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The Intermediate Reference Laboratories (IRLs) function as a culture and drug susceptibility testing (C&DST) facility for the state level.

In addition to performing CDST, IRL is also responsible for:

Those who are suspected of having TB disease are first screened for symptoms like cough and fever for more than 2 weeks, blood stained sputum and weight-loss. If found positive on screening, then TB patients are referred for testing to the nearest health facility. If diagnosed with TB, then they are subsequently initiated on treatment.

The State TB Cell or STC is the state-level implementing structure of the National TB Elimination Program (NTEP). It is the leading institution for management of NTEP activities at the state level. 

The STC is a State Government entity that acts as the bridge between the Central and State Governments for implementing the NTEP. It works under the guidance of the Central TB Division (CTD), and it oversees the program implementation at the districts.

• National Reference Laboratories (NRLs) conducts annual on-site evaluation/supervisory visits to laboratories for assessing the quality of microscopy, culture and drug susceptibility test (C&DST), and for improvement of the overall laboratory quality. 
• NRLs also assist Central TB Division (CTD), in developing laboratory guidelines, standard operating procedures (SOPs), and conduct training to state-level Intermediate reference laboratories (IRLs) and other technical issues.

There are 6 national institutes under the National Tuberculosis Elimination Programme (NTEP). These include:

1. National Institute of Research in Tuberculosis (NIRT), Chennai
2. National Tuberculosis Institute (NTI), Bengaluru
3. National Institute of TB & Respiratory Diseases (NITRD), New Delhi
4. Central JALMA Institute of Leprosy other Mycobacterial diseases (JALMA), Agra
5. Regional Medical Research Centre (RMRC), Bhubaneswar
6. Bhopal Memorial Hospital and Research Centre, (BMHRC) Bhopal

The Central TB Division (CTD) is the apex institution for managing the National TB Elimination Programme (NTEP) for the entire country at the central level. 

CTD works under the Directorate General of Health Services, Ministry of Health and Family Welfare (MoHFW), Government of India, and is the technical arm of the MoHFW. 

Figure: Relationship of CTD in the MoHFW

National Tuberculosis Elimination Programme (NTEP) is a centrally sponsored programme being implemented under the aegis of National Health Mission.

National Level: Managed by Central TB Division (CTD), the technical arm of the Ministry of Health and Family Welfare (MOHFW)

The National Health Mission (NHM) was launched by the Government of India in 2013, subsuming the National Rural Health Mission (NRHM) and National Urban Health Mission (NUHM). Figure 1 shows the history of the NHM.

The vision of NHM is “Attainment of Universal Access to Equitable, Affordable and Quality health care services, accountable and responsive to people's needs, with effective intersectoral convergent action to address the wider social determinants of health.”

The National Strategic Plan (NSP) for TB elimination 2017–25 is a bold strategic framework to drive the  acceleration of progress toward TB Elimination, and achieving the Sustainable Development Goal (SDG) and End TB targets for India. It expects to guide the activities of all stakeholders including the national and state governments, development partners, civil society organizations, international agencies, research institutions, private sector, and many others whose work is relevant to TB elimination in India.