Prevalence of major risk factors for tuberculosis in COVID-19 active case-finding camps in India

TB) remains a major public health challenge in India, driven by undernutrition, diabetes, alcohol use, and tobacco exposure. Under the Global Fund-supported COVID-19 Response Mechanism (C19RM), we implemented integrated active case finding (ACF) and risk screening to estimate the prevalence of key risk factors among individuals with TB. We assessed their combined influence on detection yield, and examined state-wise variation in TB and non-communicable disease (NCD) comorbidity patterns.

This cross-sectional analysis included 17,288 C19RM-supported ACF camps across 11 states. Screening combined digital chest X-ray, molecular diagnostics, and NCD risk assessment, including anthropometry, self-reported diabetes and hypertension, opportunistic blood sugar testing, and self-reported tobacco and alcohol use. Multivariable logistic regression estimated adjusted odds ratios (aORs) for TB diagnoses.

Among 1,383,058 individuals screened, 11,012 TB cases were identified (0.8% yield). Undernutrition (BMI <18.5 kg/m²) accounted for 40% of cases and showed the strongest association (aOR 3.89). Alcohol (aOR 1.62) and tobacco use (aOR 1.51) were independently associated with TB, while diabetes showed an inverse adjusted association despite 10% prevalence. Interaction analyses indicated higher TB odds with coexisting risk factors, with geographic clustering observed.

Integrated TB-NCD screening revealed clustering of nutritional, behavioural, and metabolic risks, supporting risk-prioritised ACF strategies.