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{{short description|Health issue in India}}
[[File:Depiction of a tuberculosis patient.png|thumb|400px|right|tuberculosis patient]]
'''Tuberculosis in India''' is a major health problem, causing about 220,000 deaths every year. In 2020, the Indian government made statements to eliminate [[tuberculosis]] from the country by 2025 through its [[National TB Elimination Program (India)|National TB Elimination Program]]. Interventions in this program include major investment in health care, providing supplemental nutrition credit through the [[Nikshay Poshan Yojana]], organizing a national epidemiological survey for tuberculosis, and organizing a national campaign to tie together the Indian government and private health infrastructure for the goal of eliminating the disease.

India bears a disproportionately large burden of the world's tuberculosis rates, with [[World Health Organization]] (WHO) statistics for 2011 giving an estimated incidence figure of 2.2 million cases for India out of a global incidence of 9.6 million cases.<ref>TB Statistics for India. (2012). TB Facts. Retrieved April 3, 2013, from http://www.tbfacts.org/tb-statistics-india.html</ref>

Tuberculosis is one of India's biggest health issues, but what makes this problem even worse is the recent discovery of Totally Drug-Resistant Tuberculosis, [[TDR-TB]]. This issue of [[drug resistance]] began with [[MDR-TB]], moved to [[XDR-TB]] and, as of 2021, has grown to embrace the most dangerous form, [[TDR-TB]].<ref>{{Cite journal|last1=Udwadia|first1=Zarir|last2=Vendoti|first2=Deepesh|date=2013-06-01|title=Totally drug-resistant tuberculosis (TDR-TB) in India: every dark cloud has a silver lining|url=https://jech.bmj.com/content/67/6/471|journal=J Epidemiol Community Health|language=en|volume=67|issue=6|pages=471–472|doi=10.1136/jech-2012-201640|issn=0143-005X|pmid=23155059|s2cid=42481569}}</ref><ref>{{Cite journal|last=Loewenberg|first=Samuel|date=2012-01-21|title=India reports cases of totally drug-resistant tuberculosis|url=https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60085-3/abstract|journal=The Lancet|language=English|volume=379|issue=9812|pages=205|doi=10.1016/S0140-6736(12)60085-3|issn=0140-6736|pmid=22272391|s2cid=39443765}}</ref>

The cost of this death and disease to the Indian economy between 2006 and 2014 was approximately US$1 billion.<ref name=WHO2009-Epidemiology>{{cite book |title=Global tuberculosis control: epidemiology, strategy, financing |author=World Health Organization |year=2009 |isbn=978-92-4-156380-2 |chapter=Epidemiology |chapter-url=https://apps.who.int/iris/bitstream/handle/10665/44035/9789241563802_eng.pdf;jse |access-date=14 June 2020 |pages=6–33 }}</ref>

==Epidemiology==
[[File:Tuberculosis checkup for child India 2009.jpg|thumb|right|300px|alt=a mother holds a baby while a doctor places a stethoscope on their back|Children have special needs both in preventing and treating tuberculosis.]]
Tuberculosis is one of India's major public health problems. According to World Health Organization ([[WHO]]) estimates, India has the world's largest tuberculosis epidemic.<ref>WHO. Global tuberculosis control. WHO report. WHO/HTM/TB/2006.362. Geneva: World Health Organization, 2006.</ref> In 2020, India accounted for 26% of the incident TB cases across the globe.India has incidence rate of 192 cases per 100,000 of population. India accounted for 38% of global TB deaths among HIV-negative people and for 34% of the combined total number of TB deaths in HIV-negative and HIV-positive people.Further in 2020, India accounted for 24% of global gap between estimated TB incidence and the number of people newly diagnosed with TB and reported.<ref>{{cite book |title=Global Tuberculosis Report 2021 |date=2021 |publisher=World Health Organization |location=Geneva |isbn=978-92-4-003702-1 |url=https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2021 |access-date=3 November 2021}}</ref> Many research studies have investigated the effects and consequences of TDR-TB, especially in India, where social and economic development is still in progress. A report by [[Zarir Udwadia]], originating from studies at the [[Hinduja Hospital]] in [[Mumbai]], discusses the drug-resistant effects and results.<ref>{{cite journal |doi=10.1136/jech-2012-201640 |pmid=23155059 |title=Totally drug-resistant tuberculosis (TDR-TB) in India: Every dark cloud has a silver lining |journal=Journal of Epidemiology and Community Health |volume=67 |issue=6 |pages=471–472 |year=2013 |last1=Udwadia |first1=Zarir |last2=Vendoti |first2=Deepesh |s2cid=42481569 }}</ref> An experiment was conducted in January 2012 on four patients to test how resistant and unique the “new category” of TDR-TB is. These patients were given all the first-line drugs and second-line drugs that usually are prescribed to treat tuberculosis, and were resistant to all. As a response, the government of India appeared to stay in denial, while the WHO decided that although patterns of drug-resistance were evident, there was insufficient evidence to create a new category of TDR-TB from these results.<ref>{{cite web |last1=Kanabus |first1=Annabel |title=Totally drug resistant TB - resistance to all known drugs |url=https://tbfacts.org/totally-drug-resistant/ |website=TBFACTS.ORG Information about Tuberculosis |publisher=Global Health Education, England |access-date=5 September 2021}}</ref>

Compared to India, [[Canada]] has about 1,600 new cases of TB every year.<ref name="C-Health">Tuberculosis - Causes, Symptoms, Treatment, Diagnosis. (2013). C-Health. Retrieved April 3, 2103, from http://chealth.canoe.ca/channel_condition_info_details.asp?disease_id=231&channel_id=1020&relation_id=71085</ref> Citing studies of TB-drug sales, the government of India now suggests the total has gone from being 2.2 million to 2.6 million people nationwide.<ref name="Anand & McKay 2012">{{cite web |last1=Anand |first1=Geeta |last2=McKay |first2=Betsy |title=Awakening to Crisis, India Plans New Push Against TB |url=https://www.wsj.com/articles/SB10001424127887324461604578193611711666432 |website=Wall Street Journal |date=26 December 2012}}</ref> On March 24, 2019, TB Day, the Ministry of Health & Family Welfare of India notified that 2.15 million new tuberculosis patients were discovered only in 2018.<ref name=":0">{{Cite web|url=https://nation.com.pk/26-Mar-2019/india-records-2-15m-new-tb-patients-in-2018|title=India records 2.15m new TB patients in 2018|date=2019-03-26|website=The Nation|language=en|access-date=2019-03-27}}</ref>

In India, tuberculosis is responsible for the death of every third AIDS patient. Moreover, India accounts for about a quarter of the global tuberculosis burden.<ref name=":0" /> The ministry reiterated their commitment to eliminating tuberculosis in the country by 2025.<ref name=":0" /> As part of its efforts to eliminate tuberculosis, the Union Government changed the name of Revised National Tuberculosis Control Program (RNTCP) to National Tuberculosis Elimination Program (NTEP) on December 30, 2019.<ref>{{Cite web|url=https://telanganatoday.com/tb-eradication-mission-renamed|title=TB eradication mission renamed|last=AuthorTelanganaToday|website=Telangana Today|language=en-US|access-date=2020-01-02}}</ref>

==Cause and symptoms==
The bacterium that causes TB is called [[mycobacterium tuberculosis]]. A person can unknowingly acquire this bacteria and have it lie dormant within them, a condition known as inactive tuberculosis. [[Active tuberculosis]] begins when the bacteria starts developing, and the signs and symptoms begin to be visible. Although the TB bacteria can infect any organ (e.g., kidney, lymph nodes, bones, joints) in the body, the disease commonly occurs in the lungs.<ref name="C-Health"/> Around 80% of all TB cases are related to pulmonary or lung.

Common symptoms include:
[[coughing]] (that lasts longer than 3 weeks with green, yellow, or [[bloody sputum]]),
[[weight loss]],
[[fatigue (medical)|fatigue]],
[[fever]],
[[night sweats]],
[[chills]],
[[chest pain]],
[[shortness of breath]], and
[[loss of appetite]].

==Additional causes==
[[File:Mycobacterium tuberculosis.jpg|thumb|Scanning electron micrograph of ''[[Mycobacterium tuberculosis]]'']]
Susceptibility to tuberculosis is heightened by a weak [[immune system]]. That is why babies, children, and senior adults have a higher risk of developing TB.<ref name="C-Health"/> The bacterium spreads in the [[air sacs]] and passes into the [[lungs]]. Coughing, sneezing, and even talking to someone can release the mycobacterium into the air, and a person's chances of becoming infected are higher in countries where TB is common and where there is a big proportion of homeless people.<ref name="C-Health"/> India, having the most TB cases of any country,<ref name=":1">Sachdeva, Kuldeep Singh et al. “New vision for Revised National Tuberculosis Control Programme (RNTCP): Universal access - "reaching the un-reached".” ''The Indian journal of medical research'' vol. 135,5 (2012): 690-4.</ref> clearly falls into this category.

=== Socioeconomic Dimensions of TB ===
Local decreases in the incidence of tuberculosis in India correlate with improvements in social and economic determinants of health more than with access to quality treatment.<ref name=pmid21330583>{{cite journal |last1=Hargreaves |first1=James R. |last2=Boccia |first2=Delia |last3=Evans |first3=Carlton A. |last4=Adato |first4=Michelle |last5=Petticrew |first5=Mark |last6=Porter |first6=John D. H. |title=The Social Determinants of Tuberculosis: From Evidence to Action |journal=American Journal of Public Health |date=April 2011 |volume=101 |issue=4 |pages=654–662 |doi=10.2105/AJPH.2010.199505 |pmid=21330583 |pmc=3052350 }}</ref> In India, [[pollution]] is widespread throughout the country. Pollution causes many effects in the air that people breathe, and since TB can be passed from person to person through the air, the chances of catching TB remain high in many parts of India.{{Citation needed|date=December 2020}}

===Lack of infrastructure===
Another major cause for the growth of TB in India has to do with its standing as a [[developing country]]. A study of Delhi slums has correlated higher scores on the [[Human Development Index]] and high proportions of one-room dwellings tend to correlate with TB at higher rates.<ref>{{cite journal |last1=Chandra |first1=Shivani |last2=Sharma |first2=Nandini |last3=Joshi |first3=Kulanand |last4=Aggarwal |first4=Nishi |last5=Kannan |first5=Anjur Tupil |title=Resurrecting social infrastructure as a determinant of urban tuberculosis control in Delhi, India |journal=Health Research Policy and Systems |date=17 January 2014 |volume=12 |issue=1 |pages=3 |doi=10.1186/1478-4505-12-3 |pmid=24438431 |pmc=3898563 }}</ref> Poorly built environments, including hazards in the workplace, poor ventilation, and overcrowded homes have also been found to increase exposure to TB <ref name=pmid21330583/>

===Lack of access to treatment===
Another major reason for the high incidence of TB in India is because the majority of those infected are not able to afford the treatment drugs prescribed. ''“At present, only the 1.5 million patients already under the Indian government's care get free treatments for regular TB. That leaves patients who seek treatment in India's growing private sector to buy drugs for themselves, and most struggle to do that, government officials say.”''<ref name="Anand & McKay 2012" /> Although the latest phase of the state-run tuberculosis eradication program, the [[Revised National Tuberculosis Control Program]] (RNTCP), has focused on increasing access to TB care for poor people,<ref name=":1" /> the majority of poor people still cannot access TB care financially.<ref name=pmid23413398>{{cite journal |last1=Verma |first1=Ramesh |last2=Khanna |first2=Pardeep |last3=Mehta |first3=Bharti |title=Revised National Tuberculosis Control Program in India: The Need to Strengthen |journal=International Journal of Preventive Medicine |date=2013 |volume=4 |issue=1 |pages=1–5 |pmc=3570899 |pmid=23413398 }}</ref> ''“It is estimated that just 16% of patients with drug-resistant TB are receiving appropriate treatment”''.<ref name="Rowland2012">{{cite journal |doi=10.1038/nature.2012.9797 |title=Totally drug-resistant TB emerges in India |journal=Nature |year=2012 |last1=Rowland |first1=Katherine |s2cid=84692169 }}</ref> To combat this huge problem, India has begun a new program to try to provide free drugs to all those infected in the country.<ref name="Anand & McKay 2012" />

While RNTCP has created schemes to offer free or subsidized, high quality TB care, less than 1% of private practitioners have become fully involved.<ref name=pmid23413398/> This is exacerbated by a lack of education and background information which practitioners and professionals hold for prescribing drugs, or those private [[therapy]] sessions. A study conducted in Mumbai by Udwadia, Amale, Ajbani, and Rodrigues, showed that only 5 of 106 private practitioners practicing in a crowded area called Dharavi could prescribe a correct prescription for a hypothetical patient with MDR-TB.<ref>{{cite journal |doi=10.1093/cid/cir889 |pmid=22190562 |title=Totally Drug-Resistant Tuberculosis in India |journal=Clinical Infectious Diseases |volume=54 |issue=4 |pages=579–581 |year=2011 |last1=Udwadia |first1=Z. F |last2=Amale |first2=R. A |last3=Ajbani |first3=K. K |last4=Rodrigues |first4=C |doi-access=free }}</ref> Because the majority of TB cases are treated by private providers, and because the majority of poor people access informal (private) providers, the RNTCP's goals for universal access to TB care may have difficulty being met.<ref name=pmid23413398/>

===Poor health===
Poverty and a lack of financial resources are also associated with malnutrition, poor housing conditions, substance misuse, and HIV/AIDS incidence. These factors often contribute to a weakened immune system and are accordingly correlated with a higher susceptibility to TB.<ref name=pmid21330583/> They also tend to have a greater impact on people from high incidence countries such as India.<ref>{{cite journal |last1=Dye |first1=Christopher |last2=Bourdin Trunz |first2=Bernadette |last3=Lönnroth |first3=Knut |last4=Roglic |first4=Gojka |last5=Williams |first5=Brian G. |last6=Gagneux |first6=Sebastien |title=Nutrition, Diabetes and Tuberculosis in the Epidemiological Transition |journal=PLOS ONE |date=21 June 2011 |volume=6 |issue=6 |pages=e21161 |doi=10.1371/journal.pone.0021161 |pmid=21712992 |pmc=3119681 |bibcode=2011PLoSO...621161D |doi-access=free }}</ref> Indeed, addressing these factors may have a stronger correlation with decreased TB incidence than removing the financial burdens associated with care.<ref name=pmid21330583/> Yet, the RNTCP's treatment protocols do not address these social determinants of health.<ref name=pmid21330583/>

==Treatment==
Although tuberculosis is on the rise in India, [[Therapy|treatment]] for it is also on the rise. To prevent spreading TB, it is important to get help quickly and to follow the treatment from your doctor through to completion. This can stop transmission of the bacteria and the appearance of [[antibiotic-resistant]] [[strain (biology)|strains]]. Bacterial [[infections]] like tuberculosis require [[antibiotics]] for treatment and prevention, thus, commonly you will see that patients diagnosed with tuberculosis have certain pills and antibiotics carried around with them. The antibiotics most commonly used include [[isoniazid]], [[rifampin]], [[pyrazinamide]], and [[ethambutol]]. It is crucial for a patient to take the medication that is prescribed by their doctor, and to continue taking it for the full course of the treatment (which may last for months or even years). This will help to ward off types of TB [[bacteria]] that are antibiotic-resistant, which take longer and are more difficult to treat.<ref name="C-Health"/> In India, the majority of infections are of a type that is resistant to regular antibiotic treatment (MDR-TB, XDR-TB, TDR-TB), therefore, rather than one or two medications, a combination of different medications will be prescribed over a course of between 18 and 24 months, depending on how deep the infection is. Since the 1960s two drugs, [[isoniazid]] and [[rifampicin]], have been the standard TB treatment.<ref name=Rowland2012/> In addition to antibiotics, a [[vaccine]] is available to limit the spread of bacteria after TB infection. This vaccine is generally used in countries or communities where the risk of TB infection is greater than 1% each year,<ref name="C-Health"/> which includes parts of India.<ref name=Rowland2012/> In the past, treatment modalities in the public sector in India did have some drawbacks.<ref>{{cite journal |doi=10.20529/IJME.2014.013 |pmid=24509111 |title=XDR-TB: An outcome of programmatic management of TB in India |journal=[[Indian Journal of Medical Ethics]] |volume=11 |issue=1 |pages=47–52 |year=2014 |last1=Mishra |first1=Gyanshankar |last2=Ghorpade |first2=S. V |last3=Mulani |first3=J }}</ref> However, recently there has been a significant improvement in TB healthcare services in the public sector. The National TB Elimination Program (NTEP) in India has broadened its spectrum, in addition to providing free diagnostic and treatment services for drug sensistive as well as drug resistant forms of tuberculosis. The program is currently also targeting the TB Preventive therapy in vulnerable population with TB infection, who are at an increased risk of progressing to active TB disease.

70-80% of TB patients first visit the private sector, where the diagnostic and treatment services of TB are suboptimal and need to be improved.<ref>{{cite journal |last1=Mishra |first1=Gyanshankar |title=Public-private mix in tuberculosis |journal=The Lancet Infectious Diseases |date=2012 |volume=12 |issue=12 |pages=908–909 |doi=10.1016/S1473-3099(12)70257-8 |pmid=23174376 |url=https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(12)70257-8/fulltext |access-date=4 September 2021}}</ref><ref>{{cite journal |last1=Mishra |first1=Gyanshankar |last2=Mulani |first2=Jasmin |title=Tuberculosis Prescription Practices In Private And Public Sector In India |journal=National Journal of Integrated Research in Medicine |date=2013 |volume=4 |issue=2 |pages=71–78 |doi=10.6084/m9.figshare.13271513 |url=http://nicpd.ac.in/ojs-/index.php/njirm/article/view/2153/1966 |access-date=4 September 2021}}</ref> Directly observed therapy (DOT) has been helpful to increase adherence and reduce resistance. In recent years, as smartphone usage and accessibility to low-cost internet services have gained traction in India, perceptions of alternative services such as SMS reminders, voice calls and video DOT (vDOT) have been explored and shown to be acceptable to a variety of patient population thus saving time and money.<ref>{{Cite journal |last1=Kumar |first1=Anil A. |last2=Costa |first2=Ayesha De |last3=Das |first3=Arundathi |last4=Srinivasa |first4=G. A. |last5=D'Souza |first5=George |last6=Rodrigues |first6=Rashmi |date=2019-04-03 |title=Mobile Health for Tuberculosis Management in South India: Is Video-Based Directly Observed Treatment an Acceptable Alternative? |url=https://mhealth.jmir.org/2019/4/e11687 |journal=JMIR mHealth and uHealth |language=EN |volume=7 |issue=4 |pages=e11687 |doi=10.2196/11687|pmid=30942696 |pmc=6468344 }}</ref>

==History==
India's response to TB has changed with time and with the increasing sophistication of technology.<ref name="Sandhu 2011">{{cite journal |last1=Sandhu |first1=GK |title=Tuberculosis: current situation, challenges and overview of its control programs in India. |journal=Journal of Global Infectious Diseases |date=April 2011 |volume=3 |issue=2 |pages=143–50 |doi=10.4103/0974-777X.81691 |pmid=21731301|pmc=3125027 }}</ref> Responses to TB have evolved, from pre-independence through post-independence to the current WHO-assisted period.<ref name="Sandhu 2011"/> The first national study of tuberculosis was carried out by [[Arthur Lankester]] in 1914.<ref name=":AL">{{cite news |title=TB a national emergency: Health Minister Harsh Vardhan |url=https://economictimes.indiatimes.com/industry/healthcare/biotech/healthcare/tb-a-national-emergency-health-minister-harsh-vardhan/articleshow/41883445.cms |work=The Economic Times |date=6 September 2014 }}</ref><ref name=":BJV">{{cite book |last1=Venkhat |first1=Bharat Jayram |title=At the Limits of Cure |date=2021 |publisher=Duke University Press |location=Durham |isbn=9781478091776 |url=https://directory.doabooks.org/handle/20.500.12854/74606 |access-date=5 January 2023}}</ref>

Following Independence, the Indian government established various regional and national TB reduction programmes.<ref name="Sandhu 2011"/> The Indian government's Revised National TB Control Programme ([[RNTCP]]) started in India during 1997. The program used the WHO-recommended Directly Observed Treatment Short Course ([[DOTS]]) strategy to develop ideas and data on TB treatment. This group's initial objective was to achieve and maintain a TB treatment success rate of at least 85% in India among new patients.<ref>http://www.scidev.net/tb/facts{{full citation needed|date=August 2018}}{{dead link|date=August 2018}}</ref>{{Unreliable source?|date=August 2018}} ''“In 2010 the RNTCP made a major policy decision that it would change focus and adopt the concept of Universal Access to quality diagnosis and TB treatment for all TB patients”''.<ref name=Coghaln2012>{{cite news |last1=Coghaln |first1=Andy |date=12 January 2012 |title=Totally drug-resistant TB at large in India |url=https://www.newscientist.com/article/dn21350-totally-drug-resistant-tb-at-large-in-india/ |work=New Scientist }}</ref> By doing so, they offered a helping hand to all people diagnosed with TB, by providing better quality services and improvement in therapy for these patients.

The contemporary response to TB includes India's participation and leadership in global TB reduction and elimination programs.<ref name="Sandhu 2011"/> Treatment recommendations from Udwadia, et al. suggest that patients with TDR-TB only be treated ''“within the confines of government-sanctioned DOTS-Plus Programs to prevent the emergence of this untreatable form of tuberculosis”''.<ref name=Rowland2012/> Given this conclusion by Udawadai, et al., it is considered certain, as of 2012, that the new Indian government program will insist on providing drugs free of charge to TB patients of India, for the first time ever.<ref name="Anand & McKay 2012"/>

==Society and culture==
===Organizations===
The Tuberculosis Association of India is a voluntary organization that was set up in February 1939. It is affiliated to the government of India and is working with the TB Delhi center.<ref>{{Cite web | url=http://tbassnindia.org/home.html |title = Welcome to the Tuberculosis Association of India}}</ref>

===Laboratories===
The [[Revised National Tuberculosis Control Program]] (RNTCP) has established a network of laboratories where TB tests can be done for purposes of diagnosis and to determine whether a person has drug-resistant TB. The laboratory system comprises the National Reference Laboratories (NRLs), state level Intermediate Reference Laboratories (IRLs), Culture & Drug Susceptibility Testing (C & DST) laboratories and Designated Microscopy Centres (DMCs). Some private laboratories are also accredited as Culture & Drug Susceptibility Testing laboratories for tuberculosis (i.e. Microcare Laboratory & tuberculosis Research Centre, Surat)

===Stigma===
Disempowerment and stigma are often experienced by TB patients as they are disproportionately impoverished or socially marginalized.<ref>{{cite journal |last1=Daftary |first1=Amrita |last2=Frick |first2=Mike |last3=Venkatesan |first3=Nandita |last4=Pai |first4=Madhukar |title=Fighting TB stigma: we need to apply lessons learnt from HIV activism |journal=BMJ Global Health |date=31 October 2017 |volume=2 |issue=4 |pages=e000515 |doi=10.1136/bmjgh-2017-000515 |pmid=29225954 |pmc=5717927 }}</ref> The DOTS treatment regimen of the RNTCP is thought to deepen this sentiment,<ref>{{cite journal |last1=Achmat |first1=Z |title=Science and social justice: the lessons of HIV/AIDS activism in the struggle to eradicate tuberculosis |journal=The International Journal of Tuberculosis and Lung Disease |date=December 2006 |volume=10 |issue=12 |pages=1312–7 |pmid=17167946 }}</ref> as its close monitoring of patients can lead to stigma. To counteract disempowerment, some countries have engaged patients in the process of implementing the DOTS and in creating other treatment regimens that give more attention to their nonclinical needs. This knowledge can complement the clinical care provided by the DOTS.<ref>{{cite book |doi=10.7551/mitpress/6494.003.0004 |chapter=Street Science: Characterizing Local Knowledge |title=Street Science |year=2005 |isbn=978-0-262-27080-9 }}</ref> Pro-poor strategies, including wage compensation for time lost to treatment, working with civil society organizations to link low income patients to social services, nutritional support, and offering local NGOs and committees a platform for engagement with the work done by private providers may reduce the burden of TB<ref>{{cite journal |last1=Kamineni |first1=Vishnu VARDHAN |last2=Wilson |first2=Nevin |last3=Das |first3=Anand |last4=Satyanarayana |first4=Srinath |last5=Chadha |first5=Sarabjit |last6=Singh Sachdeva |first6=Kuldeep |last7=Singh Chauhan |first7=Lakbir |title=Addressing poverty through disease control programmes: examples from Tuberculosis control in India |journal=International Journal for Equity in Health |date=2012 |volume=11 |issue=1 |pages=17 |doi=10.1186/1475-9276-11-17 |pmid=22449205 |pmc=3324374 }}</ref> and lead to greater patient autonomy.

===Economics===
Some legal advocates have argued that [[public interest litigation in India]] must be part of the TB response strategy to ensure that available resources actually fund the necessary health response.<ref>{{cite journal |last1=McBroom |first1=K |title=Litigation as TB Rights Advocacy: A New Delhi Case Study. |journal=Health and Human Rights |date=June 2016 |volume=18 |issue=1 |pages=69–84 |pmid=27781000|pmc=5070681 }}</ref> India has a large burden of the world's TB, with an estimated economic cost of US$100 million lost annually due to this disease.<ref>{{cite journal |doi=10.1136/thoraxjnl-2012-201663 |pmid=22427352 |title=MDR, XDR, TDR tuberculosis: Ominous progression |journal=Thorax |volume=67 |issue=4 |pages=286–288 |year=2012 |last1=Udwadia |first1=Zarir F |doi-access=free }}</ref>

===Special populations===
How [[Scheduled Castes and Scheduled Tribes|Scheduled Tribes]] and other [[Adivasi]] are coping with TB highlights a lack of research and understanding of the health of this demographic.<ref name="Rao 2018">{{cite journal |last1=Rao |first1=VG |last2=Muniyandi |first2=M |last3=Bhat |first3=J |last4=Yadav |first4=R |last5=Sharma |first5=R |title=Research on tuberculosis in tribal areas in India: A systematic review. |journal=The Indian Journal of Tuberculosis |date=January 2018 |volume=65 |issue=1 |pages=8–14 |doi=10.1016/j.ijtb.2017.06.001 |pmid=29332655}}</ref><ref name="Thomas 2015">{{cite journal |last1=Thomas |first1=BE |last2=Adinarayanan |first2=S |last3=Manogaran |first3=C |last4=Swaminathan |first4=S |title=Pulmonary tuberculosis among tribals in India: A systematic review & meta-analysis. |journal=The Indian Journal of Medical Research |date=May 2015 |volume=141 |issue=5 |pages=614–23 |doi=10.4103/0971-5916.159545 |doi-broken-date=1 August 2023 |pmid=26139779|pmc=4510760 }}</ref> There is a belief that this community is more vulnerable and has less access to treatment, but details are lacking on how TB affects tribal communities.<ref name="Rao 2018"/><ref name="Thomas 2015"/>

==References==
{{reflist|2}}

==Further consideration==
*{{cite web |author1=Central TB Division |title=India TB Report 2020 |url=https://tbcindia.gov.in/showfile.php?lid=3538 |website=tbcindia.gov.in |publisher=[[Ministry of Health and Family Welfare]] |date=March 2020}}
*{{cite web |author1=WHO Stop TB Department |title=A Brief History of Tuberculosis Control in India |url=https://apps.who.int/iris/bitstream/handle/10665/44408/9789241500159_eng.pdf;jsessionid=05AD595C291B6482F23E59AF2F854DC2?sequence=1 |publisher=World Health Organization |date=2010}}

==External links==
{{Scholia|topic}}
{{commons category|Tuberculosis in India}}
*[https://tbcindia.gov.in/ Central Tuberculosis Division] of the Government of India

{{Tuberculosis}}
{{Asia topic|Tuberculosis in}}
{{Health in India}}
{{Social issues in India}}

[[Category:Tuberculosis in India| ]]

Tuberculosis in India - Revision history

Ajay Kumar: Created a new article