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

Area of Science:

• Public Health
• Infectious Diseases
• Epidemiology

Background:

• Tuberculosis (TB) is a major global health issue, with 1.3 million deaths in 2020.
• The COVID-19 pandemic worsened the TB burden, increasing mortality by 11% in India (2019-2020).
• Early identification of severely ill TB patients is vital to meet WHO targets of 90% and 95% reduction in TB deaths by 2030 and 2035, respectively.

Purpose of the Study:

• To identify adult TB patients at high risk of severe illness (HRSI) using a programmatic screening tool.
• To assess referral linkages for high-risk TB patients.
• To evaluate care outcomes within 7 days post-diagnosis in Bengaluru, India.

Main Methods:

• A 18-month cross-sectional study (August 2022-July 2023) in Bengaluru, India.
• Screened 263 adult drug-sensitive TB patients using a tool assessing BMI, respiratory rate, and oxygen saturation within 7 days of diagnosis.
• Analyzed patient characteristics and outcomes using descriptive statistics and Chi-square/Fisher's exact tests.

Main Results:

• 20.9% of TB patients were identified as HRSI.
• Among high-risk patients, 73.3% accessed inpatient care, with 19.4% mortality compared to 0% for outpatients.
• Key severity indicators included low BMI (≤14 kg/m2), high respiratory rate (>24/min), low oxygen saturation (<94%), and inability to stand unaided.

Conclusions:

• Early identification and referral of HRSI TB patients are essential for reducing mortality.
• A simple screening tool is effective in routine programmatic settings.
• Targeted interventions and improved healthcare access are needed for high-risk TB patients in India.