with numerous obstacles, not least of which are drug-resistant TB variants such as MDR-TB (Multi-Drug Resistant TB) and XDR-TB (Extensively Drug-Resistant TB). These variants do not respond to conventional drug regimens and require longer, more toxic treatments with lower success rates.
Government Measures: From Diagnosis to Digital Solutions
The Government of India has ramped up efforts through the National TB Elimination Programme (NTEP). Key measures include:
- Introduction of the BPaL regimen: A novel treatment for drug-resistant TB, combining Bedaquiline, Pretomanid, and Linezolid. This drastically shortens therapy duration from 18–24 months to just 6 months for eligible patients.
- Nutritional support under Nikshay Poshan Yojana: TB patients receive ₹500 per month for the duration of their treatment, aiming to tackle malnutrition, a known co-factor for TB progression.
- Digital platforms like Ni-kshay: These help monitor patient adherence, treatment outcomes, and track case notifications. Ni-kshay Mitras, under the Prime Minister’s TB Mukt Bharat Abhiyaan, allows citizens to adopt TB patients and support them nutritionally and emotionally.
- Awareness campaigns: Initiatives such as TB Harega Desh Jeetega seek to reduce stigma, encourage early diagnosis, and engage communities.
- Universal access to free care: Diagnostic tools like CB-NAAT (Cartridge-Based Nucleic Acid Amplification Test) and Line Probe Assays are being decentralized to make early and accurate detection accessible in remote areas.
The Challenge of Drug Resistance and Diagnosis
Perhaps the most daunting threat in India’s TB control journey is the rise of drug-resistant TB. Inadequate treatment adherence, incorrect prescriptions in the private sector, and self-medication have contributed to an alarming increase in MDR and XDR cases. These variants require expensive second-line drugs and intensive monitoring, with treatment success rates hovering around 50–60%.
Additionally, diagnostic delays remain a concern, particularly in rural and tribal regions. Many patients remain undiagnosed for weeks or even months, allowing the disease to spread unchecked. Lack of access to sophisticated testing facilities and trained personnel in Primary Health Centres (PHCs) creates further delays.
The co-morbidity factor also complicates TB treatment. Conditions like HIV, diabetes, undernutrition, and alcoholism increase susceptibility and worsen outcomes. According to recent studies, TB patients with diabetes face nearly double the risk of death during treatment compared to non-diabetic patients.
Societal Barriers: Stigma, Awareness, and Poverty
While medical infrastructure can be scaled, changing social attitudes is a slower process. TB patients often face discrimination in the workplace, educational institutions, and even within families. The fear of social exclusion causes many to delay or avoid seeking treatment altogether. In particular, women in low-income households may suffer silently, hiding symptoms due to fear of domestic repercussions.
Awareness levels in many rural and semi-urban areas remain dangerously low. Despite national advertising campaigns, myths about TB transmission and treatment still persist. For example, some communities believe TB is hereditary or caused by “cold weather” rather than a bacterial infection.
Moreover, poverty and malnutrition are both causes and consequences of TB. Many patients are daily-wage earners who cannot afford to take time off work for diagnosis or treatment. Without nutritional support and financial incentives, treatment adherence is jeopardized.
Partnerships with the Private Sector
India’s fragmented healthcare system means that nearly 50% of TB patients first consult private practitioners. However, private sector engagement in TB notification and standardized treatment remains inconsistent. In recent years, steps have been taken to bridge this gap:
- Mandatory TB case notification by private hospitals and clinics.
- Public-Private Mix (PPM) model: Encouraging private providers to align with NTEP guidelines for diagnosis and care.
- Incentivization schemes: Financial support to private doctors for notifying TB cases and initiating treatment under government protocols.
If scaled effectively, such collaborations can bring a significant proportion of unreported cases into the national database and ensure timely, quality treatment.
Strengthening the Path Ahead
To meet the 2025 elimination target, India must take a multi-pronged approach:
- Expand rapid diagnostic tools like CB-NAAT, Truenat, and digital chest X-rays across PHCs and CHCs.
- Improve contact tracing and initiate preventive therapy for high-risk groups.
- Enhance training for health workers and lab technicians to reduce diagnostic errors.
- Integrate TB and non-TB services to manage co-morbidities like HIV and diabetes under one roof.
- Strengthen supply chains to avoid drug shortages, especially for second-line treatment.
- Foster community ownership by empowering TB survivors as advocates and peer counselors.
Conclusion: Toward a TB-Free India
While India’s commitment to eradicating tuberculosis by 2025 is laudable, success will require much more than policy declarations. It demands investment in diagnostics, drug development, and healthcare delivery systems, especially in under-served regions. Equally crucial is the fight against social stigma, without which even the best medical tools will fall short.
With the right mix of political will, technological innovation, grassroots mobilization, and international collaboration, India can indeed turn its TB crisis into a story of resilience and public health transformation. The road is steep, but the destination — a TB-free India is within reach if the country accelerates its efforts in the remaining years.