Boosting TB detection in Haryana: early program gains

Tuberculosis remains a major public health problem in parts of India, and Haryana is described as a high-TB burden state in north India with an annual shortfall of presumptive TB examinations. Faced with people who may have TB not being captured by routine services, a statewide effort was launched to strengthen health systems so that more people with symptoms are enrolled, tested and diagnosed. The work, reported by corresponding author Hitesh Verma, looked at an initiative that aimed to make routine, passive case finding more systematic across public-sector peripheral health institutions (PHIs). Rather than introducing new tests or treatments, the program focused on making sure peripheral clinics were connected into the TB information system and had clear responsibilities and community support for getting sputum samples to diagnostic centers. The study presents early, real-world findings from practical changes made across the state with the goal of catching more people with presumptive TB who would otherwise be missed by the health system.

The evaluation used a quasi-experimental (before and during) design comparing July–September (before) with October–December 2024 (during initiative). The multi-pronged health systems strengthening initiative was implemented state-wide and included three core actions: i) enrollment of PHIs below primary health centre level in Ni-kshay (web-based TB information management system), ii) identification of a nodal person from each PHI-without TB diagnosis centre (TDC) for enrolling presumptive TB in Ni-kshay and iii) identification of community volunteers for transport of sputum to TDCs. Results show that among PHIs with a TDC, the proportion enrolling more than 10 presumptive TB cases stayed at 87%. In PHIs without a TDC, that proportion rose from 51% before the initiative to 63% during it. The mean number of sputum transports per non-TDC PHI increased from 12 to 22. Overall, the presumptive TB enrolment rate increased from 1020 to 1660 per 100,000 population. These early numeric changes document measurable system-level shifts during the initial months.

Although these are early implementation findings, the changes carry practical importance. Enrolling peripheral clinics in Ni-kshay and assigning a local nodal person created clearer lines for recording and following people with TB symptoms, while community volunteers for sputum transport helped bridge gaps where on-site diagnosis was not available. The increases seen in non-TDC PHIs suggest that strengthening logistics and information flows at the edges of the health system can raise identification and sample referral rates. By raising the presumptive TB enrollment rate from 1020 to 1660 per 100,000, the initiative moved toward reducing the number of people with undiagnosed TB who are otherwise “missing” from program data. The authors intend to sustain and expand these measures in 2025 with additional interventions, with the end goal of earlier diagnosis and reducing missing TB across Haryana, validating that programmatic, system-level fixes can yield measurable early gains.