ArticleMicrobiology spectrum2026
Evaluating the nationwide availability of essential diagnostics for tuberculosis toward achieving a TB-free India.
Article in Microbiology spectrum, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
India continues to face a high tuberculosis (TB) burden, as reaffirmed by the latest World Health Organization (WHO) Global TB Report. This trend highlights the need for a critical appraisal of the country's TB management framework. In this study, we assessed the distribution of TB Treatment Units (TUs) and Culture and Drug Susceptibility Testing (CDST) laboratories across states and union territories in India. The analysis revealed a pronounced national deficit of 61.56% in CDST laboratory capacity relative to projected diagnostic needs, with the gap most evident in rural and geographically remote regions. Lack of proportional availability of drug susceptibility testing or alternative molecular methods in conjunction with TB Treatment Units, leading to non-selective antibiotic use, could be the reason India has the highest multidrug-resistant TB. Our multi-state assessment of 327 healthcare facilities across seven states and the National Capital Region-Delhi revealed marked deficiencies in the implementation of essential diagnostics (ED) for tuberculosis in primary-level public health care facilities. Notably, access to molecular diagnostics, such as nucleic acid amplification tests (NAATs), remains insufficient for early case detection, contributing to a high proportion of missed TB cases. The key TB treatment management and monitoring investigations, such as comprehensive metabolic panels (CMP) and complete blood counts (CBC), are inconsistently available at TB Units linked to Primary and Community Health Centers. Addressing these systemic deficiencies through targeted policy action is critical to integrating essential diagnostics into routine care pathways and ensuring an accessible, high-quality TB elimination program. IMPORTANCE: The study analyzes the Government of India's tuberculosis (TB) Free India by 2025 campaign in the context of the availability of essential tuberculosis diagnostics. Our findings raise the question of why India may not achieve the ambitious goal of eliminating tuberculosis, perhaps by 2030, in the absence of a proportionate and balanced TB diagnostic toolkit. To date, a comprehensive study of the availability and access gap for the World Health Organization's Essential Diagnostics List (EDL) in India is lacking in the scientific and public health discourse.
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