National TB Elimination Program (India)

Sputum smear microscopy, using the Ziehl–Neelsen staining technique, is conducted at the DMCs. This is the most widely available test with over 20,000 quality controlled laboratories across India. For diagnosis, two sputum samples are collected over two days (as spot-morning/morning-spot) from chest symptomatic (patients with presenting with a history of cough for two weeks or more) to arrive at a diagnosis. In addition to the test's high specificity, the use of two samples ensures that the diagnostic procedure has a high (>99%) test sensitivity as well.

Cartridge Based Nucleic Acid Amplification Test (CBNAAT) using the GeneXpert Platform, and TruNat are rapid molecular tests for TB diagnosis and Rifampicin resistance detection . This test is the first choice of diagnostic test for high risk population, children, contacts of drug resistant cases and PLHA(Patient Living With HIV AIDS) . Currently there are about 1200 CBNAAT and 200 TruNat laboratories in the country, at the district and in some cases at a sub-district level.

Advanced tests such as the Line Probe Assay, Liquid and Solid Culture, and Drug Susceptibility Testing are available at C&DST(Culture and Drug Sensitivity Testing) Labs are located at a few select places in the state, often within the IRL; these provide additional drug resistance/ susceptibility testing services for a number of Anti-TB drugs.

TB control efforts got organized with the National TB program (NTP) primarily focusing on BCG vaccinations as a preventive measure.

At that time, the Indian government lacked the financial backing to meet its public health goals. Therefore, external sources of funding and administration, often from the WHO and UN, became common in the realm of public health.[10] In 1992, the WHO and Swedish International Development Agency evaluated the NTCP, finding that it lacked funding, information on health outcomes, consistency across management and treatment regimens, and efficient diagnostic techniques.[8]

In order to overcome the deficiencies of the NTP, the Government decided to give a new thrust to TB control activities by revitalising the NTP, with assistance from international agencies, in 1993. Given TB's high curability rate 6–12 months after diagnosis, moving toward a clinical and treatment-based strategy was a sensible progression from the NTP.[11] The Revised National TB Control Programme (RNTCP) thus formulated, adopted the internationally recommended Directly Observed Treatment Short-course (DOTS) strategy, as the most systematic and cost-effective approach to revitalise the TB control programme in India. DOTS was adopted as a strategy for provision of treatment to increase the treatment completion rates. Political and administrative commitment were some of its core strategies, to ensure the provision of organized and comprehensive TB control services was obtained. Adoption of smear microscopy for reliable and early diagnosis was introduced in a decentralized manner in the general health services. Supply of drugs was also strengthened to provide assured supply of drugs to meet the requirements of the system.[12] The RNTCP was built on the infrastructure and systems built through the NTP. Major additions to the RNTCP, over and above the structures established under the NTP, was the establishment of a sub-district supervisory unit, known as a TB Unit, with dedicated RNTCP supervisors posted, and decentralization of both diagnostic and treatment services, with treatment given under the support of DOT (directly observed treatment) providers.

Large-scale implementation of the RNTCP began in late 1998.[13] Expansion of the programme was undertaken in a phased manner with rigid appraisals of the districts prior to starting service delivery. In the first phase of RNTCP (1998–2005), the programme's focus was on ensuring expansion of quality DOTS services to the entire country. The initial 5-year project plan was to implement the RNTCP in 102 districts of the country and strengthen another 203 Short Course Chemotherapy (SCC) districts for introduction of the revised strategy at a later stage. The Government of India took up the massive challenge of nationwide expansion of the RNTCP and covering the whole country under RNTCP by the year 2005, and to reach the global targets for TB control on case detection and treatment success. The structural arrangements for funds transfer and to account for the resources deployed were developed and thus the formation of the State and District TB Control Societies was under- taken. The systems were further strengthened and the programme was scaled up for national coverage in 2005. India achieved country wide coverage under RNTCP in March 2006.

This was followed up with RNTCP Phase II, developed based on the lessons learnt from the implementation of the programme over the previous 12-year period, from 2006 onwards. During this period the programme aimed to widen services both in terms of activities and access, and to sustain the achievements. The second phase aimed to maintain at least a 70% case detection rate of new smear positive cases as well as maintain a cure rate of at least 85%, in order to achieve the TB-related targets set by the Millennium Development Goals for 2015.[14] The design of the RNTCP II remained almost the same as that of RNTCP I but additional requirements of quality assured diagnosis and treatment were built in through schemes to increase the participation of private sector providers and also inclusion of DOTS+ for MDR TB and XDR TB. Systematic research and evidence building to inform the programme for better design was also included as an important component. The Advocacy, Communication and Social Mobilization were also addressed in the design. The challenges imposed by the structures under NRHM were also taken into account.

NIKSHAY, the web based reporting for TB programme has been another notable achievement initiated in 2012 and has enabled capture and transfer of individual patient data from the remotest health institutions of the country.

Consolidating a series of rapid and progressive advancements in RNTCP from 2016 onward, and with Government of India's commitment to achieve the END TB targets 5 years earlier, RNTCP was renamed as the National TB Elimination Program. The change came into effect from 1 January 2020.[15] This decision was declared by Special Secretary, Sanjeeva Kumar, Ministry of Health and Family Welfare, in a letter to all the State Chief Secretaries.[16]