Tuberculosis in India

Tuberculosis is one of India's major public health problems. According to World Health Organization (WHO) estimates, India has the world's largest tuberculosis epidemic. In 2020, India accounted for 26% of the incident TB cases across the globe. India has incidence rate of 192 cases per 100,000 of population. India accounted for 38% of global TB deaths among HIV-negative people and for 34% of the combined total number of TB deaths in HIV-negative and HIV-positive people. Further in 2020, India accounted for 24% of global gap between estimated TB incidence and the number of people newly diagnosed with TB and reported. Many research studies have investigated the effects and consequences of TDR-TB, especially in India, where social and economic development is still in progress. A report by Zarir Udwadia, originating from studies at the Hinduja Hospital in Mumbai, discusses the drug-resistant effects and results. An experiment was conducted in January 2012 on four patients to test how resistant and unique the "new category" of TDR-TB is. These patients were given all the first-line drugs and second-line drugs that usually are prescribed to treat tuberculosis, and were resistant to all. As a response, the government of India appeared to stay in denial, while the WHO decided that although patterns of drug-resistance were evident, there was insufficient evidence to create a new category of TDR-TB from these results. Compared to India, Canada has about 1,600 new cases of TB every year. Citing studies of TB-drug sales, the government of India now suggests the total has gone from being 2.2 million to 2.6 million people nationwide. On March 24, 2019, TB Day, the Ministry of Health & Family Welfare of India notified that 2.15 million new tuberculosis patients were discovered only in 2018. In India, tuberculosis is responsible for the death of every third AIDS patient. Moreover, India accounts for about a quarter of the global tuberculosis burden. ==Cause and symptoms==

The bacterium that causes TB is called mycobacterium tuberculosis. A person can unknowingly acquire this bacteria and have it lie dormant within them, a condition known as inactive tuberculosis. Active tuberculosis begins when the bacteria starts developing, and the signs and symptoms begin to be visible. Although the TB bacteria can infect any organ (e.g., kidney, lymph nodes, bones, joints) in the body, the disease commonly occurs in the lungs. Around 80% of all TB cases are related to pulmonary or lung. Common symptoms include: coughing (that lasts longer than 3 weeks with green, yellow, or bloody sputum), weight loss, fatigue, fever, night sweats, chills, chest pain, shortness of breath, and loss of appetite. ==Additional causes==

'' Susceptibility to tuberculosis is heightened by a weak immune system. That is why babies, children, and senior adults have a higher risk of developing TB. clearly falls into this category. Socioeconomic Dimensions of TB Local decreases in the incidence of tuberculosis in India correlate with improvements in social and economic determinants of health more than with access to quality treatment. In India, pollution is widespread throughout the country. Pollution causes many effects in the air that people breathe, and since TB can be passed from person to person through the air, the chances of catching TB remain high in many parts of India. Lack of infrastructure Another major cause for the growth of TB in India has to do with its standing as a developing country. A study of Delhi slums has shown that lower scores on the Human Development Index and high proportions of one-room dwellings tend to correlate with TB at higher rates. Poorly built environments, including hazards in the workplace, poor ventilation, and overcrowded homes have also been found to increase exposure to TB. "It is estimated that just 16% of patients with drug-resistant TB are receiving appropriate treatment". To combat this huge problem, India has begun a new program to try to provide free drugs to all those infected in the country. Because the majority of TB cases are treated by private providers, and because the majority of poor people access informal (private) providers, the RNTCP's goals for universal access to TB care may have difficulty being met. Indeed, addressing these factors may have a stronger correlation with decreased TB incidence than removing the financial burdens associated with care. Yet, the RNTCP's treatment protocols do not address these social determinants of health. ==Treatment==

Although tuberculosis is on the rise in India, treatment for it is also on the rise. To prevent spreading TB, it is important to get help quickly and to follow the treatment from your doctor through to completion. This can stop transmission of the bacteria and the appearance of antibiotic-resistant strains. Bacterial infections like tuberculosis require antibiotics for treatment and prevention; thus, commonly, you will see that patients diagnosed with tuberculosis have certain pills and antibiotics carried around with them. The antibiotics most commonly used include isoniazid, rifampin, pyrazinamide, and ethambutol.The treatment under the National TB Elimination Program (NTEP) in India consists of a 2 (HRZE)/4(HRE) anti-TB regime wherein INH, Rifampicin, Pyrazinamide, and ethambutol are given for an initial two months(intensive phase) followed by four months of INH, Rifampicin and Ethambutol. This treatment is a daily Fixed-dose combination-based treatment regime. It is crucial for a patient to take the medication that their doctor prescribes and to continue taking it for the full course of the treatment (which may last for months or even years). This will help to ward off types of TB bacteria that are antibiotic-resistant, which take longer and are more difficult to treat. However, recently there has been a significant improvement in TB healthcare services in the public sector. The National TB Elimination Program (NTEP) in India has broadened its spectrum, in addition to providing free diagnostic and treatment services for drug sensitive as well as drug resistant forms of tuberculosis. The program is currently also targeting the TB Preventive therapy in vulnerable population with TB infection, who are at an increased risk of progressing to active TB disease. Scope of Services under NTEP The National TB Elimination Programme (NTEP) provides a comprehensive framework for TB care in India. Its scope includes early diagnosis of TB patients, prompt treatment with quality‑assured drugs and regimens, and systematic engagement with patients seeking care in the private sector. Preventive strategies such as contact tracing in high‑risk populations, airborne infection control, and a multi‑sectoral response to address social determinants of health are integral components of the programme. Achievements under NTEP The programme has achieved significant milestones in TB control. India developed a nationally customized mathematical model for TB burden estimation, supported by WHO and national experts, to provide incidence and mortality estimates at both national and state levels. The *Pradhan Mantri TB Mukt Bharat Abhiyaan* launched in 2022 mobilized over 1.6 lakh Nikshay Mitras linked to more than 11 lakh TB patients, with nearly 18 lakh support kits distributed. Case notifications have steadily increased, with 25.5 lakh TB patients reported in 2023, including a seven‑fold rise in private sector notifications over the past eight years. Diagnostic infrastructure has expanded to over 24,500 microscopy centres and nearly 6,500 molecular laboratories. Treatment success rates have consistently remained above 80%, reaching 87.6% in 2023. Preventive services, nutritional support through the *Nikshay Poshan Yojana*, and active case finding in vulnerable populations have further strengthened TB control. Additionally, medical colleges, task force mechanisms, and sub‑national certification initiatives have enhanced research, advocacy, and monitoring of TB elimination efforts. ==Non-Programmatic Treatment of TB in India==

In India, an estimated 70–80% of tuberculosis (TB) patients initially seek care in the private sector, where diagnostic and treatment services are often suboptimal and require improvement. Historical research has consistently highlighted challenges with standardized care in non-programmatic settings. A landmark 1991 study by Uplekar et al. found that 100 private practitioners in the slums of Mumbai prescribed 80 different treatment regimens, the majority of which were clinically inappropriate and expensive. A follow-up study two decades later by Udwadia et al. (2010) revealed that the situation remained largely unchanged; among 106 practitioners, 63 different drug regimens were recorded, with only six respondents providing a prescription that adhered to the established standard of care. More recently, the PRAMAN India study—the first meta-analysis of anti-tuberculosis prescription practices in non-programmatic settings across India (1990–2024)—was presented at the 2026 Asia-Pacific Region Conference (APRC) of the IUTALD, confirming that non-standardized regimens with significant clinical errors have persisted in the private sector for over three decades. The study reported that approximately one in two anti-tuberculosis prescriptions in non-programmatic settings were inappropriate, corresponding to an estimated 2–3 million faulty prescriptions annually in India, or roughly four to five per minute. ==History==

India's response to TB has changed with time and with the increasing sophistication of technology. Responses to TB have evolved, from pre-independence through post-independence to the current WHO-assisted period. Following Independence, the Indian government established various regional and national TB reduction programmes. "In 2010 the RNTCP made a major policy decision that it would change focus and adopt the concept of Universal Access to quality diagnosis and TB treatment for all TB patients". By doing so, they offered a helping hand to all people diagnosed with TB, by providing better quality services and improvement in therapy for these patients. The contemporary response to TB includes India's participation and leadership in global TB reduction and elimination programs. Treatment recommendations from Udwadia, et al. suggest that patients with TDR-TB only be treated "within the confines of government-sanctioned DOTS-Plus Programs to prevent the emergence of this untreatable form of tuberculosis". Given this conclusion by Udawadai, et al., it is considered certain, as of 2012, that the new Indian government program will insist on providing drugs free of charge to TB patients of India, for the first time ever. ==Society and culture==

Organizations The Tuberculosis Association of India is a voluntary organization that was set up in February 1939. It is affiliated to the government of India and is working with the TB Delhi center. Laboratories The Revised National Tuberculosis Control Program (RNTCP) has established a network of laboratories where TB tests can be done for purposes of diagnosis and to determine whether a person has drug-resistant TB. The laboratory system comprises the National Reference Laboratories (NRLs), state level Intermediate Reference Laboratories (IRLs), Culture & Drug Susceptibility Testing (C & DST) laboratories and Designated Microscopy Centres (DMCs). Some private laboratories are also accredited as Culture & Drug Susceptibility Testing laboratories for tuberculosis (i.e. Microcare Laboratory & tuberculosis Research Centre, Surat) Stigma Disempowerment and stigma are often experienced by TB patients as they are disproportionately impoverished or socially marginalized. The DOTS treatment regimen of the RNTCP is thought to deepen this sentiment, as its close monitoring of patients can lead to stigma. To counteract disempowerment, some countries have engaged patients in the process of implementing the DOTS and in creating other treatment regimens that give more attention to their nonclinical needs. This knowledge can complement the clinical care provided by the DOTS. Pro-poor strategies, including wage compensation for time lost to treatment, working with civil society organizations to link low income patients to social services, nutritional support, and offering local NGOs and committees a platform for engagement with the work done by private providers may reduce the burden of TB and lead to greater patient autonomy. Economics Some legal advocates have argued that public interest litigation in India must be part of the TB response strategy to ensure that available resources actually fund the necessary health response. India has a large burden of the world's TB, with an estimated economic cost of US$100 million lost annually due to this disease. Special populations How Scheduled Tribes and other Adivasi are coping with TB highlights a lack of research and understanding of the health of this demographic. There is a belief that this community is more vulnerable and has less access to treatment, but details are lacking on how TB affects tribal communities. ==References==