Non-tuberculous Mycobacteria, drug-resistant and extra-pulmonary tuberculosis: Challenges and advancing algorithms for tuberculosis elimination in India by 2025

Background: Accurate detection of non-tuberculous mycobacteria (NTM) is crucial due to its similarity to tuberculosis (TB) but distinct treatment requirements. Misdiagnosis can lead to ineffective therapy and poor outcomes. For drug-resistant tuberculosis (DR-TB), advanced diagnostic methods are essential. Rapid molecular tests like GeneXpert and whole-genome sequencing offer quicker and more accurate detection of drug resistance compared to traditional cultures, enabling timely treatment adjustments and reducing transmission. Extra pulmonary tuberculosis (EPTB) presents diagnostic challenges, necessitating improved techniques such as advanced imaging and molecular tests for early detection. To meet India’s goal of eliminating TB by 2025, the National Tuberculosis Elimination Program should adopt these advanced approaches. Integrating rapid molecular diagnostics, expanding comprehensive testing for DR-TB, EPTB, and ensuring accurate TB and NTM differentiation are vital. Strengthening diagnostic infrastructure as well as suggested diagnostic algorithms, enhancing healthcare worker training are essential steps can significantly reduce TB prevalence and advance towards TB elimination.The aim of this study was to emphasize the importance of accurate and rapid diagnostic methods for DR-TB, EPTB and NTM, particularly in the context of India’s ambitious goal to eliminate TB by 2025. It highlights the need for integrating advanced diagnostic technologies and strengthening healthcare systems for effective control of TB. It is crucial to prioritize NTM detection, improve DR-TB diagnostics, and increase EPTB detection. To overcome the remaining obstacles and realize the goal of a TB-free India by 2025, sustained innovation, funding, and attention to these areas will be essential.