TB-free India

TB-Free India, the Fight Against Tuberculosis: Read here to learn about the progress, persistent challenges and the road to elimination

According to the World Health Organization’s (WHO) Global Tuberculosis Report 2025, India recorded a 21% decline in tuberculosis (TB) incidence between 2015 and 2024, compared with a global decline of approximately 12%. India’s estimated incidence rate fell from 237 to 187 cases per lakh population, while treatment coverage increased from 53% to 92%. However, India continued to account for approximately one-fourth of the global TB burden in 2024.

To accelerate progress, the government is strengthening the National Tuberculosis Elimination Programme (NTEP), expanding technology-enabled screening and preventive treatment, and mobilising communities through the TB Mukt Bharat Abhiyaan. The JOSH (Joint Squad for Health) initiative, launched nationally in October 2026, seeks to harness youth participation in early detection, treatment adherence and stigma reduction.

What is Tuberculosis?

Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. It primarily affects the lungs but can also affect the brain, kidneys, bones, spine and other organs.

• Transmission: TB spreads through the air when a person with infectious pulmonary or laryngeal TB releases bacteria while coughing, speaking or sneezing, particularly in poorly ventilated spaces. It does not ordinarily spread through handshakes, sharing food or utensils, or using public toilets.
• Latent TB infection: The bacteria remain in the body without causing active disease or making the person infectious. Infection may progress to active Tuberculosis, particularly in people with weakened immunity.
• Symptoms: Persistent cough, fever, night sweats, chest pain, fatigue and unexplained weight loss are common symptoms. Extrapulmonary Tuberculosis may produce symptoms specific to the affected organ.
• Risk factors: Undernutrition, diabetes, HIV infection, tobacco use, overcrowded housing and poor ventilation increase the risk of developing or transmitting TB.
• Prevention and treatment: Tuberculosis is preventable and curable with appropriate antibiotic regimens. The BCG vaccine protects children against severe forms of TB, although it does not provide complete protection against all forms of the disease.

India’s Progress in TB Control

The WHO report highlights improvements in case detection and treatment coverage, reflecting stronger surveillance, diagnostic access and programme implementation.

Nevertheless, progress must be assessed against both the number of people developing Tuberculosis and the number who are diagnosed, treated successfully and protected against recurrence.

Key developments include:

• Declining incidence: Estimated incidence fell from 237 to 187 cases per lakh population between 2015 and 2024.
• Improved treatment coverage: Coverage rose to 92% in 2024, indicating that a substantially larger proportion of estimated cases were being diagnosed and treated.
• Wider case detection: India reported more than 26 lakh TB patients in 2024, reflecting expanded screening and notification.
• Better treatment outcomes: Government reporting placed the treatment success rate under the TB Mukt Bharat Abhiyaan at around 90%.

Despite these gains, the high absolute burden means that even a moderate decline in incidence leaves millions vulnerable to disease, household financial hardship and premature death.

Government Initiatives for TB-free India

1. National Tuberculosis Elimination Programme (NTEP)

The Revised National Tuberculosis Control Programme was renamed the National Tuberculosis Elimination Programme in 2020. Its strategic approach is organised around four pillars: Detect, Treat, Prevent and Build.

• Detect: Expand early diagnosis through community screening, contact tracing and rapid molecular tests.
• Treat: Ensure prompt, quality-assured treatment for drug-sensitive and drug-resistant TB.
• Prevent: Provide TB preventive treatment to eligible household contacts and other high-risk groups.
• Build: Strengthen public health infrastructure, surveillance, private-sector engagement and community participation.

The programme also works with private healthcare providers to improve case notification, treatment continuity and access to quality care.

India set a national ambition to eliminate TB by 2025, ahead of the global 2030 target. However, the 2025 deadline was not achieved; sustained efforts are required to close the remaining gap.

2. Pradhan Mantri TB Mukt Bharat Abhiyaan

• Launched on 9 September 2022, the campaign seeks to transform TB elimination into a Jan Andolan, or people’s movement.
• It encourages participation by civil society, elected representatives, voluntary organisations, corporations and individuals.
• The campaign emphasises patient support, awareness, nutritional assistance and the reduction of stigma associated with TB.

3. Ni-kshay Poshan Yojana and Ni-kshay Mitra

Undernutrition is both a risk factor for TB and a consequence of the disease. Nutritional support is therefore essential to improving recovery and treatment outcomes.

• Ni-kshay Poshan Yojana: Provides eligible notified TB patients with financial assistance for nutritional support through Direct Benefit Transfer. The monthly assistance was increased to ₹1,000 in November 2024.
• Ni-kshay Mitra initiative: Enables individuals, organisations, companies and community groups to provide supplementary nutritional, psychosocial and other support to TB patients.

These initiatives recognise that completing treatment can be difficult when patients face lost wages, food insecurity, transport costs and social exclusion.

4. 100-Day TB Mukt Bharat Abhiyaan

• Launched on 7 December 2024, the 100-day campaign initially targeted 347 high-priority districts across 33 States and Union Territories.
• It focused on identifying vulnerable populations, expanding screening and diagnosing cases earlier.
• Its approach combined government departments, local representatives, healthcare workers and community organisations.
• Subsequent expansion of screening efforts has sought to reach people who might otherwise remain undiagnosed, including those with few or no obvious symptoms.

5. JOSH: Joint Squad for Health

Launched nationally in October 2026, JOSH aims to strengthen grassroots participation in TB elimination. The initiative brings together MY Bharat volunteers, National Cadet Corps cadets and designated government officers.

Its objectives include:

• Raising awareness of TB symptoms and available services.
• Encouraging timely screening and diagnosis.
• Supporting treatment adherence and follow-up.
• Challenging stigma and misinformation.
• Mobilising young people as community health advocates.

JOSH reflects the principle that TB elimination requires sustained public participation alongside medical and administrative interventions.

Technological and Treatment Innovations

1. Rapid molecular diagnostics

• Technologies such as CBNAAT and Truenat can detect TB and, where supported by the test, identify drug resistance more rapidly than conventional diagnostic pathways.
• Expanded access to molecular testing can reduce diagnostic delays and help patients receive appropriate treatment earlier.
• Culture and drug-susceptibility testing remain important for confirming resistance patterns and guiding treatment where necessary.

2. Artificial intelligence in screening

• AI-enabled chest X-ray systems can help identify people who require further diagnostic evaluation, especially in areas with limited access to radiologists.
• Handheld X-ray devices can support screening in remote communities and high-risk settings.
• AI-assisted tools can improve the reach and efficiency of screening, but they are not substitutes for confirmatory testing, clinical assessment or appropriate medical supervision.

3. Digital monitoring through Ni-kshay

• The Ni-kshay platform supports TB case notification, patient tracking, programme monitoring and delivery of financial assistance.
• Digital systems can help identify missed follow-ups and strengthen coordination between health workers and treatment facilities.
• Their effectiveness depends on reliable data, patient privacy, digital accessibility and timely action by healthcare personnel.

4. Shorter treatment for drug-resistant TB

• Drug-resistant TB is more difficult and expensive to treat and can require prolonged, complex treatment.
• The BPaLM regimen, bedaquiline, pretomanid, linezolid and moxifloxacin, offers an approximately six-month treatment option for eligible patients with multidrug-resistant or rifampicin-resistant TB.
• The regimen must be prescribed according to clinical and drug-susceptibility criteria.
• Continued monitoring is necessary to manage adverse effects, assess response and prevent the development of further resistance.

5. TB preventive treatment

• Preventive treatment can reduce the risk of latent TB infection progressing to active disease.
• Eligible household contacts, children and people living with HIV are important groups for assessment.
• Preventive treatment should be supported by appropriate screening to rule out active TB and by follow-up to ensure completion.

What Challenges Remain?

1. A high absolute disease burden

• Although incidence has declined, India remains the country with the largest share of global TB cases.
• The scale of the epidemic requires sustained investment in diagnosis, treatment, prevention and surveillance.

2. Undernutrition and poverty

• Undernutrition weakens immunity, while TB can cause further weight loss and reduce a patient’s ability to work.
• Lost wages, travel expenses and caregiving responsibilities may discourage patients from continuing treatment.
• Cash transfers and food support are important, but their impact depends on adequacy, timely delivery and local availability of nutritious food.

3. Delayed diagnosis and missed cases

• People may delay seeking care because of stigma, financial barriers, limited awareness or geographical distance.
• Some patients are diagnosed in the private sector but may not be promptly notified or linked to the public programme.
• Children, older adults and people with extrapulmonary TB may face additional diagnostic challenges.

4. Drug resistance and treatment adherence

• Incorrect, interrupted or incomplete treatment can contribute to poor outcomes and drug resistance.
• Adverse effects, lengthy treatment, weak follow-up and financial insecurity can make adherence difficult.
• Access to drug-susceptibility testing and patient-centred support is essential to reducing treatment failure.

5. Stigma and discrimination

• Fear of isolation, loss of employment or rejection by family and community can prevent people from seeking diagnosis or disclosing their condition.
• Awareness campaigns must therefore be accompanied by confidentiality, non-discrimination and practical support.

6. Health-system and technology gaps

• Diagnostic facilities, trained staff and reliable treatment services are not equally accessible everywhere.
• AI-enabled screening can identify potential cases, but insufficient confirmatory testing capacity may delay diagnosis.
• Digital systems also need safeguards against data misuse and exclusion of people with limited digital access.

Way Forward

• Strengthen early and targeted detection: Combine community outreach, contact investigation, risk-based screening and rapid molecular diagnostics, with particular attention to underserved populations.
• Integrate TB care with nutrition and social protection: Improve the timeliness and adequacy of nutritional assistance, link patients to relevant welfare schemes, and reduce out-of-pocket expenditure and income loss.
• Expand prevention: Systematically assess eligible contacts for TB infection and preventive treatment, while improving ventilation and infection-control practices in healthcare facilities, workplaces and crowded indoor settings.
• Improve drug-resistant TB care: Ensure access to drug-susceptibility testing, appropriate shorter regimens where eligible, adverse-effect monitoring and uninterrupted supplies of quality-assured medicines.
• Use technology responsibly: Expand AI-assisted screening and digital case management while ensuring confirmatory diagnosis, human oversight, data protection and equitable access.
• Make communities partners in care: Strengthen initiatives such as Ni-kshay Mitra and JOSH, involve local bodies and frontline workers, and promote accurate information to reduce stigma.
• Improve accountability: Track not only screening numbers and notifications but also diagnostic delays, treatment completion, recurrence, mortality, patient costs and outcomes among vulnerable groups. Independent evaluation can help identify gaps and direct resources where they are most needed.

Conclusion

India’s reduction in Tuberculosis incidence and improvement in treatment coverage demonstrate the value of sustained public investment, expanded diagnostics and community mobilisation. Yet the country’s large share of global cases underlines that progress must translate into fewer infections, earlier diagnosis, successful treatment and reduced mortality.

A TB-free India will require more than medical interventions. It depends on addressing undernutrition and poverty, protecting patients from discrimination, preventing drug resistance and ensuring that every person can access timely, quality-assured care.

The path forward lies in combining scientific innovation, strong public health systems and community participation to make TB elimination a durable national achievement.