Cough syrup buyers get referred but not tested: private pharmacy-based tuberculosis surveillance pilot in Jaipur, India.

SETTING: In the private sector of Rajasthan (north Indian state), missed tuberculosis (TB) notifications were seven times the reported notifications. The higher the private cough syrup sales in districts, the higher the missed TB notification. OBJECTIVE: We assessed the operational feasibility of engaging private pharmacies to refer cough syrup buyers for TB testing by the routine health system in Jaipur II district, Rajasthan. METHODS: This was a longitudinal descriptive study using aggregate secondary data. In collaboration with the state TB and drug control authorities, private pharmacy-based TB surveillance (PPTS) was piloted from November 2025 to January 2026. Random cross-verification of the care cascade data was done by designated district officials by telephonically contacting cough syrup buyers. RESULTS: Of 2,413 cough syrup buyers shared by pharmacies, 759 (31%) were reported as tracked and 334 (44%) of them underwent sputum examinations, yielding three (1%) PPTS-detected TB. After cross-verification, we estimated that against ≈2200 (90% of 2,413) private cough syrup buyers, there were an estimated ≈110 (30% of 334) PPTS sputum examinations and three PPTS-detected TB (3%). CONCLUSION: Private pharmacies have the potential to share cough syrup buyers' details that can contribute to significant TB notifications. Tracking cough syrup buyers needs urgent attention.