Tamil Nadu's Differentiated TB Care Initiative Reports Significant Reduction in Death Rates

A statewide public health initiative in Tamil Nadu aimed at reducing tuberculosis (TB) mortality has recorded a reduction in death rates ranging from 38 per cent to 56 per cent across quarterly diagnosis cohorts between July 2024 and December 2025.

According to a study conducted by the ICMR National Institute of Epidemiology (NIE) and the Tamil Nadu State TB Cell, the results were achieved under the Tamil Nadu Kasanoi Erappila Thittam (TNKET). The programme is designed to identify severely ill TB patients at the time of diagnosis and prioritise them for hospital referral and inpatient care.

The monitoring and evaluation framework of the initiative was published as a practice paper in BMJ Global Health. The authors noted that the framework is intended to guide high TB-burden states and countries in implementing differentiated TB care models.

Implemented from April 2022 to December 2025, TNKET covered all adults aged 15 years and above diagnosed with drug-sensitive TB in public health facilities across the state, which averages about 60,000 such diagnoses annually. Under the programme, patients are evaluated using five clinical parameters at diagnosis: body mass index (BMI), pedal oedema, respiratory rate, oxygen saturation, and the ability to stand without support.

Patients identified with severe undernutrition, respiratory insufficiency, or poor physical performance are prioritised for inpatient care. The study tracked preparatory inputs, the patient-care cascade, admission outputs, and quality of care to measure outcomes.

Researchers observed that it took two years of statewide implementation to minimise losses along the patient-care cascade and improve triaging and inpatient care quality. Against a baseline reported death rate of 6.3 per cent at the start of TNKET, reductions ranged from 38 per cent (dropping to 3.9 per cent) among patients diagnosed in October-December 2024 to 56 per cent (dropping to 2.8 per cent) for those diagnosed in July-September 2025.

Despite these improvements, the study identified operational gaps, specifically noting that systematic tracking of severely ill patients at the two-month post-discharge mark did not exceed 35 per cent in any quarter. This highlighted ongoing challenges in maintaining post-discharge monitoring through routine public health systems.

Based on their findings, the researchers outlined three key lessons for resource-constrained healthcare settings: differentiated TB care requires sustained implementation over time to reduce statewide death rates; triaging should rely on simple, easily measurable clinical parameters; and mandatory repeated follow-up assessments after hospital discharge may not be feasible at scale.

"The findings from the Tamil Nadu TB care initiative offer a valuable operational blueprint for healthcare management. By focusing on simple clinical parameters at the point of diagnosis and streamlining the patient-care cascade, large-scale public health programmes can achieve measurable improvements in clinical outcomes. The study underscores the importance of aligning public health interventions with existing operational capacities, particularly in resource-constrained environments." — Dr. Shishir Gupta, Founder & CEO, StartupLanes