The TB control journey so far...
The National Tuberculosis Programme of India (NTP) was initiated in 1962 for domiciliary
treatment, using selfadministered standard drug regimens. However, it could not achieve
its objectives of TB control and hence, on the recommendations of an expert committee, a
revised strategy to control TB-Revised National Tuberculosis Control Programme (RNTCP)
was started in 1997. This programme used the DOTS (Directly Observed Treatment, Short
course chemotherapy) strategy and has achieved several milestones related to TB diagnosis
and treatment services since 2006.
National AIDS Control Programme and RNTCP have developed a 'National framework of joint
TB/HIV Collaborative activities'. The Government also proactively engages with private practitioners,
number of private organizations, NGOs, Professional bodies like Indian Medical Association, to
enhance notification of TB cases. The Standards for TB Care in India (STCI) have been published
jointly by RNTCP and World Health Organization (WHO) in 2014, which
own the uniform standards for TB care for all stakeholders in the country
The Government of India, Ministry of Health and family Welfare made a landmark move by
prohibiting the import of sero diagnostic test kits for TB and also the manufacture, sale, distribution
and use of such kits for TB. The banning of serological tests for diagnosis of active TB,
saved countless persons from inaccurate test results and
unnecessary expense and treatment.
An innovative and visionary electronic recording and reporting system
(Nikshay) was also rolled out across the country in 2012, with 98% of
reporting units sending in case-based reporting of TB patients, including
notifications from private providers. Modern media creatively used for TB
control with India's leading actor, Amitabh Bachchan's campaign, "TB
Harega, Desh Jeetega", with commendable investments by the Ministry and
corporations to broadcast these messages.
At the start of 2020 the central government has renamed the RNTCP
as the National Tuberculosis Elimination Program (NTEP). In a letter
to all the State Chief Secretaries of states and UTS, the commitment
is emphasized on the Union government achieving the sustainable
development goal of ending TB by 2025, five years ahead of the
Now, India has been engaged in TB control activities for
more than 50 years. Yet it continues to be India's severest
health crisis. Decades of unrestrained transmission has left
millions of Indians with latent TB infection, which may
re-activate at any time. A significant ratio of the population
is undernourished, weakening the Immunity and driving TB
reactivation. Infectious TB cases spread the disease to their
family and community, perpetuating the age-old cycle of
transmission and risk. Tens of millions with previous,
inadequately treated TB may recur at any time.
This brings a need for an end to this continued
suffering, tragic loss of life, poverty with concerted
efforts from all of us.
Strategic Pillars Of "Detect - Treat - Prevent -
The National Strategic Plan for moving towards TB
elimination has been integrated into the four strategic
pillars of "Detect-Treat - Prevent-Build."
Detect all Drug Sensitive TB and Drug Resistant TB
cases with an emphasis on reaching TB patients who seek care
from private providers and undiagnosed TB in high-risk populations
Treat-Initiate and sustain all patients on appropriate
anti-TB treatment wherever they seek care, with patient friendly
systems and social support
Prevent the emergence of TB in susceptible
Book TB whole genome sequencing profile
Build and strengthen enabling policies,
empowered institutions and human resources with
What can doctors do to help?
Because pulmonary TB is a potential public health threat,
patients who are living in close quarters with other susceptible
individuals (eg, in homeless shelters, prisons, nursing homes,
or in house with children below 5 years) should not be discharged
to these settings if the risk of the disease is significant. These patients
should be kept in the hospital until appropriate testing is performed.
Providers cannot legally detain patients against their will for known or
suspected TB because that requires a court order from a judge. If a
patient poses a real risk to the community, we can give our best to
convince them to stay. If they insists on leaving, obtain the best
contact information available and notify your TB liaison or department
of public health.
On the flip side, for patients who are at low risk for
active pulmonary TB and are reliable for follow-up, outpatient evaluation
and management may be considered. These patients should have sputum
sent off for acid-fast bacilli stain, PCR and culture before discharge.
The provider must then notify the department of public health within
24 hours for additional testing and evaluation to be arranged
How is TB controlled and prevented?
DOTS is a treatment cum control strategy recommended
by the WHO and being widely used as a part of RNTCP in
our country. DOTS has been described using five important
elements by WHO as follows:
1. Political commitment with increased and
This element describes a need for committed support from
National government in order to ensure an effective adoption
of DOTS for TB treatment and its eradication. Strategic plans
thus to be implemented are required to cover all the aspects
involved, such as proper infrastructures, financial requirements,
drug supply to the center dedicated for DOTS, sourcing of qualified
health care workers attending the patients, etc. This, in the end,
will aid in attaining a broad reach to the affected individual in a
2. Case detection through quality-assured bacteriology
Another crucial aspect is detection of the disease. Accurate and
timely diagnosis of the disease is the first step towards achieving
a control over it and hence, a need for well-managed network of
laboratories is seen. Bacteriology is the recommended method for
an accurate diagnosis of the disease and thus, the laboratories
involved should be well-equipped to manage the samples and should
have well-trained microbiologists and other personnel to attend the same.
3. Standardized treatment, with supervision and patient support This element puts forth
the need to follow an appropriate treatment regimen which is standard throughout the
country for all types of patients thus addressed, be it adult or pediatric. An emphasis is
also put on adhering to uncompromised and uninterrupted support, and supervision for
the patients during DOTS implementation.
4. An effective drug supply and management system This defines the need for a well
managed and effective supply of drugs for treatment of TB. Accurate management and
sustaining supply of quality anti-TB drugs is of fundamental importance. Hence, an
unfaltering management system in place to support uninterrupted supply and distribution
of drugs to all the facilities dedicated towards DOTS program is essential.
5. Evaluation and monitoring system As stated, it involves implementation of accurate
monitoring and evaluation systems to manage records of patient data including even the
treatment outcomes. The data thus will also serve to analyze the efficacy of treatment and
for building strategies for betterment, and to ensure consistent high quality measures are in
place. Having summarized on the implementation of DOTS for treatment of TB, the situation
is not as planned throughout the Indian demography.
Book Pathology Test starting @ Rs 750 Only
The resources present are not adequate enough and
thus we need to put in extra effort to get additional resources mobilized for a progress in
eradication strategy through implementation of DOTS. Improvement in channels aiding
financial support for overall management of the project and many critical aspects such as
accurate healthcare workers, drug distribution, proper guidance in following the course
without interruption, etc. is still needed. The centers thus built for attending the requirement
of TB patients should be proactive even in addressing the nation's concern in micro yet effective
levels. Awareness about the disease with equal importance in rural and urban areas is needed.
This will contribute in addressing TB at a thoughtful level and hence eventually, a complete
Prompt diagnosis and effective treatment are the only solutions to curb the emergence
and spread of drug resistance. Being aware of the complications associated with a disease
and getting timely diagnosis for it are also important aspects of disease prevention and