Evaluation of intensified case finding of tuberculosis using four symptom complex screening through reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework in Puducherry.

Introduction: Tuberculosis (TB) remains the leading infectious cause of death worldwide, with co-morbidities such as diabetes mellitus (DM) significantly increasing the risk of developing TB and leading to poor treatment outcomes. The End TB Strategy and Sustainable Development Goals emphasize addressing TB co-morbidities to achieve TB elimination. We have assessed the impact of implementing joint TB-DM collaborative activities using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework in a tertiary care setting.

Objectives: This study aimed at evaluating the impact of the execution of the TB-DM collaborative activity, using the RE-AIM framework.

Material and methods: This study was undertaken by the Department of Community Medicine, in outpatient departments (OPDs) at Sri Manakula Vinayagar Medical College and Hospital (SMVMCH), Puducherry from March 2021 to September 2022. The study involved three phases: qualitative design of intervention strategies, quantitative pre- and post-intervention evaluation, and post-intervention qualitative assessment. Interventions included sensitization programs for healthcare professionals, the use of Institutional Ethics Committee (IEC) materials, and systematic screening of DM patients using the 4s complex (cough >2 weeks, fever >2 weeks, night sweats, weight loss). The outcome of the implementation of TB-DM collaborative activity was evaluated using the RE-AIM framework.

Results: The application of the RE-AIM framework for joint TB-DM collaborative activities emphasized healthcare professional sensitization, IEC material development, and effective inter-departmental collaboration. Key outcomes included enhanced TB case detection through 4s screening, improved knowledge among healthcare professionals, and sustainable integration of interventions into routine practices for long-term impact.

Conclusion: Implementation of the 4s complex screening activity improved TB detection among DM patients and demonstrated the feasibility and effectiveness of joint TB-DM collaborative strategies. The RE-AIM framework provided a structured evaluation, highlighting the intervention's strengths and areas for improvement. Sustaining these efforts and expanding to other high-risk groups is critical to achieving TB elimination targets.