TB is rising among the middle class. Here’s how India plans to eliminate it

“When I was diagnosed with TB in 2019, I knew nothing about the disease. I struggled to make sense of it,” he says. “By the time I completed my six-month treatment, I had learned enough to help others navigate it.”

In 2022, Kumar became a “TB champion”, volunteering with the district’s TB centre and nonprofits to offer community support. Last year, 60 TB champions across Haryana, including Kumar, came together to form a network to expand their reach. Riding their bikes from village to village, they frequent public spaces—the village chaupal, hospitals, schools, markets, bus stands—to spread awareness about TB, encourage screenings, conduct home visits and connect people with health centres.

Their grassroots movement, and of other similar networks across the country, reflects a growing push to boost India’s broader goal: eliminating TB—the world’s deadliest infectious disease—by 2025.

However, in March this year, the World Health Organization (WHO) raised the alarm over global efforts to fight TB hitting a roadblock due to severe funding cuts—particularly in the US, the largest donor, contributing about $200 to $250 million annually for TB programmes. The cuts threaten decades of progress: global TB programmes have saved over 79 million lives in the past 20 years and averted 3.65 million deaths last year alone, according to WHO.

India’s TB programme is funded by the Indian government and the Global Fund, an international financing and partnership organization to tackle epidemics, headquartered in Geneva. “Many government departments working on TB in India are understaffed and rely on technical support units from nonprofits, so if the global funding is cut back on that, it could have some implications,” says Chapal Mehra, public health specialist and convener of the community Survivors Against TB.

The progress so far

India’s TB story is one of hard-won gains and lingering gaps. According to WHO’s Global Tuberculosis Report 2024, India accounted for the highest share of global TB cases in 2023—26%. The covid-19 pandemic set back efforts significantly, with TB case notifications dipping by 80%, leaving a large number of cases undiagnosed and untreated. However, the union health ministry reports signs of recovery under the National TB Elimination Programme (NTEP), which recorded the highest-ever TB notifications in 2024—2.6 million cases. The TB incidence rate has declined by 17.7% over the past eight years. TB-related deaths have also fallen during this period, from 28% to 22% per 100,000 population.

In the run up to the 2025 elimination target, campaigns like ‘TB Mukt Bharat–100 Days Intensified Campaign,’ covering 455 high-priority districts, have gained momentum. The ‘India Innovation Summit–Pioneering Solutions to End TB,’ held in New Delhi last month, highlighted 200 innovations—from handheld X-ray devices for rapid TB screening to AI-driven diagnostic tools and next-generation molecular testing technologies and ongoing vaccine trials.

TB diagnostics are evolving, too, moving beyond sputum testing to more accessible samples like tongue swabs and urine, though they are still in the testing stage or awaiting regulatory approval.

Recently, John Hopkins University launched the ‘TB-Free School’ programme in India to focus on paediatric TB elimination, targeting detection and treatment of both active and latent tuberculosis among students.

“The political commitment to address TB in India is at an all-time high. The more politicians talk about a disease, the greater the chances for better funding and better strategies. There has been some progress in the last few years—government health workers are more proactive, and states are more concerned about TB,” says Mehra.

India has also scaled up diagnostic capability, active community screening, especially among high-risk populations, and introduced rapid molecular diagnostic technologies like CBNAAT and Truenat that can be used even in remote settings, notes Dr. Ramya Ananthakrishnan, director, Reach India, a nonprofit mobilising efforts to end TB.

The TB incidence rate has declined by 17.7% over the past eight years. TB-related deaths have also fallen during this period, from 28% to 22% per 100,000 population.

Rapid molecular diagnostic technologies are highly effective lab tests that can detect genes of pathogens, and often drug resistant mutations, within hours.

“We have moved from thrice-weekly to daily treatment regimens, with drug resistance testing now available at the first point of contact. We have also placed greater focus on the social dimensions of TB, and are one of the first countries to implement a gender-responsive framework for TB care,” she adds.

TB cases are tracked via the government’s NIKSHAY portal, a national patient management system for healthcare workers across public and private sectors to register patients, track treatment and medication adherence.

Gaps and emerging threats

But major barriers remain. Though rapid molecular testing has been adopted—which is far more accurate and efficient than the widely-used sputum smear microscopy method—it remains expensive and not accessible everywhere.

Shortages of the cartridges required to run these machines are also frequently reported. “We’re trying to solve a long-standing issue using the same tools we’ve always relied on, yet expecting different results,” says Mehra. Moreover, most of the progress has focused on pulmonary TB, which makes up 60% of cases, leaving extra-pulmonary TB, which occurs outside the lungs, behind. Nearly 50% of India’s TB cases are either misdiagnosed or diagnosed in the private sector, where testing is often not done early enough, he explains.

Most of the progress has focused on pulmonary TB, which makes up 60% of cases, leaving extra-pulmonary TB, which occurs outside the lungs, behind.

Doctors also note that TB is no longer confined to low-income groups, as previously believed. “We’re seeing a rise in cases among the middle class, likely due to the growing prevalence of chronic conditions like lung disease, heart disease, and diabetes—all of which raise the risk of developing TB,” says pulmonologist Dr. Loveleen Mangla. Underreporting is another issue. “A large number of patients receive treatment without officially registering their cases. We need stronger regulation and greater awareness,” he adds.

Another long-standing problem is reports of recurring shortage of TB medicines, though the health ministry has denied unavailability of drugs. TB-affected patients tell a different story. Kritika Damwani, 25, who completed her treatment for multidrug-resistant (MDR-TB) in Mumbai last year, recalls facing a six-month-long shortage of drugs. “I finally found the medicines at a pharmacy in Gujarat through a relative,” she says. “But others weren’t so lucky — they ended up missing doses.”

Such interruptions in treatment have serious consequences, such as fuelling the rise of drug-resistant TB, making the disease harder to manage and cure.

Drug resistance

Rising cases of MDR-TB is indeed a growing threat in India, with the second-largest burden in the world, and a 40-50% survival rate. Dr. Mangla has observed a rise from 2% to nearly 6% in drug-resistant TB cases he has seen over the past 8-10 years. “Many patients stop treatment after just one month, once they begin to feel better—and that’s exactly how drug-resistant TB develops,” he says. Since MDR-TB medicines are not yet available at most private healthcare facilities, doctors refer patients to government facilities, where medications are more accessible and free of cost. TB survivors Mint interviewed said private treatment for MDR-TB could cost ₹30-40 lakh overall.

The adoption of shorter, all-oral Bedaquiline-based regimens for MDR-TB has been encouraging, according to government data, improving success rates from 68% in 2020 to 75% in 2022. The rollout of the mBPaL regimen—which combines Bedaquiline, Pretomanid, and Linezolid—has shown success rates of up to 80%, cutting treatment to just six months, instead of 1.5-2 years. This treatment is an all-oral antimycobacterial, antimicrobial and antibiotic regimen. In April, Pretomanid’s price dropped by 25% because of a strategic move by its developer, the nonprofit TB Alliance. It partnered with additional manufactures to broaden access to the key drug.

Closing gaps in care

To speed up TB eradication efforts, the last-mile delivery of treatment needs to be improved, particularly in rural areas, and expand rapid testing to a wider population, according to Dr. Ananthakrishnan. “Currently, 40% of individuals who test negative for symptoms still have TB,” she explains. “So, limiting our focus to only symptomatic individuals means we’re missing a substantial number of cases.”

She points out that payments under the existing cash transfer model for nutritional support are often delayed. It also lacks equity, as patients with more severe forms of TB need greater support, but the system does not always account for that.

Another major gap is the inconsistent engagement with the private healthcare sector. In many districts, private providers are not linked to the public Patient Provider Support Agency, which serves as a critical bridge. This disconnect often leads to underreporting of cases, unscreened family members, and a breakdown in follow-up care.

There is a growing demand for more robust support for livelihood loss and mental health for TB patients. Experts are also calling for legally mandated annual health check-ups and widespread mass screenings to identify and treat cases proactively.

“A multi-sectoral approach is crucial,” says Dr. Ananthakrishnan. “This includes expanding health insurance coverage, mobilizing corporate funding, and developing sustainable public-private models for TB care—similar to what we achieved during the covid-19 vaccine rollout.”

Emerging tech innovations

Innovations in TB detection—driven by partnerships between the government and technology companies—are beginning to emerge in pockets across India. While the government’s appetite for such innovations is growing, large-scale implementation remains slow and uneven.

One example is Qure.ai’s AI-powered software, which is integrated into both traditional and portable X-ray machines. The software generates diagnostic reports within seconds, significantly improving case detection rates. It also reduces costs—saving ₹640 per detection—and shortens turnaround time. Currently deployed in 25 states across India, Qure.ai’s technology has also been scaled to 90 countries, including Nigeria, Indonesia, and South Africa, and has been used in settings ranging from the Kumbh Mela to Mount Everest’s base camp.

At a hospital in Mumbai, the software led to a 13% increase in TB case detection, and 29% of the detected cases were incidental, meaning patients had come in for non-TB-related symptoms. “By expanding the funnel of testing, we could detect about 3 million probable TB cases each year at an early stage, preventing further spread,” says Dr. Shibu Vijayan, chief medical officer at Qure.ai.

Another promising innovation is Wadhwani AI’s Cough Against TB app—a low-cost, non-invasive screening tool currently being used by community health officers at primary health centres.

“A major challenge in meeting India’s 2025 TB elimination target is identifying undiagnosed cases, especially those missed by traditional screening methods when symptoms are mild or absent,” says Nakul Jain, vice president of product and design at Wadhwani AI. “At the request of the Central TB Division, we adapted our covid-19 cough-based prediction model for TB by combining cough sounds with symptom data to improve detection.”

So far, Cough Against TB has screened 120,000 individuals, and identified an additional 17% of TB cases, including many asymptomatic ones. It is currently live in states such as Nagaland, Punjab, Jammu & Kashmir, and Delhi, and is being deployed in high-risk areas such as slums and prisons for active case finding.

Building community support

Despite the growing momentum, TB survivors say stigma and the challenges of returning to normal life persist. Community networks, helplines, social media chat support and survivor-led advocacy are gradually normalising the conversation to reduce the shame associated with the disease.

When Damwani was diagnosed with TB, she felt completely alone—until she found solidarity through Survivors Against TB. “I was preparing to leave for the US in 2022 to study finance when I developed a lingering cough and lumps in my breasts,” she recalls. “It was misdiagnosed for months—as allergies, even breast cancer.”

The two-year treatment was long and painful, but the mental trauma and side effects, she says, were worse. “I still can’t wear socks and shoes, it’s too painful. As a woman, when your appearance changes—as mine did with skin discoloration—it hits hard. People still ask, ‘Who will marry you?’”

Mumbai-based theatre actor Akshata Acharya, 27, another advocate part of Survivors Against TB, says though she was disease-free in 2023, the aftereffects still linger. “I was taking 22 pills a day that came with severe side effects: vomiting, hair loss, facial rashes, insomnia.” The medication darkened her skin, damaged her nerves and bone marrow, and left her temporarily in a wheelchair with peripheral neuropathy and on antidepressants. “I’m still finding my feet,” she says. “We don’t talk enough about post-TB care or the mental toll it takes—how to truly reintegrate into society after treatment.”

Her experience inspired her to write a book, Eclipsed, on what she calls one of the least understood diseases: “If we don’t talk about it, we can’t eliminate it.”

Damwani and Acharya are among a swell of survivors who have stepped up support to those affected by TB, especially students and young women who reach out to them on social media. Says Damwani: “I feel it’s my responsibility as a survivor to speak out. TB needs empathy, engagement, and awareness—not stigma or silence.”