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NTEP National Tuberculosis Elimination Program India 2025 guidelines

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NTEP tuberculosis elimination India program

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Here is a detailed overview of NTEP - National Tuberculosis Elimination Programme:

NTEP - National Tuberculosis Elimination Programme

Background and Renaming

The NTEP is India's national program to eliminate tuberculosis. It evolved from earlier programs:
  • 1962: National Tuberculosis Programme (NTP) launched - but treatment success rates were low, death and default rates remained high.
  • 1993: Revised National TB Control Programme (RNTCP) was launched, adopting the internationally recommended DOTS (Directly Observed Treatment, Short-course) strategy.
  • 2020: RNTCP was renamed to NTEP in alignment with the WHO's "End TB Strategy" and India's ambitious goal to eliminate TB by 2025 - five years ahead of the global 2030 target.

Goal and Targets (National Strategic Plan 2017-2025)

Compared to 2015 baseline, India aims to achieve by 2025:
Indicator2015 Baseline2024 Status2025 Target
TB Incidence Rate208/lakh/year153/lakh/year (27% reduction)42/lakh/year (80% reduction)
TB Death Rate4.47%3.6% (19% reduction)0.5% (90% reduction)

Four Strategic Pillars: Detect - Treat - Prevent - Build (DTPB)

The National Strategic Plan is built around four pillars:
  1. Detect - Early diagnosis through quality microscopy, NAAT (GeneXpert), culture, and active case finding
  2. Treat - Standardized treatment regimens with DOTS, patient-wise drug boxes, and adherence support
  3. Prevent - TB Preventive Therapy (TPT) for household contacts and vulnerable groups
  4. Build - Strengthening health systems, IT infrastructure, and multi-sector collaboration

Organizational Structure (NTEP Organogram)

NTEP operates across five levels:

1. National Level

  • Central TB Division (CTD) under the Ministry of Health & Family Welfare manages the programme nationally.
  • Supported by:
    • NTI (National TB Institute, Bengaluru)
    • NIRT (National Institute for Research in Tuberculosis, Chennai) - also a WHO Supra National Reference Lab for South-East Asia
    • NITRD (Delhi) - WHO Centre of Excellence in TB lab services
    • JALMA Institute, Agra
    • RMRC, Bhubaneshwar
    • BMHRC, Bhopal
    • Six total National Reference Laboratories (NRLs)

2. State Level

  • State TB Officer (STO) heads the State TB Cell (STC)
  • Supported by STDCs (State TB Training and Demonstration Centres) with:
    • Training unit
    • Supervision and monitoring unit
    • Intermediate Reference Laboratory (IRL)

3. District Level

  • District TB Officer (DTO) manages the District TB Centre (DTC)

4. Sub-District Level (Tuberculosis Unit - TU)

  • A major organizational change in NTEP - creation of sub-district (TU) level
  • Programme mainstreamed with National Health Mission (NHM)

5. Peripheral Health Institution Level

  • Designated Microscopy Centres (DMCs), health posts, subcentres

NTEP-Endorsed TB Diagnostics

  1. Smear Microscopy - Ziehl-Neelsen staining or fluorescence staining
  2. Culture - Solid (Lowenstein-Jensen) or liquid (Middlebrook/BACTEC/MGIT) media
  3. Rapid Molecular Diagnostics:
    • Line Probe Assay (LPA) - conventional PCR-based
    • NAAT - Real-time PCR (e.g., GeneXpert/CBNAAT) - now the preferred upfront test
  4. Radiography (X-ray chest)
  5. Tuberculin Skin Test (TST)

Key New Initiatives

NIKSHAY (IT Surveillance System)

  • Case-based web application launched May 2012
  • Combines Hindi words "Ni + Kshay" = eradication of TB
  • Functions include: patient registration, diagnosis tracking, DOT provider details, HIV status, contact tracing, outcomes, SMS alerts, mobile app for notification
  • 99DOTS and other IT-enabled adherence tools integrated

Drug Resistance Surveillance (DRS)

  • DRS surveys (2014-2016) found:
    • MDR-TB in 2.84% of new cases
    • MDR-TB in 11.60% of retreatment cases
  • DR-TB Centres: 20-30 bedded tertiary facilities serving ~10 million population

Treatment Drug Boxes

  • Patient-wise drug boxes (PDB) containing full course of treatment in blister packs
  • Intensive phase: daily blister packs
  • Continuation phase: weekly blister packs
  • Red boxes = Category I patients; Blue boxes = Category II patients

Ni-kshay Poshan Yojana (NPY)

  • Financial nutritional support (₹500/month) for TB patients during treatment

TB Preventive Therapy (TPT)

  • For household contacts of TB patients and vulnerable groups (PLHIV, diabetics, malnourished, etc.)

DOTS Strategy (Historical Foundation)

Five core components originally:
  1. Political and administrative commitment
  2. Diagnosis by quality-assured sputum smear microscopy
  3. Adequate supply of quality-assured short-course chemotherapy
  4. Directly Observed Treatment (DOT)
  5. Systematic monitoring and accountability

Private Sector Engagement

TB notification from private providers is mandatory in India. NTEP works to integrate private sector through:
  • Nikshay portal notifications
  • Public-private mix (PPM) framework
  • A recent systematic review (PMID 39019586) identifies key facilitators and barriers for private sector engagement in TB care

Current Status (2024-2025)

A 100-day campaign (Dec 2024 - Mar 2025) was launched to accelerate case detection in high-burden districts through:
  • Upfront NAAT (GeneXpert) and X-ray screening
  • Saturating services: bank seeding, NPY payments, HIV/diabetes linkage
  • TB death audits and differentiated care
Despite progress, India has not fully achieved its 2025 elimination targets - TB incidence has reduced by ~27% (target was 80%), and sustained commitment remains critical.
Source: Park's Textbook of Preventive and Social Medicine; Government of India / PIB; Maharashtra PHD / NTEP guidelines
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