Is Isolation of Active Pulmonary Tuberculosis Cases  the Last Mile Strategy to Achieve Tuberculosis  Elimination in India?

Kartik Chadhar; Jugal Kishore; Akshun Jani; Chander Shekhar; Kishan Kumar Jani; Neeru Gupta

Kartik Chadhar Department of Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi
Jugal Kishore Director Professor, Department of Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
Akshun Jani Junior Resident, Department of General Medicine, Ram Manohar Lohia Hospital, New Delhi, India
Chander Shekhar Former Additional DG, Indian Council of Medical Research, Delhi, India
Kishan Kumar Jani Chief Medical Officer, Health Department, Municipal Corporation of Delhi, India
Neeru Gupta Scientist F, Division of Reproductive and Child Health and Nutrition, Indian Council of Medical Research, Delhi, India

Keywords: Tuberculosis, isolation, transmission, MDR-TB, infection control, household contacts, disease elimination

Abstract

Tuberculosis (TB), despite extensive global efforts for elimination, continues to pose significant public health challenges, particularly in high-burden countries like India. This review explored the isolation of active (open) TB cases as a critical strategy to curb transmission and achieve TB elimination targets. Analysing historical and current epidemiological data, we discussed the burden of TB and its transmission dynamics, emphasising the role of early detection and isolation in halting community spread. Multidrug-resistant TB (MDR-TB) and associated comorbidities such as diabetes, undernutrition, and tobacco and alcohol use exacerbate challenges in TB control. We presented isolation policies, modelled on the success of infection control strategies during the
COVID-19 pandemic, as pivotal interventions, particularly in managing MDR-TB and extensively drug-resistant TB (XDR-TB). Recommendations included targeted use of isolation, enhanced ventilation, respiratory hygiene, and community education to mitigate household and community transmission. The role of community health workers, such as ASHAs and ANMs, is critically examined to ensure their involvement maximises TB care without increasing the risk of transmission. Key strategies include implementing evidence-based harm reduction in crowded settings through maximised natural ventilation and strict respiratory hygiene. Critically, these measures must be integrated into the National TB Elimination Programme (NTEP) through structural support, such as training community health workers to conduct home assessments, establishing community-based short-stay isolation centers, and making psychosocial support a routine component of care. By integrating
robust public health measures with comprehensive psychosocial and financial support, the path toward TB elimination, while challenging, becomes increasingly feasible and equitable.

How to cite this article:
Chadhar K, Kishore J, Jani A, Shekhar C, Jani K K, Gupta N. Is Isolation of Active Pulmonary Tuberculosis Cases the Last Mile Strategy to Achieve Tuberculosis Elimination in India? J Commun Dis. 2025;57(3):182-190.

DOI: https://doi.org/10.24321/0019.5138.202585