Operational Challenges in Conducting a Subnational TB Prevalence Survey in India: Lessons Learned for Resource-Limited, High-Burden Settings

The quality of the entire survey depends on staff training.

Staff attrition in large-scale surveys should be anticipated, and ready-made training materials in audio-video format should be available to train staff anytime, anywhere.

Staff safety must be a priority during emergency situations to avoid delays in the survey.

The involvement of community leaders and local community engagement is critical for the survey.

Implementing an information, education, and communication program through local health authorities can sensitize the community and increase survey participation.

Planning cluster activities in sessions of 3–4 hours each and scheduling a 4-hour break for the X-ray unit reduces the frequency of X-ray breakdowns.

Care should be taken to avoid operating the X-ray unit when the outdoor temperature is high.

Funding for surveys should try to include a special agency for sputum transportation with cold chain monitoring exclusively for the survey.

Reference laboratories must be prepared with adequate staff and consumables to manage increases in samples.

Strong leadership and effective collaborative networks should be engaged to mobilize consumables quickly and help manage supply chain issues.

An adequate budget should be allocated and a trained standardized radiologist/pulmonologist should be assigned to read X-rays daily so that the eligible participants can be approached as early as possible.

Wherever funding is possible, incorporating artificial intelligence/teleradiology should be considered.

Having a competent and responsive data management team from survey design to completion is essential.

To avoid data collection delays caused by connectivity issues, the survey team should be prepared to collect data on paper.

The use of bar codes and bar code scanners reduces errors in data entry and matching records.