Screening for Severe Illness at Diagnosis Has the Potential to Prevent Early TB Deaths: Programmatic Experience From Karnataka, India

Abstract

Paramedical TB program staff screened adults with TB for "high risk of severe illness" at notification using a screening tool involving simple and easily measurable indicators. n Early deaths were seen in 7% of patients; deaths were significantly higher among people with a high risk of severe illness.

­­Eleven tips for operational researchers working with health programmes: our experience based on implementing differentiated tuberculosis care in south India

“…However, comprehensive assessment requires diagnostic and clinical capacity in the facilities that diagnose TB, and not all facilities have similar capacity. Measurement of 16 indicators among all TB patients may require a referral and induce a possible delay [ 18 ]. In the neighbouring state of Karnataka, early deaths (within two months) were high (7%), and half of them occurred within two weeks [ 18 ].…”

“…Measurement of 16 indicators among all TB patients may require a referral and induce a possible delay [ 18 ]. In the neighbouring state of Karnataka, early deaths (within two months) were high (7%), and half of them occurred within two weeks [ 18 ]. Early TB deaths were 2.4 times more likely among patients with very severe undernutrition or respiratory insufficiency, or poor performance status at diagnosis (also called ‘high risk of severe illness) ( Box 1 ) when compared to those without any one of these conditions [ 18–20 ].…”

“…In the neighbouring state of Karnataka, early deaths (within two months) were high (7%), and half of them occurred within two weeks [ 18 ]. Early TB deaths were 2.4 times more likely among patients with very severe undernutrition or respiratory insufficiency, or poor performance status at diagnosis (also called ‘high risk of severe illness) ( Box 1 ) when compared to those without any one of these conditions [ 18–20 ]. Early deaths were as high as 14% among those with very severe undernutrition and 18% among those with poor performance status.…”

“…These may act as a ‘how we did it’ guide for other Indian states and countries with high TB burden that are targeting to end TB deaths. Globally and nationally, beyond the pilots assessing the feasibility of triaging for severe illness at diagnosis, there is limited experience in implementing the differentiated TB care cascade holistically in routine TB programme settings [ 18 , 20 , 21 ]. For operational researchers interested in providing technical assistance for strengthening implementation and conducting OR in health systems and programmes (TB or other health programmes), following these tips will increase the chances of i) an enriching engagement, ii) policy/practice change based on findings of OR and iii) sustained implementation after the organisation providing technical support phases out.…”

The First Differentiated TB Care Model From India: Delays and Predictors of Losses in the Care Cascade

“…Therefore, assessment could be time-consuming and require clinical and diagnostic capacity not uniformly available in the facilities that diagnose and treat TB (peripheral health institutions [PHI]), particularly those in the periphery. 5 As most TB deaths occur within 2 months (early deaths) and half of early deaths happen within the first 2 weeks of diagnosis, 6 assessment mandates a quick decision at diagnosis.…”