International Institute for Population Sciences
Deemed to be University (An Autonomous Organization of Ministry of Health & Family Welfare, Government of India)

Introduction: Tuberculosis (TB) remains one of India’s most urgent public health challenges, contributing significantly to the global burden. The National TB Elimination Programme (NTEP) has expanded diagnostics, community screening, and treatment, but TB trends are influenced by drug resistance, HIV co-infection, social determinants, and COVID-19 disruptions. Objective: To analyze trends in key TB indicators in India (2000–2023), identify inflection points, and provide insights for elimination strategies. Methodology: Thirteen indicators, including incidence, case notifications, extrapulmonary and pediatric TB, rifampicin resistance, MDR/RR-TB, TB–HIV co-infection, and mortality, were extracted from India’s TB Reports and WHO estimates. Joinpoint regression was applied, with Annual Percentage Change (APC) and 95% confidence intervals quantifying trend shifts. Critical Findings: TB incidence rose in 2002–2004 (+49.34%/year) and 2012–2015 (+32.79%/year), then stabilized. TB–HIV co-infection steadily declined, with steep reductions in 2000–2003 (–13.29%/year) and after 2011 (–11.99%/year). Extrapulmonary TB rose in 2000–2008 (+10.90%/year) and 2017–2020 (+17.13%/year). Rifampicin-resistant TB decreased during 2015–2019 (–5.50%/year) but plateaued afterward, while MDR/RR-TB detection rose until 2019, then declined. Notifications surged in 2000–2004 (+49.21%/year) and 2014–2021 (+6.35%/year) but collapsed in 2021–2023 (–28.07%/year) due to COVID-19. Mortality declined steadily in 2000–2018 (–5.44%/year), with sharper reductions among HIV-positive patients after 2012 (–19.41%/year). Conclusion: India has reduced TB–HIV co-infection and mortality but faces challenges of drug resistance, pediatric TB, and pandemic setbacks. Strengthened detection, resistance control, and resilient patient-centered services are essential to achieve the 2025 elimination target.