Pradhan Mantri TB Mukt Bharat Abhiyaan-A step towards the elimination of the oldest known infectious disease

Tuberculosis (TB) is known to humankind for a very long time.1, 2 This bacterial disease is a paramount public health hurdle, especially in the low-income countries of Asia, Africa, and Europe.3 TB is one of the most frequent causes of morbidity and mortality in these low-income countries.3 India is the capital of TB and the data from the WHO statistics for the year 2021 from India reveals that the incidence and prevalence are 188 and 312 per one lakh population respectively.4, 5 Although India has a high burden of TB cases still there are various concrete efforts in place aimed at TB elimination 6. The goal of TB elimination by 2025 which is five years earlier than the international goals set by the current prime minister of India.6 And to achieve this goal efforts on the war front are going on throughout the country. One such recent effort was launched by the President of India on September 9^th, 2022 in the name of ‘Pradhan Mantri TB Mukt Bharat Abhiyaan’.7 This program is aimed to gel the various community stakeholders to increase the support for TB patients. 7, 8

Another important launch was that of the Ni-kshay Mitra initiative, which is the major building block for the success of the Pradhan Mantri TB Mukt Bharat Abhiyaan.7, 8 The whole program would run through Ni-kshay 2.0 portal.8 This Ni-kshay Mitra portal would act as a single point where donors would lend their support to the TB patients undergoing the treatment and who has given consent (OTP based) for inclusion in the program.8 This support consists of three important assistance i.e., nutritional, additional diagnostic support for the diagnosed TB patients, and vocational support 9. And these Ni-kshay Mitras’ would be from a diverse range of stakeholders from elected representatives, political parties, to corporates, NGOs, and individuals. 9 These Ni-kshay Mitras’ have to provide support for a minimum of one year however there are options for a support program for 2-3 years.8 Except for the individual Ni-kshay Mitras’ who could choose from the patients on TB treatment, the rest of the Ni-kshay Mitras’ have to pick the complete geographical unit i.e., blocks or urban wards or districts, or states. 10

These Ni-kshay Mitras’ would make a food basket every month and there will be two options to choose from which are mentioned in Table 1, Table 2.10

In place of milk/milk powder, groundnuts free from aflatoxin 1000gm for adults and 700gm for children might be used as a constituent of the food basket.10 The Ni-kshay Mitra may opt for the food basket as per the local state of affairs and cultural practices and the deliveries of these food baskets could be done by working with a mutually agreed NGO/Self-Help Group (SHG).10 Patients should be counseled for micronutrient adequacy to consume nearby accessible fresh vegetables, beans, and fruits every day.10 Besides, a supplement consisting of one Recommended Dietary Allowance (RDA) of B complex vitamins, mainly pyridoxine (B6) and vitamin C may be supplied as long as the patient is on treatment.10 Other essential vitamins and minerals as per the RDA might also be supplemented during the treatment of TB. 10

The program aims at increasing awareness of TB and patients suffering from this disease. This program targets at bringing the communities, corporates, NGOs, and individuals from various backgrounds together for lending a helping hand to the patients on TB treatment. Another important goal is to reduce the stigma associated with the disease by bringing the communities together for TB elimination.10 Other salient features of this program include the abatement of out-of-pocket expenditure for the patient and his family.10 Lastly, nutritional supplementation would have a favorable impact on the treatment outcomes.10

This initiative will be independent of other initiatives which are already given to the TB patient like the Nikshay Poshan Yojana, an aadhar-linked direct benefit transfer (DBT) of 500 INR per month for the total duration of the treatment.11, 12 The efforts of TB champions would also continue for the patient benefit.13

The operational plan would be the devising of the health system in the states and districts for the initiative including Ayushman Bharat–Health and Wellness Centres (AB-HWCs).10 Dissemination plan for the initiative. Nationwide drive for acquiring consent from TB patients.10 Assessment of the blocks/urban wards/districts/states.10 Ni-kshay Mitras’ will be identified and registered in the Ni-kshay portal and all the efforts of such initiative by these donors will be reported on the portal. 10 Delivery of services/support to the beneficiary. Grievances will be redressed through the Ni-kshay Sampark helpline no. 1800116666.10

Till 17^th September, 15,415 registrations of 'Ni-kshay Mitras’ has been done with over 9,56,352 lakh TB patients have been adopted of the total 13,53,443 TB patients, including the multi-drug resistant patients, currently on treatment in India.8

District TB officer (DTO) would act as the main link between the donors and the TB patients and will share the list of active TB patients who have consented to receive the community support with the Ni-kshay Mitras’ on the 23^rd of every month, for all the concerted areas.10 It will be the duty of Ni-kshay Mitras’ to ensure that the agreed benefits are delivered timely to the patients.10 The monitoring and supervision of the status of receipt of assistance by the beneficiaries i.e., TB patients will be mutually done by the district TB cell and the Ni-kshay Mitra regularly.10 The DTO will verify and report the assistance handed over to the patients at set intervals.10

To conclude, the Government of India has ramped up efforts to achieve its ambitious goal of TB elimination by 2025. The latest effort that is ‘Pradhan Mantri TB Mukt Bharat Abhiyaan’ is an important step for community involvement to support TB patients and this will also help in reducing the stigma associated with the disease. Nutritional supplements will help a lot in achieving favorable treatment outcomes and ultimately help in reducing mortality.