iDEFEAT TB Project

1. The iDEFEAT TB Project, a joint initiative of the Indian Institute of Public Health Gandhinagar (IIPHG) and The Union, funded by USAID, marked a significant milestone in India’s fight against tuberculosis (TB). Concluded on May 31, 2025, the project aimed to address systemic challenges in TB management—especially drug-resistant TB (DR-TB)—by harnessing the power of digital technology. The project was implemented from January 16, 2024, to May 31, 2025, and focused on developing and scaling the Ni-kshay SETU platform.

Vision and Purpose

India carries the highest TB burden globally, with over 2.7 million cases annually and 24% of the world’s DR-TB cases. Recognizing this urgent public health crisis, the iDEFEAT TB project was conceptualized to modernize training, support, and decision-making mechanisms for healthcare workers managing TB across the country. The centerpiece of this innovation was Ni-kshay SETU (Support, Engage, Train, and Update)—a digital platform designed to empower healthcare providers with evidence-based knowledge, AI-driven tools, and scalable learning systems.

Collaboration between IIPHG and iDEFEAT TB Project (The Union)

The primary objective of this collaboration is to execute activities aligning with the goals of the ‘iDEFEAT TB – Institutional Strengthening to Accelerate Actions for TB and Drug-Resistant TB in India’ project. Additionally, the Indian Institute of Public Health, Gandhinagar, has made commitments under the ‘Closing the Gaps in TB care cascade,’ supported by USAID, to extend its objectives regarding the enhancement of TB services nationwide. This contract is designed to fortify institutions involved in TB care, with a focus on programmatic and clinical management of TB and DR-TB patients, utilizing the digital solution, Ni-kshay SETU application. This contribution aims to facilitate the achievement of India’s National Strategic Plan and the targets of the United Nations High-Level Meeting on TB. Moreover, the program intends to engage the corporate sector in supporting India’s TB response.

This collaboration will address two primary objectives, encompassing four broad objectives:

1. 1.  Enhancing the Modernized Training System through Ni-kshay SETU
   2.  DR-TB Institution Strengthening through Ni-kshay SETU, technical support, and field assistance.

Key Innovations and Tools 

The project delivered four critical digital plug-ins within Ni-kshay SETU:

Modernized Training System (MTS)

The MTS provided mobile-based, cadre-specific learning modules accessible in 8 regional languages. It included:

• • • Seamless integration with the KBase knowledge database using chatbot functionality.
    • Speech-to-text accessibility and multilingual support.
    • Contextual learning suggestions tailored to user behavior.
    • Backend services enabling dynamic updates and performance monitoring.

Knowledge Assessment System

An adaptive quiz engine tested healthcare providers’ TB knowledge:

• • • Role-specific assessments for Medical Officers, Lab Technicians, etc.
    • Randomized questions aligned with national TB guidelines.
    • Leaderboards, performance dashboards, and real-time feedback to foster engagement.

Decision Support System (DSS) for DR-TB

Built upon the existing Manage TB India tool, this DSS included:

• • • AI-powered regimen recommendations based on patient profiles.
    • Clinical logic for factors like drug resistance, comorbidities, and past treatments.
    • Admin dashboard for rule customization and anomaly detection.

Clinical Query Response System

A structured, ticket-based platform enabled expert consultation across different levels:

• • • Real-time triaging and escalation of clinical queries.
    • Role-based access controls to maintain confidentiality.
    • Automated documentation and audit-friendly reporting.

Implementation Approach

The iDEFEAT TB project employed a collaborative, structured, and adaptable implementation model:

• • Planning and Architecture: The team built a modular, open-source framework with scalable plugin architecture. Stakeholders from NTEP and state TB cells participated in planning and review workshops to ensure alignment with ground-level realities.
  • Integration and Deployment: Ni-kshay SETU was successfully deployed across all 35 States and Union Territories in India. It achieved secure integration with major app stores and adhered to data privacy standards.
  • Capacity Building: Over 15,000 healthcare providers were trained, with 78% reporting increased confidence in managing complex TB cases. The project also introduced simplified workflows for field-level users to boost adoption.

Impact and Reach

The impact of the iDEFEAT TB project has been far-reaching:

• National Scale Implementation: Ni-kshay SETU reached users in every Indian state and UT, making it a nationally adopted digital tool.
• Broad Usage and Engagement:
  • 44,500+ subscribers, all states of India and footfalls in 80% districts.
  • 1.56 million app sessions
  • 304,676+ minutes of engagement
  • 52% of grassroots workers actively use the platform in daily TB case management.

• Positive User Feedback:
  • Overall app rating: 4.55/5
  • 95% of users recommended the app to peers.

Challenges and Resolutions

While implementing a national digital health solution posed numerous challenges, the project team actively resolved them:

• User Acceptance Testing Delays : Addressed through virtual workshops and proactive feedback mechanisms.
• Technical Bugs (e.g., iOS voice commands): Resolved via UI optimizations, backend tuning, and error logging.
• Navigation Barriers for Field Workers: Solved through simplified design, visual cues, and on-ground training.
• Rigid Data Entry: Flexibility introduced with “Not Available” defaults and auto-fill options.
• Query Routing Errors: Resolved through comprehensive institution mapping and coordination with DRTB centers.

Sustainability and Way Forward

One of the hallmark achievements of the project is its commitment to open-source development. Ni-kshay SETU is available on platforms like the Digital Health Atlas, Atlas of TB Innovations, and GitHub, ensuring transparency, adaptability, and global collaboration.

The future roadmap includes:

• Integration with other disease programs (e.g., NCDs, maternal health).
• New modules for private sector engagement and newer healthcare cadres.
• Continued support and co-development from IIPHG and other partners.
• Orientation and training for broader adoption among healthcare workers.

Financial Highlights

The project achieved a 97.5% budget utilization, demonstrating exceptional financial accountability. Despite challenges, the team delivered all expected outputs within budget—underscoring cost-effectiveness and operational excellence.

Conclusion

The iDEFEAT TB project has catalyzed a transformative shift in India’s TB care delivery. By bridging clinical knowledge gaps, improving decision-making, and empowering the healthcare workforce, Ni-kshay SETU now stands as a national digital backbone for TB management. Its modular architecture, open-source availability, and cross-disease potential ensure it remains a sustainable public health asset—not just for India but for global TB elimination efforts.

This project reaffirms our commitment to leveraging innovation for health equity, and we are proud to have led this impactful journey with support from The Union.