Sex-disaggregated patterns in tuberculosis treatment coverage and outcomes among a nationally representative sample of deaths in India: 2019–2022

Background: We report on TB treatment coverage and outcomes by sex among a nationally representative sample of deaths in the background of the national framework for a gender-responsive approach to TB adopted by India. Methods: Detailed interviews were undertaken for a nationally representative sample of deaths of all ages between 2019 and 2022 from the adult most knowledgeable about the deceased. Details about TB treatment were documented for females and males for whom history of TB diagnosis ever. Findings: Detailed data were available for 26,957 (92.1% participation) deaths. The prevalence of TB diagnosis ever was 2.9% (95% CI 2.6–3.2) and 5.8% (95% CI 5.4–6.1) among females and males, respectively. TB treatment coverage was similar for females (81.4%; 95% CI 76.7–85.3) and males (82.4%; 95% CI 79.8–84.7). TB treatment coverage was significantly lower for males with TB diagnosis in years 2021 and 2022 as compared to those diagnosed in 2019 (−12.1%; 95% CI −22.7 to −1.5). A similar proportion of females (55%) and males (58.9%) were on TB treatment at the time of death, had completed TB treatment (39.3% females and 35% males, and had discontinued TB treatment (5.3% females and 5.2% males); significant variation in treatment status was seen by age and state for both, and by wealth index quartile for males. Majority took TB treatment from public sector (females 72.9% and males 76.0%). Interpretation: The sex-disaggregated findings from this nationally representative sample of deaths are a value-add to effectively address TB in India as majority of such understanding towards gender-responsive strategies is available from those who are alive. Funding: United States Agency for International Development (USAID).