Abstract
BACKGROUND: Indigenous tribes face a disproportionately high tuberculosis (TB) burden due to deep–rooted socioeconomic disadvantage, highlighting the need for strengthened, culturally sensitive control strategies.
METHODS: We conducted a 21–year retrospective study (2005–2025) among tribal and neighboring non–tribal populations attending a tribal–serving hospital in Karnataka. Pre–Nikshay data were transcribed from paper registers, and post–Nikshay data were obtained from the digital system. We assessed negative binomial interrupted time–series regression model, data completeness, TB risk factors, and used multivariable logistic regression to identify determinants of poor treatment outcomes and household contact screening yield.
RESULTS: We analyzed 1,512 TB cases (tribal = 1,021; non–tribal = 491). TB detection increased significantly over time, with a steeper rise among tribal populations (p<0.001). Nikshay implementation significantly improved data completeness (Wilcoxon W = 9900, p<0.001). Among tribal patients, males had higher odds of poor treatment outcome (aOR 2.81, 95% CI 1.70– 4.85; p<0.001). Diabetes (aOR 2.10, 95% CI 1.05– 4.03; p=0.029) was independently associated with poor treatment outcome. Among 503 index cases, 1,535 household contacts were identified and 1,161 (75.6%) screened; coverage was lower among tribal contacts (69.8% vs 87.2%; p<0.001).
CONCLUSIONS: Nikshay strengthened TB surveillance and improved assessment of TB burden and risk factors in tribal communities.