The 100-day intensified TB elimination campaign was launched on December 7, 2024 across 455 intervention districts in 33 States and Union Territories to screen and test for TB among people belonging to the vulnerable or high-risk group — diabetics, smokers, alcoholics, people living with HIV, those with TB in the past, geriatric population, house-hold contacts of TB patients. Besides screening people who have TB symptoms, the main intent of the intensified campaign is to use a chest X-ray to screen people for subclinical or asymptomatic TB disease followed by bacteriological confirmation using a molecular test.

“This isn’t just about diagnosing patients who show symptoms; it’s about finding those hidden cases who would otherwise remain undetected by using Chest X-rays, enhanced with AI, an effective method for screening individuals who may have TB but may not have the classical symptoms of TB,” Dr. Vinod Paul, Member of Niti Aayog wrote in an Opinion article in Business Line on March 5, 2025.

As per a February 22, 2025 PIB press release, over 5.1 lakh (0.51 million) TB notifications have been recorded across India. Of the 5.1 lakh total notifications across India, over 3.5 lakh TB notifications are from the 455 intervention districts after more than 10 crore (100 million) vulnerable individuals were screened between December 7, 2024 and February 22, 2025. The detection of over 3.5 lakh TB cases in the intervention districts have been as a “result of accelerated case detection efforts and reduced diagnostic delays”, the press release says.

According to data available on the Ni-kshay website, the number of TB cases notified across India from December 7, 2024 to March 6, 2025 is 6,35,035. During the corresponding period last year — December 7, 2023 to March 6, 2024 — 6,34,815 cases were notified across India. Between December 7, 2024 and February 22, 2025, there have been 5,77,676 TB notifications across India, which are more than the 5,10,000 notifications mentioned in the February 22 press release.

The increase in the TB notifications on the Ni-kshay website is not unusual as there is generally a 15-day lag for the exact data to get reflected on the website. The number of TB notifications during the corresponding period last year — December 7, 2023 to February 22, 2024 — was 5,33,091. So compared with the corresponding period last year, the total TB notifications even across India has increased by only 44,585 between December 7, 2024 and February 22, 2025.

Therefore, it is certainly wrong to attribute all the 3.5 lakh TB cases detected in the intervention districts to accelerated case detection during the 100-day intensified TB elimination campaign. In other words, the government’s claim would mean that all 3.5 lakh cases would have been missed in the absence of the accelerated case detection, which does not get reflected in the TB notifications on the Ni-kshay website. The total number of TB notifications across India between December 7, 2024 and March 6, 2025 has been almost the same as the corresponding period last year.

While the campaign would have surely picked up more cases, even the increase of 44,585 cases during the period December 7, 2024 to February 22, 2025 compared with the corresponding period last year cannot be ascribed to intensified case detection alone. The reason: aside from the fact that the 44,585 more TB cases notified are across India (788 districts) and not from the 455 intervention districts alone, the number of TB cases notified has been increasing each year in the last few years. From 21,35,830 TB cases notified in 2021, it increased to 24,22,121 notifications in 2022, and then to 25,37,235 notifications in 2023, and 26,18,499 notifications in 2024.

As per the National TB Prevalence Survey 2019-2021, 42.6% of TB cases would have been “missed” if a chest X-ray was not used for screening, thus revealing the magnitude of subclinical/asymptomatic TB cases in India. To detect such cases, the campaign claimed that a “new strategy was designed” for early identification of TB by using X-ray for screening people without TB symptoms. Yet, only 38 lakh of the over 10 crore (100 million) individuals have been using X-rays as of February 22, which is just 3.8%. Worse, despite the fact that asymptomatic TB disease cases can be detected only with a chest X-ray, all the 38 lakh people screened using a chest X-ray did not belong to this category. As per the press release, only a “substantial population” of people without TB symptoms were screened with a chest X-ray. Though it claims “several asymptomatic TB patients” are detected, there is no mention of the actual numbers.

Major limitation

It is not surprising that only a small fraction of the high-risk population was screened using a chest X-ray. As per the press release, there are just 836 vans equipped with portable X-ray machines to screen the high-risk population in the 455 intervention districts. Thus, the “new strategy” for early TB identification has very few portable X-ray machines for screening despite the 100-day intensified door-to-door outreach campaign relying on portable X-ray units for screening. Limited use, if at all, of the untested, HTA-unapproved AI-assisted chest X-ray interpretation tool is another major limitation of the campaign. Finally, the 100-day campaign is too short to come anywhere close to achieving Prime Minister Narendra Modi’s goal of “eliminating” TB by 2025.