Evaluation of active case finding for Tuberculosis in selected districts of Madhya Pradesh, India (2023-24): Challenges and opportunities

Introduction Tuberculosis (TB) remains a major public health concern in India, necessitating proactive strategies such as Active Case Finding (ACF) to improve case detection among high-risk populations. This study evaluates ACF implementation in seven districts of Madhya Pradesh, assessing key performance indicators and identifying challenges encountered by program implementers. Methods A mixed-methods study was conducted from August 2023 to January 2024, integrating quantitative analysis of ACF performance indicators with qualitative insights from key stakeholders. The study assessed mapping, screening, presumptive TB case identification, testing, diagnosis, and treatment initiation rates. In-depth interviews were conducted with District Tuberculosis Officers (DTOs), Medical Officers (MOTCs), District Program Coordinators (DPCs), and field staff to explore implementation challenges. Data were analyzed using Epi-Info 7, and thematic analysis was applied to qualitative findings. Results None of the districts met all six ACF quality indicators. Only six districts met the mapping target (≥11 %), while none achieved the screening target (>90 %). Presumptive TB case identification was below 5 % in all districts, and testing rates varied between 75 and 94.9 %. While two districts exceeded the diagnostic threshold (>5 %), others performed sub-optimally. Treatment initiation was successful (>95 %) in five districts. Key challenges included inadequate mapping, workforce constraints, TB-related stigma, and inconsistent diagnostic practices. Conclusion ACF implementation in Madhya Pradesh demonstrated critical gaps, particularly in early case detection and community engagement. Strengthening workforce training, community awareness, and diagnostic infrastructure is essential to improve ACF outcomes and achieve India's TB elimination goals by 2025.