Discuss India's approach to tuberculosis (TB) elimination and evaluate how integration of TB services within the broader public health system contributes to achieving universal health coverage.

Introduction

Tuberculosis remains a significant public health challenge in India despite substantial progress in recent years. India's approach has evolved from vertical disease control programs to an integrated health system strategy aimed at achieving tuberculosis elimination while advancing universal health coverage (UHC).

Progress and Key Strategies

Expansion of molecular testing for rapid detection of TB and drug-resistance

Introduction of shorter, all-oral BPaL treatment regimens for drug-resistant TB

Enhanced nutrition support through Nikshay Poshan Yojana (doubled to ₹1,000 monthly)

Integration of TB services within both components of Ayushman Bharat: PMJAY insurance scheme and Ayushman Arogya Mandirs

Decentralization of care through sputum collection centers at primary healthcare facilities

Active case-finding campaigns like the '100 Days' initiative to reduce pre-diagnosis costs

Involvement of TB survivors and community champions to combat stigma

Implementation of TB preventive therapy for at-risk populations

Challenges and Future Directions

Need for person-centered care approaches addressing social and clinical vulnerabilities

Recognizing intersectionalities of gender, age, caste, disability, and socioeconomic status

Promoting integrated screening for comorbidities like COPD, depression, and hypertension

Expanding social protection through nutrition support, wage-loss compensation, and livelihood programs

Addressing private sector engagement, where over 50% of TB patients seek initial care

Improving public awareness and science-based information to reduce stigma

Conclusion

India's 17.7% decline in TB incidence from 2015 to 2023 demonstrates progress, but achieving TB elimination requires continued integration within the broader health system. By applying an equity lens to tuberculosis control efforts, India can accelerate progress toward both TB elimination and universal health coverage for all citizens.