How India is advancing towards United Nations' TB elimination goal by 2030

India has made notable progress under the National TB Elimination Programme. However, given TB's complexity and its deep connection to social factors, a longer, more sustained effort will be essential

World TB Day is observed every year on March 24 to raise awareness about Tuberculosis and its global impact. This article examines India's progress towards the United Nations' Sustainable Development Goals (SDGs), which include ending the TB epidemic by 2030. The 2015 End TB targets aim for a 90 per cent reduction in incidence, a 95 per cent reduction in mortality, and zero catastrophic costs. 

 

According to the Global TB Report 2024, there are growing concerns that the above-mentioned targets are unlikely to be met by 2030. Despite significant advances, TB diagnostics remain relatively complex and difficult to deploy in the field, and TB drug regimens are complex and often require patient monitoring. There are serious concerns related to undiagnosed TB cases, lack of health care infrastructure, inequities in access to TB services and drug-resistant TB.

 

  It’s important to look at India’s progress in light of the concerns raised in the Global TB Report. One key indicator is TB Treatment Coverage, which shows the percentage of newly diagnosed TB cases compared to the estimated total cases for the year. The global target for treatment coverage by 2027 is 90 per cent, and India has already reached 92.4 per cent, which is a positive sign. The Treatment Success Rate in 2022 was 87.6 per cent, against a target of 92 per cent. Since 2017, there has been a tenfold increase in molecular diagnostic testing (NAAT), with a total of 6.832 million tests conducted in 2023.

 

According to the report, India accounts for 26 per cent of the world's TB cases, with a very high TB incidence of 195 cases per 100,000 population. A total of 2.552 million TB cases were reported, missing the target of 2.762 million. These missing cases contribute to the spread, illness, and deaths from TB. Only 21 per cent of suspected TB cases were tested using NAAT, while 79 per cent were tested with microscopy. Microscopy has some limitations, such as lower sensitivity in cases with fewer bacteria (like in HIV-positive patients or children), it cannot detect drug-resistant strains, and it relies on skilled technicians. There’s also a risk of false negatives due to sample quality or staining problems, making it unreliable for accurate diagnosis.

 

In 2023, only 58 per cent of TB patients received drug susceptibility testing (DST), and the treatment success rate for notified drug-resistant patients was just 65 per cent.

 

Now, with this progress, to reach the SDG target of reducing TB incidence to 47 cases per 100,000 population by 2030, India needs to achieve an annual decline of 21 points over the next seven years. The programme has to identify missing cases, which are around 210,000 cases, ensure 98 per cent of TB patients receive DST, ensure a treatment success rate of 92 per cent for notified drug-sensitive patients and 73 per cent for notified drug-resistant patients.

 

Further, in 2023, over 1.563 million people received TB preventive treatment (TPT), and the global target is to provide treatment to 90 per cent among high-risk populations. This number needs to increase by at least 1 million, with the hope of getting around 36,000 new cases as close contacts have roughly 3.6 per cent TB prevalence.

 

Data on the achievement of 100 per cent active case finding for key affected populations is not available. The National TB Elimination Programme (NTEP) recommends three rounds of active case finding, spread over 45 days, to ensure field staff screen all household members. The goal is to screen 110,000 people per million in vulnerable populations and identify 5 per cent of those with TB symptoms through house-to-house screening.

 

Experts say most new TB cases initially come from people unaware of their condition, and in the second stage, TB mainly spreads among high-risk groups and close contacts. Realising this, India’s NTEP must work to bring the TB programme to the primary health care level, i.e., at the level of Ayushman Arogya Mandirs. This would also require stepping out of the verticality of the programme and screening, finding and treating all undiagnosed TB patients by improving vulnerability mapping and active case finding in remote areas, rural locations, and urban slums. It is at this level that the programme would need to have focused interventions, including household contact investigation, scaling up TB preventive treatment, and effective community mobilisation.

 

Ayushman Arogya Mandirs performing these roles should have modern diagnostic tools, trained staff to screen patients, interpret results, and guide them to proper treatment. They would also require smooth referral systems and a continuous supply of medicines. Mobile TB diagnostic vans equipped with sputum microscopy, digital X-ray, and CBNAAT, visiting rural and tribal areas, would add to their performance.

 

The programme needs to focus on engaging the community more actively. The “Ni-kshay Mitra” initiative should be expanded to involve community members and civil society organisations, ensuring real people’s participation. This will help reduce delays in seeking care, improve treatment adherence, support patients’ needs, and assist in tracking TB patients. It will also be a great platform to promote vaccination once available.

 

Further, the areas related to having a sufficient number of trained health care workers, scaling up molecular diagnostics, detecting drug-resistant TB early, ensuring universal drug sensitivity tests, managing HIV/TB co-infection, and providing free daily treatment for all new patients would also need close attention. This also includes expanding access to newer medications and ensuring a treatment success rate of over 90 per cent through digital tracking. The "end of treatment culture" initiative will help confirm full recovery and catch missed cases by using more reliable tests than sputum smears. Strengthening collaboration with the private sector is important to improve diagnostic standards, ensure case notifications, and the free supply of medicines.

 

India has made notable progress under the National TB Elimination Programme, with strong political commitment and consistent funding. The 100-day campaign, launched on 7 December 2024, and set to conclude on 24 March 2025, aims to detect an additional 200,000 TB cases, achieve 90 per cent screening through X-rays, and 90 per cent testing via NAAT, along with full coverage by Ni-kshay Poshan Yojana and Ni-Kshay Mitra. This initiative is a significant step towards closing existing gaps. However, given TB's complexity and its deep connection to social factors, a longer, more sustained effort will be essential. 

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Dr Manohar Agnani is a Public Health professional and retired IAS officer (Additional Secretary, MoHFW, GoI).  Currently, he is Professor, Public Health at Azim Premji University at Bhopal, Madhya Pradesh.

 

(Disclaimer: Views expressed in this article are personal.)