National Tuberculosis Elimination Programme — India: Objectives, Components and Achievements

The National Tuberculosis Elimination Programme (NTEP), formerly known as the National Tuberculosis Control Programme (NTCP), is India’s flagship public health initiative aimed at combating tuberculosis (TB). Re-branded in 2020 to align with the strategic goal of eliminating TB by 2025—five years ahead of the Sustainable Development Goals (SDG) target of 2030—the programme operates under the administrative framework of the Central TB Division (CTD) within the Ministry of Health and Family Welfare.

Historical Evolution and Governance Structure

Organizational Shift from Control to Elimination

• India launched the National TB Control Programme (NTCP) in 1962, focusing on domiciliary treatment through primary health centers.
• Following a review in 1992, the Revised National TB Control Programme (RNTCP) was designed and pilot-tested in 1993, expanding nationwide by 2006.
• RNTCP adopted the Directly Observed Treatment Short-Course (DOTS) strategy recommended by the World Health Organization (WHO).
• In January 2020, the government renamed RNTCP as the National Tuberculosis Elimination Programme (NTEP) to emphasize the shift from disease control to complete elimination.

Strategic Framework: NSP 2017–2025

• The National Strategic Plan (NSP) for TB Elimination 2017–2025 serves as the operational roadmap for NTEP.
• NSP rests on four key pillars: Detect, Treat, Prevent, and Build (DTPB).
• Detect: Early identification of all TB cases through passive and active case finding, universal drug-susceptibility testing (UDST), and private sector engagement.
• Treat: Provision of daily fixed-dose combination (FDC) regimens, access to newer anti-TB drugs like Bedaquiline and Delamanid, and treatment support.
• Prevent: Scaling up TB Preventive Treatment (TPT) among household contacts and high-risk populations, alongside airborne infection control.
• Build: Strengthening health systems, surveillance technology, political commitment, and financial allocation.

Key Interventions and Technological Innovations

Digital Surveillance and Support Mechanisms

• Ni-kshay Portal: A centralized web-based database for real-time tracking, case notification, and monitoring of TB patients across public and private health sectors.
• Ni-kshay Poshan Yojana (NPY): Launched in 2018, this Direct Benefit Transfer (DBT) scheme provides financial support of 500 rupees per month to registered TB patients for nutritional support throughout treatment duration.
• Ni-kshay Mitra Initiative: Part of the Pradhan Mantri TB Mukt Bharat Abhiyan launched in 2022, allowing individual donors, corporate bodies, and NGOs to adopt TB patients and provide nutritional, diagnostic, and vocational support.

Diagnostic and Treatment Strategies

• Molecular Diagnostics: Deployment of Truenat and CBNAAT (Cartridge Based Nucleic Acid Amplification Test) machines at district and sub-district levels to detect TB and Rifampicin resistance rapidly.
• Active Case Finding (ACF): Systematic screening of high-risk populations, including prisoners, urban slum dwellers, tribal pockets, and industrial workers.
• Private Sector Engagement: Schemes like Patient Provider Support Agencies (PPSA) incentivize private healthcare practitioners to notify TB cases and adhere to standardized treatment guidelines.

Key Performance Metrics and Comparative Targets

Key Exam-Oriented Facts

• Tuberculosis is caused by Mycobacterium tuberculosis, a bacterium that primary affects the lungs (pulmonary TB) but can affect other organs (extrapulmonary TB).
• India bears the highest global TB burden, accounting for approximately 26% of total worldwide TB cases.
• World TB Day is observed annually on March 24, commemorating Dr. Robert Koch’s discovery of the TB bacillus in 1882.
• Bacillus Calmette-Guérin (BCG) vaccine, included in India’s Universal Immunization Programme (UIP), protects infants against severe forms of childhood TB like tuberculous meningitis.
• Multidrug-Resistant TB (MDR-TB) refers to strains resistant to at least Isoniazid and Rifampicin, the two most potent first-line anti-TB drugs.
• Extensively Drug-Resistant TB (XDR-TB) is resistant to Rifampicin, Isoniazid, any fluoroquinolone, and at least one additional group A drug (Bedaquiline or Linezolid).
• The WHO End TB Strategy aims for a 95% reduction in TB deaths and a 90% reduction in TB incidence by 2035 compared to 2015 levels.
• India’s statutory notification of TB was made mandatory by the Ministry of Health and Family Welfare in May 2012 for both public and private health practitioners.