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The latest data reveals that India’s tuberculosis (TB) incidence has decreased from 237 to 195 cases per 100,000 population between 2015 and 2023—a 17.7% reduction, more than double the global average of 8.3%.
This progress highlights the success of the National TB Elimination Program (NTEP). However, India remains far from its 2025 target of reducing incidence to 10 cases per 100,000 population, five years ahead of the global goal. The high disease burden and other factors continue to pose challenges.
India accounts for 62% of multidrug-resistant TB cases worldwide
Dr. Sushrut Ganpule, Consultant in Chest Medicine at Jupiter Hospital (Pune): India’s significant contribution to the global TB burden. Alongside Russia and China, India accounts for 62% of multidrug-resistant TB (MDR-TB) cases worldwide, bearing 30% of the global TB burden.
“India’s National Strategic Plan (2017–25) aims to reduce TB incidence rapidly, aligning with global targets. Community engagement is vital to educate people, reduce stigma, and address challenges faced by TB patients.”
“Investing in research for new diagnostics, treatments, and healthcare delivery models like telemedicine is crucial. Advances like rapid molecular tests (e.g., Xpert MTB/RIF) and shorter drug-resistant TB regimens have improved outcomes and reduced side effects,” Dr. Ganpule said.
Whole genome sequencing and BPaLM regimen: A game-changers
Dr Niranjan Patil, Scientific Business Head and AVP – Infectious Diseases, Head- Microbiology & Infectious Molecular Biology (Metropolis Healthcare): Advanced molecular diagnostics, such as CBNAAT (Genexpert Ultra, Xpert XDR) and Line Probe Assays are crucial for rapid and precise detection of TB and drug resistance patterns like MDR, Isoniazid monoresistance, and Pre-XDR. Automated TB culture tests (e.g., MGIT) provide insights into resistance to newer drugs like Bedaquiline and high-dose Moxifloxacin, part of the BPAL-M regimen for multi-drug-resistant TB.
“Whole Genome Sequencing (WGS) using Next-Generation Sequencing (NGS) helps resolve discrepancies in test results, identify novel mutations, and detect drug resistance for 18 anti-TB drugs, including newer ones like Bedaquiline and Delamanid. WGS also aids in strain typing, lineage detection, and molecular surveillance to track TB transmission and guide public health measures,” said Dr Patil.
“Government initiatives like the 100-Day TB Elimination Campaign and expanded diagnostic access through Ayushman Aarogya Mandirs and private labs are strengthening India’s fight against TB, aiming for a TB-free future by 2025,”.
New era with personalised, effective therapies
Dr. Ravi Shekhar Jha, Director & HOD, Pulmonology at Fortis Hospital (Faridabad): TB treatment has advanced with shorter, more effective regimens. For drug-sensitive TB, a 4-month regimen combining Rifapentine, Moxifloxacin, Isoniazid, and Pyrazinamide offers similar cure rates to the traditional 6-month treatment but with better adherence and fewer side effects. For drug-resistant TB, the BPaL regimen (Bedaquiline, Pretomanid, Linezolid) has revolutionized care, providing a 6-month, all-oral treatment with high success rates and reduced toxicity. Innovations like therapeutic drug monitoring and molecular diagnostics enable personalized treatment, while research into host-directed therapies and new vaccines aims to enhance immune responses and improve outcomes. These advancements are transforming TB care, aiming for faster cures, lower relapse rates, and better patient quality of life.
Alarming statistics
Data from City X-Ray and Scan Clinic over the past six months shows that 21% of pediatric cases (up to 16 years) and nearly 14% of adults were microbiologically confirmed TB cases, including both pulmonary and extrapulmonary TB. Also, latent TB testing (IGRA) revealed 23% positivity in children and 43% in adults.
Dr. Aakaar Kapoor, CEO and Lead Medical Advisor at City X-Ray and Scan Clinic said “The high TB caseload reflects widespread ignorance and malnutrition, particularly among those with weakened immune systems. While pulmonary TB is widely recognized, extrapulmonary TB—where the infection spreads to other organs—is equally serious and often overlooked.”
Call for early detection and prevention
Health experts stress the importance of early diagnosis and stronger preventive measures.
Dr. Vikas Mittal, Director – Pulmonologist, CK Birla Hospital (Delhi): TB remains a global public health challenge, primarily affecting the lungs. Early symptoms include a persistent cough (with or without blood), low-grade fever, weight loss, and chest pain. Advanced stages can cause severe respiratory distress. Despite global efforts, drug-resistant strains and challenges like inadequate healthcare access, stigma, and long treatment durations hinder progress. The WHO emphasises early diagnosis, improved treatment regimens and vaccination programs. Strengthening public awareness, ensuring timely treatment, and investing in research are critical to reducing the global TB burden and achieving elimination goals.
Dr. Ravi Kapoor, Founder and Senior Consultant Radiologist at City X-Ray and Scan Clinic, said: “Early detection is crucial to prevent complications and curb transmission. Accurate diagnosis is half the battle won. This requires enhanced surveillance, improved screening, and more accredited labs for reliable testing.”
Role of private players in TB elimination
Experts highlight the critical role of private healthcare providers in supporting NTEP to combat TB. Dr. Aakaar Kapoor said “India has outperformed many high-burden countries, but preventive care, early diagnosis, and public-private collaboration need urgent attention. Integrating private diagnostic centers with advanced technology, involving them in policymaking, and leveraging their expertise can accelerate progress. Labs with robust infrastructure should also assist others in capacity building.”
“Mandatory accreditation for diagnostic labs and a triple-layer verification system for TB detection can enhance accuracy. Schools should run awareness programs to detect extrapulmonary TB in children early.”