Tuberculosis continues to remain one of India’s most pressing public health challenges, even as the country makes steady strides toward its elimination. With evolving diagnostic technologies, expanding treatment access, and ambitious national targets, the fight against TB is at a critical juncture—marked equally by progress and persistent hurdles.

On the occasion of World TB Day, this insightful and thought-provoking conversation brings timely focus to the realities of tuberculosis in India. Prof. Sanjeev Sinha, Department of Medicine at AIIMS Delhi shares his expert perspective in an in-depth discussion with Rohit Shishodia, Senior Correspondent at Drug Today Medical Times (DTMT).

In this interview, Prof. Sinha unpacks the progress made in reducing TB incidence and mortality, while also shedding light on the growing challenge of drug-resistant forms like MDR-TB and the socio-economic factors that continue to fuel the disease.

From evaluating whether India’s TB elimination goals are truly within reach to emphasizing the urgent need for awareness, early detection, and stronger healthcare integration, this conversation offers a comprehensive and grounded view of the road ahead.

As the world observes World TB Day, this interview serves as both a reflection on how far we’ve come and a powerful reminder of the collective effort still required to eliminate tuberculosis in India.

Here are the excerpts.....

DTMT: Professor Sinha, how would you assess the current progress and challenges in tuberculosis control across India?

Prof. Sanjeev Sinha: Over the past few years, India has made notable progress in tuberculosis (TB) control. We’ve seen a decline in both incidence and mortality, which is encouraging. Diagnostic capabilities have improved significantly, especially with wider access to rapid molecular tests like NAAT for detecting drug resistance. The programmatic implementation of DOTS for both drug-sensitive and drug-resistant TB has strengthened treatment delivery, and patients now have free access to medications. Additionally, digital platforms like Nikshay have improved patient tracking, and there’s been better notification from the private healthcare sector.

However, several challenges remain. One of the biggest issues is poor treatment awareness, which often leads to interruptions in therapy. Access to advanced drug susceptibility testing is still limited in many areas. Social determinants such as stigma, poverty, malnutrition, and overcrowded living conditions continue to fuel the disease. Underreporting, especially from private providers, is another concern. Furthermore, comorbidities like diabetes and the increasing use of immunosuppressive therapies and chemotherapy are making patients more vulnerable and complicating treatment outcomes.

DTMT: Do you think tuberculosis elimination is a realistic goal for India? What key strategies are required to achieve it?

Prof. Sanjeev Sinha: TB elimination is certainly possible, but achieving it in the immediate future is extremely challenging. The 2025 targets, while ambitious and well-intentioned, may not be entirely realistic given the current ground realities.

To move closer to elimination, we need a multi-pronged strategy. Ensuring treatment adherence is critical—this can be achieved through DOTS, shorter treatment regimens, and strong patient support systems. Universal access to expanded drug susceptibility testing must be prioritized, along with mandatory NAAT testing at the start of treatment.

Equally important is addressing the underlying social issues—poverty, malnutrition, and stigma—that continue to drive the disease. Active case finding and robust contact tracing will help detect cases early and prevent spread. Lastly, stronger integration of the private healthcare sector into national TB control strategies is essential for comprehensive coverage.

DTMT: Could you explain multidrug-resistant tuberculosis (MDR-TB), and what measures are most effective in its prevention and management?

Prof. Sanjeev Sinha: Multidrug-resistant TB, or MDR-TB, refers to tuberculosis that is resistant to at least isoniazid (H) and rifampicin (R), the two most powerful first-line anti-TB drugs.

MDR-TB typically develops due to improper treatment—this includes incorrect drug regimens, inadequate treatment duration, stopping treatment prematurely, or interruptions in therapy. Sometimes, persistent disease at the time of stopping treatment can also contribute.

Prevention is key. Ensuring strict adherence to treatment is the most effective measure. Expanding access to drug resistance testing, including second-line drugs, helps in early detection and appropriate management. Infection control measures, especially preventing droplet transmission from confirmed MDR-TB patients, are crucial. Additionally, providing free and widespread access to MDR-TB treatment regimens and individual drugs can significantly improve outcomes.

DTMT: What are the early warning signs and common symptoms of tuberculosis that the public should be aware of?

Prof. Sanjeev Sinha: Early detection plays a vital role in controlling TB. The most common symptom is a persistent cough lasting more than two to three weeks. Other warning signs include fever, especially in the evening, unexplained weight loss, night sweats, fatigue, and loss of appetite. In some cases, patients may also cough up blood.

It’s important for people to recognize these symptoms early and seek medical attention promptly. Early diagnosis not only improves the chances of recovery but also helps prevent transmission to others.

DTMT: Thank you, Professor Sinha, for sharing such valuable insights.

Prof. Sanjeev Sinha: Thank you. It’s important that we continue raising awareness and strengthening our efforts to combat TB in India.