From RNTCP to NTEP: Two Decades of Policy Transitions and Their Impact on Tuberculosis Indicators in India-An Interrupted Time-Series Analysis

To examine the long-term, phase-specific effects of national tuberculosis program transitions on key TB indicators in India using interrupted time-series analysis, informing future TB policy and program design. Thirteen key tuberculosis indicators were analysed using data from the India TB Report and World Health Organisation estimates. Interrupted time-series analysis with linear generalised estimating equations was used to quantify level and trend changes associated with successive national tuberculosis program phases Revised National Tuberculosis Control Programme Phase-I(2000–2005), Revised National Tuberculosis Control Programme Phase-II (2006–2011) Combined as a RNTCP (2000–2011), Revised National Tuberculosis Control Programme National Strategic Plan Phase-I (2012–2016), Revised National Tuberculosis Control Programme National Strategic Plan Phase-II ( 2017–2019) and the National Tuberculosis Elimination Programme (2020–2023) reflecting the programme renaming effective 1 January 2020 and the availability of data at the time the analysis was finalised, over the study period 2000–2023. Across tuberculosis indicators, observed outcomes diverged substantially from model-derived counterfactual trajectories, with heterogeneity by programme phase. TB incidence per lakh population showed no immediate deviation during RNTCP, followed by a cumulative reduction of 52% (215 fewer cases per lakh population) during RNTCP NSP Phase-II (2017–2019), and the greatest excess during NTEP (296%; 146 additional cases per lakh population). TB–HIV co-infection remained consistently below counterfactual expectations from RNTCP NSP Phase-I (2012–2016) onward, with sustained reductions exceeding 110% during NTEP (2020–2023). Bacteriologically confirmed pulmonary TB closely followed counterfactual trends until 2017, declined under RNTCP NSP Phase-II (2017–2019) (− 18%), and increased during NTEP (2020–2023) (+ 44%). Extrapulmonary TB showed phase-specific reversals, with deficits during RNTCP NSP Phase-I (2012–2016) (− 42%) and late NTEP (2020–2023) (− 22%), but excesses during RNTCP NSP Phase-II (2017–2019) (+ 62%). Drug-resistant TB indicators declined during RNTCP NSP Phase-II (2017–2019) but increased during NTEP (2020–2023). Household contact tracing declined under RNTCP NSP Phase-II (2017–2019) (− 24%) and rebounded strongly during NTEP (2020–2023) (+ 73%). Notification of all TB cases per lakh population showed no immediate deviation during RNTCP, remained below counterfactual expectations from RNTCP NSP Phase-I (2012–2016) onward, with modest deficits during RNTCP NSP Phase-II (2017–2019), and reached the largest cumulative reduction during NTEP (2020–2023) (− 50%; 114 fewer notifications per lakh population). TB mortality declined most during RNTCP Phase-I (− 43%) and again during NTEP (2020–2023), with TB deaths among HIV-positive individuals showing the most sustained reductions (> 90%) in later phases. Overall, programme effects varied considerably across tuberculosis indicators and programme phases, highlighting the dynamic impact of successive policy transitions in India. Population-adjusted analyses demonstrated that RNTCP NSP Phase-II (2017–2019) achieved the greatest cumulative reduction in TB incidence per lakh population, whereas notification of all TB cases per lakh population declined progressively from RNTCP NSP Phase-I onward, with the largest deficit observed during NTEP. In contrast, drug-resistant TB indicators and household contact tracing showed divergent trajectories, reflecting changes in diagnostic capacity, surveillance, and programme implementation. Mortality outcomes generally improved across successive programme phases, although gains were not uniform across all indicators. Collectively, these findings indicate that successive TB programme reforms produced heterogeneous epidemiological and programmatic effects, underscoring the importance of sustained surveillance, timely case detection, and continuous programme adaptation to accelerate progress towards TB elimination.