**6. Surgical treatment of tuberculosis**

Although tuberculosis is usually treated with drugs, it can also be treated surgically in select situations, particularly in cases of drug resistance and some pulmonary tuberculosis sequelae. Surgical lung biopsy can be used to distinguish between pulmonary tuberculosis and lung cancer. Endobronchial tuberculosis, as well as significant adverse responses, severe haemoptysis, empyema, pneumothorax, and bronchopleural fistula, are all surgical indications. Surgical intervention may be indicated in situations of symptomatic pulmonary residual, fungal ball, and haemoptysis in tuberculosis sequelae [46, 47].

### **7. Treatment services under national TB elimination programme in India**

The National Tuberculosis Elimination Program (NTEP) aims to reach every TB patient for free diagnosis and treatment. In 2019, 94% of TB patients who had been notified were started on treatment for the disease [16]. According to current policy, universal DST is supplied to informed TB patients (including private sector TB patients) to determine the presence of Rifampicin resistance at the time of TB diagnosis in order to provide an appropriate regimen based on the Drug Susceptibility Test (DST). Further tests are offered based on the DST result, as part of the integrated DR TB methodology, to rule out resistance to additional medications. UDST was offered to 58% of all reported TB patients in 2019 [16]. As a result of DST, suitable changes in the regimen are made in accordance with the PMDT standards in India [16].

#### **7.1 Treatment of drug sensitive TB**

When a patient is diagnosed with tuberculosis, a standard first-line anti-TB regimen in the form of Fixed Dosage Combination (FDC) is given to them right away, usually from the centre where the diagnosis was made or while the patient is being transferred to the appropriate health facility for treatment initiation, especially when the diagnosis is not the same as the TB patient's relapse (e.g. Mobile or migrant population). The NIKSHAY digital surveillance system enables for the tracking of tuberculosis patients who are referred or transferred from one health unit to another across multiple geographic locations. Through several means, including the PPSA, the National TB Elimination Program has expanded free access to anti-TB drugs to patients seeking care in the private sector. The National TB Elimination Programme uses the services of a contact centre to provide patient counselling and connect them with suitable public resources for patients who are unaware of the nearest diagnostic or therapy institution [16].
