: Soil-transmitted helminths (STHs) remain a major public health concern, especially in low- and middle-income countries. Although Ascaris lumbricoides , Trichuris trichiura , and hookworms ( Ancylostoma duodenale and Necator americanus ) are commonly identified in humans, emerging evidence using molecular diagnostics capable of differentiating morphologically similar ova suggests zoonotic drivers of transmission, particularly in areas with close human–animal interaction. This pilot study investigated human and animal STH infections across nine villages of Meghalaya in the northeastern region of India, using quantitative polymerase chain reaction with species-specific primers. The estimated STH prevalence was 23.3% (95% CI: 17.9–29.9%). Zoonotic potential was evident, with Ancylostoma ceylanicum detected in humans (2.8%), and Ascaris spp. and Necator americanus detected in pigs (64.5% and 3.2%, respectively) and goats (15.2% and 3.0%, respectively). To meet World Health Organization’s target of eliminating STH morbidity by 2030, endemic regions may need to adopt an integrated One Health approach.