Thread by @HShewade

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1/15
Screening People with Tuberculosis for High Risk of Severe Illness at Notification: Programmatic Experience from Karnataka, India mdpi.com/1151162 in journal #TMID via @MDPIOpenAccess

#OperationalResearch led by @SharathBN and me

https://twitter.com/hshewade/status/1403664059690405897

2/15
Before #COVID19, #TB was the leading infectious disease killer

People with TB r not systematically screened for severe illness @ diagnosis. Something we do in COVID19

To #EndTBDeaths, @TbDivision recommends assessment of severity @ diagnosis n referral 4 inpatient care

3/15
Existing #TBProgramme guidance to assess severity among people with TB requires clinical capacity and diagnostic and radiology infrastructure

This is usually not present in peripheral health institutes where patients are diagnosed

4/15
Even if the guidance is used, it takes time to complete the assessment (current guidance includes 14 indicators involving clinical, laboratory and radiological assessment)

Also most of the TB deaths happen early during treatment mandating quick assessment

5/15
Hence, we need a #ScreeningTool that can be used by para-medical health staff in peripheral health institutes to identify severe illness immediately at diagnosis. Without the need for laboratory and radiological work up.

6/15
We developed a screening tool involving indicators of very severe undernutrition, respiratory insufficiency and patient performance status

7/15
#Karnataka state, India, took the initiative and piloted this screening tool.

At TB notification, paramedical staff screened all adults from all public facilities of 16 districts between 15 Oct and 30 Nov 2020.

We assessed the #feasibility of using the tool and #burden

8/15
Feasibility - #coverage of screening

Of 3020 adults with TB, 51% were screened. The coverage was affected by the prevailing COVID-19 pandemic.

It varied from 13-90%, Low in districts where big cities are there and high in predominantly rural districts.

9/15
Feasibility - #delay in screening

Screening was on an average done within two days of notification. This is encouraging as this helps in early identification of severe illness and referral for care

10/15
Feasibility - severe illness #DataQuality

For 90% of patients, all data relevant to severe illness was collected (body mass index, respiratory rate, oxygen saturation, ability to stand without support). Data errors were minimal and satisfactory for programme setting

11/15
#Burden of ‘high risk of severe illness’

Among screened, 35% had ‘high risk of severe illness’.

As screening was done by paramedical staff, we used the phrase ‘high risk of severe illness’ instead of ‘severe illness’

12/15
We have recommended Systematic #screening, #referral and #InpatientCare of severely ill TB patients if we are to End TB deaths in Karnataka and India. Once patients recover, they can be discharged for usual ambulatory DOT care

13/15
The high burden at notification, feasibility of screening and high early deaths among those with severe illness (follow up research article on this should be out soon) provides evidence towards this intervention

Coverage of screening is expected to improve post COVID-19

14/15
The indicator #percentage of TB deaths with ‘high risk of severe illness’ (trend over time) can also be used as an indicator to assess the TB case finding.

High percentage indicates long delay in TB diagnosis.

15/15

@DHFWKA @TheUnion_TBLH @sureshshastri06 @YenUniT Thank you for the support and guidance

@TbDivision @SATB1231 @mla_sudhakar @StopTB @JeetInd18 @TBbrigden @shibuvij @SarabChadha @paimandhu