# TB Programme > NTEP for FMGE Community Medicine: 2HRZE 4HRE regimen, CBNAAT first test, Ni-kshay notification, Nikshay Poshan, MDR-TB BPaLM and TB-free India by 2025. - Canonical URL: https://prepelephant.com/topics/fmge/community-medicine/tb-programme-fmge - Exam / course: FMGE · Subject: Community Medicine - Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team - First published: 2026-10-02 - Last updated: 2026-10-02 - How to cite: "TB Programme", PrepElephant, https://prepelephant.com/topics/fmge/community-medicine/tb-programme-fmge ## 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.