This multi-component intervention, integrating quarterly systematic ACF with decentralized NAAT, demonstrated a substantial reduction in TB incidence and enhanced care cascade efficiency in this remote island setting. The Lakshadweep model highlights the effectiveness of geographically tailored, decentralized ending TB strategies, offering potential for replication in other hard-to-reach or insular populations globally.

Geospatial mapping of routine surveillance data, coupled with a robust multi-sectoral accountability framework, provides a powerful strategy for localized TB elimination. The experience in Kasargod highlights the potential of utilizing tools like QGIS to empower local administrations to plan and achieve significant progress towards national TB elimination goals.