First-ever Experience of Implementing Therapeutic Nutrition for Very Severely Undernourished Adults with TB in...

'Delhi Triage and Treat Tuberculosis (D-TAT)' is a statewide differentiated tuberculosis care initiative to reduce tuberculosis deaths involving triaging for severe illness at diagnosis, followed by inpatient care. This operational research aimed to assess the feasibility in settings like Delhi (high transfers out of state, tuberculosis burden, and population density) and provide therapeutic nutrition (oral liquid Formula75) with a focus on inpatient care for very severely undernourished (one of the conditions identified during triaging) adults with tuberculosis.

This was a longitudinal descriptive study among public notified adults (≥15 y) with tuberculosis. Secondary data from Ni-kshay (case-based information management system of tuberculosis program), D-TAT severe tuberculosis web application, and paper-based therapeutic nutrition clinical tracking tool were used.

Of 48 407 notified during January to September 2024, 22 326 (46%) were triaged, 899 (4% of triaged) were triage-positive, and 335 (38%) were admitted for a median of 8 days. Of 216 triage-positive in the January to June 2024 cohort, 75 had very severe undernutrition along with the provision of Formula 75, with a mean of 1085 mL consumption per day. Of these 75, 44 (59%) were unable to stand without support at admission, and this reduced to 11 (15%) on day 7. A total of 52 (69%) were stabilized and shifted to a high protein diet after a mean of 4 days (standard deviation: 2). Three died during admission.

There is a need to improve the quality and coverage of triaging and earmark isolation beds with therapeutic nutrition in additional hospitals. The first-ever findings of therapeutic nutrition are encouraging and should be scaled up.