National Tuberculosis Elimination Programme (NTEP)
India carries 27% of the global TB burden — the highest of any country. The National Tuberculosis Elimination Programme (NTEP), renamed from RNTCP in 2020, is the country's flagship response. NTEP has committed to eliminating TB by 2025, five years ahead of the global SDG target, through expanded diagnostic access, daily treatment regimens, active case finding, and patient support schemes.
The Revised National Tuberculosis Control Programme (RNTCP) was launched in 1997, scaling up DOTS (Directly Observed Treatment, Short-course) nationwide by 2006. In January 2020, RNTCP was renamed the National Tuberculosis Elimination Programme (NTEP) to reflect India's commitment to eliminating TB by 2025 — defined as reducing incidence to less than 1 case per 10 lakh population. The current incidence is approximately 210 per lakh (India TB Report 2024).
NTEP is fully integrated into the general health system. Diagnosis is free at all NTEP microscopy centres and CBNAAT (Cartridge Based Nucleic Acid Amplification Test) facilities, and treatment is free at all public health facilities including DOT centres run by ASHAs and TB Health Visitors. NTEP also partners with private sector providers — India's first large-scale mandatory notification disease, with all private practitioners legally required to notify every TB case to the Nikshay portal within 24 hours of diagnosis.
Investigations Available Under NTEP
- Sputum smear microscopy (ZN stain): Free at all Designated Microscopy Centres (DMCs). At least 2 samples (on-the-spot and early morning) examined. WHO replaced the 3-sample scheme with a 2-sample scheme in 2010.
- CBNAAT (Xpert MTB/RIF): Molecular test that simultaneously detects Mycobacterium tuberculosis DNA and rifampicin resistance within 2 hours. Currently available at over 6,000 sites in India. First-line test for all paediatric TB, all HIV-TB co-infected cases, all extra-pulmonary TB samples, and all previously-treated TB cases.
- Truenat: Newer chip-based molecular test deployed at PHC level for primary screening, with rifampicin resistance confirmation on the same platform.
- Line Probe Assay (LPA): For second-line drug resistance testing (FL-LPA for first-line, SL-LPA for second-line). Used for diagnosis of MDR-TB and pre-XDR-TB.
- Chest X-ray: Used as a screening tool in active case finding and symptomatic patients with negative sputum; NTEP has deployed mobile X-ray vans with AI-assisted reading (qXR, CAD4TB) for active case finding.
- GeneXpert Mycobacterium tuberculosis Ultra: More sensitive than Xpert MTB/RIF for paucibacillary TB (children, HIV, extra-pulmonary).
India shifted from intermittent (thrice-weekly) DOTS to daily regimen in 2017-18 for drug-sensitive TB. Current standard regimens:
| Category | Regimen | Duration |
|---|---|---|
| Drug-sensitive pulmonary TB (new) | HRZE daily for 4 doses/week x 8 weeks, then HR x 4 doses/week x 16 weeks | 6 months |
| TB meningitis / bone & joint TB | HRZE daily x 8 weeks + HR daily x 28 weeks | 12 months |
| MDR-TB (short-course) | 9-month all-oral regimen (BPaLM in 2022 onwards for eligible) | 9 months |
| Pre-XDR / XDR-TB | 6-month BPaLM (Bedaquiline + Pretomanid + Linezolid ± Moxifloxacin) | 6 months |
Drugs used: H = Isoniazid, R = Rifampicin, Z = Pyrazinamide, E = Ethambutol. The fixed-dose combination (FDC) tablets are colour-coded by weight band and dispensed in patient-wise boxes free of cost. Treatment adherence is monitored through Nikshay with weekly missed-dose flags and ASHA-supported DOT.
Nikshay (https://nikshay.in) is the official web-based TB notification and patient tracking system, launched in 2016 and made mandatory for all providers (public and private) by the gazette notification of 16 March 2018. Every TB patient — diagnosed anywhere — must be notified within 24 hours. The portal allows:
- Online notification by public and private healthcare providers
- Patient-wise treatment tracking with daily adherence records
- Automatic linkage to patient support schemes (Nikshay Poshan Yojana, Nikshay Aushadhi, TB Mukt Bharat)
- Real-time dashboards for district, state, and national programme managers
- Private provider engagement (PPE) — incentives for notification and treatment completion
Failure to notify a TB case is a punishable offence under the Indian TB notification regulations. NTEP provides support to private doctors for free diagnostics, free drugs, and patient support directly through the Nikshay portal.
- Nikshay Poshan Yojana (NPY): Rs 500 per month for the entire duration of treatment, Direct Benefit Transfer to patient's Aadhaar-linked bank account. Launched April 2018; over 60 lakh beneficiaries have received benefits.
- Nikshay Aushadhi: Free anti-TB drugs to private sector patients through designated NTEP pharmacies.
- Nikshay Shakti: Vehicle for nutritional and transport support to marginalised patients (state-specific).
- Pradhan Mantri TB Mukt Bharat Abhiyan (PMTBMBA): Launched September 2022 — community-based TB adoption where individuals, NGOs and corporates 'adopt' TB patients and provide additional nutritional, diagnostic or vocational support for 1-2 years.
- Free diagnostic packages for private practitioners, paid by NTEP through the Nikshay portal.
India's TB elimination target is < 1 case per 10 lakh population by 2025. The current incidence (2024 data) is around 210 per lakh — meaning incidence needs to fall by ~85% in 5 years, an unprecedented pace globally. The strategy is built on four pillars: Detect-Prevent-Treat-Build. 'Detect' focuses on active case finding in high-risk groups. 'Prevent' scales up TB Preventive Treatment (TPT) for contacts of confirmed cases, especially children under 5 and PLHIV. 'Treat' focuses on shorter all-oral MDR regimens and universal DST. 'Build' strengthens the health system, including private sector engagement and social protection.
Key challenges: private sector under-notification (estimated 25-30% of cases still not reported), high out-of-pocket expenditure on diagnostics and second-line drugs, social determinants (undernutrition, crowded housing, smoking) and the rising threat of drug resistance. For UPSC CMS candidates, NTEP is among the most predictable interview topics — knowing the daily regimen, CBNAAT indications, Nikshay's mandatory notification rule, and NPY amount is essential. Reference: tbcindia.gov.in and India TB Report 2024.
NTEP is among the most operationally complex programmes in Indian public health. Its diagnostic algorithm alone (smear, CBNAAT, Truenat, LPA) covers the full spectrum of drug susceptibility testing. For UPSC CMS candidates, knowing NTEP at the level of detail in this page is the difference between an average and a top-quartile PSM interview performance.