RECENT UPDATE IN TB TREATMENT INDIA
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Here is a comprehensive update on recent TB treatment changes in India under the National Tuberculosis Elimination Programme (NTEP):
Recent Updates in TB Treatment - India (NTEP) 2024-2026
1. Drug-Susceptible TB (DS-TB) - Standard Regimen
The existing standard regimen for new DS-TB patients remains:
| Phase | Duration | Drugs |
|---|---|---|
| Intensive | 2 months | HRZE (Isoniazid + Rifampicin + Pyrazinamide + Ethambutol) |
| Continuation | 4 months | HR (Isoniazid + Rifampicin) |
Key point: India has not yet officially adopted the 4-month regimen (2HPZM/2HPM with Rifapentine + Moxifloxacin) at the NTEP program level - that shorter regimen is currently in the 2025 ATS/CDC/ERS international guidelines. India is expected to align progressively with WHO.
2. Drug-Resistant TB (DR-TB) - Major Updates
This is where the biggest changes have happened.
A. Current NTEP Standard of Care (SoC) for MDR/RR-TB (as of 2024)
Shorter regimen (9-11 months) - for ~42% of MDR patients:
- Intensive phase (4-6 months): Bedaquiline + Levofloxacin + Clofazimine + Pyrazinamide + Ethambutol + high-dose Isoniazid + Ethionamide
- Continuation phase (5 months): Levofloxacin + Clofazimine + Pyrazinamide + Ethambutol
Longer regimen (18-20 months) - for ~58% of MDR patients:
- Bedaquiline + Levofloxacin + Clofazimine + Linezolid + Cycloserine
B. BPaLM / BPaL Introduction (Major 2025 Update)
India formally introduced the BPaL-M regimen into the NTEP in early 2025, following a successful two-year domestic clinical trial:
- BPaL: Bedaquiline + Pretomanid + Linezolid (6-9 months)
- BPaLM: Bedaquiline + Pretomanid + Linezolid + Moxifloxacin (6-9 months)
India-specific finding: Indian patients required a lower linezolid dose (600 mg) compared to the global recommendation of 1,200 mg - reducing toxicity significantly while maintaining efficacy. This was an important finding from the Indian trial.
Rollout: 5 Centres of Excellence (including JJ Hospital, Mumbai) started treating patients from December 2024. Early results (September 2025 reports) show patients being declared cured with complete disease resolution. A Times of India report noted 9 patients cured in Mumbai with "magical" results.
Cost-effectiveness data (2025): Indian health economists showed BPaL and BPaLM are cost-saving vs. existing SoC in terms of DALYs averted - strengthening the case for wider rollout. [PMID: 41520273]
C. Bedaquiline Resistance Monitoring
With expanded bedaquiline use, India has initiated systematic phenotypic DST and genotypic characterization of bedaquiline resistance in DR-TB strains - a critical surveillance step. [PMID: 42276191, June 2026]
3. Diagnostics Updates
| Tool | Update |
|---|---|
| Universal DST (UDST) | All TB-positive patients mandatorily tested for rifampicin/isoniazid resistance via CBNAAT (GeneXpert) |
| Line Probe Assay (LPA) | Used for rapid detection of fluoroquinolone and second-line drug resistance |
| Culture & DST labs | Expanded CDST laboratory network across states |
| Nikshay portal | Centralized digital notification and treatment tracking - cure declarations made on this platform |
4. TB Preventive Therapy (TPT)
NTEP has expanded TPT beyond child contacts <5 years and PLHIV to broader eligible groups. Two regimens are offered:
- 6H - 6 months daily Isoniazid
- 3HP - 3 months weekly Rifapentine + Isoniazid (for eligible contacts)
5. Nutritional and Social Support
- Nikshay Poshan Yojana (NPY): Rs. 1,000/month direct benefit transfer to all TB patients for nutritional support, continued even for up to 2 years of treatment
- Healthcare providers receive Rs. 1,000 (Rs. 500 for notification + Rs. 500 for treatment support)
- WHO's 2025 consolidated TB guidelines have now formally endorsed nutritional assessment and food support as core TB strategies - India's NPY was ahead of this global recommendation
6. India TB Report 2024 - Programmatic Status
India remains the country with the highest TB burden globally. The NTEP (formerly RNTCP) continues its push toward the national goal of TB elimination by 2025 (5 years ahead of WHO's 2030 target), though this target remains aspirational given current incidence rates.
Summary Table
| Area | Update |
|---|---|
| DS-TB regimen | 2HRZE/4HR continues; 4-month rifapentine regimen not yet NTEP-adopted |
| MDR-TB SoC | All-oral 9-11 month shorter regimen + 18-20 month longer regimen |
| NEW: BPaLM | Introduced in NTEP March 2025; 5 CoEs operational since Dec 2024 |
| Linezolid dosing | India uses 600 mg (vs. 1200 mg globally) for better tolerability |
| Diagnostics | UDST for all, LPA, expanded CDST labs |
| TPT | 6H and 3HP for expanded eligible populations |
| Nutritional support | Rs. 1,000/month NPY DBT - continues |
| Bedaquiline resistance | Active surveillance initiated (2025-2026) |
Key references:
- India TB Report 2024 - Central TB Division, MoHFW
- National Guidelines for Management of Drug Resistant TB, 2024
- [PMID 40381662] - RCT: Long-term outcomes with Bedaquiline-Pretomanid-Linezolid varying doses (India, 2025)
- [PMID 41520273] - Cost-effectiveness of BPaL/BPaLM vs. SoC in India (2025)
- [PMID 42031472] - Delamanid vs. Pretomanid for MDR-TB - Indian perspective (2026)
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Excellent - I have the latest 2026 data. Here is the complete, updated reference:
Modified BG Prasad Socioeconomic Scale
Background
- Originally proposed by Brahm Govind Prasad in 1961, classifying families into 5 socioeconomic classes based on monthly per capita income
- Periodically updated using the Consumer Price Index for Industrial Workers (CPI-IW) published by the Ministry of Labour & Employment, Government of India
- The CPI-IW base year was revised to 2016 = 100 (from the old 2001 base)
Formula for Updating
New income = Old income (1961) × CPI-IW of that month/year × Linking factors
The linking factors account for changes in base years across CPI-IW series:
- 1960 → 1982 series: ×4.63
- 1982 → 2001 series: ×4.93
- 2001 → 2016 series: ×2.88
Simplified formula (from 2016 base):
New income = Old per capita income (2016) × CPI-IW correction factorCorrection factor = CPI-IW (current year, base 2016=100) ÷ 100
Updated Income Thresholds by Year
| Class | Social Status | 1961 (Original) | 2024 | Jan 2025 | Jan 2026 |
|---|---|---|---|---|---|
| I | Upper | ≥ ₹100 | ≥ ₹8,783 | ≥ ₹9,400 | ≥ ₹9,769 |
| II | Upper Middle | ₹50 - 99 | ₹4,392 - 8,782 | ₹4,700 - 9,399 | ₹4,885 - 9,768 |
| III | Middle | ₹30 - 49 | ₹2,635 - 4,391 | ₹2,820 - 4,699 | ₹2,931 - 4,884 |
| IV | Lower Middle | ₹15 - 29 | ₹1,318 - 2,634 | ₹1,410 - 2,819 | ₹1,465 - 2,930 |
| V | Lower | < ₹15 | < ₹1,318 | < ₹1,410 | < ₹1,465 |
All values are per capita monthly income in Indian Rupees (₹)
CPI-IW Values Used
| Year | CPI-IW (Base 2016=100) | Multiplication Constant |
|---|---|---|
| January 2024 | 138.9 | ~91.24 |
| January 2025 | ~142.8 | ~93.98 (approx) |
| January 2026 | 148.2 - 148.6 | 97.41 - 97.69 |
- Two publications for 2026 report slightly different values (148.2 vs 148.6) due to different CPI-IW sources - the difference in final thresholds is minimal (₹9,742 vs ₹9,769 for Class I)
Key Points for Exams / Research
- 5 classes - Class I (Upper) to Class V (Lower)
- Based on per capita monthly income (total family income ÷ family members)
- Updated every year (ideally every month/quarter for research accuracy)
- Uses CPI-IW (not CPI-Rural or CPI-Urban) - specifically for Industrial Workers
- No weightage for education or occupation (unlike Kuppuswamy scale)
- Applicable to both rural and urban populations
- Simple and widely used in community medicine and epidemiological research in India
Comparison with Kuppuswamy Scale
| Feature | BG Prasad | Kuppuswamy |
|---|---|---|
| Parameters | Income only | Income + Education + Occupation |
| Income used | Per capita monthly | Total family monthly |
| Applicability | Both rural & urban | Primarily urban |
| Classes | 5 | 5 (but scored 3-29) |
| Jan 2026 top threshold | ≥ ₹9,769 (per capita) | ≥ ₹66,007 (family) |
Sources:
- Singh P et al. Ensuring Contemporary Socio-economic Classification: Updated Modified BG Prasad Scale for 2026. Indian Journal of Community Health. 38(2):486-488, 2026
- Chaudhary D et al. Revised Kuppuswamy and Prasad Scale 2026. Int J Community Med Public Health, 2026
- IJMEDPH. Updated BG Prasad Socioeconomic Classification for 2026 using CPI-IW (Base 2016=100)
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