Lakshadweep becomes first Indian Union Territory to reach TB elimination levels

By Shobha Shukla – CNS (Citizen News Service)

INDIA—Lakshadweep has become the first Indian state or union territory to reach tuberculosis (TB) elimination levels, marking a major milestone in the country’s efforts to end the disease.

The achievement highlights how a person-centred, rights-based approach that focuses on preventing, finding, and treating every case of TB can deliver results even in geographically isolated settings.

Ahead of the Union World Conference on Lung Health 2026, the End TB Dialogues session featured Dr MP Nezeeda, State TB Officer of Lakshadweep, who shared insights into the territory’s progress towards TB elimination.

She attributed the achievement to sustained community engagement, intensified door-to-door screening, regular follow-up of people receiving TB treatment, and strong administrative support.

These measures have helped Lakshadweep overcome its geographic isolation and bring TB services closer to residents.

Low TB burden despite geographic isolation

Lakshadweep is a remote archipelago in the Arabian Sea, off the southwestern coast of India. Its islands are separated from the mainland and from one another by several hours of sea travel.

Since December 2024, the territory has notified only 35 TB cases. Since January 2026, health authorities have reported 14 people with TB disease, including individuals transferred from neighbouring Kerala.

Six of these patients have completed treatment, while eight remain on treatment.

According to Dr Nezeeda, all current cases are drug-sensitive TB, with no cases of multidrug-resistant TB reported. Three of the 14 cases are extrapulmonary TB.

Lakshadweep comprises small and larger islands that can be four to five hours apart by sea.

Andrott, the closest island to Kerala, can take 13 to 15 hours to reach by ship from the mainland, while Kavaratti, the territory’s capital, is about 18 to 20 hours away by ship.

Alternatively, travellers can fly from Kochi to Agatti, Lakshadweep’s only airport, and then travel another three to five hours by boat to Kavaratti.

Rough seas and adverse weather conditions further complicate movement between the islands.

“Because of the geographic dispersion and heavy dependence on maritime transport, the inter-island connectivity always remains uncertain,” said Dr Rakesh PS, a TB elimination expert who spoke during a CNS session at the 26th International AIDS Conference (AIDS 2026)

“In a typical year, for almost five months, monsoon- and weather-related disruptions make it difficult even for supplies to reach these islands.”

Community-led approach drives TB detection

The State TB Cell of the Indian government’s National TB Elimination Programme operates from Kavaratti, while each of the 10 inhabited islands has its own dedicated TB team.

The island-level teams bring together TB survivors and local community leaders, medical officers, panchayat executive officers and other health workers.

Together, they coordinate TB detection, awareness and treatment activities within their communities.

Dr Nezeeda said Lakshadweep’s small population makes it possible for health workers to know residents personally.

As India’s smallest union territory by population, the close-knit communities allow health teams to directly engage political leaders, religious figures, teachers and other influential community members.

“We almost know each and everyone personally,” she said.

This familiarity has helped transform TB control into a community-led effort rather than a programme driven solely by health authorities.

Accredited Social Health Activists (ASHAs) play a central role in identifying people who may have TB.

Every quarter, frontline workers conduct house-to-house screening campaigns, focusing on people with symptoms or other risk factors for TB.

They refer people with symptoms to the nearest health facility or collect sputum samples themselves when individuals cannot travel to a hospital.

Teachers also conduct TB awareness sessions in schools, enabling students to take information about symptoms, screening and treatment home to their families.

Religious leaders contribute to the effort by using five to 10 minutes during Friday prayers, or Juma, to discuss TB symptoms, screening campaigns, and the government’s Nikshay Poshan Yojana nutritional support programme.

More than 96% of Lakshadweep’s population is Muslim.

Meanwhile, panchayat members mobilise residents to participate in TB and other health screening campaigns.

“Basically, this is a people’s movement. Everyone is actively involved,” Dr Nezeeda said.

Decentralised testing brings diagnosis closer

The community-led approach is supported by decentralised diagnostic services.

In the past, TB molecular testing using CB-NAAT was available only in Kavaratti.

This created delays because sputum samples from other islands had to cross the Arabian Sea before reaching the testing facility, according to Dr Rakesh.

Today, each of Lakshadweep’s 10 inhabited islands has a WHO-recommended Truenat machine for rapid molecular testing.

Some of the machines were initially purchased using disaster management funds for COVID-19 testing and were later repurposed for TB diagnosis.

Truenat platforms can perform molecular testing for more than 40 diseases and can detect rifampicin resistance within about an hour.

“Decentralisation of molecular testing brought the diagnosis closer to the people,” Dr Rakesh said.

The territory has also expanded access to chest X-ray screening.

With support from the Indian Council of Medical Research (ICMR), all islands have access to indigenously developed artificial intelligence-enabled digital X-ray systems, including fixed units.

Kavaratti also has a handheld X-ray device to support community screening campaigns.

Health authorities send samples requiring culture or additional drug-susceptibility testing to a reference laboratory in Thiruvananthapuram, Kerala.

Teams adapt to logistical challenges

Despite improvements in diagnostic capacity, geographic isolation continues to create operational challenges.

When a Truenat machine requires maintenance, health authorities must send it to the mainland for repairs.

Testing capacity can therefore temporarily decline until a ship is available to transport the repaired machine back to the islands, Dr Nezeeda said.

Health teams compensate by using available diagnostic resources on neighbouring islands whenever possible.

Administrative authorities have also supported the expansion of screening campaigns beyond health facilities to government offices and other community locations.

Intensive follow-up supports treatment completion

Lakshadweep’s TB response extends beyond diagnosis to intensive patient support.

Medical officers visit people receiving TB treatment every month, while every TB patient undergoes a differentiated TB care assessment regardless of their individual risk level.

Staff from the State TB Cell, including Senior Treatment Supervisors (STS) and Senior TB Laboratory Supervisors (STLS), also make regular calls to patients to monitor treatment progress and their overall well-being.

ASHAs provide additional support by visiting each person receiving TB treatment daily, at a time convenient for the patient, to help ensure treatment adherence.

Nutritional assistance also extends to caregivers. Each TB patient and their caretaker receive a 10-kilogramme food basket, while government incentives are provided on time.

Dr Nezeeda said the combination of medical, nutritional, psychosocial and practical support helps patients remain engaged with treatment.

“They know we are there to support them in every aspect,” she said.

Health workers also provide customised support when patients encounter difficulties during treatment, helping them overcome challenges and complete therapy.

During their routine visits, ASHAs and other frontline workers also record information on people with non-communicable diseases (NCDs).

Conditions such as diabetes can increase the risk of developing TB or progressing from latent TB infection to active disease.

TB prevention remains a key focus

Health authorities also offer TB preventive treatment to eligible household and other contacts of people diagnosed with TB disease.

The intervention aims to prevent people with latent TB infection from progressing to active TB disease.

Patients in Lakshadweep have shown little hesitation about testing or treatment, according to Dr Nezeeda.

The close-knit nature of the communities also enables people diagnosed with TB to receive emotional, psychosocial and practical support from health workers, families and community members.

Lakshadweep’s long-running TB elimination campaign

The Government of India launched the Lakshadweep TB Elimination Mission in 2018.

Dr Nezeeda credited previous State TB Officers, health teams and other partners with establishing the foundation for the territory’s current TB response.

She said years of sustained screening campaigns, community participation and improvements in diagnosis and treatment have progressively strengthened the programme.

In 2021, the Government of India, the World Health Organization (WHO) India and the Indian Council of Medical Research certified Lakshadweep as the first TB-free geography in India.

“The sun of a TB-free India arose in the west,” Dr Rakesh said.