Palliative care in tuberculosis: Need, challenges and future directions for India

Tuberculosis (TB) continues to be a major public health challenge in India, contributing significantly to mortality, morbidity, and long-term disability. Although TB is considered a curable disease, people with TB frequently experience substantial physical, psychological, social, and spiritual suffering throughout the disease trajectory. Drug-resistant tuberculosis (DR-TB), recurrent TB, HIV-associated TB, severe extrapulmonary disease, and post-tuberculosis lung disease (PTLD) are associated with particularly high symptom burden and impaired quality of life. Traditionally, palliative care has been associated with advanced cancer and end-of-life care; however, emerging evidence suggests that palliative care should be integrated early into TB care to relieve suffering, improve treatment adherence, and support people affected by TB and caregivers. Palliative care for people with TB has several distinctive considerations, including the need to integrate symptom relief and psychosocial support with ongoing disease-directed treatment and, where relevant, communicable-disease-control measures. India's National TB Elimination Programme (NTEP) already incorporates several patient-support mechanisms, including nutritional support, counselling, peer support, and community-based interventions. However, comprehensive palliative care services remain underdeveloped within TB care pathways. This review discusses the need for palliative care in tuberculosis, examines distinctive considerations in TB palliative care, assesses implementation challenges in India, and proposes feasible models for integration within the Indian healthcare system. The review advocates for a person-centred, multidisciplinary, and decentralized approach aligned with the WHO End TB Strategy and emerging national guidance documents.