Lessons and updates from India's National Tuberculosis Elimination Program - bold decisions and innovative ways of...

India has the highest burden of tuberculosis (TB) globally. Strong political commitment, bold targets, and innovations have been the hallmark of the TB response. Lessons learned in India, such as understanding the diversity of TB epidemiology, approaches beyond conventional response strategies, bold decisions, and innovations, are invaluable for the global TB response. The India TB response is supported by strong political commitment cascading from the Prime Minister to local stakeholders. An initial key step was the sub-national assessment of the diverse TB burden and recognition of the public and private health care landscape. India effectively demonstrated innovative models to meaningfully engage all stakeholders, leveraging technology to bridge gaps. Community participation and social engineering movements were used to reduce stigma and address the nutritional needs of TB patients. Patient-support systems through an innovative adoption program, crowdsourced solutions, and direct benefit cash transfers were implemented to mitigate the socio-economic impact of TB. Decentralized initiatives such as the TB-Free Panchayat, district, and city schemes empowered local stakeholders and encouraged healthy sub-national competition. Advances in research and development of screening tools, rapid molecular diagnostics, real-time integrated digital surveillance systems such as Ni-kshay, and innovations such as telemedicine, call centers, direct benefit transfers, and artificial intelligence (AI)-based tools are accelerating the TB response in India.