TY - JOUR T1 - Screening for Severe Illness at Diagnosis Has the Potential to Prevent Early TB Deaths: Programmatic Experience From Karnataka, India JF - Global Health: Science and Practice JO - GLOB HEALTH SCI PRACT DO - 10.9745/GHSP-D-21-00736 AU - Hemant Deepak Shewade AU - Sharath Burugina Nagaraja AU - Basavarajachar Vanitha AU - Hosadurga Jagadish Deepak Murthy AU - Madhavi Bhargava AU - Anil Singarajipura AU - Suresh G. Shastri AU - Bharatkumar Hargovandas Patel AU - Kajal Davara AU - Ramesh Chandra Reddy AU - Ajay M.V. Kumar AU - Anurag Bhargava Y1 - 2022/08/04 UR - http://www.ghspjournal.org/content/early/2022/08/03/GHSP-D-21-00736.abstract N2 - Key FindingsSeverity is not systematically assessed at the start of TB treatment among adults due to a lack of policy and/or diagnostic and clinical capacity.Paramedical TB program staff screened adults with TB for “high risk of severe illness” at notification using a screening tool involving simple and easily measurable indicators.Early deaths were seen in 7% of patients; deaths were significantly higher among people with a high risk of severe illness.Key ImplicationsScreening for severe illness should be explored as a potential strategy to end TB deaths.Considering the increase in estimated TB deaths due to the coronavirus disease (COVID-19) pandemic, program managers should use this window of opportunity to implement screening for severe illness.Due to the coronavirus disease (COVID-19) pandemic and its associated response, TB deaths increased for the first time in a decade. In any potentially fatal illness, an assessment of severity is essential. This is not systematically done for adults with TB, mostly due to a lack of policy and/or limited availability of diagnostic and clinical capacity. We developed a screening tool using simple and easily measurable indicators that can be used by paramedical TB program staff to quickly identify people with severe illness. During October–November 2020 in Karnataka, India, the paramedical program staff from 16 districts screened people with TB (aged ≥15 years) notified by public facilities for “high risk of severe illness,” which was defined as the presence of any of the following indicators: (1) body mass index (BMI) ≤14.0 kg/m2; (2) BMI ≤16.0 kg/m2 with bilateral leg swelling; (3) respiratory rate >24/minute; (4) oxygen saturation <94%; (5) inability to stand without support. In this cohort study, we determined the incidence of program-recorded early deaths (within 2 months) and its association with high risk of severe illness. Of 3,010 people with TB, 1,529 (50.8%) were screened at diagnosis/notification, of whom 537 (35.1%) had a high risk of severe illness. There were 195 (6.5%, 95% CI=5.7, 7.4) early deaths: 59 (30.2%) within a week and 100 (51.3%) within 2 weeks of treatment initiation. The incidence of early deaths was significantly higher among those with high risk of severe illness (8.9%) at diagnosis compared to those without (3.8%) [adjusted relative risk: 2.36 (95% confidence interval=1.57, 3.55)]. To conclude, early deaths were especially high during the first 2 weeks and strongly associated with a high risk of severe illness at diagnosis/notification. Screening for severe illness should be explored as a potential strategy to end TB deaths. ER -