RECENT ADVANCES IN TB PROGRAMME

1. RECENT ADVANCES IN
TUBERCULOSIS PROGRAMME
Presenters: Avantika Gupta
L.Tarakishwor Singh
Moderator: Prof. Romola P

2. OUTLINE
Burden
Timeline
End TB
strategy
Goals &
Objectives
NSP 2020-2025
Pillars
Conclusion

3. In 2019, an estimated 10 million people fell ill with
TB worldwide
1.4 million people died from TB
Eight countries account for two thirds of the total,
with India leading the count
TB incidence is falling at about 2% per year
Present rate of ~3% annual
decline needs to be accelerated
to ~11% to achieve 2030 SDG
targets by 2025

4. OUTLINE
Burden
Timeline
End TB
strategy
Goals &
Objectives
NSP 2020-2025
Pillars
Conclusion

5. TIMELINE
1962
National TB Control Program started
with the aim to detect cases at earliest
& treat them
1992
WHO and SIDA evaluated the NTCP
1993 • NTP revised to RNTCP
• WHO declared TB as global
emergency
• DOTS strategy adopted
1997 Large scale implementation of
RNTCP began in phased
manner
1998
• Phase I RNTCP (1998-2005)
• Focus: Expansion of quality
DOTS services to the entire
country
• Sep: RNTCP implemented in
Imphal, Manipur
2002
RNTCP covered state of
Manipur
2006
• India achieved country wide
coverage under RNTCP in
March
• Phase II RNTCP (2006-2012)
• DOTS PLUS
2012
• Phase III RNTCP (2012-2017)
• National Strategic Plan (NSP)
2012-2017 was documented with
the goal of ‘universal access to
quality TB diagnosis and
treatment for all TB patients in
the community’
• Mandatory notification of TB
• NIKSHAY
2017
NSP 2017-2025
2018
13th March:
“TB Free India
Campaign”
2018
25th Sep:
“TB Harega, Desh
Jeetega”
2019
11th – 22nd Nov:
WHO-GoI
JMM two week
intensive review
of TB program
in India
2020
• 1st Jan:
RNTCP
renamed
NTEP
• NSP 2020-
2025

6. CHALLENGES
JOINT MONITORING MISSION, 2019
Only 6%
annually
28% case
notification
from private
sector
Vacancy rate (%) for
state level positions

7. OUTLINE
Burden
Timeline
End TB
strategy
Goals &
Objectives
NSP 2020-2025
Pillars
Conclusion

9. Adaptation of the strategy and targets at country level, with global
collaboration
Protecting & promoting human rights, ethics and equity
Building a strong coalition with civil society & communities
Gvt. Stewardship & accountability, with monitoring & evaluation
Integrated,
patient-
centred TB
care and
prevention
Bold policies
& supportive
systems
Intensified
research &
innovation
Pillars
Principles

10. OUTLINE
Burden
Timeline
End TB
strategy
Goals &
Objectives
NSP 2020-2025
Pillars
Conclusion

11. • To cure ≥ 85% of all newly detected infectious
cases of pulmonary TB
• To detect ≥ 70% of estimated new smear +ve
pulmonary TB cases
OBJECTIVES
• To reduce mortality and morbidity from TB
• To interrupt chain of transmission until TB
ceases to be a public health problem in India
GOALS

12. To reduce incidence of TB & mortality due to TB
To prevent emergence of drug resistance & effectively manage drug
resistant TB
To improve outcomes among HIV-infected TB patients
To involve private sector
To decentralize & align RNTCP management units with NHM block
level units within general health system
NEW OBJECTIVES

13. OUTLINE
Burden
Timeline
End TB
strategy
Goals &
Objectives
NSP 2020-2025
Pillars
Conclusion

14. GOAL:
To achieve a rapid decline in
burden of TB, morbidity &
mortality to achieve the SDG of
80% ↓ in incidence and 90% ↓ in
deaths by 2025
VISION:
TB-Free India with zero deaths,
disease and poverty due to TB

15. Impact Indicators:
Outcome Indicators:
44

16. OBJECTIVES
Build, strengthen and sustain enabling policies,
empowered institutions, multi-sectoral collaborations,
engaged communities, and human resources with
enhanced capacities to create a supportive ecosystem
Prevent the emergence of TB in vulnerable
populations
Initiate & sustain, equitable access to free high quality
TB treatment, care and support services
Early identification of presumptive TB, at the
first point of contact & prompt diagnosis
B-P-D-T
(NSP 2020-2025)
D-T-P-B
(NSP 2017-2025)

17. OUTLINE
Burden
Timeline
End TB
strategy
Goals &
Objectives
NSP 2020-2025
Pillars
Conclusion

18. TB FREE INDIA

19. USD 201 million
(Jan 2018 – March 2021)
USD 280 million
(April 2021 – March 2024)
“RNTCP World Bank IBRD
USD 500 million” project
moving towards elimination of
TB 2018-2025

20. Update terms of reference (TOR)
Leverage Health System
Training
Human resource recruitment agencies
Health worker surveillance
National fellowship & experiential learning program

21. National TB Policy & TB bill
• Accelerate efforts
• Contextual strategies
• Generate healthy competition
• Recognition
Sub-national certification of disease
free status

22. Sub-national certification of disease free status
Award
categories
Criteria: decline
in incidence rate
compared to 2015
Monetary
award for
district (Rs)*
Monetary
award for
state (Rs)*
Non-monetary
award
Bronze 20% 2 lakh 25 lakh Medal &
felicitation at
national level
Silver 40% 3 lakh 50 lakh
Gold 60% 5 lakh 75 lakh
TB Free
State/
District
80% 10 lakh 1 crore
Certification &
felicitation at
national level
*For states/ UTs with population <50 lakh & districts <2 lakhs, award shall be 50% of
the amounts considered
One district (Budgam, J&K) and one UT (Lakshadweep)
were declared TB Free on 24 Mar 2021

23. National TB Policy & TB bill
Sub-national certification of disease free status
Gazette on TB notification
• Provision of 269 &
270 IPC
• Jail from 6 months
to 2 yrs or a fine or
both
Direct benefit transfer schemes

24. Nikshay Poshan Yojana
(NPY)
Incentive to Treatment
supporters/ DOTS
providers
Transport incentive to
Tribal TB patients
Notification incentive to
private providers
DBT
Introduced in April 2018
Beneficiary
All notified TB patients for
duration of treatment
Objective
To provide financial incentive
for nutritional support to TB
patients from time of
notification
Benefit
amount
Rs 500/month during course of
treatment
Incentive to Treatment
supporters/ DOTS
providers
Beneficiary
Community Treatment
supporters
Objective To provide honorarium
Benefit
amount
• Rs 1000 on update of
outcome for drug sensitive
TB patients
• Rs 2000 on completion of
IP & Rs 3000 on
completion of CP
Notification incentive to
private providers
Beneficiary
Private providers who notify TB
patients to NTEP
Objective To provide financial incentives
Benefit
amount
• Rs 500 as one- time payment
on notification
• Rs 500 for updating patient’s
treatment outcome
Transport incentive to
Tribal TB patients
Beneficiary
All notified TB patients from
Notified Tribal areas
Objective
To provide financial support for
transportation
Benefit
amount
Rs 750 as one-time payment at
time of notification
Fast tracking DBT under NTEP:
• CTD introduced Digital Signature Certificate
(DSC) in year 2019, to ensure that DBT
beneficiaries get their due benefits much quicker
• 82% districts have implemented DSC

25. National TB Policy & TB bill
Sub-national certification of disease free status
Gazette on TB notification
Expedite setting up of governance & management structures to
State & district level
Direct benefit transfer schemes

26. MoHFW
Central TB Division
State TB Cell
District TB Centre (DTC)
TB Unit (TU)
TB Diagnostic Centres
(TDCs)
TB treatment centres (DOT)
ORGANOGRAM
National level
State level
District level
Sub-district level
PHC/BPHC
HWCs
National TB
Elimination
Board
State TB
Elimination
Board
District TB
Elimination
Board
Block TB
Elimination
Board

27. “MISSION MODE”
25th Sep, 2020:
M/o Labour & Employment
8th Oct, 2020:
M/ o Department of North Eastern
region
Two latest MoUs signed

28. Incentives through DBT
Joint Effort for Elimination of TB (JEET)
15th May, 2018 (Delhi launch)
OBJECTIVE:
To set up effective and sustainable structures to
strengthen existing systems and seamlessly extend
quality TB care to patients in the private sector
JEET efforts during COVID-19:
• Advocacy & facilitation of case finding strategies
 Bidirectional screening
 Outreach
 Establishing linkages
• Treatment services
• Patient support services
• Direct Benefit Transfer (DBT)

29. Incentives
Joint Effort for Elimination of TB (JEET)
15th May, 2018 (Delhi launch)
Corporate TB Pledge (CTP) initiative (April, 2019)
Silver
Commitment
Gold
Commitment
Awareness
Platinum
Commitment
Awareness
Investment
Diamond
Commitment
Awareness
Investment
Champion
Offers a tiered approach for
corporates to use their
resources (human and
financial), to combat TB, raise
awareness & ultimately
improve TB health outcomes

30. Apollo Tyres Foundation organized
“TB free transhipment locations”
campaign for reaching out to trucking &
migrant communities of India
• 2 week campaign at 31 different
locations in 19 states
• Of 1310 TB facilitated during
campaign, 52 TB patients were
identified and put on treatment

31. Institutional mechanism of
community led response
•These forums have
representation of
people affected by
TB, elected
representatives,
policy makers,
CSO/ NGOs &
program managers
By end of 2019, TB forums constituted in >700 (99%)
districts across country
TB
treatment
literacy Advocacy
Counselling
&
mentoring
Health
financing
Programme
planning
Implementation
Monitoring
& review
TB champions
TB survivors
Engaging
existing
community
groups

32. Tb survivor led
networks in 6
states & national
level

33. In partnership with NTEP,
working towards integrating TB
services at AB-HWCs
Operational guidelines
launched on 28th Dec, 2020
Collaborative framework for
management of TB in
pregnancy (to be launched in
2021)
Learning resource package
for training of CHOs
(to be rolled out in 2021)
Vulnerability score cards for
differential TB care

34. Rebranding RNTCP
Red colour:
beginning,
emotions &
energy
yellow colour:
protection
Objectivity
Swirl of flag:
Pride of all
Focus of the
programme
Human figure:
celebration,
positivity &
success
Signifies bigger
picture

35. Rebranding RNTCP
National photo exhibition “Courage & Resilience”
Media engagement-National media sensitization workshop
Television
New India
Sankalp-2 on TB
(12th Feb,2020)
MTV NISHEDH
“Alone Together”
27th Nov, 2020
Radio: Popularizing Free diagnosis, drugs & NPY
Advocacy for industry
17th Aug, 2020
Nikshay Patrika Newsletter
Nikshay Patrika Newsletter:
A significant
communication tool to
build, motivate, raise
awareness, learnings &
achievements
Pledge for TB Free India
CTD collaborated with MyGov
platform for all citizens to
pledge to make every village,
district, state and country TB
free under initiative “TB
Harega, Desh Jeetega”

36. Online review of program performance to
overcome impact of COVID-19
National TB prevalence survey: 25th Sep, 2019
• Buses will serve as fully-
equipped mobile clinics,
with trained staff , backed
by a chain of reference
laboratories
State TB Index: A composite measure of the program’s performance
has been developed
• CTD assesses the states/UTs achievements & performances
using 9 key indicators
• Maximum total score of 100

37. 1. Studies on strengthening surveillance & TB notifications
2. Studies for improvement of TB disease burden estimation; improved TB
diagnostics including childhood TB and EPTB
3. Studies on TB transmission and its interruption
4. Related to systematic screening of high-risk groups and intensified case findings
5. DR-TB management
6. Cascade of care in public & private sector
7. Preventive therapy
8. Socio-economic impact & poverty alleviation
9. Strengthening NTEP management
10. TB therapeutics (recurrent re-infection TB)
11. Co-morbidity studies
12. Lab, supply chain, sample transportation
13. ACSM
14. Collaborative studies with other ministries
RESEARCH PRIORITIES 2020
(MoHFW)
CTD
ICMR
NIRT
Non-
NTEP
ITRC
BRICS
66 proposals were received
by 20th Noc,2020
a. DST on newer drugs
b. NTBP Survey
c. Accuracy of 99 DOTS
d. Phase III RCT to evaluate
efficacy & safety of two
vaccines
 VPM1002
 Immuvac (Mw)
e. Airborne Infection Control
(AIC) practices in health
facilities
a. TB STAMP (TB Screen,
Track & Map Project)
b. Value TB project
c. RATIONS (Reducing
Activation of TB by
Improvement Of
Nutritional Status)
4 thematic areas:
1. Therapeutics
2. Diagnostics
3. Vaccines
4. Implementation Research
BRICS Countries (Brazil, India, China,
Russia & South Africa) established
collaborative TB research network

38. Nikshay Aushadhi
Launched on 24th
March, 2018:
Electronic drug
distribution
management system
To enable real time
visibility into stock
status at all levels and
enable forecasting,
quantification &
further distribution of
TB drugs and
diagnostics
Procurement &
supply chain
managemnet Quantification
and Forecasting
Monitoring and
Distribution
Recording and
Reporting
Data
Management
and Analysis
Training and
Capacity
Building
3PL system (Third party logistic system)

39. NSP 2020-2025 will aggressively pursue the
expansion of the digital information
ecosystem over the next five years
Vision: To create a digital information ecosystem where information is
captured in real time, processed and visualized, enabling efficient service
delivery and responsive program management, driving TB Elimination in
India and all over the world
NIKSHAY SAMPARK
• National TB Call Centre for TB helpline
managed by CTD (May 2018)
• Operating from two sites
 Noida
 Mumbai
• 7 days/ week (7am to 11pm)
Services provided:
Resolving queries related to TB
Reporting & management of TB services related grievances
Resolving queries related to Hepatitis under NVHCP
Tele-counselling
Feedback on NTEP services
COVID-19 (Toll Free 1075 since 16th March, 2020)

40. Sep 2018, CTD launched enhanced vision of Nikshay
Establish the National
Knowledge Cell under
Central TB Division

41. Strengthening TSN & make TA responsive
to emerging TB landscape in India
Extend TA to other ministries
Expedite establishment of planned TSUs
Create a platform to enlist & provide information on available TA
experts
All partner organizations (health economics, digital health etc) under
one umbrella of WHO-TSN consultants network

42. • To aim for equitable, rights-based TB services for women, men and
transgender persons by adopting a gender-specific programmatic approach at
all levels
• To mobilise, empower and engage women, men and transgender persons in
the TB response at the health system and community levels
Framework for addressing stigma

43. Data from Nikshay TB
notification system for
April to Aug 2020, in
comparison to similar
data for 2019
Number of patients with
TB registered on DOTS
and completed
treatment, in India’s
NHM-HMIS for the Jan
to June 2020 period, in
comparison to similar
data for 2019
Modelling analysis project:
Additional 6.3 mil cases of TB
& 1.4 mil TB deaths
attributable to COVID-19
between 2020 & 2025
Manipur
Total notification Jan-Feb 2020 (A) 430
Total notification Mar-April 2020 (B) 207
Total notification May-Dec 2020 (C) 926
% decrease between B & A 52%
% increase between C & B 11%

44. Diagnostic
algorithm
Case
finding-
public &
private
sector
Sample
collection &
transportation
services
Treatment
services
Patient
support
services
Provider
support
services
DBT
services
Demand
generation
activities
Rationale
use of
PPE
Monitoring,
surveillance
& evaluation
Program
management,
administrative
support

45. TB FREE INDIA
TB Preventive Treatment (TPT) &
Programmatic Management of TPT
(PMTPT)
Airborne Infection Control (AIC)

46. TB Preventive Treatment (TPT) & Programmatic Management of TPT
(PMTPT)
In September 2018, countries committed to
provide TPT to at least 30 million individuals
by 2022, including 24 mil household contacts
of TB patients and 6 mil PLHIV

47. TB Preventive Treatment (TPT) & Programmatic Management of TPT
(PMTPT)
In 2020, NTEP plans saturation of TPT & monitoring in:
• PLHIV
• Paediatric contact of active TB patients
• Additional inclusion of
 Asymptomatic contact of all ages
 Patient with silicosis
 Immunosuppressive therapy
 Anti-TNF treatment
 Dialysis
 Transplantation
Fast track approvals & phase wise capacity augmentation for
detection of LTBI:
• TST
• 4th generation IGRA
Rapidly adopt & scale-up use of shorter rifamycin based TPT
regimen:
• 3HP (3 months of Isoniazid + Rifapentine)
• 1HP ( 1 month of Isoniazid + Rifapentine)
• 3HR (3 months of Isoniazid + Rifampicin)
• 4R (4 months of Rifampicin)
• Rapid scale up to reach 5 mil/yr
• Establish TB prevention cell at national & state level
• Integrate TB preventive services in all ACF efforts
• Financial incentives for complete coverage
• Strengthening monitoring & evaluation by ensuring capture of
data for TPT in:
 Nikshay platform
 Scaling of digital tools: LTBI mobile app

48. Airborne Infection Control (AIC)
Revise AIC
guidelines
in line with
NTEP
AIC as
necessary
clause in
NABH
accreditation in
private sector
Leverage
ongoing
initiatives
(HWCs,
Kayakalp)
AIC
helpdesk
Sustained
national
campaign in
education
institutions
Provide
AIC kits
to all TB
patients

49. TB FREE INDIA

50. Evolution of strategies for improving case finding

51. TB Co morbidities
Launch by MoHFW and MoTA with technical
assistance by USAID
In the tribal districts of the states under fifth
schedule and tribal districts of NE states under
sixth schedule
TB vulnerability mapping and periodic TB-
Active case finding drives of all individuals in
all tribal districts

52. Provision of Isoniazid preventive
therapy(IPT)
Improving the operational efficiency of
Village Health Sanitation
Nutrition days
Jan Arogya Samiti plateform
Jan Andolan initiative
Engaging TB champions
Training of faith healers

53. Linking of Swasthya with Nikshay
Notified TB patient get Rs.750 at the time of notification

54. Join TB-Diabetes collaboration
• Collaboration with NTEP and NPCDCS
• Bidirectional screening of TB and Diabetes Mellitus
• TB patient linked to anti diabetic treatment

55. Join TB-HIV collaboration
• Collaboration with NTEP and NACO
• In 2019, TB-HIV collaboration committee was restructured by MoHFW to
form a TB Co-morbidity collaborative committee at National, State and
District level
• Bidirectional screening of TB and HIV
• During the routine outreach services of HIV, team member screen HRG and
bridge populations for TB symptoms and refer to the nearest TB center for
diagnosis and treatment

56. • “Single window” services for TB and HIV
• Gazette notification by GoI dated 28th October 2020 about the
mandatory requirement of ART centers and Drug resistant TB services
in all Medical colleges
TB-Tobacco
• Collaboration between NTEP and NTCP
• Tobacco used status were identified among TB patient and linked to
tobacco cessation services

57. Childhood TB
• NTEP collaboration with Child Health Programme in the country (RBSK and
RKSK)
• Screening of children in the age group(0-18 years) will be done through
Mobile health teams of RBSK and Adolescent Friendly Resource centres of
RKSK

58. NTEP-COVID-19

59. TB FREE INDIA

60. Classification of TB diagnosis
1. Drug sensitive TB
2. H mono/ poly DR-TB
3. MDR/RR TB
4. XDR TB

61. National strategic plan(2020-2025)
Diagnosis
• Rapid transition of TB diagnosis from smear microscopy to molecular testing
using NAAT right up to the Block level
• Introduction of Point of care (POC) sequencing platform
• Roll out the use of novel skin test like C-Tb to support the diagnosis of
pediatric TB( replacement for PPD based TST)
• Introduction of next generation whole genome sequencing

62. Treatment
Pan country roll out of injectible free regimen for DS-TB
Post treatment follow up till 2 years after completion of the anti-TB
treatment
Digital adherence technologies to inform and enable more
differentiated patient care

69. Recommended daily dose regimen for drug sensitive TB
Adult
Intensive phase
4 FDC (2 months)
Isoniazide(H)
Rifampicin(R)
Pyrazinamide(Z)
Ethambutol(E)
 Continuation phase
3 FDC (6 months)
HRZ
Children
Intensive phase
3 FDC (2 months)
 HRZ
Continuation phase
2 FDC (6 months)
 HR

70. Shorter oral bedaquiline-containing MDR/RR-TB regimen
Inclusion criteria
1.DST based inclusion criteria
Rifampicin resistance detected/inferred
MDR/RR-TB with H resistance detected/ inferred based on InhA mutation
only or based on KatG mutation only (not both)
MDR/RR-TB with FQ resistance not detected

71. 2.Other inclusion criteria
 Children, aged 5 years to less than 18 years of age and weighing at least
15 kg, given their special needs, in consultation with the pediatrician
 No history of exposure to previous treatment with second-line medicines
in the regimen(Bdq, Lfx, Eto or Cfz) for > 1 month
 No extensive TB disease
 No severe extra-pulmonary TB
 Women who are not pregnant or lactating

72. Exclusion criteria
1. DST based exclusion criteria
 MDR/RR-TB patients with H resistance detected with both KatG and
InhA mutation; and
 MDR/RR-TB patients with FQ resistance detected

73. Exclusion criteria
2.Other exclusion criteria
If result for FL-LPA, SL-LPA and DST to Z,BDQ & Cfz is not available
after pre-treatment evaluation is completed and it is a time to initiate the
first dose of the regimen, then, excluded those with history of exposure
for>1 month to Bdq, Lfx, Eto or Cfz
Intolerence to any drug or risk of toxicity from a drug in shorter oral
Bedaquiline containing MDR/RR-TB regimen

74.  Extensive TB disease found in presence of bilateral cavitary disease or
extensive parenchymal damage on chest radiography
 In children aged under 15 yrs, presence of cavities or bilateral disease on
chest radiography
 Severe EP-TB disease where there is a presence of military TB or TB
meningitis or CNS TB. In children aged under 15 yrs, extrapulmonary
forms of ds other than lymphadenopathy
 Pregnant and lactating women
 Children below 5 years

75. Shorter oral bedaquiline-containing MDR/RR-TB regimen
• From start to end of 4 months-Bdq, Lfx, Cfz, Z, E, Hh ,Eto
• From start of 5 months to end of 6 months-(If IP not extended)
-Bdq, Lfx, Cfz, Z, E
• From start of 6 months to end of 9 months-Lfx, Cfz, Z, E
• If the IP is extended upto 6 months then all 3 drugs Bdq, Hh and Eto are
stopped together
(4-6) Bdq(6 m), Lfx, Cfz, Z, E, Hh, Eto (5)Lfx, Cfz, Z, E

76. Grouping of anti-TB drugs & steps for designing long MDR-TB regimen
Groups & Steps Medicine Abbreviation
Group A Levofloxacin or Lfx
Include all three medicines Moxifloxacin Mfx
Bedaquiline Bdq
Linezolid Lzd
Group B Clofazimine Cfz
Add one or both medicines Cycloserine or Cs
Terizidone Tr

77. Grouping of anti-TB drugs & steps for designing long MDR-TB regimen
Groups & Steps Medicine Abbreviation
Group C Ethambutol E
Add to complete the
regimen and when
medicines from group A &
B cannot be used
Delamanid Dlm
Pyrazinamide Z
Imipenem-cilastatin or Ipm-Cln
Meropenem Mpm
Amikacin Am
(or Streptomycin) S
Ethionamide or Eto
Prothionamide Pto
p-aminosalicylic acid PAS

78. Longer oral M/XDR-TB regimen
• It is of 18 -20 months with no separate IP or CP
• Dose of Lzd will be tapered to 300 mg after the initial 6-8 months of treatment
• Bdq will be given for 6 months and extended beyond 6 months as an exception
• Pyridoxine to be given to all DR-TB patients as per weight band
• For XDR-TB patients the duration of longer oral XDR-TB regimen would be for
20 months
(18-20) Lfx, Bdq(6 month or longer), Lzd, Cfz, Cs

79. Management of MDR-TB patients during pregnancy

80. Bedaquiline,Pretomanid,Linezolid (BPaL) regimen
• Bpal regimen for MDR-TB with additional fluoroquinolones resistance
• Duration: 6-9 months
• Used under operational research conditions to TB patient who have either no
previous exposure to bedaquiline and linezolid or have been exposed for no
more than 2 weeks

81. Bedaquiline,Pretomanid,Linezolid (BPaL) regimen
Dosage
• Pretomanid - 200 mg once daily for 26 weeks
• Bedaquiline - 400 mg once daily for the first 2 weeks and then 200 mg three
times/ week for 24 weeks
• Linezolid – 1200 mg once daily for 24 weeks

82. OUTLINE
Burden
Timeline
End TB
strategy
Goals &
Objectives
NSP 2020-2025
Pillars
Conclusion

83. 170
148
120
199
44
0
50
100
150
200
250
2019 2020 2021 2022 2023 2024 2025
Inciddence
rate
(cases
per
100,000
population)
Scenario I Scenario II Scenario III Scenario SDG
NTEP impact modelling
Scenario 1: Sustained service delivery at the current trends with available tools
Scenario 2: Scale-up of existing strategies and introduction of newer tools
Scenario 3: Accelerated expansion of existing and newer tools
Scenario SDG: Newer vaccine, drugs, diagnostics, and non-pharmaceutical interventions

84. - Highest level of political &
administrative commitment
- State strategic plans based on NSP
- Much greater financial resources
- Availability of new drugs, regimens,
diagnostics, approaches
- Insufficient human resources
- Low coverage of basic program services
for those accessing care in private sector
- Addressing social determinants of TB
- COVID-19 pandemic response focus
attention on Respiratory Diseases
- Integration with other ministries
- Enforcement of mandatory notification
- Expansion of AB-PMJAY to cover TB
- Innovative solutions
• - Insufficient budgetary outlay for
health in national budgets
• - COVID-19 derailing efforts of TB
programs
• - Economic slowdown owing to
lockdown
SWOT

85. 1. MoHFW. National multisectoral action framework for TB- free India. New Delhi:MoHFW;2020 [cited
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