India’s Struggle to Eliminate Tuberculosis by 2025

India’s ambitious goal to eliminate tuberculosis (TB) by 2025 faces significant challenges, as detailed by Dr. Brajaraj S. Ghosh and Dr. Shweta Arora. Despite promising interventions such as newer drugs and shorter therapy regimens for drug-resistant TB, the COVID-19 pandemic has severely disrupted progress. The National TB Elimination Programme (NTEP) reports a worrying increase in TB cases, rising from 21% in 2017 to 30% in 2022. This increase highlights the pandemic’s impact, halting essential activities under the NTEP for nearly two years.

Key Challenges Hindering TB Elimination in India:

Unregulated Drug Use and Missing Cases: The major hurdle is the vast number of unreported TB cases. In private sectors, especially in cities like Delhi and states such as Uttar Pradesh and Maharashtra, there is a rampant unregulated use of anti-TB drugs. This not only compromises treatment quality but also contributes to antimicrobial resistance. Many practitioners, often unregistered, prescribe ineffective treatments and are reluctant to refer patients to authorized treatment centers.

Lack of Training and Awareness Among Healthcare Providers: The NTEP’s Patient Provider Support Agency (PPSA) struggles to engage with untrained and uninformed healthcare providers who serve a large portion of the economically disadvantaged population. These providers are often outside the purview of legal mandates, lacking in both training and awareness about proper anti-TB treatment protocols. This contributes to delayed diagnoses and continuation of inadequate treatments.

Drug Shortages and Inadequate Infrastructure: The NTEP has faced challenges such as drug shortages, affecting the availability of essential anti-TB and preventive therapy medications across the country. Additionally, there’s a need for upgrading diagnostic tools like replacing outdated Ziehl Nielson Stain microscopes with more effective fluorescence microscopes to enhance sensitivity and specificity in TB detection.

Funding and Policy Implementation: While funding from domestic sources and the Global Fund for AIDS, TB and Malaria (GFATM) remains robust, there is a potential to increase allocations from Corporate Social Responsibility (CSR) budgets towards TB. Policies need strengthening, particularly in empowering district TB Officers with more autonomy in procuring necessary drugs and medical supplies.

India’s journey towards eliminating TB by 2025 is fraught with systemic and operational challenges. It requires coordinated efforts involving policy amendments, improved healthcare provider training, and robust public-private partnerships. The goal remains challenging but achievable with sustained commitment and innovative strategies.