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Due to the workload and lack of a critical mass of trained operational researchers within their ranks, health systems and programmes may not be able to dedicate sufficient time to conducting operational research (OR). Hence, they may need the technical support of operational researchers from research/academic organisations. Additionally, there is a knowledge gap regarding implementing differentiated tuberculosis (TB) care in programme settings. In this ‘how we did it’ paper, we share our experience of implementing a differentiated TB care model along with an inbuilt OR component in Tamil Nadu, a southern state in India. This was a health system initiative through a collaboration of the State TB cell with the Indian Council of Medical Research institutes and the World Health Organisation country office in India. The learnings are in the form of eleven tips: four broad principles (OR on priority areas and make it a health system initiative, implement simple and holistic ideas, embed OR within routine programme settings, aim for long-term engagement), four related to strategic planning (big team of investigators, joint leadership, decentralised decision-making, working in advance) and three about implementation planning (conducting pilots, smart use of e-tools and operational research publications at frequent intervals). These may act as a guide for other Indian states, high TB burden countries that want to implement differentiated care, and for operational researchers in providing technical assistance for strengthening implementation and conducting OR in health systems and programmes (TB or other health programmes). Following these tips may increase the chances of i) an enriching engagement, ii) policy/practice change, and iii) sustainable implementation.

To reduce TB deaths in resource-limited settings, triaging at diagnosis can identify those with immediate need for comprehensive assessment and inpatient care. n This type of differentiated TB care model was successfully implemented in Tamil Nadu, India, without additional stress on the health system. n Half of the patients referred as a result of triaging were very severely undernourished, which implies a need for capacity-building of inpatient care facilities in clinical management of very severe undernutrition in adults.nThe identification of predictors of not being triaged and comprehensively assessed will inform ongoing and future improvements to the care model.

This chapter gives clinicians the tools to use therapeutic carbohydrate restriction as a dietary intervention for type 2 diabetes patients. The chapter is divided into three section, each addressing a different aspect of therapeutic carbohydrate restriction (TCR). Section 1 delves into the background of carbohydrate restriction, nutrition physiology, the three levels of therapeutic carbohydrate restriction physiological, and metabolic rationale for using TCR to treat the symptoms of type 2 diabetes. Section two explains how to start TCR in a patient population. It goes over which patients are good candidates for TCR and which ones should be approached with caution when implementing this dietary change and explains the importance of baseline assessments. Section three spells out how to administer and manage TCR in a clinical setting. It covers behavior change support, patient education on TCR principles, medication adjustments during the early stages of the intervention, and anticipating and treating common side effects.