“STRENGTHENING EARLY DISEASE DETECTION THROUGH COMMUNITY-BASED SCREENING: A COMPREHENSIVE REVIEW OF TUBERCULOSIS, NON-COMMUNICABLE DISEASES, AND COMMON MENTAL DISORDERS.”
Main Article Content
Keywords
Community-based screening; Tuberculosis; Non-communicable diseases; Mental health; Early detection; Active case finding; Dig
Abstract
Introduction
Tuberculosis (TB), non-communicable diseases (NCDs), and common mental disorders contribute substantially to the global and Indian disease burden, particularly in low-resource settings where delayed diagnosis remains a persistent challenge. Facility-based services alone have been unable to close the diagnostic gap, making community-based screening an essential strategy for early
identification and timely referral.
Aims and Objectives
The review aims to evaluate the role, effectiveness, and challenges of community-based screening models for TB, NCDs, and mental health disorders. Specific objectives include synthesizing global, national, and Gujarat-based evidence, assessing screening strategies and innovations, and identifying gaps and opportunities for strengthening community-level early detection.
Methodology
A narrative review was conducted using PubMed, Google Scholar, Scopus, WHO databases, and national programme reports. Keywords related to community screening, TB detection, NCD screening, and mental health assessment were used. Inclusion criteria focused on community-based, CHW-led, or household-level screening approaches. Data were synthesised thematically across
disease groups and screening strategies.
Content Review / Results
Evidence indicates that community-based TB screening through active case finding, contact tracing, and AI-supported chest radiography increases case detection by 30–60%. Community screening for NCDs improves early identification of hypertension, diabetes, and obesity, especially when integrated with household visits and digital tools. Mental health screening using PHQ-9, GAD-7,
AUDIT, and mhGAP protocols enhances detection of depressive and anxiety disorders in underserved populations. Integrated multi-disease screening models, supported by Health and Wellness Centres, digital technologies, and AI tools, improve efficiency and scalability.
Conclusion
Community-based screening models substantially improve early detection of TB, NCDs, and mental health disorders. Integrating screening into routine CHW workflows, supported by digital tools and strong referral systems, is essential to advance Universal Health Coverage and national health goals. Future efforts must prioritize scalability, digital integration, supply-chain stability, and
sustained community engagement.
References
2. World Health Organization. TB Missing Millions Initiative Report. Geneva: World Health Organization; 2022.
3. World Health Organization. Noncommunicable Diseases: Key Facts. Geneva: World Health Organization; 2023.
4. World Health Organization. Depression and Other Common Mental Disorders: Global Health Estimates. Geneva: World Health Organization; 2017.
5. Patel V, Chisholm D, Parikh R, Charlson F, Degenhardt L, Dua T, Ferrari A, Hyman S, Whiteford H, Saxena S. Addressing the burden of mental, neurological, and substance use disorders: key messages from Disease Control Priorities. Lancet. 2016;387:1672–1685.
6. Ministry of Health and Family Welfare. India TB Report 2024. New Delhi: Central TB Division, MoHFW; 2024.
7. National Centre for Disease Control. National NCD Monitoring Survey (NNMS) 2020. New Delhi: NCDC; 2020.
8. National Institute of Mental Health and Neurosciences. National Mental Health Survey of India 2015–2016. Bengaluru: NIMHANS; 2016.
9. Central TB Division. State TB Profile: Gujarat. In: India TB Report 2024. New Delhi: Ministry of Health and Family Welfare; 2024.
10. International Institute for Population Sciences. National Family Health Survey – 5 (2019–21), Gujarat Fact Sheet. Mumbai: IIPS; 2021.
11. MacPherson P, Houben RMGJ, Glynn JR, Corbett EL, Kranzer K.Pre-treatment loss to follow-up in tuberculosis patients in low- and lower-middle-income countries and high-burden countries: a systematic review and meta-analysis.Bull World Health Organ. 2014;92(2):126–138.doi:10.2471/BLT.13.124800
12. Cazabon D, Alsdurf H, Satyanarayana S, Nathavitharana R, Subbaraman R, Daftary A, Pai M. Quality of tuberculosis care in high burden countries: the urgent need to address gaps in the care cascade. Int J Infect Dis. 2017 Mar;56:111-116.
13. NCD Risk Factor Collaboration (NCD-RisC).Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019. Lancet. 2021;398(10304):957–980. doi:10.1016/S0140-6736(21)01330-1
14. Sagili KD, Muniyandi M, Shringarpure K, Singh K, Kirubakaran R, Rao R, Tonsing J, Sachdeva KS, Tharyan P. Strategies to detect and manage latent tuberculosis infection among household contacts of pulmonary TB patients in high TB burden countries – a systematic review and meta-analysis. Trop Med Int Health. 2022 Oct;27(10):842–863. doi:10.1111/tmi.13808.
15. Piette JD, List J, Rana GK, Townsend W, Striplin D, Heisler M.Mobile health devices as tools for worldwide cardiovascular risk reduction and disease management. Circulation. 2015;132(21):2012–2027.doi:10.1161/CIRCULATIONAHA.114.008723
16. World Health Organization. Global Status Report on Noncommunicable Diseases 2022. Geneva: World Health Organization; 2022.
17. Ved RR, Gupta G, Singh S.India’s Health and Wellness Centres: revitalising primary health care for universal health coverage.Indian J Med Res. 2019;150(4):353–360.doi:10.4103/ijmr.IJMR_1257_19
18. Jeon CY, Murray MB.Diabetes mellitus increases the risk of active tuberculosis: a systematic review of 13 observational studies.PLoS Med. 2008;5(7):e152.doi:10.1371/journal.pmed.0050152
19. Basu P, Mahajan M, Patira N, et al. A pilot study to evaluate home-based screening for the common non-communicable diseases by a dedicated cadre of community health workers in a rural setting in India. BMC Public Health. 2019;19:14. doi:10.1186/s12889-018-6350-4.
20. Hossain MM, Tasnim S, Sharma R, Sultana A, Shaik AF, Faizah F, Kaur R, Uppuluri M, Sribhashyam M, Bhattacharya S. Digital interventions for people living with non-communicable diseases in India: A systematic review of intervention studies and recommendations for future research and development. Digit Health. 2019 Dec 16;5:2055207619896153. doi: 10.1177/2055207619896153. PMID: 31897307; PMCID: PMC6920343.
21. Kranzer K, Afnan-Holmes H, Tomlin K, Golub JE, Shapiro AE, Schaap A, Corbett EL, Lönnroth K, Glynn JR. The benefits to communities and individuals of screening for active tuberculosis disease: a systematic review. Int J Tuberc Lung Dis. 2013 Apr;17(4):432-46. doi: 10.5588/ijtld.12.0743. PMID: 23485377.
22. Ministry of Health and Family Welfare. Operational Guidelines for Health and Wellness Centres under Ayushman Bharat. New Delhi: MoHFW; 2022.
23. Harries AD, Kumar AM, Satyanarayana S, Lin Y, Zachariah R, Lönnroth K, Kapur A. Diabetes mellitus and tuberculosis: programmatic management issues. Int J Tuberc Lung Dis. 2015 Aug;19(8):879-86. doi: 10.5588/ijtld.15.0069. PMID: 26162352; PMCID: PMC4497633.
24. Katende B, Bresser M, Kamele M, Chere L, Tlahali M, Erhardt RM, et al. (2023) Impact of a multi-disease integrated screening and diagnostic model for COVID-19, TB, and HIV in Lesotho. PLOS Glob Public Health 3(8): e0001488. https://doi.org/10.1371/journal.pgph.0001488
25. McCombe G, Lim J, Hout MCV, Lazarus JV, Bachmann M, Jaffar S, Garrib A, Ramaiya K, Sewankambo NK, Mfinanga S, Cullen W. Integrating Care for Diabetes and Hypertension with HIV Care in Sub-Saharan Africa: A Scoping Review. Int J Integr Care. 2022 Jan 31;22(1):6. doi: 10.5334/ijic.5839. PMID: 35136387; PMCID: PMC8815447.
26. Scott K, Beckham SW, Gross M, Pariyo G, Rao KD, Cometto G, Perry HB. What do we know about community-based health worker programs? A systematic review of existing reviews on community health workers. Hum Resour Health. 2018 Aug 16;16(1):39. doi: 10.1186/s12960-018-0304-x. PMID: 30115074; PMCID: PMC6097220.
27. Agarwal S, Sripad P, Johnson C, Kirk K, Bellows B, Ana J et al. A conceptual framework for measuring community health workforce performance within primary health care systems. Hum Resour Health. 2019 Nov 20;17(1):86. doi: 10.1186/s12960-019-0422-0. PMID: 31747947; PMCID: PMC6868857.
28. Sinha P, Moll AP, Brooks RP, Deng YH, Shenoi SV. Synergism between diabetes and human immunodeficiency virus in increasing the risk of tuberculosis. Int J Tuberc Lung Dis. 2018 Jul 1;22(7):793-799. doi: 10.5588/ijtld.17.0936. PMID: 29914606; PMCID: PMC6050202.
29. Aitambayeva N, Aringazina A, Nazarova L, Faizullina K, Bapayeva M, Narymbayeva N, Svetlanova S. A Systematic Review of Tuberculosis Stigma Reduction Interventions. Healthcare (Basel). 2025 Jul 29;13(15):1846. doi: 10.3390/healthcare13151846. PMID: 40805879; PMCID: PMC12346600.
30. Atre S, Barthwal M, Gaikwad S, Sawant T, Sahasrabudhe T, Kakrani A, Lokhande R, Deshmukh S, Raskar S, Hodgar B, Jadhav V, Gupte N, Gupta A, Golub J, Mave V. Cascade of care for people with TB and diabetes in India. Int J Tuberc Lung Dis. 2022 Aug 1;26(8):787-788. doi: 10.5588/ijtld.22.0180. PMID: 35898132.
31. Qin ZZ, Ahmed S, Sarker MS, et al. Can artificial intelligence (AI) be used to accurately detect tuberculosis (TB) from chest X-ray? A multiplatform evaluation of five AI products used for TB screening in a high TB-burden setting. arXiv [Preprint]
32. Ministry of Health and Family Welfare. Ayushman Bharat Health and Wellness Centre Operational Guidelines. New Delhi: MoHFW; 2022.
33. Rana RK, Kapoor N, Kumar D, Verma M, Taneja G. Digital Health Revolution in India: Transforming Health and Medicine. Indian J Community Med. 2024 Dec;49(Suppl 2):S205-S209. doi: 10.4103/ijcm.ijcm_803_24. Epub 2024 Dec 30. PMID: 40124867; PMCID: PMC11927824.
34. Carwile ME, Prakash Babu S, Cintron C, Dauphinais M, Pan SJ, Thulasingam M, Horsburgh CR Jr, Sarkar S, Hochberg NS, Sabin LL, Flynn D, Kumar B, Sinha P, Singh UB. TB stigma in India: A narrative review of types of stigma, gender differences, and potential interventions. PLOS Glob Public Health. 2025 Sep 22;5(9):e0005109. doi: 10.1371/journal.pgph.0005109. PMID: 40982550; PMCID: PMC12453202.
35. Prathiksha G, Daniel BD, Natrajan M. Active case-finding for tuberculosis in India. Natl Med J India 2019;32:90-95
36. Vijayan S, Jondhale V, Pande T, Khan A, Brouwer M, Hegde A. Implementing a chest X-ray artificial intelligence tool to enhance tuberculosis screening in India: lessons learned. PLOS Digit Health. 2023;2(12):e0000404. doi:10.1371/journal.pdig.0000404.
37. Singh UB, Rade K, Rao R, Kumar N, Mattoo SK, Nair S, Zumla A, Sahu S. Lessons and updates from India’s National Tuberculosis Elimination Program: bold decisions and innovative ways of fast-tracking progress toward ending tuberculosis. IJID Reg. 2025;14(Suppl 2):100599. doi:10.1016/j.ijregi.2025.100599. PMID:40201556; PMCID:PMC11973646.
38. Shah H, Sabhahit GG, Patley R. A pan-India digitally driven capacity-building program to strengthen primary mental healthcare: summary of its implementation and performance evaluation. Indian J Psychol Med. 2025;47:1–10. doi:10.1177/02537176251358469.
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Tejas Shah
Associate Professor, Community Medicine Department, GMERS Medical College and Hospital, Dharpur- Patan
Parth Thakar
Assistant Professor, Community Medicine Department, GMERS Medical College and Hospital, Dharpur- Patan
Venu Shah
Professor, Community Medicine Department, GCS Medical College, Hospital & Research Centre, Ahmedabad
