Context

• Tuberculosis (TB) remains a significant public health challenge in India, but substantial progress has been made in its detection, treatment, and prevention.
• Integrating TB services into the broader healthcare system, particularly within the Ayushman Bharat National Health Protection Scheme, has played a crucial role in decentralising TB care.
• However, to accelerate TB elimination and achieve universal health coverage (UHC), India must address key challenges such as inequitable access to healthcare, high out-of-pocket expenditure (OOPE), and the need for integrated care.

Advancements in TB Care and Their Impact

• Improved TB Diagnosis through Molecular Testing
  • One of the most significant advancements in India’s TB response is the expansion of molecular testing.
  • Conventional diagnostic methods, such as sputum smear microscopy, often led to delays in detection and lower sensitivity, resulting in missed cases.
  • However, the rollout of molecular testing platforms, such as CBNAAT (Cartridge-Based Nucleic Acid Amplification Test) and TrueNat, has revolutionised TB diagnosis.
  • Molecular tests detect TB within hours and identify drug-resistant strains, enabling early initiation of appropriate treatment.
  • The government has set up molecular testing laboratories across districts to ensure faster and more accessible diagnosis, even in rural areas.
  • With rapid and accurate diagnosis, patients begin treatment sooner, reducing transmission and improving survival rates.
• Introduction of the Shorter, All-Oral BPaLM Treatment Regimen
  • India has transitioned towards better and shorter TB treatment regimens to improve patient compliance and reduce side effects.
  • Traditionally, TB treatment required long-term, multi-drug therapies, often leading to high dropout rates and the development of drug-resistant TB.
  • The introduction of the all-oral BPaLM (Bedaquiline, Pretomanid, Linezolid, Moxifloxacin) regimen is a major breakthrough in treating multidrug-resistant TB (MDR-TB).
  • Unlike older regimens that lasted 18–24 months, BPaLM reduces treatment to just 6 months, lowering the burden on patients.
  • The regimen eliminates painful injectable drugs that caused severe side effects, such as hearing loss.
  • Patient completes treatment faster, reducing the likelihood of treatment failure and further resistance development.
• Strengthened Nutritional Support through Ni-kshay Poshan Yojana (NPY)
  • Malnutrition is a key risk factor for TB. Many TB patients, particularly from economically weaker sections, struggle to maintain proper nutrition, which affects their immune response and recovery.
  • Under the NPY, the government increased the monthly entitlement from ₹500 to ₹1,000 per patient, helping them access nutritious food.
  • The scheme ensures direct cash transfers to patients’ bank accounts, minimising financial stress.
  • This has resulted in access of proper nutrition which improves immunity, helping TB patients recover faster.
  • With improvement in health, fewer patients drop out of treatment midway.
• Integration of TB Services into Ayushman Bharat
  • India has traditionally delivered TB services through vertical programs, such as the National Tuberculosis Elimination Programme (NTEP).
  • While effective, these programs often operated separately from general healthcare services, leading to gaps in accessibility.
  • Government has integrated TB services into Ayushman Bharat, ensuring that TB diagnosis, treatment, and prevention are part of routine healthcare.
  • Ayushman Arogya Mandirs (AAMs) AAMs serve as sputum collection centres, enabling quick testing.
  • Patients diagnosed at tertiary hospitals can now access treatment at local health centres, reducing travel costs and dropout rates.
  • Community health officers are trained to monitor early-stage TB patients, ensuring timely hospitalization for severe cases.
  • Patients receive seamless care at their nearest health facility, making TB services more accessible and affordable.
  • Reduced financial and logistical barriers encourage early treatment-seeking behaviour.
• Community Involvement and TB Champions
  • Recognising the importance of community support in TB care, India has encouraged TB survivors and Champions to play a larger role in spreading awareness and supporting patients.
  • Survivors share their experiences to encourage patients to adhere to treatment and overcome stigma.
  • NGOs, self-help groups, and health workers actively engage in case-finding, awareness drives, and counselling.
  • It has led to greater awareness and social support for higher treatment adherence, also reduced stigma makes patients more willing to seek care early.

Steps Required to Achieve Equitable TB care

• Strengthening Person-Centred Care
  • Initiatives like Tamil Nadu’s Kasanoi Erappila Thittam (TN-KET), which focuses on identifying and admitting high-risk TB patients, have demonstrated success in reducing TB mortality.
  • Similar targeted interventions should be scaled up nationwide, particularly for vulnerable groups like tribal communities, migrants, and the homeless.
• Recognizing Intersectional Barriers
  • Factors such as gender, socio-economic status, and disability influence healthcare access.
  • The NTEP’s gender-responsive framework is a step forward in addressing these disparities, but further efforts are needed to understand and mitigate the impact of intersectional vulnerabilities on TB outcomes.
• Integrating TB Care with General Health Services
  • Many TB patients suffer from coexisting conditions like chronic obstructive pulmonary disease (COPD) or depression.
  • Implementing AI-enabled chest X-rays for TB and COPD screening, along with routine tests for non-communicable diseases, can improve overall patient health.
• Reducing Financial Burdens on Patients
  • While initiatives like NPY provide financial support, indirect costs such as wage loss during treatment remain high.
  • Expanding social protection measures, such as wage-loss compensation and livelihood programs for TB survivors, can help mitigate these economic challenges.
• Enhancing Public Awareness and Stigma Reduction
  • Misinformation about TB continues to hinder early diagnosis and treatment adherence.
  • Lessons from the COVID-19 pandemic show that large-scale public health communication campaigns can drive awareness and behaviour change.
  • A similar approach is needed to combat TB stigma and improve treatment-seeking behaviour.

Conclusion

• India has made significant strides in TB care, but achieving TB elimination and UHC requires a sustained focus on equity, integration, and financial protection.
• By decentralising TB care, strengthening person-centred approaches, and addressing intersectional vulnerabilities, India can ensure that every TB patient receives high-quality care, regardless of their socio-economic background.
• Applying an equity lens to TB policies will not only accelerate India’s progress but also set global benchmarks in TB elimination efforts.