Quality improvement package for severe tuberculosis triage in Tamil Nadu, India

Tamil Nadu Kasanoi Erappila Thittam (TN-KET) is a statewide differentiated tuberculosis (TB) care initiative to reduce TB deaths involving triaging for severe illness at diagnosis and referral of severely ill for appropriate inpatient care (2022-2025). Eleven out of 30 districts did not reduce their TB death rates despite achieving the target process indicators.

To assess the implementation fidelity and effect of a quality improvement (QI) package to improve triage coverage and quality in the select 11 districts of Tamil Nadu.

A quasi-experimental pre-post study was conducted between October 2024 to February 2025 (pre-QI) and June to December 2025 (post-QI). The QI package was introduced in poorly performing districts. Data were extracted from Ni-kshay and TB SeWA (e-tools of the TB programme and TN-KET, respectively), supplemented by independent triage audits.

Integrating the QI package within TN-KET achieved high fidelity. The extent of missing triage data reduced from 38% to 12%, and median delays in entry of triage details reduced from 13 to 9 days and early TB deaths reduced from 3.7% to 3.3%.

The QI package improved documentation and timeliness of triage assessment, contributing to modest reductions in early TB deaths. District-level supervision and triaging at diagnosis for early admission will sustain the reduced death rate.