Identifying High-Risk Tuberculosis Cases: Implementation of a Programmatic Screening Tool in Bengaluru

Tuberculosis (TB) remains a significant global health challenge, causing 1.3 million deaths in 2020. The COVID-19 pandemic has further exacerbated the TB burden, leading to an 11% rise in TB mortality in India from 2019 to 2020. The World Health Organization aims to reduce TB deaths by 90% by 2030 and 95% by 2035. Early identification and management of severely ill TB patients are crucial for achieving these targets. This study aimed to identify adult TB patients at high risk of severe illness (HRSI) using a programmatic screening tool, assess referral linkages, and evaluate care outcomes within the first 7 days post-diagnosis in Bengaluru, India.

A cross-sectional study was conducted over 18 months (August 2022 to July 2023) across five Tuberculosis Units in the Bruhat Bengaluru Mahanagara Palike district. Data were collected from National Tuberculosis Elimination Program records and patient interviews, including 263 adult drug-sensitive TB patients diagnosed at public health facilities. Patients were screened for HRSI within 7 days of diagnosis using a tool assessing body mass index (BMI), respiratory rate, and oxygen saturation. Descriptive statistics summarized patient characteristics and outcomes, and associations were analyzed using Chi-square and Fisher's exact tests.

Of the 263 TB patients screened, 20.9% were identified as being at HRSI. Among these high-risk patients, 73.3% accessed inpatient care, with 51% seeking treatment at district hospitals and 20% at private hospitals. Inpatient mortality among high-risk patients was 19.4%, while no deaths were reported among those managed as outpatients. Key severity indicators included BMI ≤14 kg/m2 (12%), respiratory rate >24 breaths/min (3%), oxygen saturation <94% (7%), and inability to stand without support (8%). High-risk status was more prevalent among patients over 65 years of age, males, those with microbiologically confirmed or smear-positive pulmonary TB, HIV-reactive status, and diabetes mellitus.

Early identification and referral of TB patients at HRSI are essential to reduce mortality. The study highlights the effectiveness of a simple screening tool in routine programmatic settings and underscores the need for targeted interventions and improved healthcare access for high-risk TB patients in India.