India’s tuberculosis control programme has recorded a 12 per cent increase in treatment success rates over a one-year period, but infection and treatment outcomes for over 230,000 patients remain unknown, the programme’s annual report released on Wednesday said.

The national TB report from the Union health ministry has also estimated that the programme was unable to register an estimated 2.9 lakh patients with new infections and 2.5 lakh patients who have had a TB relapse or need retreatment — or 5.4 lakh “missing” TB cases across India.

However, improvements in case detection have led to a decrease in such missing new incident cases from around 10 lakh in 2017 to 2.9 lakh, the report said.

The TB control programme — renamed as the National TB Elimination Programme — has set a target of reducing the country’s TB incidence rate from 217 patients per lakh population in 2015 to 77 by 2023 and 44 by 2025.

India in 2019 registered 24 lakh TB patients, a 14 per cent increase over the previous year, and treatment success rates improved from 69 per cent in 2018 to 81 per cent in 2019. But the estimated incidence of 199 per lakh population is still distant from the 2025 goal.

Around 86,000, or 4 per cent, of the TB patients who were offered treatment were lost to follow-up, the report said, analysing the treatment outcomes in 2018. Over 144,000, or 7 per cent, of patients were “not evaluated” after registration.

Public health experts say such patients who are lost during follow-up or are not evaluated may suffer from worsening infection and spread it to other people.

“These figures point to gaps in follow-up efforts to ensure that all patients continue their full treatment,” said Nerges Mistry, director of the Foundation for Medical Research, Mumbai, a community medicine specialist involved in tracking TB treatment services for patients in Mumbai and Patna.

A “joint monitoring mission” of the TB control programme by the health ministry with the World Health Organisation has also cautioned that nearly 5 lakh people with TB disease remain “missing” to TB surveillance, notification and services and are likely in private health care or the community.

“Those who are found experience attrition through the cascade of care, hundreds of thousands are lost along their journey through diagnosis and treatment, particularly among those reported by private (healthcare) providers,” the mission has said in its report.

The mission said India’s current trajectory while showing improvements on many counts would “fall far short” of the country’s goal to virtually eliminate the TB epidemic in India by 2025 and has called for a “redoubling of effort and investment” through people and money.

The annual TB report shows that the National TB Elimination Programme has consistently received lower-than-requested budgetary funds over the past five years, marked by a shortfall of Rs 3,195 crore between 2014-15 and 2019-20.