"Tuberculosis in India: NTEP, WHO Guidelines & Updates for NORCET 2025"

Tuberculosis (TB) remains a major public health challenge in India, which accounts for 26% of the global TB burden. For nursing aspirants preparing for the Nursing Officer Recruitment Common Entrance Test (NORCET), mastering TB-related topics as per the National Tuberculosis Elimination Programme (NTEP) and World Health Organization (WHO) guidelines is essential. This blog provides a comprehensive overview of TB, key points from NTEP and WHO, recent updates in India’s TB control efforts, and previously asked MCQs to aid your exam preparation.

Understanding Tuberculosis

Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis, primarily affecting the lungs (pulmonary TB) but also capable of impacting other organs (extrapulmonary TB). It spreads through airborne droplets from coughing or sneezing by an infected person. Despite being preventable and curable, TB remains a leading cause of death from a single infectious agent globally.

Key Points from NTEP

The National Tuberculosis Elimination Programme (NTEP), previously the Revised National Tuberculosis Control Programme (RNTCP), is India’s flagship initiative under the National Health Mission (NHM) aiming to eliminate TB by 2025, ahead of the global Sustainable Development Goals (SDG) target of 2030. Below are the critical points:

Vision and Goals:

Vision: A TB-free India with zero deaths, disease, and poverty due to TB.

Goals: Reduce TB incidence by 80% and mortality by 90% by 2025 compared to 2015, with zero catastrophic costs for patients.

Strategic Pillars (Detect – Treat – Prevent – Build):

Detect: Early case identification through active case finding (ACF) and universal drug susceptibility testing (UDST) using rapid diagnostics like CB-NAAT and TrueNat.

Treat: Free, quality-assured anti-TB drugs with daily fixed-dose combinations (FDCs) and shorter oral regimens for drug-resistant TB (DR-TB).

Prevent: TB preventive treatment (TPT), BCG vaccination, and addressing comorbidities like malnutrition, diabetes, and HIV.

Build: Strengthening health systems, training, and community engagement.

Diagnostic Infrastructure:

Over 24,573 Designated Microscopy Centers (DMCs), 6,496 molecular diagnostic labs, and 81 Culture and Drug Susceptibility Testing (C&DST) labs by 2023.

Tests include sputum smear microscopy, CB-NAAT, TrueNat, and chest X-rays. TrueNat, an ICMR-developed tool, detects Mycobacterium tuberculosis and rifampicin resistance in under an hour.

Treatment Regimens:

New Cases: 6-month regimen with first-line drugs (Isoniazid, Rifampicin, Pyrazinamide, Ethambutol) in a 2-month intensive phase (HRZE) and 4-month continuation phase (HRE).

Drug-Resistant TB: Shorter oral regimens with newer drugs like Bedaquiline and Delamanid for MDR/RR-TB.

Nutritional Support:

Nikshay Poshan Yojana (NPY): Provides ₹500/month via Direct Benefit Transfer (DBT) to TB patients for nutrition, disbursing ₹2,781 crore to ~1 crore beneficiaries by 2023.

Logo for NTEP 

Community Engagement:

ASHA workers and TB champions (TB Vijeta) receive incentives (₹500 for case identification, ₹1,000 for treatment completion, ₹5,000 for DR-TB cases).

The Joint Effort for Elimination of Tuberculosis (JEET) enhances private sector case notification.

Innovative Initiatives:

Nikshay Portal: Tracks case notifications and treatment adherence.

MERM Container Box: A GPS-enabled device for monitoring medication compliance.

TB Mukt Gram Panchayat: Over 2,251 gram panchayats in Maharashtra declared TB-free in 2023.

100-Day TB Elimination Campaign (2024): Targets 347 districts to improve case detection and reduce delays.

Achievements:

TB incidence reduced by 17.7% (237 to 195 per 100,000) and mortality by 21.4% (28 to 22 per lakh) from 2015 to 2023.

In 2023, 1.89 crore sputum smear tests and 68.3 lakh NAAT tests were conducted.

Key Points from WHO

WHO provides evidence-based guidelines for TB prevention, diagnosis, treatment, and care, organized into five modules: prevention, screening, diagnosis, treatment, and comorbidities/vulnerable populations. Key points include:

Global Burden and Goals:

TB affects ~25% of the global population with latent infection. In 2022, there were 10.6 million new cases and 1.3 million deaths worldwide.

The End TB Strategy targets a 90% reduction in incidence and 95% in deaths by 2035 compared to 2015.

Screening and Diagnosis:

Systematic screening for high-risk groups (e.g., slum dwellers, prisoners) using chest X-rays, symptom screening, and rapid tests like Xpert MTB/RIF.

WHO’s 2021 guidelines emphasize rapid diagnostics for early detection of TB and drug resistance.

Treatment:

Standard 6-month regimen for drug-susceptible TB.

Shorter regimens (9–11 months) for DR-TB with drugs like Bedaquiline and Delamanid.

Treatment success rate: ~85% for drug-susceptible TB.

Prevention:

TB preventive treatment (TPT) for latent TB in high-risk groups like HIV-positive individuals and household contacts.

BCG vaccination for infants, with selective adult vaccination in high-burden areas.

Comorbidities and Vulnerable Populations:

Address risk factors like malnutrition, diabetes, HIV, and substance abuse.

Emphasizes people-centered, gender-responsive care to reduce stigma.

Operational Handbooks:

WHO’s handbooks (e.g., Module 2: Screening, Module 3: Diagnosis) guide TB program implementation tailored to local needs.

Recent Updates on TB in India (2024–2025)

India TB Report 2024:

Decline in Burden: TB incidence dropped 18% (237 to 195 per lakh, 2015–2023), surpassing the global decline of 8%. Mortality fell from 28 to 23 per lakh (2015–2022).

Missing Cases: Reduced from 3.2 lakh (2022) to 2.3 lakh (2023), with 95% of diagnosed patients initiating treatment.

Private Sector: Contributed 33% of 25.5 lakh TB cases in 2023 (8.4 lakh cases), up from 1.9 lakh in 2015.

Estimated Burden: 27.8 lakh incident cases in 2023, with 3.2 lakh deaths.

New Treatment:

**BPaLM Regimen**: Approved in September 2024 for MDR-TB, this shorter oral regimen (Bedaquiline, Pretomanid, Linezolid, Moxifloxacin) enhances treatment efficacy.

Diagnostic Advancements:

Over 800 AI-enabled portable chest X-ray machines are being procured to bolster India’s network of 7,767 molecular testing labs and 87 C&DST labs.

Nikshay Shivir: In August 2025, Fatehpur, Kangra, conducted 581 chest X-rays in a day, identifying 52 presumptive TB cases.

Community Efforts:

Nikshay Mitra and PMTBMBA: 100% patient adoption in Narmada district’s public facilities, with nutritional support via food baskets and ₹500/month DBT.

TB Mukt Bharat Campaign: Strengthens community involvement through District TB Forums.

Challenges:

Risk Factors: In 2022, 7.44 lakh TB patients were undernourished, 1.02 lakh had diabetes, and 94,000 had TB-HIV co-infection.

DR-TB: 119,000 MDR-TB cases in 2021, with 1.5–11% progressing to XDR-TB.

Elimination Target: Experts note the 2025 goal (1 case per 10 lakh) is ambitious due to insufficient annual decline rates and post-COVID disruptions.

Global Recognition:

WHO’s Global TB Report 2024 praised India’s progress, citing decentralized healthcare via 1.7 lakh Ayushman Arogya Mandirs and increased NTEP funding.

Previously Asked MCQs for NORCET

What is the causative organism of tuberculosis?

A) Mycobacterium bovis

B) Mycobacterium tuberculosis

C) Streptococcus pneumoniae

D) Staphylococcus aureus

Ans.-B)Mycobacterium tuberculosis

What is the duration of the intensive phase for new pulmonary TB cases under NTEP?

A) 2 months

B) 4 months

C) 6 months

D) 8 months

Ans.-A) 2 months

What is the financial support under Nikshay Poshan Yojana?

A) ₹300/month

B) ₹500/month

C) ₹700/month

D) ₹1,000/month

Ans.-B) ₹500/month

Which test detects rifampicin resistance under NTEP?

A) Sputum smear microscopy

B) Chest X-ray

C) CB-NAAT

D) ELISA

Ans.-C) CB-NAAT

What is India’s TB elimination target year under NTEP?

A) 2025

B) 2030

C) 2035

D) 2040

Ans.-A) 2025

Which vaccine is recommended by WHO for TB prevention in infants?

A) DPT

B) BCG

C) MMR

D) OPV

Ans.-B) BCG

What is the primary mode of TB transmission?

A) Waterborne

B) Foodborne

C) Airborne

D) Contact

Ans.-C) Airborne

NORCET Preparation Tips

Master NTEP Framework: Focus on the four pillars, diagnostic tools (CB-NAAT, TrueNat), and treatment regimens.

Know Key Statistics: Memorize India’s TB burden (195 cases per lakh in 2023) and achievements (18% incidence reduction).

Understand DR-TB: Study MDR-TB, RR-TB, and newer regimens like BPaLM.

Practice MCQs: Solve TB-related questions on NTEP, WHO guidelines, and clinical aspects.

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Stay Updated: Refer to the India TB Report 2024 and WHO Global TB Report for recent data.

Conclusion

India’s fight against TB, led by NTEP and aligned with WHO guidelines, showcases significant progress through advanced diagnostics, shorter treatment regimens, and community-driven initiatives. However, challenges like drug resistance and social determinants persist. For NORCET aspirants, combining knowledge of NTEP’s strategies, WHO’s guidelines, and recent updates with consistent MCQ practice is key to success. Stay informed and contribute to India’s vision of a TB-free nation by 2025!

Resources:

NTEP: https://tbcindia.gov.in/

WHO TB Guidelines: https://www.who.int/tb

Best of luck for your NORCET exam!