A first: Tamil Nadu’s differentiated ‘TB care model’ brings down mortality rate

In a first-of-its-kind model in India, Tamil Nadu’s differentiated TB care model has brought down the mortality rate among people with tuberculosis.

Spearheaded by Indian Council of Medical Research-National Institute of Epidemiology (ICMR-NIE), the initiative — TN-KET (Tamil Nadu Kasanoi Erappila Thittam) meaning TB death-free project which began in April 2022 in public healthcare facilities of the state — has achieved significant reduction in the number of early TB deaths.

Tamil Nadu has the highest TB prevalence of 322 per 1,00,000 population. During the Covid pandemic, the death of TB patients in Tamil Nadu increased to 6.4%, and more than 70% of deaths were within 2 months.

At the heart of the TN-KET lies an assessment to find whether people with TB require outpatient care or admission in a health facility. The preliminary assessment of patients under the model is based on just three conditions — very severe undernutrition, respiratory insufficiency and poor physical condition.

After the implementation of TN-KET, officials at ICMR-NIE said that statewide early deaths were reduced by 20% within two quarters of implementation and two-thirds of districts in 2024 have documented 20-30% reduction in TB deaths.

TN-KET is also supported by World Health Organisation India.

Scientists from ICMR-NIE, WHO India, in a study published in Indian Journal of Community Medicine explained TN-KET.

“A paper‑based triage form has been introduced in all the public health facilities that diagnose TB. A paper‑based case record form and inpatient care guide has been introduced in all the nodal inpatient care facilities for standard comprehensive assessment and care of triage‑positive. In the nodal TN‑KET inpatient care facilities (medical college hospital, district headquarter hospital, sub‑district hospitals with a physician), TB beds along with nodal physicians have been identified,” the study said.

The triage‑positive patients undergo comprehensive assessment, confirmation of severe illness, identification of reasons for severe illness (issues to be addressed during inpatient care) and clinical care.

In order to reduce the average time from diagnosis to hospital admission, Tamil Nadu has now launched a model which predicts the probability of deaths among adults with TB.

India