National Tuberculosis Elimination Program Guidelines and its Relevance to the Indian Population in the Post-COVID-19 Pandemic Era

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Sriram Krishnamoorthy, MS, MCh, DNB, FRCS (Glasgow) Kalpana Ramachandran, MS, DNB, FRCS (Glasgow)



Introduction: Though tuberculosis was declared a public health emergency in 1993 and the revised national tuberculosis control programme gained momentum soon after, south Asian countries were left with a daunting task in the effective implementation of the control measures. The decades of progress achieved in tuberculosis control and elimination measures were almost wiped off in the last 12 to 18 months of the COVID-19 pandemic, clearly indicating that these measures need to be more structured and resilient. This manuscript focuses on the impact of the COVID-19 pandemic on TB control and also on the measures taken by the Government of India in effectively combating this syndemic.

Tuberculosis and COVID – a synergistic syndemic: The positive trends in tuberculosis elimination strategies observed till 2019 showed a dramatic reversal after the onset of the COVID-19 pandemic. The sharp decline observed in the TB notification rates in 2020 and 2021 showed signs of improvement in the first two quarters of 2022. Biological interactions between tuberculosis and COVID-19 agents, lung parenchymal damage occurring in both diseases, multiple lockdowns, the reduced workforce at tuberculosis notification centres and reallocation of funds to control the new-onset pandemic were some of the reasons for the decline in overall notifications across the globe.

Government goals (post-syndemic) and measures: The National Tuberculosis Elimination Programme initiated a holistic approach to eliminate TB from South Asia by 2030. Innovative strategies like digitalization of service delivery systems, telemedicine consultations and a four-tier hierarchy system resulted in a rise in the number of tuberculosis notifications. Making this campaign a public movement, creating Public Support Groups and propagating an online Nikshay portal for tuberculous notification greatly facilitated efforts to create a tuberculosis-free world.

Conclusions: Despite the COVID-19 pandemic causing a temporary slowdown in the measures to eliminate tuberculosis by 2030, digitalization processes and various innovative strategies have kept disease elimination hopes still alive. The government alone may not be able to accomplish this goal. Combined efforts and collective responsibility from the public, medical and para-medical support staff are imperative in making this dream of a tuberculosis free society, soon a reality.

Keywords: RNTCP, tuberculosis, COVID-19, pandemic, syndemic

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How to Cite
KRISHNAMOORTHY, Sriram; RAMACHANDRAN, Kalpana. National Tuberculosis Elimination Program Guidelines and its Relevance to the Indian Population in the Post-COVID-19 Pandemic Era. Medical Research Archives, [S.l.], v. 10, n. 12, dec. 2022. ISSN 2375-1924. Available at: <>. Date accessed: 29 jan. 2023. doi:
Research Articles


1. McQuaid CF, Vassall A, Cohen T, Fiekert K, White RG. The impact of COVID-19 on TB: a review of the data. Int J Tuberc Lung Dis. 2021 Jun 1;25(6):436-446. doi: 10.5588/ijtld.21.0148.
2. Sahu S, Ditiu L, Sachdeva KS, Zumla A. Recovering from the Impact of the Covid-19 Pandemic and Accelerating to Achieving the United Nations General Assembly Tuberculosis Targets. Int J Infect Dis. 2021 Dec;113 Suppl 1:S100-S103. doi: 10.1016/j.ijid.2021.02.078.
3. Houben RMGJ, Menzies NA, Sumner T et al. Feasibility of achieving the 2025 WHO global tuberculosis targets in South Africa, China, and India: a combined analysis of 11 mathematical models. Lancet Glob Health. 2016 Nov;4(11):e806-e815. doi: 10.1016/S2214-109X(16)30199-1.
4. Migliori GB, Thong PM, Akkerman O et al. Worldwide effects of coronavirus disease pandemic on tuberculosis services, January-April 2020. Emerg Infect Dis. 2020;26(11):2709–12. doi: 10.3201/eid2611.203163.
5. Dey S, Rao AP, Kumar A, Narayanan P. Awareness & utilization of NIKSHAY and perceived barriers for tuberculosis case notification among the private practitioners in Udupi district, Karnataka. Indian J Tuberc. 2020 Jan;67(1):15-19. doi: 10.1016/j.ijtb.2020.01.004.
6. Trajman A, Felker I, Alves LC et al. The COVID-19 and TB syndemic: the way forward. Int J Tuberc Lung Dis. 2022 Aug 1;26(8):710-719. doi: 10.5588/ijtld.22.0006.
7. Yasobant S, Bhavsar P, Kalpana P, Memon F, Trivedi P, Saxena D. Contributing Factors in the Tuberculosis Care Cascade in India: A Systematic Literature Review. Risk Manag Healthc Policy. 2021 Aug 10;14:3275-3286. doi: 10.2147/RMHP.S322143.
8. Guan WJ, Liang WH, Zhao Y et al. Comorbidity and its impact on 1590 patients with COVID-19 in China: A nationwide analysis. Eur Respir J 2020; 55: 2000547. doi: 10.1183/13993003.00547-2020.
9. Huddart S, Svadzian A, Nafade V, Satyanarayana S, Pai M. Tuberculosis case fatality in India: A systematic review and meta-analysis. BMJ Glob Health 2020; 5: e002080. doi: 10.1136/bmjgh-2019-002080.
10. Trajman A, Felker I, Alves LC et al. The COVID-19 and TB syndemic: the way forward. Int J Tuberc Lung Dis. 2022 Aug 1;26(8):710-719. doi: 10.5588/ijtld.22.0006.
11. Buonsenso D, Iodice F, Sorba Biala J, Goletti D. COVID-19 effects on tuberculosis care in Sierra Leone. Pulmonology. 2021 Jan-Feb;27(1):67-69. doi: 10.1016/j.pulmoe.2020.05.013.
12. Hogan AB, Jewell BL, Sherrard-Smith E et al. Potential impact of the COVID-19 pandemic on HIV, tuberculosis, and malaria in low-income and middle-income countries: a modelling study. Lancet Glob Health 2020;8(9): e1132–1141. doi: 10.1016/S2214-109X(20)30288-6.
13. Migliori GB, Thong PM, Alffenaar JW et al. Gauging the impact of the COVID-19 pandemic on tuberculosis services: a global study. Eur Respir J 2021;58(5):2101786. doi: 10.1183/13993003.01786-2021.
14. Grange JM, Zumla A. The global emergency of tuberculosis: what is the cause? J R Soc Promot Health 2002; 122: 78–81. doi: 10.1177/146642400212200206.
15. Dikid T, Chaudhary S, Goel K et al. Responding to COVID-19 pandemic: Why a strong health system is required. Indian J Med Res. 2020 Feb & Mar;151(2 & 3):140-145. doi: 10.4103/ijmr.IJMR_761_20.
16. Cucinotta D, Vanelli M. WHO Declares COVID-19 a Pandemic. Acta Biomed. 2020 Mar 19;91(1):157-160. doi: 10.23750/abm.v91i1.9397.
17. Soko RN, Burke RM, Feasey HRA et al. Effects of Coronavirus Disease Pandemic on Tuberculosis Notifications, Malawi. Emerg Infect Dis. 2021 Jul;27(7):1831-1839. doi: 10.3201/eid2707.210557.
18. Vashi K, Pathak YV, Patel J. Understanding the gaps in elimination of tuberculosis in India. Indian J Tuberc. 2021 Jan;68(1):114-118. doi: 10.1016/j.ijtb.2020.08.012.
19. Thakur G, Thakur S, Thakur H. Status and challenges for tuberculosis control in India - Stakeholders' perspective. Indian J Tuberc. 2021 Jul;68(3):334-339. doi: 10.1016/j.ijtb.2020.10.001.
20. Ruwanpura, A.I., 2022. Invest to end TB. Save lives"- World TB Day 2022. Journal of the College of Community Physicians of Sri Lanka, 28(1), pp.518–519.
21. Saini V, Garg K. Case finding strategies under National Tuberculosis Elimination Programme (NTEP). Indian J Tuberc. 2020 Dec;67(4S):S101-S106. doi: 10.1016/j.ijtb.2020.09.029.
22. Lee Y, Raviglione MC, Flahault A. Use of Digital Technology to Enhance Tuberculosis Control: Scoping Review. J Med Internet Res. 2020 Feb 13;22(2):e15727. doi: 10.2196/15727.
23. Kumar AM, Harries AD, Satyanarayana S, Thekkur P, Shewade HD, Zachariah R. What is operational research and how can national tuberculosis programmes in low- and middle-income countries use it to end TB? Indian J Tuberc. 2020 Dec;67(4S):S23-S32. doi: 10.1016/j.ijtb.2020.11.009.
24. Rieder HL. Air pollution, COVID-19, and tuberculosis interrelationship. Indian J Tuberc. 2020 Jul;67(3):281-283. doi: 10.1016/j.ijtb.2020.07.033.
25. Pai M, Bhaumik S, Bhuyan SS. India's plan to eliminate tuberculosis by 2025: converting rhetoric into reality. BMJ Glob Health. 2017 Mar 20;2(2):e000326. doi: 10.1136/bmjgh-2017-000326.
26. Purty AJ. Detect-Treat-Prevent-Build: Strategy for TB Elimination in India by 2025. Indian J Community Med. 2018 Jan-Mar;43(1):1-4. doi: 10.4103/ijcm.IJCM_321_17.
27. Potty RS, Kumarasamy K, Adepu R et al. Community health workers augment the cascade of TB detection to care in urban slums of two metro cities in India. J Glob Health. 2021 Jul 17;11:04042. doi: 10.7189/jogh.11.04042.
28. Arentz, M., Ma, J., Zheng, P. et al. The impact of the COVID-19 pandemic and associated suppression measures on the burden of tuberculosis in India. BMC Infect Dis 22, 92 (2022). doi: 10.1186/s12879-022-07078-y.
29. Pattnaik S. Analysis of tuberculosis case report in Hyderabad district of Telangana state. J Family Med Prim Care. 2018 May-Jun;7(3):561-564. doi: 10.4103/jfmpc.jfmpc_110_18.
30. Cilloni L, Fu H, Vesga JF et al. The potential impact of the COVID-19 pandemic on the tuberculosis epidemic a modelling analysis. E Clinical Medicine. 2020 Oct 24;28:100603. doi: 10.1016/j.eclinm.2020.100603.
31. Bhatia V, Srivastava R, Reddy KS et al. Ending TB in Southeast Asia: current resources are not enough. BMJ Glob Health. 2020 Mar 5;5(3):e002073. doi: 10.1136/bmjgh-2019-002073.
32. Ntoumi F, Nachega JB, Aklillu E et al. World Tuberculosis Day 2022: aligning COVID-19 and tuberculosis innovations to save lives and to end tuberculosis. Lancet Infect Dis. 2022 Apr;22(4):442-444. doi: 10.1016/S1473-3099(22) 00142-6.