How a novel initiative helped Tamil Nadu bring down TB deaths in the state

Indian Express

3 days ago

Tamil Nadu has witnessed a dip in the number of tuberculosis (TB) deaths in the state after the rollout of the Tamil Nadu Kasanoi Erappila Thittam (TN-KET), or TB death free initiative, in 2022.
Due to the initiative, three districts — Dharmapuri, Karur, and Villupuram — witnessed a reduction in the number of TB deaths between 2022 and 2023, according to a paper published in the Indian Journal of Community Medicine. The TB death rate in Dharmapuri went down from 12.5% to 7.8%, in Karur from 7.1% to 5.3%, and in Villupuram from 6.1% to 5.2%.
Scientists at the National Institute of Epidemiology told The Indian Express that within the six months of the TN-KET program, Tamil Nadu saw a dip in the number of early TB deaths by 20% across the state. Two-thirds of the districts in the state documented a 20% to 30% reduction in total deaths in 2024, according to scientists.
Experts say, the program has been successful for two reasons.
One, it uses a quick, easy-to-use tool, which helps a doctor determine whether a patient is severely ill and needs to be hospitalised soon after being diagnosed with TB. The tool does not require any laboratory-based investigations.
Two, the initiative follows a differentiated care model which offers a patient-centred approach instead of a one-size-fits-all treatment.
Tamil Nadu health workers use a paper-based triage tool which prioritises patient care based on the severity of the illness. To determine the severity, health workers record five key parameters for all TB patients in the state.
If a patient has a BMI of less than 14 kg/sq m, or suffers from respiratory issues, or performs poorly on any of the other metrics, they are tagged as 'severely ill'. Such a patient is immediately referred for comprehensive assessment and inpatient treatment (care provided in a hospital or in some sort of medical facility).
Note that this paper-based triage tool is simpler than other tools where health workers have to record 16 parameters of a patient, and send them for laboratory-based investigation. This makes the process of diagnosis at least a week long. Using the TN-KET program's triage tool, a diagnosis can be made within a day.
Since the implementation of the initiative, 98% of the patients diagnosed with TB in Tamil Nadu get examined using the triage tool, and 98% of those confirmed to be severely ill are admitted to hospitals within seven days of diagnosis, according to scientists.
The Tamil Nadu government has also launched a portal called Severe TB Web Application, where once the recorded parameters are entered, one can assess 'the probability of a patient dying', Manoj Murhekar, head of the National Institute of Epidemiology, told The Indian Express. 'This will help guide the health workers to take immediate action and prevent TB deaths,' he said.
The TN-KET is one of India's first initiatives to implement the differentiated care guidelines issued by the National Tuberculosis Elimination Programme (NTEP) in 2021. By following a patient-centred model, it provides treatment based on a patient's medical history and medical parameters such as age, weight, and specific disease conditions. It also considers the severity of the disease in all patients diagnosed with TB, and provides comprehensive care to the worst affected.
Combined with a quick examination of TB patients through the triage tool, this model has been highly effective in preventing early deaths of the worst affected patients. Usually, 50% of those who die due to TB, lose their lives within the first two months after being diagnosed.
'Immediate inpatient care can reduce the probability of early death in severely ill patients by 1% to 4%. Usually, the probability of death in such patients is between 10% and 50%,' said Hemant Shewade, senior scientist at the National Institute of Epidemiology, who has studied the implementation of the TN-KET.
Currently, India bears the highest burden of TB across the world. With an estimated 28 lakh cases, the country accounted for 26% of the global TB burden in 2023, according to the Global TB report, which was released last year. With 3.15 lakh deaths due to TB in 2023, India accounted for 29% of the global burden, the report revealed.
The success of the TN-KET program has demonstrated that a differentiated care model combined with the use of a simple triage tool could save the lives of TB patients. This initiative can now be emulated by other states, helping reduce the number of TB deaths across the country.
Anonna Dutt is a Principal Correspondent who writes primarily on health at the Indian Express. She reports on myriad topics ranging from the growing burden of non-communicable diseases such as diabetes and hypertension to the problems with pervasive infectious conditions. She reported on the government's management of the Covid-19 pandemic and closely followed the vaccination programme.
Her stories have resulted in the city government investing in high-end tests for the poor and acknowledging errors in their official reports.
Dutt also takes a keen interest in the country's space programme and has written on key missions like Chandrayaan 2 and 3, Aditya L1, and Gaganyaan.
She was among the first batch of eleven media fellows with RBM Partnership to End Malaria. She was also selected to participate in the short-term programme on early childhood reporting at Columbia University's Dart Centre. Dutt has a Bachelor's Degree from the Symbiosis Institute of Media and Communication, Pune and a PG Diploma from the Asian College of Journalism, Chennai. She started her reporting career with the Hindustan Times.
When not at work, she tries to appease the Duolingo owl with her French skills and sometimes takes to the dance floor. ... Read More