Tamil Nadu’s statewide tuberculosis programme has been associated with a substantial fall in death rates among patients diagnosed with drug-sensitive TB. The programme identifies people who are severely ill at diagnosis and prioritises them for hospital referral and inpatient care.
A practice paper describing the programme’s monitoring system reports a reduction in death rates across quarterly diagnosis groups from July 2024 through December 2025. In one group, the rate fell from a baseline of 6.3% to 3.9%; in a later group it reached 2.8%.
The programme is called Tamil Nadu Kasanoi Erappila Thittam, or TNKET. It has been implemented across the state since 2022 and covers adults aged 15 and older diagnosed with drug-sensitive TB.
How patients are assessed
At diagnosis, patients are assessed using five clinical measures: body mass index, swelling in the feet or ankles, breathing rate, oxygen saturation and the ability to stand without support.
The aim is to identify severe illness early. People with indicators such as very severe undernutrition, breathing problems or poor physical functioning can be referred for hospital assessment and care.
That approach differs from relying only on routine treatment follow-up. It attempts to direct additional attention toward patients who may face a greater risk of complications or death.
Tamil Nadu diagnoses about 60,000 adults with drug-sensitive TB each year through public health facilities, according to the reported programme figures. At that scale, screening and referral require coordination between clinics, hospitals and community health teams.
Building a care pathway
The programme’s evaluation framework follows the patient journey from initial triage through hospital admission and inpatient care. It also measures the quality of assessments and tracks the eventual outcome of TB deaths.
Researchers reported that it took around two years of implementation to reduce losses along the care pathway and improve the quality of triage and inpatient care. The lower death rates appeared across later diagnosis cohorts, and the analysis adjusted for possible confounding factors and changes over time.
The results are encouraging, but they should be read carefully. The evidence comes from an observational programme evaluation, not a randomised trial, so it shows an association rather than proving that the programme alone caused the decline.
Follow-up remains difficult
The evaluation also identified a significant weakness: tracking patients after they leave hospital. In no quarter did systematic follow-up at the two-month point exceed 35% among patients identified as severely ill at diagnosis.
That gap matters because recovery does not end at discharge. Patients may need continued monitoring, support to complete treatment and help returning to care if their health worsens.
The researchers say the findings could guide other high-burden states and countries considering differentiated TB care. The model offers a structured way to identify high-risk patients, but each health system would need to adapt it to its staffing, referral capacity and local needs.
What the findings suggest
TNKET shows how routine clinical checks can be organised into a statewide care pathway. Measuring nutrition, breathing and mobility at diagnosis may help health workers identify patients who need more intensive attention.
The results also show that a programme’s impact depends on what happens after the first assessment. Screening and hospital referral need to be matched with reliable follow-up once a patient returns home.
For public health planners, the next challenge is to strengthen that continuity of care while sustaining improvements in triage and inpatient treatment. The study offers a promising model, with post-discharge monitoring remaining an area for further work.