A valued lifeline with critical gaps: a qualitative systematic review with meta-synthesis of the Nikshay Poshan Yojana for TB patients in India

Background India is grappling with a significant challenge of tuberculosis (TB), which is greatly worsened by undernutrition. To support the country’s aim of eradicating TB, the Nikshay Poshan Yojana (NPY) was introduced in 2018 by the government of India. This initiative is a direct benefit transfer program that offers ₹500 monthly for nutritional assistance to TB patients. Although there are quantitative assessments of this scheme, a comprehensive understanding of patient experiences is essential to inform policy decisions. This review aimed to synthesize the perspectives of TB patients in India on NPY, including its perceived benefits, the barriers to receiving and using it, and their suggestions for improvement. Methods We carried out a systematic review in accordance with a pre-registered protocol available on the Open Science Framework (OSF; https://doi.org/10.17605/OSF.IO/G5HWB ) and reported it in line with the PRISMA 2020 statement. Our search encompassed PubMed, Scopus, Embase, and grey literature to identify qualitative and mixed-methods studies published from 2017 to June 2025 (last searched on 3–4 June 2025) that explore patient perspectives on NPY in India. The methodological quality of included studies was evaluated using the CASP, MMAT, and NOS tools. We conducted a thematic synthesis of the qualitative findings and assessed confidence in these findings using the GRADE-CERQual approach. Results Thirteen studies fulfilled the criteria for inclusion. The thematic analysis indicated that patients appreciated NPY for facilitating the purchase of healthy food, offering some financial relief, and serving as a psychosocial support that promoted adherence to treatment. Nonetheless, the advantages of the scheme were consistently and significantly hindered by two main obstacles: the perceived inadequacy of the financial amount to satisfy actual nutritional requirements and the considerable, often multi-month, delays in payment distribution. Additional significant challenges included operational issues such as the absence of bank accounts, lack of information about the scheme, and confidentiality concerns related to stigma. Conclusion TB patients view NPY as a crucial support system, yet its effectiveness is significantly hindered by systemic and operational obstacles. A two-fold approach is necessary: ensuring the assistance is both sufficient and prompt, while drastically streamlining administrative procedures. The shift towards hybrid models, like the community-led Nikshay Mitra initiative that offers in-kind aid, deserves further investigation. As India progresses swiftly towards its TB eradication targets, ongoing research focused on these evolving patient-centered support systems is vital. Clinical trial number Not applicable.