Does active case finding detect TB early in programme settings? A national-level study in India

SETTING: Since 2017, India’s TB programme is implementing active case finding (ACF) in high-risk populations in all districts. Symptom screening followed by confirmatory testing was the ACF algorithm. OBJECTIVE: To determine differences in pre-treatment delays and severe illness at diagnosis between ACF- and passive case finding (PCF)-detected adults with drug-sensitive pulmonary TB in high-risk populations. DESIGN: Cross-sectional analytical study from 28 randomly sampled districts across India (2023). Post-triaging, severe illness was defined as presence of very severe undernutrition, respiratory insufficiency, or poor performance status. RESULTS: Of 790 enrolled, 426 were ACF-detected and 364 PCF-detected. ACF-detected adults were significantly older (mean 47.1 year vs 43.9 year), lived farther from diagnosis facilities (median 8 km vs 6 km), had lower formal education exposure (52% vs 37% with no formal education), lower household income (₹20,000 vs ₹24,000 annual per capita), and experienced fewer health care provider visits (median 1 vs 2). Pre-treatment delay from symptom onset to treatment initiation (median 46 days in both groups) and burden of severe illness (39% vs 34%, P = 0.180) were similar. CONCLUSION: Though ACF linked the vulnerable to care and reduced health care provider visits, this did not translate into early detection. High burden of severe illness at diagnosis is a concern.