National Tuberculosis Elimination Programme (NTEP) in India: Achievements, Ongoing Challenges, and the Expanding Role of Pharmacists

India bears the highest global burden of Tuberculosis (TB), accounting for nearly one-quarter of worldwide cases, with persistent challenges related to Multidrug-Resistant TB (MDR-TB) and healthcare access. In alignment with the WHO End TB Strategy, India committed to eliminating TB by 2025, five years ahead of the global Sustainable Development Goals target. The National TB Elimination Program (NTEP), evolved from the Revised National Tuberculosis Control Programme (RNTCP), serves as the central strategic framework guiding this ambition. This review critically evaluates the achievements and ongoing challenges of NTEP and examines the expanding clinical and public health role of pharmacists within India's TB elimination strategy. A narrative review of peer-reviewed literature and national policy documents published between 2010 and 2026 was conducted using databases including PubMed and Scopus, alongside government and programmatic reports. Studies addressing TB epidemiology, MDR-TB prevalence, program implementation, and health system barriers in India were included. Evidence was synthesized qualitatively to assess progress toward elimination targets. NTEP has strengthened case notification systems, expanded molecular diagnostic capacity, implemented Universal Drug Susceptibility Testing, and enhanced digital case notification and patient management through the Nikshay platform. Nutritional support initiatives and structured private sector engagement have improved treatment accessibility. However, MDR-TB remains a substantial obstacle, with notable prevalence among both new and previously treated cases. Persistent challenges include underreporting, treatment adherence gaps, socioeconomic vulnerabilities, and incomplete private sector integration. Pharmacists are increasingly recognized as potentially valuable contributors through medication therapy management, adverse drug reaction monitoring, adherence counselling, antimicrobial stewardship, and community-based referral. Although NTEP demonstrates substantial structural progress aligned with global TB control frameworks, achieving the 2025 elimination target required intensified system strengthening and multidisciplinary collaboration. Formal integration of pharmacists into clinical and public health components of NTEP can enhance treatment safety, adherence, and overall program effectiveness.