Sustained reduction in program-reported TB death rate in six districts following Tamil Nadu Kasanoi Erappila Thittam in southern India

(TN-KET) is India's first statewide and state-specific differentiated TB care initiative to reduce TB deaths. Under TN-KET, starting April 2022, adults with TB were triaged for severe illness at diagnosis, and those with very severe undernutrition or respiratory insufficiency or poor performance status (anyone) were prioritized for comprehensive clinical assessment and inpatient care. Following TN-KET, we report sustained TB death rate reduction from six districts over 2 years. Routine aggregate data showed a reduction in the July 2022-June 2024 cohort when compared to July 2021-June 2022 cohort: Dharmapuri (from 12.6% to 4.8%), Karur (from 7.0% to 4.7%), Villupuram (from 6.1% to 4.6%), Kanniyakumari (from 10.4% to 8.1%), Cuddalore (from 6.7% to 4.1%), and Salem (from 7.8% to 4.9%). We also documented sustained TB death rate reduction through standardized mortality ratios (SMR). TN-KET not only worked in districts with relatively higher TB death burden (SMR > 1) but also in districts with relatively lower TB death burden (SMR < 1). These findings demonstrate that a simple triage-based differentiated TB care model implemented within routine public health systems can achieve sustained reductions in TB deaths across diverse district contexts.