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.