Pharmacy based surveillance for identifying missing tuberculosis cases: A mixed methods study from South India

Indian J Tuberc. 2021 Jan;68(1):51-58. doi: 10.1016/j.ijtb.2020.09.017. Epub 2020 Sep 25.


Background: No Indian studies have assessed the implementation of recent policy on pharmacy based surveillance and its contribution in TB notification. So, this study was conducted with objectives to describe: a) pharmacy based TB surveillance and TB notification, and b) experiences of pharmacy based surveillance implementation from the programme managers and pharmacists perspective.

Methods: A mixed methods study-quantitative (cross-sectional) and qualitative (in-depth interviews) in two selected districts Dharmapuri and Salem districts of Tamil Nadu State, India.

Results: In 2018, 45 (11%) of 397 pharmacies in Dharmapuri and 90 (6%) of 1457 pharmacies in Salem districts reported sale of anti-TB drugs to 1307 and 1673 persons respectively. Upon validation through direct patient contact 942 (72%) persons in Dharmapuri and 863 (52%) persons were identified as previously 'un-notified' TB patients. These patients constituted 20% and 29% of the total TB cases notified in Dharmapuri and Salem respectively. The enablers for implementing this activity were: understanding the importance of notification, availability of resources (manpower, computers) to record, report and validate the patient data, repeated trainings and partnerships. The barriers were: patients' hesitancy to share their details to pharmacists (confidentiality), cumbersome recording and reporting process, difficulties in recording patient details during high workload busy business hours.

Conclusion: This process contributed about one-fourth of the TB patients notified in these districts. Its implementation needs to be strengthened and should be scaled up in other parts of the country.

Keywords: Anti-TB drug Sales; Notification; Operational research; Private pharmacy; Validation.

MeSH terms

  • Antitubercular Agents / economics
  • Antitubercular Agents / therapeutic use
  • Commerce / statistics & numerical data
  • Cross-Sectional Studies
  • Humans
  • India / epidemiology
  • Interviews as Topic
  • National Health Programs
  • Outcome Assessment, Health Care*
  • Pharmaceutical Services*
  • Population Surveillance*
  • Tuberculosis, Pulmonary / drug therapy
  • Tuberculosis, Pulmonary / epidemiology*


  • Antitubercular Agents