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India has made significant strides in tuberculosis (TB) care, exemplified by a 17.7% reduction in TB incidence from 237 to 195 per lakh population between 2015 and 2023. This progress reflects a comprehensive approach incorporating rapid molecular testing, new drug regimens, enhanced nutritional support, and community engagement. However, to achieve universal health coverage (UHC) and eliminate TB by 2025, as targeted by the National Tuberculosis Elimination Programme (NTEP), further integration and decentralization of services are crucial.

Key Developments in TB Care

India’s efforts to combat TB have included the roll-out of the BPaLM regimen (a combination of four drugs: Bedaquiline, Pretomanid, Linezolid, and Moxifloxacin), which shortens the treatment period for drug-resistant TB.

Additionally, the Ni-kshayPoshan Yojana (NPY), which provides nutritional support of ?1,000 per month to TB patients, addresses the need for holistic care. Community participation has also been enhanced through the inclusion of TB survivors as “TB champions,” promoting awareness and treatment adherence at the grassroots level.

Furthermore, TB care has been integrated into the Ayushman Bharat scheme, ensuring that TB services are available through the Pradhan Mantri Jan Arogya Yojana (PMJAY) and Ayushman Arogya Mandirs (AAMs), which offer comprehensive primary health care across India. These efforts aim to decentralize TB care, ensuring that treatment is accessible at the community level, reducing delays in diagnosis, and minimizing out-of-pocket expenses for patients.

Challenges to Achieving Equitable TB Care

Despite these advancements, challenges persist. Over 50% of TB patients seek treatment in the private sector, where standards are inconsistent, leading to delays and higher costs. The private sector’s underreporting further complicates the efforts to ensure complete coverage and comprehensive care. Additionally, barriers such as gender, caste, disability, and socio-economic status often affect TB diagnosis and treatment outcomes. These social determinants necessitate a targeted approach to ensure equitable access to care.

TB services in India have largely remained vertical, with distinct TB care pathways separate from general healthcare services. Integrating TB care into the broader public health system is critical for the country’s goal of achieving UHC. Another challenge is the lack of integrated care that combines TB treatment with screening for other diseases like chronic obstructive pulmonary disease (COPD), diabetes, and mental health conditions.

Recommendations

India must focus on five key strategies to enhance TB care and achieve UHC:

• Person-Centered Care: Model programs like Tamil Nadu’s KasanoiErappilaThittam, which identifies vulnerable populations and provides tailored care, should be scaled up nationwide.
• Intersectionality: Address the intersection of gender, caste, disability, and socio-economic status to ensure that marginalized groups are not left behind.
• Integrated Care: TB care should be integrated with the broader healthcare system, including screenings for non-communicable diseases (NCDs) and mental health issues, using tools like AI-enabled diagnostics.
• Financial Protection: Expanding social protection measures such as wage-loss schemes, livelihood support, and extended nutritional assistance will reduce financial barriers for TB patients.
• Awareness and Communication: A multi-platform public education campaign similar to the one used during the COVID-19 pandemic is essential to dispel myths, reduce stigma, and promote early detection and treatment.

Conclusion

India’s ambitious goal to eliminate TB by 2025, ahead of the global target, is a crucial step toward achieving UHC. By strengthening integrated, person-centered, and equitable care, addressing the social determinants of health, and promoting community-driven initiatives, India can lead the global fight against TB and set a benchmark for future health interventions.