Health Ministry reworks protocol as India’s TB elimination drive plateaus

India's struggle to eliminate tuberculosis by 2025 faces challenges due to high incidence, mortality, and missing cases.

India’s goal to achieve rapid decline in the burden of tuberculosis (TB) morbidity and mortality, while working towards the elimination of TB in the country by 2025, has plateaued, a senior Health Ministry official said. The Indian Council of Medical Research (ICMR) is looking at reworking the protocol, the official added, specifically TB medication and its duration, to reboot the TB-free initiative with zero deaths, disease, and poverty resulting from the disease.

According to the Health Ministry, India has been engaged in TB control activities for more than 50 years, yet the disease continues to be the country’s severest health crisis.

TB kills an estimated 480,000 Indians every year or over 1,400 patients every day. Additionally, the country also has more than a million ‘missing’ TB cases annually, which are not notified. Most remain either undiagnosed, or unaccountably and inadequately diagnosed and treated in the private sector.

“We are sure that this tragic loss of life, and continued suffering and poverty, needs to end. There are several new technologies which help in early detection and we are also better prepared to address TB. We now have advanced and effective interventions and technologies for diagnosis, treatment and care of TB,’’ the official said.

India has mandated the notification of all TB cases, and has integrated TB programmes with general health services under the National Health Mission. Alongside, there has been an expansion of diagnostic services, service expansion in programmatic management of drug-resistant TB (PMDT), single-window service for TB-HIV cases, national drug resistance surveillance, and the revision of partnership guidelines.

The Health Ministry, however, maintains there is a need to recognise that more needs to be done to drastically reduce the incidence of TB in India. It added that although India has managed to scale up basic TB services in the public health system, treating more than 10 million TB patients under the Revised National TB Control Programme (RNTCP), the rate of decline is too slow to meet the 2030 Sustainable Development Goals (SDG) and 2035 End TB targets.

“New, comprehensively-deployed interventions are required to hasten the rate of decline of incidence of TB many fold, to more than 10-15% annually. The requirements for moving towards TB elimination have been integrated into the four strategic pillars of ‘Detect – Treat – Prevent – Build’ (DTPB),’’ the Ministry said in its report on the National Strategic Plan for TB Elimination 2017-2025.