The TB cascade of care estimates 2,840,000 incident TB patients in India out of which 68% accessed TB tests; 57% successfully diagnosed with TB; 50% started TB treatment; 43% completed TB treatment; and 37% achieved the optimal outcome of one-year recurrence-free survival.  Similarly, the MDR-TB cascade of care estimates an incident 130,000 MDR-TB cases in 2013, with a drop-off to 47% accessing TB tests, 19% diagnosed with MDR-TB, 15% registered for MDR TB treatment, 7% achieving treatment success, and 5% achieving recurrence-free survival. The care cascade can be used as a program monitoring tool to implement quality improvement (QI) interventions to improve case finding, diagnosis, linkages to free treatment, medication adherence, and recurrence- free survival of TB patients. This project aims to strengthen district health systems in their ability to comprehensively monitor and respond to the TB care cascade with quality improvement (QI) interventions.

Objectives:

• Identify cascade care leakages to evaluate outcomes across the various stages of patient engagement with the health system
• Implement multi-component and targeted interventions to address dropouts in care cascade; demonstrate patient and population-level impact that can be scaled
• Optimize workflows to coordinate the care cascade; motivate and build district capacity to continuously monitor and drive quality improvement (QI) initiatives

 Selected Geography:

• Gujarat State: Gandhinagar, Surat Corporation and Surat District
• Jharkhand State: Ranchi and Purbi Singhbhum

 Role of Partners:

• WHP: Implementation of all interventions; Monitoring of improvements in care cascade due to intervention support; Joint program review with district and state teams.
• IIPHG: Formative research, base/end line, process documentation, process documentation of interventions to understand priority areas of focus; development of digital training content through Ni-kshay SETU digital applications for healthcare staff and district teams for all interventions.
• Everwell: Appropriate Nikshay web and mobile applications development to assist healthcare workers and district/state teams; development of ADR module and LTBI (Latent TB Infection) module in guidance of CTD

 Expected Outcome:

• The project will develop a framework to monitor the TB care cascade and demonstrate intervention models to close cascade gaps in selected geographies. Care cascades for TB sub-populations will also be created, including for individuals with DR-TB, comorbidities, and other key populations.