India rolled out a 100-days Tuberculosis (TB) Elimination Campaign in December 2024 to intensify progress towards ending the disease through improved case detection, reduction in diagnostic delays, and enhanced treatment outcomes across 347 districts in 33 states. The campaign will leverage existing health infrastructure, including over 160 000 Ayushman Aarogya Mandirs (health and wellness centres), to take TB services close to where people live in high-burden areas. The Kurung Kumey district in Arunachal Pradesh is one of the districts selected for the campaign.
Strategies such as improved access to advanced diagnostics, no delay in initiation of treatment, nutritional support and preventive treatment for close contacts under National TB Elimination Programme (NTEP) have led to significant reduction in TB in India since 2023. The TB incidence rate in India declined from 237 per 100 000 in 2015 to 195 per 100 000 in 2023 (17.7% reduction), and TB-related deaths reduced from 28 per 100 000 population to 22 per 100 000 (21.4% decline) during the same period.
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A WHO India technical officer reviewing data to strengthen TB services at Urban Health Centre Itafort in Itanagar (Photo: Sanchita Sharma / © WHO India)
Scattered tribal populations living in remote pockets in hard-to-reach areas are the biggest challenges in Arunachal Pradesh, which has adopted a multi-pronged approach to reach the unreached. These include active case finding with the support of the private sector for increased case notification, community mobilization for ensuring adherence to treatment and addressing stigma, nutritional food distribution under the Nikshay Mitra Programme, and screening marginalized communities, people living in remote and underserved areas, and people with co-morbidities, such as diabetes, HIV, and malnutrition.
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The WHO team with ASHAs (community health volunteers) and the health workforce at Urban Primary Health Centre Itafort in Itanagar, Arunachal Pradesh, after a lively discussion on the successes and challenges of providing tuberculosis services(Photo: Sanchita Sharma / © WHO India)
“Stigma still exists in urban areas, and even people who cough continuously don’t want to give sputum for diagnosis. We go house-to-house to convince people that it’s not a bad disease, treatment is free and you can get completely cured if you continue taking the medicine,” said Ms Kichimuni, ASHA (community health volunteer) facilitator for the neighbourhoods around Urban Health Centre, Itafort in Itanagar.
In collaboration with development partners, the state health department has strengthened Tribal TB Elimination Initiative that focuses on community ownership, multi-sectoral collaboration, and integrated care through empowering tribal communities, engaging local governance structures, and addressing co-morbidities.
This has resulted in the post-pandemic TB notification rate remaining above 75% of the target set by Central TB Division, and more than 80% of people diagnosed with TB completing treatment.
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Intensified case finding, no delays in treatment initiation and uninterrupted supply of TB drugs are a priority for Tuberculosis Unit at Urban Health Centre Itafort (Photo: Sanchita Sharma / © WHO India)
Higher awareness is also leading to self-reporting of cases. One such self-reported case was Mr Rokom Gamno, a traffic warden from Itanagar, Arunachal Pradesh, who was diagnosed with extrapulmonary tuberculosis (TB) after two sputum negative results for pulmonary TB.
“I had intermittent cough, night sweats, weight loss and fatigue, but my sputum tested negative twice for TB. An ultrasound and a CT finally led to my diagnosis of extra-pulmonary TB, and I’ve now completed two months of my six-months treatment in November. My symptoms have improved, though I’m still a bit weak,” said Mr Gamno, who met WHO Representative Dr Roderico H. Ofrin during a field visit to Itanagar.
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WHO Representative to India Dr Roderico H. Ofrin with Mr Rokom Gamno, who completed two months of his six-months treatment for extrapulmonary tuberculosis in November (Photo: Sanchita Sharma / © WHO India)
“Services for TB, noncommunicable disease management, undernutrition and mental health has to be integrated seamlessly to provide comprehensive continuum of care to the community. People with TB are at higher risk of mental health issues, just as people with diabetes are at higher risk for TB. We must leverage digital platforms like TeleMANAS to provide anonymous counselling services, particularly to the digitally savvy youth population, who are also at risk of tobacco, alcohol and drug abuse,” said Dr Roderico H. Ofrin, WHO Representative to India.
WHO India provides technical and field support to the Ministry of Health and Family Welfare at the district level in 10 states to assist in accelerating actions to end TB.