Elimination of tuberculosis in India: Accelerating to the Sustainable Development Goals targets

Elimination of tuberculosis in India: Accelerating to the Sustainable Development Goals targetsOver its long association with tuberculosis (TB), India has been one of the pioneers in research globally, and in innovations in programming.Since the beginning of the 20th century, TB has been categorized as a paramount public health concern in India.For 2023, the incidence of TB in India is estimated at 2.80 million (195/100 000) and mortality at 323 000 (22/100 000).In 2015, the incidence was 3.13 million (237/ 100 000) and mortality was 424 000 (32/100 000). 1 In 2015, 35% of the households affected by TB suffered catastrophic expenditure. 2A recent study in India found 39% of the TB cases to be subclinical 3 and an earlier one found this in more than 50% of the cases. 4It is critical to underscore that, in 2023, 27.5% of the world's TB cases, 47% of the new multidrug resistant (MDR) TB cases and about 22% of deaths due to TB took place in India. 5Importantly, despite a major disruption during the pandemic, for some TB-services India restored performance to pre-pandemic levels by 2022 and for others exceeded pre-pandemic levels.Top risks factors for TB include malnutrition (BMI [body mass index] <18.5 kg/ m 2 ), HIV, diabetes, silicosis, substance-abuse illness, smoking, and drinking alcohol.Socio-cultural-economic determinants and vulnerabilities for TB include belonging to a scheduled tribe, gender, poverty, inadequate social protection, inadequate housing, displacement, imprisonment, inadequate healthcare access, and stigma and discrimination.Hence, taking the circumstances of the person with TB (PwTB) holistically into consideration becomes essential for not only timely detection and but also clinical management and treatment success.Under its commitments to the UN's Sustainable Development Goals (SDGs), India aims to reduce the baseline numbers of 2015 for TB incidence by 80%, TB mortality by 90%, and households with TB-related catastrophic expenditure to zero by 2030 (an accelerated timeline till 2025 was announced in 2018, but will not be met).Given the vulnerabilities and risk factors for TB, outcomes with TB in India are clearly bidirectionally intertwined with other SDGs such as achieving universal health coverage, ending malnutrition, eradicating poverty, and strengthening social protection.The Ministry of Health and Family Welfare (MoHFW), Government of India runs the National TB Elimination Programme (NTEP) for achieving TB goals with the Central TB Division (CTD) as the apex technical body for TB.Public health institutes and expert committees support CTD with further technical expertise and state and sub-state structures (with designated manpower) deliver services under the programme down to the community level.NTEP is implemented across India through this system by the Central and State Governments under the National Health Mission framework.Additionally, NTEP engages with the private sector and other relevant ministries for furthering TB goals.The 2023 approved annual budget for NTEP stood at 3113 crores. 1 It will be useful to frame the discussion on accelerating the achieving of SDG targets around the three broad objectives of mortality reduction, timely and quality detection, and incidence/prevalence reduction as this will help appreciate nuances and develop actionable and measurable plans.