Food support for tuberculosis care: coverage, outcomes, and implementation lessons from the Ni-kshay Mitra scheme in India

SETTING Vadodara City (Gujarat, India) has a mixed public–private tuberculosis (TB) care landscape. Since 2022, the city has implemented ‘ Ni-kshay Mitra ’ scheme, where individuals and organisations voluntarily ‘adopt’ persons with TB (PwTB) and provide food kits (distributed at monthly camps) during treatment. OBJECTIVE To assess coverage (received at least one kit) and effectiveness of Ni-kshay Mitra on treatment outcomes, and explore implementation facilitators, barriers, and solutions from the stakeholders’ perspective. DESIGN Explanatory mixed-methods study: quantitative cohort analysis of secondary programme data followed by qualitative interviews and focus group discussions with donors (n = 3), programme staff (n = 18), and PwTB (n = 35). RESULTS Among 2,068 PwTB notified between January and June 2025, 1,238 (60%) consented to the scheme, 666 (32%) received ≥1 food kit, and 68 (3%) received complete package (≥6 kits). Median kits received were 2 (interquartile range: 2–4). Unsuccessful treatment outcomes were 7% (2022, pre-scheme) and 6% (2023, post-scheme), not statistically significant. Donor non-availability and opportunity costs of attending camps were the major barriers; presence of dedicated non-profit organisations was a key facilitator. CONCLUSION Coverage of Ni-kshay Mitra remains suboptimal, largely due to donor participation gaps, possibly explaining limited effectiveness on outcomes. Strengthening donor engagement and alternate delivery models are essential to enhance reach and effectiveness.