TB Programme
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Direct answer
India carries the largest tuberculosis burden in the world — roughly a quarter of all global cases — and the National TB Elimination Programme (NTEP), renamed from the Revised National TB Control Programme in 2019, runs the response with a target of a TB-free India by 2025, five years ahead of the global End TB goal of 2030. Its pillars are universal drug-susceptibility testing with molecular tests (CBNAAT or Truenat) as the first diagnostic, daily weight-band-fixed drug regimens (2HRZE/4HRE for drug-sensitive disease), mandatory notification through the Ni-kshay portal, all-oral regimens including BPaLM for drug-resistant tuberculosis, and patient support such as the Ni-kshay Poshan nutrition payment of 500 rupees per month.
What you must remember
- Timeline: National TB Control Programme 1962; DOTS piloted under RNTCP in 1993 and scaled from 1997; renamed NTEP in 2019 with elimination (incidence below 1 case per million population) targeted for 2025.
- The first diagnostic test for any presumptive TB case is a molecular assay — cartridge-based NAAT (CBNAAT/Xpert MTB-RIF) or Truenat — detecting rifampicin resistance within about two hours; sputum smear microscopy is no longer the entry test.
- Drug-sensitive tuberculosis: daily fixed-dose combination of isoniazid, rifampicin, pyrazinamide and ethambutol for 2 months, then isoniazid, rifampicin and ethambutol for 4 months (2HRZE/4HRE), dosed by weight band.
- Tuberculosis has been a notifiable disease since 2012 — every provider including the private sector must report cases on the Ni-kshay digital portal.
- Ni-kshay Poshan Yojana provides 500 rupees per month to every notified TB patient for nutrition during treatment.
- Drug-resistant tuberculosis now gets all-oral regimens: the 6-month BPaLM (bedaquiline, pretomanid, linezolid, moxifloxacin) for eligible multidrug-resistant patients, replacing injectable-containing regimens.
- Tuberculosis is the commonest opportunistic infection in people living with HIV in India; every HIV-positive person is screened for TB and offered preventive therapy (6 months isoniazid or 3 months weekly rifapentine-isoniazid) once active disease is excluded.
- Active case-finding campaigns sweep high-risk groups, and treatment supporters (ASHA or community TB champions) administer the daily dose — the modern form of DOTS.
From cough to cure: the NTEP pathway
A 38-year-old man with cough over two weeks and night sweats reaches a health and wellness centre. He is a presumptive TB case, so a sputum sample goes for CBNAAT — not a smear first — and the result arrives the same day: Mycobacterium tuberculosis detected, rifampicin sensitive. He is notified on Ni-kshay, weighed (54 kg band), started on daily HRZE fixed-dose combinations, assigned a treatment supporter, and enrolled for Nikshay Poshan payments. At 2 months his symptoms have gone, but treatment continues to 6 months — the fixed 4-month continuation with ethambutol retained. Had the CBNAAT shown rifampicin resistance, the pathway forks: another molecular test for additional resistance, then an all-oral MDR regimen such as BPaLM after eligibility checks. Every step exists because a decade of programme learning showed that unsupervised treatment bred resistance.
How the exam frames it
Older MCQ books still carry the obsolete intermittent thrice-weekly regimen and the older category I and II labels — answering from those memories loses marks. The current answers: daily dosing, weight-band boxes, ethambutol in the continuation phase for the standard drug-sensitive regimen, and molecular testing as the first investigation. The second trap is the definition of elimination: for the NTEP it means an incidence below 1 case per million population, while "pre-elimination" is fewer than 44 new cases per million by 2025 in some documents — quote the former. Third, remember the calendar: notification became mandatory in 2012, NTEP was renamed in 2019, and the target year is 2025 for a TB-free India, not 2030 (that is the global SDG End TB milestone). A frequent one-liner asks which drug was dropped from the continuation phase and later reinstated — ethambutol, retained to guard against undetected isoniazid resistance.
Frequently asked questions
What is the current first-line regimen for drug-sensitive tuberculosis under NTEP?
Two months of daily isoniazid, rifampicin, pyrazinamide and ethambutol followed by four months of isoniazid, rifampicin and ethambutol (2HRZE/4HRE), given as weight-band fixed-dose combinations with treatment support.
Which is the first diagnostic test for a presumptive TB case and why?
A cartridge-based nucleic acid amplification test (CBNAAT/Xpert) or Truenat, because it confirms Mycobacterium tuberculosis and rifampicin resistance within about two hours, allowing the right regimen from day one.
Since when is TB notifiable in India, and on which platform?
Since 2012, for all providers including private clinics and hospitals; cases are notified digitally on the Ni-kshay portal, which also tracks treatment outcome.
What support does a notified patient receive under Ni-kshay Poshan Yojana?
A monthly nutrition support payment of 500 rupees for the duration of treatment, credited directly, in recognition that undernutrition both drives TB and worsens its outcomes.
What is BPaLM?
A 6-month all-oral regimen for multidrug-resistant tuberculosis combining bedaquiline, pretomanid, linezolid and moxifloxacin, which has replaced injectable-containing regimens for eligible patients.
What is the target year for TB elimination in India, and how is elimination defined?
2025, defined as reducing TB incidence to below 1 case per million population per year — ahead of the global End TB and SDG target of 2030.