State-wide health systems strengthening initiatives for systematic tuberculosis passive case finding under programmatic settings in Haryana-Early implementation findings

SETTINGSSystematic tuberculosis (TB) passive case finding initiative in Haryana, a high-TB burden state in north India that has an annual shortfall of presumptive TB examinations. OBJECTIVETo compare the changes in enrolling persons with presumptive TB in public-sector peripheral health institutions (PHIs) between July-September (before) and October-December 2024 (during initiative). DESIGNIn this quasi-experimental (before and during) study design, a multi-pronged health systems strengthening initiative was implemented state-wide: i) enrollment of PHIs below primary health centre level in Ni-kshay (web-based TB information management system), ii) identification of a nodal person from each PHI-without TB diagnosis centre (TDC) for enrolling presumptive TB in Ni-kshay and iii) identification of community volunteers for transport of sputum to TDCs. RESULTSThe enrolment of over 10 presumptive TB at PHIs with TDC remained at 87%, while it increased from 51% to 63% in non-TDC PHIs. The mean number of sputum transport increased from 12 to 22 per non-TDC PHI. The presumptive TB enrolment rate increased from 1020 to 1660 per 100,000 population. CONCLUSIONEarly implementation findings are encouraging. We intend to sustain this in 2025 with additional interventions, culminating in early diagnosis and reducing the missing TB.