•  TB disease burden in India

The National Tuberculosis Elimination Programme (NTEP) reclaimed these numbers. Accordingly,2021 witnessed a 19% increase from the previous year in TB patients’ notification—the total number of incident TB patients (new and relapse) notified during 2021 were 19,33,381as opposed to that of 16,28,161 in 2020. In2021, the vision of the National Strategic Plan for Elimination of Tuberculosis (NSP 2017-25) permeated to state and district levels yet again to encompass more objectives. Eighteen States have committed to Ending TB by 2025 by formally implementing State specific Strategic Plans and have gone a step ahead to devise a District-specific Strategic Plan, which shall serve as a guiding tool for the program managers and staff at the district and sub-district level toward the elimination of Tuberculosis.

•  TB diagnosis services and active cases finding

80 laboratories are equipped to support liquid culture systems. Of these, 60 are certified for First-Line Liquid Culture Drug Susceptibility Testing (FL LCDST), and 49 are certified for Second-Line Liquid Culture Drug Susceptibility Testing (SL LCDST). Moreover, Liquid culture-based DST has been expanded to include Linezolid and Pyrazinamide. Concerning Line Probe Assay (LPA), 74 Laboratories are certified for First-Line LPA, and out of these, 61 are additionally certified for Second-Line LPA.

Early identification of people with a high probability of having active TB is crucial for breaking the chain of transmission. To achieve that, it is imperative to reach the unreached and targeted groups through Active case finding (ACF) for early detection of TB cases and initiating treatment promptly. ACF has been systematically conducted across all the States/UTs in India since 2017. A special campaign was introduced in January 2021 for active case finding among risk groups: diabetes, chronic kidney and liver disease, patients on immunosuppressants, etc. In addition, to mitigate the impact of COVID-19 on TB services, a special ACF drive was launched to screen influenza-like illness (ILI) and severe acute respiratory infections (SARI) cases for TB.

• Treatment services

The NTEP has been agile in adopting and adapting newer drugs and treatment modalities. In recent years, the country has made far-reaching progress in managing TB. The program has decentralized TB services to the Ayushman Bharat – Health and Wellness Centres (AB-HWC). The “Guidelines for Programmatic Management of Drug-resistant TB (PMDT) in India - 2021”

•  TB Prevention

‘Prevent’ is one of the four critical pillars (Detect – Treat – Prevent – Build) of India’s National Strategic Plan for Elimination of Tuberculosis (NSP 2017-25) that focuses on preventing the emergence of TB in a vulnerable population. The program has offered TB Preventive Therapy (TPT) for more than a decade,

• TB comorbidities and special situations

Comorbidities like malnutrition, diabetes, HIV, tobacco smoking, and alcohol impact a person with TB in predisposition and severity. To combat these, the program brought in a multitude of initiatives program collaborated with the Ministry of Women and Child Development (MoWCD). To support

the NTEP’s objective of successful treatment and improved nutritional status among TB patients, the program, and the MoWCD have ensured the holistic development of women and children by providing additional nutrition support to TB patients.

•  Advocacy, Communication, and Community Engagement

Since its inception, Advocacy, Communication, and Community Engagement (ACSM) have bolstered the program’s foundation by solidifying the measures across all aspects of TB care. 2021 was punctuated by the highest political commitment towards TB Mukt Bharat Abhiyaan by Hon’ble Governors at the 51st Conference of Governors chaired by the President of India.

• Support and monitoring

A nationwide Joint Supportive Supervision Mission (JSSM) was conducted across 34 States/UTs. Two districts (each with high and low TB Index scores) were selected from each State/UT for the JSSM. The team provided extensive recommendations to the state officials for solidifying the TB response. Furthermore, the program division is strengthening the Ni-kshay portal by incorporating advanced analytical tools to provide regular feedback to the States on important indicators.

•  Partnership for the private sector engagement

The program has established a National Technical Support Unit at the central level to strengthen the private sector and inter-sectoral engagement. Likewise, Multi-disciplinary Technical Support Units have been formed in nine high-priority States, contributing to more than 75% of National TB notifications.

• Health Financing

The Programme Implementation Plan (PIP) of NTEP is an integral part of the NHM. The NTEP has constantly been evolving, buttressing innovations, and reinforcing strategies at all levels—mandatory notification of all TB cases, integration of the program with the general health services, expansion of diagnostics services, amplifying the Nikshay ecosystem, provision of DBT, employing newer treatment modalities, scaling up of DRTB management and last-mile support.