For most of us, tuberculosis feels like a disease from another era. We know it exists, but we also believe it can be cured with a few months of medicines. In many cases, that's true.
But that is not everyone's story.
Every year, thousands of people in India are diagnosed with a form of tuberculosis that doesn't respond to the medicines that usually work. Suddenly, what was expected to be a six-month course of treatment becomes a much longer and more uncertain battle. Medicines change, side effects become harder to live with, and recovery is no longer guaranteed. This is drug-resistant tuberculosis (DR-TB), and if India is serious about eliminating TB, it cannot afford to treat DR-TB as a side issue.
The good news is that India has made genuine progress against tuberculosis over the past decade. According to the India TB Report 2025 and the WHO Global Tuberculosis Report 2025, TB incidence has fallen by about 21% since 2015. More people are being diagnosed earlier than before, access to treatment has improved, and newer diagnostic tests are helping doctors identify the disease much faster.
But success has also exposed a different challenge.
India still has one of the highest numbers of drug-resistant TB cases in the world. Nearly one in three people globally diagnosed with multidrug-resistant or rifampicin-resistant TB lives in India. India notified about 65,000 cases of drug-resistant tuberculosis in 2024. The numbers tell us how big the problem is. They don't tell us what it is like to live with it.
A diagnosis of drug-resistant TB changes everyday life and functioning of those affected. Suddenly, life revolves around medicines, hospital visits and follow-up appointments. Families worry about how long treatment will last and whether they can afford to keep going. Some patients stop working.
Others quietly withdraw from friends and neighbours because they are afraid of being treated differently. Long after the diagnosis, many continue to carry the weight of stigma along with the disease itself.
India's response has changed considerably in recent years. Through the National TB Elimination Programme (NTEP), the emphasis is no longer just on treating tuberculosis but on finding drug resistance early, starting the right medicines as quickly as possible and helping patients stay on treatment until the end.
Kerala has long been recognised as one of India's leading states in tuberculosis control. According to the National TB Report, the state has the lowest estimated TB incidence in the country, at 67 cases per lakh population, substantially lower than the national average. The state's strong public health system continues to sustain high levels of treatment initiation, with about 94% of notified TB patients started on treatment in 2024.
Even so, Kerala has not escaped the problem of drug resistance.
In Kozhikode, multidrug-resistant TB cases increased slightly from 75 in 2023 to 78 in 2024. Health officials believe treatment interruption is one of the main reasons. When medicines are stopped too early, the bacteria are given another opportunity to survive—and eventually become resistant.
Kasaragod continues to report higher notification rates than the rest of the state, particularly in border areas adjoining Karnataka and in several coastal communities. Men between 45 and 59 years account for the largest share of reported cases, while diabetes, smoking and undernutrition continue to increase the risk of poor treatment outcomes.
There is, however, real reason for hope.
Patients in Kerala are also benefiting from the rollout of the BPaLM regimen under the National TB Elimination Programme. For eligible patients with drug-resistant TB, treatment that once extended for nearly two years can now often be completed within six months using an all-oral regimen, making treatment less burdensome and potentially improving adherence.
Technology is also making a difference. Rapid molecular tests now detect drug resistance much earlier, allowing patients to begin appropriate treatment without unnecessary delays. The Indian Council of Medical Research has introduced targeted Next-Generation Sequencing to identify resistance patterns more accurately, making treatment more precise than ever before.
Initiatives such as 'Nalumani Pookkal' under the Kudumbashree-led programmes have strengthened case detection among tribal communities in Attappadi, Idukki and other remote areas. During the latest reporting period, these efforts helped identify more than 490 TB cases among tribal populations, ensuring that treatment could begin much earlier.
The government has also recognised that medicines alone are not enough. Nutrition matters. Financial support matters. Being able to reach a health facility matters. The monthly assistance under the Nikshay Poshan Yojana has therefore been doubled from ₹500 to ₹1,000. India has also begun deploying AI-enabled handheld chest X-ray systems to support TB screening in remote and hard-to-reach communities, with plans to expand their use in high-burden areas.
Even with these advances, the work is far from over. Delayed diagnosis, interrupted treatment, undernutrition and unequal access to specialist care continue to drive drug resistance. Stigma remains another obstacle. Too many people still hesitate to seek help or disclose their diagnosis because they fear losing their job or being treated differently.
Ending drug-resistant TB will take more than better medicines or better technology. It will require health systems that stay with patients from the day they are diagnosed until they recover—offering counselling, nutritional support, financial assistance and the reassurance that they are not facing the illness alone.
India has shown that progress is possible. Kerala has shown what sustained investment in public health can achieve. But the real test of success is not how low the numbers fall. It is whether every person diagnosed with drug-resistant TB, wherever they live, has the same chance to recover.
Only then can we truly say we have brought tuberculosis under control.
Credits to: Dr Elizabeth Sunila
Consultant - Pulmonology, Allergist & Respiratory Disease, Aster Medcity, Kochi