Current challenges and future development of India’s healthcare system’ towards tuberculosis free India – research evidence and programmatic initiatives

Tuberculosis (TB), the single most infectious killer deserves special attention in a focussed manner, to reduce morbidity and mortality. We describe the challenges in the four pillars of TB control: detect or diagnosis, treat, prevent, build and elaborate the success stories, listing out newer and advanced tools like artificial intelligence, whole genome sequencing, clustered regularly interspaced short palindromic repeats based technologies, one health approach and cost effectiveness strategies for an all- round reduction in TB control. Special problems posed by paediatric and extra-pulmonary TB are dealt with. Post TB lung sequalae, reverse zoonosis and behavioural modification that can influence catastrophic costs are explored. Use of molecular and genomic methods of TB detection has revolutionized TB care with increased sensitivity of diagnosis, and timely detection of drug resistance, saving many a precious lives. Undoubtedly, the need of the hour would be shortening TB treatment duration and comprehensive preventive strategies that simultaneously decrease both the incidence and prevalence of TB. The various schemes and initiatives undertaken by the Government of India including the Pradhan Mantri TB Mukt Bharat Abhiyaan – “TB free India” stand as a unique solution in the wake of eliminating TB. India has been extending its success stories to other countries as well, by creating platforms for multilateral research and multinational implementation. This manuscript gives a concise and comprehensive outlook of process involved in TB elimination, amalgamating the research evidences with the programmatic initiatives, enlisting the existing challenges, envisaging the current achievements, providing a road map for TB elimination.