NATIONAL TUBERCULOSIS ELIMINATION PROGRAMME (NTEP)

Maharashtra State

Introduction

Tuberculosis (TB) is a disease caused by bacteria called as Mycobacterium Tuberculosis. It mainly affects lungs but can also affect all parts of body. TB spreads through air. When a person suffering from pulmonary tuberculosis coughs or sneezes, organisms are spread in air through droplets. As per Guidelines of Central Government, NTEP is being implemented in Maharashtra since 1998-99 in a phased manner. This programme is implemented all over the state since 2003. To implement this programme effectively State TB Society and 80 Districts/City TB Centers have been established.
Hon. Prime Minister has set an ambitious goal of elimination of Tuberculosis in India by 2025.

Objectives of NTEP

As Compared to 2015 achieve following by 2025:

• 80% of reduction in TB Incidence
• 90% reduction in TB Mortality
• 0% Patient having catastrophic Expenditure

Achievements:

SN	Objective	Status As on 2015	Achievement 2024	Target 2025
1	80% of reduction in TB Incidence	208 Per lakh Population per year as per estimated incidence of GoI	153 Per lakh Population per year as per current notification data in Ni-kshay (27% reduction in TB incidence Rate)	42 Per lakh Population
2	90% reduction in TB Mortality*	4.47% TB death rate programme data	3.6% TB Death rate programme data (19% reduction in TB Death rate)	0.5% TB death rate
3	0 Expenditure for TB Patient	Data Not Available	Provision of free diagnostics / free medicine/ Nutrition support through DBT/Travel support for each patient (Public & private Sector)	Provision of free diagnostics/ free medicine/ Nutrition support through DBT/Travel support for each patient (Public & private Sector)

Infrastructure under NTEP

Institutions	Number
State TB Training Demonstration Centers (STDCs) – Nagpur, Pune & Mumbai	3
State Drug Stores – Nagpur, Pune & Mumbai	3
TB Hospitals: (1) TB Sanitorium Buldhana, (2) Aundh Chest Hospital, Pune, (3) G.G.Rathi TB Hospital, Amarawati (4) Shashikala TB Hospital, Jaysingpur Dist Kolhapur), (5) Shiwari (Mumbai Municipal Corporation)	5
District TB centers	34
City TB centers	22
Mumbai TB centers (ward wise)	24
Total TB Units (TU)	539
Total Designated Microscopy Centers (DMC)	2025
Culture and DST lab (Including IRL) (Public 6 and Private 7)	13
Nodal DR TB centers	21
Handheld X-ray Machine	99
District DR TB centers	42
Mobile X ray van	6
CBNAAT Machine	171
True NAAT Machine	624
NGO working under programme	80
Partners organization	31
Medical college Total (63)	07
PPSA Districts/Corp. Under NHM State	32
Private	80

Implementation of NTEP

• Diagnosis:-

  All TB presumptive cases (based on symptoms) undergo sputum microscopy and chest X-ray as basic diagnostic tools. Further processes are done as per requirement. Diagnosis of TB is done as per diagnostic protocol under NTEP. New TB patients diagnosed are tested for drug sensitivity through Universal-Drug Susceptibility Test (U-DST) by various methods such as CBNAAT, TRUENAT, Line Probe Assay (LPA), Liquid/Solid culture, etc.
  Upfront testing by NAAT machines has been started in the state at places where NAAT machines availability.

• Treatment:- Diagnosed drug-sensitive as well as drug-resistant TB patients (DR-TB) are treated as per NTEP guidelines.

  • Uninterrupted supply of good quality fixed-dose combination drugs as per weight band is provided to TB patients for the complete duration free of cost under NTEP.

  Adherence to treatment is monitored by the Medical Officer of PHIs under the supervision of the Tuberculosis Unit.

  • If a patient is found to be drug-resistant, they are advised an appropriate drug-resistant regimen under the programme free of cost.

Different Schemes & Activities Under NTEP

• Culture & DST laboratories are functioning for the diagnosis of DRTB patients. The list of CDST labs under NTEP is as follows:

  • Microbiology Lab at J. J. Hospital, Mumbai
  • Microbiology Lab at Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha
  • BJ Medical College, Pune
  • Govt. Medical College, Aurangabad
  • GTB Hospital Sewari, Mumbai
  • IRL, State Training and Demonstration Center, Nagpur
  • IRL, State Training and Demonstration Center, Pune
  • K.E.M. Medical College, Mumbai
  • Microbiology Lab at Hinduja Hospital, Mumbai
  • Super Religare Laboratory, Mumbai
  • Metropolis Lab Mumbai
  • Infexn Laboratory, Thane
  • Suburban Lab, Mumbai

Each diagnosed TB patient in programme is tested for Rifampicin sensitivity on CBNAAT/Truenat machine. This helps in early detection of DRTB patients. State has 171 CBNAAT sites & 624 Truenat sites allocated across all districts.
Diagnosed drug resistant TB patients are advised appropriate regimen containing various drugs which needs initiation under guidance of Medical Specialists (DRTB committee).
21 Nodal Drug resistant TB (DRTB) centers are established for initiation of treatment to DR TB patients. In addition to these Nodal DR-TB Centres following 42 District DR TB canters are established where conventional MDR treatment could be initiated at district level to make the treatment services accessible to patients.

Performance under NTEP

Year	TB Suspects Examined	Suspect Exam Rate /lakh / year	TB Cases Notified Public	TB Cases Notified Private	TB Cases Notified Total	Annualized TB Case Notification Rate Public	Annualized TB Case Notification Rate Private	Annualized TB Case Notification Rate Total
2017	1005476	872	123982	69108	193090	103	57	160
2018	1019864	849	140985	61645	202630	117	51	168
2019	1126294	934	143954	83050	227004	119	69	188
2020	857694	682	95762	64310	160072	76	51	127
2021	954412	750	110216	90024	200240	87	71	158
2022	1998356	1552	132348	101524	233872	103	79	182
2023	2622646	2027	124381	103265	227646	96	80	176
2024	3531307	2697	155530	112437	227967	88	86	174

State has achieved TB Case Notification beyond the achievement of 2019 (Pre Covid stage) in the Year 2022

Information for Drug Resistant TB

Year	No. of MDR/RR TB Notified (Public+ Private)	Out of above, total no. of MDR/RR TB put on treatment (put on any regimen) (Pub+ Pvt.)	% of MDR/RR TB put on treatment (Public + Private)
2019	10778	9952	92%
2020	8085	7525	93%
2021	9608	9017	94%
2022	10384	9705	93%
2023	9023	8268	92%
2024	8654	5554	64%

Treatment Success Rate

All registered TB cases under the NTEP programme are provided free treatment under supervision, enabling successful treatment. The success rate of all new TB and previously treated cases over the years is as below.

Year	Success Rate for all New Cases (Expected > 90%)	Success Rate for previously treated Cases (Expected > 85%)
2017	87%	72%
Year	Success rate for all cases Drug Sensitivity TB (DS-TB) (Expected 90 %)	Success rate for MDR/XDR cases Drug Resister TB (DR-TB)
2018	88%	59%
2019	84%	65%
2020	84%	69%
2021	87%	74%
2022	87%	72%
2023	88%	Outcome of all patients yet not received as patients still on treatment

Universal – Drug Susceptibility Test (U-DST)

All newly diagnosed public sector and private sector TB patients need to be tested for the status of Rifampicin drug susceptibility through CBNAAT testing.

Year	Public			Private			Total
	Total Noti.	UDST Offered	%	Total Noti.	UDST Offered	%	Total Noti.	UDST Offered	%
2018	140173	66750	48%	60267	12142	20%	200440	78892	39%
2019	147486	117422	80%	75996	40027	53%	223482	157449	70%
2020	103661	87316	84%	53066	34174	64%	156727	121490	78%
2021	126737	105581	83%	70078	46832	67%	196815	152413	77%
2022	152304	108718	71%	77352	40882	53%	229656	149600	65%
2023	136624	96853	71%	74745	42398	57%	211369	139251	66%
2024	—	—	—	—	—	—	109320	86506	79%

Direct Benefit Transfer (DBT) to Beneficiaries

From 1st April 2018, the scheme for Nutritional Support to TB patients is being implemented in the State, under which the TB patient is provided Rs. 500/- per month incentive under Nikshay Poshan Yojana through Direct Benefit Transfer to the bank account of the patient.

Information of DBT Report from Nikshay & PFMS.

Year	Eligible Beneficiaries	Bank Details Validated for DBT Payment	DBT Made	% of DBT payment made under NYP
2019	221962	132457	107773	49%
2020	158608	115672	98819	62%
2021	202666	154061	149962	74%
2022	237323	191255	187851	79%
2023	207196	170605	152869	74%
2024	207721	164658	114992	55%

Performance of TB Hospitals

A total of 4 TB hospitals are functioning in the state of Maharashtra, and their performance is as follows:

Performance of TB Hospitals:-

Sr N	Name of District	Name of TB Hospital	Total No. of Beds	Year 2022		Year 2023		Year 2024
				Total No. of OPD	Total No. of patients admitted	Total No. of OPD	Total No. of patients admitted	Total No. of OPD	Total No. of patients admitted
1	Buldhana	TB Sanitorium Buldhana, Chest Hospital	100	1463	975	1927	1061	2090	645
2	Pune	Aundh Chest Hospital, Pune	120	6564	2509	4956	1460	5123	1318
3	Amravati	G.G.Rathi TB Hospital, Amarawati	50	3239	1094	3490	1103	4170	1165
4	Kolhapur	Shashikala TB Hospital, Jaysingpur Dist. Kolhapur	20	1398	81	1578	53	1747	53
5	Mumbai	Shivadi Hospital (Shivadi)	1023	24215	4103	18380	4130	15675	4354
State Total			1290	36879	8762	30331	7807	28805	7535

Sub-National Certification (SNC)

The Government of India has set an ambitious goal to achieve Ending Tuberculosis (TB) by reducing the incidence of new TB cases by 80% by 2025, five years ahead of global SDG timelines. Conventionally, there is precedence to award certification of elimination of diseases only at the national level, largely led by the World Health Organization (WHO).

In this prestigious process, Maharashtra received the highest nominations and awards in the TB Free Sub-national Certification. Maharashtra was awarded 2 Silver Medals and 7 Bronze Medals in this prestigious certification in 2020-21.

Monetary and Non-Monetary awards for TB Free Status and Interim Recognition for Progress towards TB Free Status are as follows:

Award/Status and Monetary Rewards

Award / Status	Monetary award for district(Rs.)*	Monetary award for State/UT(Rs.)**	Non-Monetary award
Bronze	2,00,000	25,00,000	Medal & Felicitation at the National level
Silver	3,00,000	50,00,000
Gold	5,00,000	75,00,000	Certification & Felicitation at the National level
TB Free District	10,00,000	1,00,00,000

NTEP Districts received award in 2020-21 (Round_1)

Sr No	NTEP District	Award
1	Kolhapur	Silver
2	Parel	Silver
3	Sindhudurg	Bronze
4	Ratnagiri	Bronze
5	Satara	Bronze
6	Nashik	Bronze
7	Ghatkopar	Bronze
8	Prabhadevi	Bronze
9	Grant Road	Bronze

NTEP Districts received award in 2021-22 (Round_2)

Sr No	NTEP District	Award
1	Ahmednagar – R	Gold
2	Ahmednagar – MC	Gold
3	Akola – R	Silver
4	Akola – MC	Silver
5	Beed	Bronze

NTEP Districts received award in 2022-23 (Round_3)

Sr No	NTEP District	Award
1	Sangli	Bronze

Financial Budget(State):- Year 2023-24 (Up to Dec.)

Major Head	Sanction Grant	Receive Grant	Expenditure	%
22100191	914371	715589	692436	97
22100674	45726	35334	30907	87
22105201	122339	96448	92706	96
22105237	35304	27090	24396	90
Total		1117740	874461	840445	96

Budget & Expenditure of PIP under NHM:-

Year	Sanction PIP	Expenditure	%
2017-18	7621.42	6257.12	82.10%
2018-19	12415.25	9245.18	74.47%
2019-20	17153.42	10263.49	59.83%
2020-21	14003.72	11987.91	85.61%
2021-22	23428.97	10287.83	43.91%
2022-23	22035.03	18926.14	85.89%
2023-24	24645.30	18051.40	73.24%
2024-25(Up to Nov.)	22665.09	10341.23	45.63%

Initiatives

• Pradhan Mantri TB Mukt Bharat Abhiyaan (PMTBMBA): Pradhan Mantri TB Mukt Bharat Abhiyan is being implemented in Maharashtra state. Under this initiative, there are 12,180 Ni-kshay Mitra registered, out of which 11,918 Nikshay Mitra have agreed to provide support. 122,354 TB patients have consented for nutrition support, and 314,767 Nutrition Kits have been provided to TB patients till date.

• BCG Vaccination: The Central Tuberculosis Department, Ministry of Health and Family Welfare, Government of India, has introduced an additional dose of the BCG vaccine. From 03 September 2024, five persons above 18 years of age in selected 40 NTEP districts of the state have been targeted. As of 17 January 2025, one additional dose of the BCG vaccine has been given to 15,58,826 persons above 18 years of age under this initiative.

• TB Mukt Gram Panchayat: The Central Tuberculosis Department, Ministry of Health and Family Welfare, Government of India, is implementing the TB Free Panchayat Abhiyan in the state. Under this campaign, the state succeeded in making 2,251 gram panchayats TB-free in 2023. These gram panchayats are honored with a bronze statue of Mahatma Gandhi and a certificate presented by the District Magistrates.

• Cy-TB: A new test developed by the Central Tuberculosis Department, Cy-TB (subcutaneous injection in the arm), screens for latent TB infection in persons without symptoms. The state has received 1,39,200 Cy-TB tests, which will be used to test household members of TB patients. Preventive treatment will be provided to infected persons under this initiative.

• TB Preventive Therapy (TPT): To achieve the ambitious target of ending TB by 2025, the state has decided to strengthen latent TB Infection Management and expand the scope of TB Preventive Treatment (TPT). Beyond the current policy of offering treatment to household child contacts below 5 years of age and PLHIV, of pulmonary TB patients. Under this initiatives 6H and 3HP regimens are given to TB patient eligible Contacts

Year	TB Patient Notified	Number eligible for TPT- (Age < 5)			Number eligible for TPT- (Age > 5)
		Number eligible for TPT- (Age < 5)	Number provided TPT- (Age < 5)	% of TPT- provided (Age < 5)	Number eligible for TPT- (Age > 5)	Number provided TPT- (Age > 5)	% of TPT- provided (Age > 5)
2019	223482	42940	36312	85%	—	—	—
2020	156727	26873	17680	66%	—	—	—
2021	185018	18404	7969	43%	—	—	—
2022	133035	26504	15690	59%	422442	77796	18%
2023	124283	22442	15648	70%	343783	143297	42%
2024	119658	22799	14919	65%	318431	160232	50%

100 Days Campaign (7 Dec 2024 to 24 Mar 2025):

• Goal- It is a nation-wide campaign to accelerate TB case detection, reduce mortality, and prevent new cases through focused interventions in districts with the highest TB burden in a stratified approach.

• Objectives-

  • Find new cases (among vulnerable groups) – Screening with X-ray and upfront NAAT

  • Ensure successful management of identified TB cases (existing & new) – saturate services (Bank Seeding, NPY Payment, HIV, Diabetes, nutrition support – PMTBMBA) and implement differentiated care including TB death audit

  • Prevent the occurrence of new cases (TB Preventive Therapy (TPT) among household contacts & among vulnerable groups)

• Campaign Districts-

  • Districts are identified based on death rate, presumptive examination rate and estimated incidence rate.

  • Rural Districts (17), Municipal Corporation Districts (12), Mumbai (24)

Beneficiary:

Tuberculosis patients (both new and existing)

Benefits:

Free diagnostic services Free medicines (for both drug-sensitive and drug-resistant TB) Nutritional support (via DBT) Travel support Support for treatment under government and private sectors