Outpatient department based digitally enabled systematic screening for TB: Experiences from a private hospital in Delhi.

National Capital Territory of Delhi, India, has a high tuberculosis (TB) prevalence of 747 cases per 100,000 population. Previous studies from Delhi have documented a significant delay in TB diagnosis from the first visit to the first health care facility and diagnosis of TB. Provider initiated facility-based case finding is considered as an intervention which requires less effort but with a large potential for impact. Sehgal Neo Hospital, a 100 bedded private hospital in Delhi, India, implemented a facility based systematic screening for all the Outpatient Department attendees using a self-reported 10 symptom-complex based digital questionnaire filled by the clients using their mobile phones by scanning a QR code. Anybody who reported symptoms was evaluated by a clinician and offered a molecular test based on evaluation. A total of 15,731 walk-in clients at the facility were screened, 839 (5.3%) individuals reported at least one symptom, 688 were clinically evaluated, 112 were tested, and 35 cases of TB were detected. The Number Needed to Screen (NNS) to get one TB was 449 and the Number needed to Test (NNT) to get one case of TB was 3.2. The experience shows that facility based digitally enabled systematic screening among the OPD attendees of a private hospital in Delhi is possible and is potentially beneficial in reducing the delay in diagnosis. The model could be replicated across public and private health care facilities in high burden geographies.