Study setting

Delhi is an union territory situated in the northern part of India, and administratively, Delhi is divided into 11 districts.[12] RNTCP has been implemented in all districts of Delhi. MAMC, and its associated hospitals, is a 2800-bedded tertiary care, teaching hospital located in the central district of Delhi. It is providing outpatient services to 7500 patients per day. All patients seeking healthcare services are screened for TB based on the clinical presentation and diagnosed using either sputum microscopy/Culture/GeneXpert. All patients diagnosed with TB are referred to RNTCP MCRU for treatment initiation or referral. Admitted patients with TB are initiated on treatment and referred to MCRU for continuation or transferring out the patients. The MCRU is manned with a medical officer in charge and other supporting staffs like Senior TB Treatment Supervisor (STS), Senior TB Laboratory Supervisor (STLS), TB Health Visitor (TB-HV) and Laboratory Technician. The flow of patients diagnosed, managed/referred via MCRU of MAMC and associated hospitals of Delhi after implementation of Nikshay is given in Figure 1.

Diagnosis, referral and feedback flow of patients with tuberculosis at MAMC and associated hospitals of Delhi from April 2018. MAMC: Maulana Azad Medical College and its associated hospitals; RNTCP: Revised National TB Control Programme