Addressing inequities in nutritional supplementation in tuberculosis: implementation research from Puducherry, India.

SETTINGS: Operational research conducted in Puducherry identified gaps in achieving an equitable distribution of food baskets to address undernutrition among all patients with tuberculosis (TB) and drug-resistant TB (DR-TB). OBJECTIVE: To assess the changes in food basket distribution following the implementation of a prioritisation mechanism in Puducherry between June and August 2025, as compared to June and August 2023. This cohort study used secondary programme data to compare outcomes before and after implementation. RESULTS: In 2025 (N = 73), the time to receive the first food basket from diagnosis was reduced by 39% (P = 0.003) in all with undernutrition and below poverty line, compared with 2023 (N = 53). Similarly, the number of food baskets they received increased by 30% (P = 0.048). The time to receive the first food basket from diagnosis and the number of food baskets improved for patients with DR-TB. CONCLUSION: Patients with TB with undernutrition and below the poverty line received food baskets earlier in 2025 than in 2023. Attempts to prioritise the number of food baskets to these vulnerable groups also improved modestly. Real-time monitoring of indicators for a wider cohort and strengthening community engagement will help sustain the distribution in the long run.