Implementation of TB Free Workplace activities under the corporate TB Pledge initiative in India: a mixed-methods study.

BACKGROUND: Tuberculosis (TB) remains a major public health challenge in India, with multisectoral engagement recognized as an important strategy for achieving TB elimination targets. Under the National TB Elimination Programme (NTEP), the Corporate TB Pledge (CTP) initiative was introduced to promote implementation of "TB Free Workplace" activities among corporate organizations. However, evidence regarding implementation and operational challenges of workplace-based TB interventions remains limited. METHODS: A mixed-methods sequential explanatory study was conducted under the Corporate TB Pledge initiative in India. Quantitative data were obtained from the Management Information System (MIS) maintained by the CTP secretariat, which included monthly performance indicators reported by participating corporate organizations between 2020 and 2024. Data related to TB screening, diagnostic testing, TB case detection, treatment initiation, and treatment completion were analyzed descriptively. Qualitative data were collected through in-depth interviews with purposively selected corporate representatives, business associations, NTEP officials, and technical partners using a pilot-tested interview guide. Interviews were transcribed, manually coded, and analyzed thematically. RESULTS: A total of 461 corporates had pledged support under the CTP initiative, of which 276 (60%) were actively contributing through corporate social responsibility support or TB Free Workplace implementation. Among them, 64 organizations had implemented TB Free Workplace activities. Twenty organizations reported cascade-of-care data between 2020 and 2024. A total of 892,719 individuals were screened for TB, among whom 71,795 underwent diagnostic testing and 3829 were diagnosed with TB disease, including 97 drug-resistant TB cases. Treatment initiation was reported among 3629 (95%) diagnosed individuals, and 2814 (78%) completed treatment successfully. The qualitative analysis revealed that implementation was primarily driven by corporate social responsibility, employee well-being, workplace safety, leadership commitment, and technical assistance from the NTEP and its partners. Key barriers included limited awareness, stigma and confidentiality concerns, competing organizational priorities, sustainability challenges, and the voluntary nature of the initiative. CONCLUSION: Workplace-based TB interventions implemented under the Corporate TB Pledge initiative demonstrated potential for supporting early TB detection and treatment linkage among working populations in India. Strengthening technical support, multisectoral collaboration, organizational leadership engagement, and integration with occupational health systems may improve implementation and scalability of TB Free Workplace initiatives.