Tuberculosis (TB) continues to be one of the important public health concerns globally, and India is among the seven countries with the largest burden of TB. There has been a consistent increase in the notifications of TB cases across the globe. However, the 2018 estimates envisage a gap of about 30% between the incident and notified cases of TB, indicating a significant number of patients who remain undiagnosed or ‘missed’. It is important to understand who is ‘missed’, find this population, and provide quality care. Given these complexities, we reviewed the diagnostic gaps in the care cascade for TB. We searched Medline via PubMed and CENTRAL databases via the Cochrane Library. The search strategy for PubMed was tailored to individual databases and was as: ((((((tuberculosis[Title/Abstract]) OR (TB[Title/Abstract])) OR (koch *[Title/Abstract])) OR (“tuberculosis”[MeSH Terms]))) AND (((diagnos *) AND (“diagnosis”[MeSH Terms])))). Furthermore, we screened the references list of the potentially relevant studies to seek additional studies. Studies retrieved from these electronic searches and relevant references included in the bibliography of those studies were reviewed. Original studies in English that assessed the causes of diagnostic gaps and interventions used to address them were included. Delays in diagnosis were found to be attributable to both the individuals’ and the health system’s capacity to diagnose and promptly commence treatment. This review provides insights into the diagnostic gaps in a cascade of care for TB and different interventions adopted in studies to close this gap. The major diagnostic gaps identified in this review are as follows: people may not have access to TB diagnostic tests, individuals are at a higher risk of missed diagnosis, services are available but people may not seek care with a diagnostic facility, and patients are not diagnosed despite reaching health facilities. Therefore, reaching the goal to End TB requires putting in place models and methods to provide prompt and quality assured diagnosis to populations at par.

Tuberculosis (TB) is the second leading cause of death due to infectious diseases globally, and delay in the TB care cascade is reported as one of the major challenges in achieving the goals of the TB control programs. The main aim of this study was to investigate the delay and responsible factors for the delay in the various phases of care cascade among TB patients in two Indian states, Jharkhand and Gujarat. This cross-sectional study was conducted among 990 TB patients from the selected tuberculosis units (TUs) of two states. This study adopted a mixed-method approach for the data collection. The study targeted a diverse profile of TB patients, such as drug-sensitive TB (DSTB), drug resistance TB (DRTB), pediatric TB, and extra-pulmonary TB. It included both public and private sector patients. The study findings suggested that about 41% of pulmonary and 51% of extra-pulmonary patients reported total delay. Delay in initial formal consultation is most common, followed by a delay in diagnosis and treatment initiation in pulmonary patients. While in extra-pulmonary patients, delay in treatment initiation is most common, followed by the diagnosis and first formal consultation. DR-TB patients are more prone to total delay and delay in the treatment initiation among pulmonary patients. Addiction, co-morbidity and awareness regarding monetary benefits available for TB patients contribute significantly to the total delay among pulmonary TB patients. There were system-side factors like inadequacy in active case findings, poor infrastructure, improper adverse drug reaction management and follow-up, resulting in delays in the TB care cascade in different phases. Thus, the multi-disciplinary strategies covering the gambit of both system and demand side attributes are recommended to minimize the delays in the TB care cascade.

BACKGROUND The five-year ahead of global target of eliminating Tuberculosis (TB) in India by 2025 depends critically on one of the components of health system strengthening, the capacity of human resources. Due to the rapid transposition of standards and protocols, the human resources for TB health are lacking in understanding recent updates and acquire needful knowledge. OBJECTIVE With a focus on the digital revolution in healthcare, there is no such platform to deliver the key updates in the national TB control program with easy access. Thus, this manuscript narrates the evolution of a digital platform for the capacity building of the Indian health system’s workforce in management of TB patients. METHODS A qualitative method study was conducted, i.e., qualitative personal interviews to understand the basic requirements of staff working in management of TB patients and then, participatory consultative meetings with the stakeholders to validate and develop the content. This study collected qualitative information from the Purbi Singhbhum and Ranchi districts of Jharkhand and Gandhinagar and Surat districts of Gujarat State. Secondly, a series of participatory workshops were conducted as part of the content validation exercises during 2021-22. RESULTS The first phase collected information from 126 healthcare staff, with the mean age of participants being 38.4 ± 8.9 years and the average work experience of 8.9 years. The assessment revealed that more than two-thirds of participants needed further training and lacked knowledge of the most current updates to the NTEP guidelines. The consultative process determined the training requirements in easily accessible formats and ready reckoner content to deliver practical solutions to programme implementation's operational issues. The digital platform should be adaptable and flexible enough to accommodate future programme revisions. CONCLUSIONS The development of staff capacity is vital to the success or failure of any programme or intervention. Having up-to-date information provides confidence to the staff when interacting with patients in the community and aids them in making quick judgements when handling case scenarios. The NI-KSHAY SETU could be one of the other examples of a digital capacity-building platform for enhancing human resources skills working for TB elimination.

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