Can India End TB? Of Course

In spite of India's proud heritage of having conquered smallpox and poliomyelitis, the challenge of overcoming the highest burden of tuberculosis (TB) of any country in the world may seem unsurmountable. India's extreme population density, especially among the very poor, makes control of TB a uniquely difficult challenge. Control of TB in India is further complicated by the presence of the second highest burden of multiple drug resistant (MDR) and extremely drug resistant (XDR)-TB. Nevertheless, the country is making important progress toward control, as evidenced by recent national statistics [1, 2]. Elements are already in place upon which India can build to achieve the World Health Organization goal to “End TB” (http://www.who. int/tb/post2015_strategy/en/). Tuberculosis control is organized under the Revised National Tuberculosis Control Program (RNTCP) (2), which receives funding from the Global Fund to Fight AIDS, Tuberculosis, and Malaria, and is designed according to the guidance of the World Health Organization (WHO). The design includes a network of Tuberculosis Units at the District and Taluka level which manage diagnostic testing by Designated Microscopy Centers (DMC) and anti-TB treatment (ATT) drug distribution and patient management. In 2014, the RNTCP provided ATT to 1,416,014 people with active TB [2], a remarkable accomplishment. The work of the RNTCP is benefitted by the efforts of the National Rural Health Mission (http://nrhm.gov.in/), which provides medical and preventive care to rural populations, including assistance with diagnosis and management of TB in many cases. The emergence of the National Urban Health Mission (http://nrhm.gov.in/nhm/nuhm.html) may augment TB control efforts among the urban poor. Approximately half of patients with TB in India are treated by private physicians, outside the purview of the RNTCP, and this effort is viewed as an important component of TB control [2]. Partnerships between government and nongovernmental organizations (NGOs) contribute to control efforts in important ways, as exemplified by the Partnership for Tuberculosis Care and Control in India (http://tbpartnershipindia.org/). Despite standardized treatment being nationally operational, the RNTCP exercises flexibility in approach by which it adapts to opportunities as it continues to make progress.