Tuberculosis: a Persistent Health Challenge for India

Purpose of Review Currently, India accounts for more than a quarter of incident TB cases globally. The Indian government recently announced a new national strategic plan to eliminate TB by 2025, but much is still unknown about the epidemic, in part due to a weakly regulated and highly privatized health sector. In this review, we provide an overview of the current landscape of TB in India, focusing on major challenges to elimination. Recent Findings Historically, political will and investment in TB care in India have been lacking. To successfully eliminate TB, India will need to broadly improve the quality of care that TB patients receive. Simulated patient studies have shown that the current quality of care is poor, especially in the private sector where drug sales estimate over one million TB patients seek care annually. Cascade of care studies indicate that TB patients are lost at every stage of care-seeking. Access is suboptimal for new diagnostic technologies such as GeneXpert and new drugs such as bedaquiline. Additionally, research in the social determinants of health indicates that factors such as undernutrition, smoking, and diabetes are major driving forces behind the TB epidemic. Summary India’s ambitious plan for TB elimination will require strong political and financial commitment to move forward. In order to effectively tackle TB, the Indian government needs to better engage the private sector and focus on quality: quality of care for patients, quality improvement of TB programs, and overall health quality to address social determinants.