Reimagining tuberculosis elimination in India: diagnostics, drug resistance, and digital health strategies

Tuberculosis (TB) remains a major global public health challenge and one of the leading infectious causes of mortality worldwide, with India contributing approximately 26% of the global TB burden. Despite substantial progress under the National Tuberculosis Elimination Programme (NTEP), India's efforts to achieve the ambitious 2025 TB elimination target continue to face major challenges due to the COVID-19 pandemic, multidrug-resistant tuberculosis (MDR-TB), healthcare disparities, and limitations in surveillance and reporting systems. This review provides a comprehensive overview of the epidemiology of TB in India and critically evaluates the impact of COVID-19, drug resistance, healthcare accessibility, and emerging diagnostic technologies on TB control efforts. A structured literature search was conducted using PubMed, Scopus, and Google Scholar, along with reports from the World Health Organization and the Government of India. The reviewed evidence indicates that the COVID-19 pandemic significantly disrupted TB diagnosis, treatment, surveillance, and healthcare accessibility, leading to declines in case notification and the possible accumulation of undiagnosed TB cases. In addition, the increasing burden of MDR/RR-TB, fragmented private healthcare systems, underreporting, and unequal access to diagnostics and treatment continue to hinder progress toward TB elimination. Although advancements including molecular diagnostics, digital surveillance platforms such as Nikshay, AI-assisted screening, and patient-support programmes have strengthened TB control strategies, important challenges related to implementation, infrastructure, scalability, and antimicrobial stewardship remain unresolved. This review highlights the need for integrated and patient-centred TB control strategies that combine rapid diagnostics, strengthened surveillance, public-private healthcare integration, health systems strengthening, and interventions addressing broader socioeconomic determinants such as poverty, malnutrition, and healthcare inequity. Coordinated multisectoral approaches will be essential for accelerating TB elimination efforts in India in the post-COVID era.