Digital tools not enough; quality control-linked incentives are needed for tuberculosis active case finding.

BACKGROUND: Low yield of tuberculosis (TB) active case finding (ACF) in routine health systems is a concern. Following identification of high-risk villages/wards guided by annual digital household survey (captured in Community Health Integrated Platform [CHIP]), the health system utilised the ACF module of CHIP for an ACF cycle (December 2025 to January 2026) in Udaipur district, Rajasthan, India. Despite advocating the recommendations from a recently concluded national-level TB ACF evaluation, sputum collection and transport and quality control-lined incentives were not implemented. OBJECTIVES: To document the reported and estimated (after telephonic data cross-verification by investigators) scale, quality, and yield of ACF, based on a longitudinal descriptive study using secondary data. RESULT: Of 1.3 million high-risk populations, 70.6% (scale) were reportedly screened. With 44 (0.6% test positivity) reported ACF-detected TB, the number needed to screen (NNS) was 21,082 (quality) and yield was 0.7% (total ACF-detected TB divided by [0.5% × total high-risk population]). The estimated scale was 35% (n = 457,240) and one out of 44 was confirmed to be ACF-detected (estimated NNS = 457,240, estimated yield <0.1%). Similar suboptimal results were observed in 33% villages/wards that were multidimensionally poor as per CHIP and additional 21% villages/wards identified as high-risk through local mapping. CONCLUSION: Suboptimal ACF yield reveals digital tools alone are insufficient.