Active case finding (ACF) for tuberculosis (TB) was implemented in 60 selected high TB burden wards of Kolkata, India. Community volunteers called TOUCH (Targeted Outreach for Upliftment of Community Health) agents (TAs) identified and referred presumptive TB patients (PTBPs) to health facilities for TB diagnosis and treatment. We aimed to describe the “care cascade” of PTBPs that were identified during July to December 2018 and to explore the reasons for attrition as perceived by TAs and PTBPs. An explanatory mixed-methods study with a quantitative phase of cohort study using routinely collected data followed by descriptive qualitative study with in-depth interviews was conducted. Of the 3,86242 individuals that were enumerated, 1132 (0.3%) PTBPs were identified. Only 713 (63.0%) PTBPs visited a referred facility for TB diagnosis. TB was diagnosed in 177 (24.8%). The number needed to screen for one TB patient was 2183 individuals. The potential reasons for low yield were stigma and apprehension about TB, distrust about TA, wage losses for attending health facilities, and substance abuse among PTBPs. The yield of ACF was suboptimal with low PTBP identification rate and a high attrition rate. Interviewing each individual for symptoms of TB and supporting PTBPs for diagnosis through sputum collection and transport can be adopted to improve the yield.

The burden of psychological distress is increasing with the spread of the pandemic and also with the enforcement of its containment measures. The aim of this research was to determine the proportion of self-reported psychological distress, loneliness and degrees of resilient coping, and to also investigate the relationship of loneliness, coping and other variables with psychological distress among apparently healthy Indians during nation-wide lockdown period. A cross-sectional, region-stratified survey using pre-designed pre-tested Google form disseminated via different social media platforms was conducted. A total of 1249 responses were analysed all over India. The form enquired about Socio-demographic profile, awareness on COVID pandemic and cases in the surroundings. UCLA Loneliness scale, Brief resilience and coping scale (BRCS) and Psychological distress scale (K6) assessed self-reported loneliness, coping and psychological distress, respectively. Special regressor technique adjusting for endogeneity and heteroskedasticity was used to extract the average marginal effects. Majority of the respondents were 18–35 years old, male, single and urban residents. News media, social media mostly acted as sources of information regarding COVID related news. Overall, 54.47% (95% CI: 51.39–57.53%) and 38.39% (95% CI: 35.57–41.29%) were reported to be lonely and had low resilient coping ability respectively. Around 44.68% had high risk of developing psychological distress. Being a student (average marginal effect coefficient (AME_Coef)_.: -0.07, 95% CI: [-0.12, -0.01]) and perceiving lockdown as an effective measure (AME_Coef: -0.11, 95% CI: [-0.19, -0.03]) were protective against psychological distress. Psychological distress was associated with male respondents (AME_Coef 0.07, 95% CI: [0.02, 0.11]), low or medium resilient copers (AME_Coef 0.89, 95% CI: [0.17, 1.61]), and perceiving a serious impact of social distancing measures (AME_Coef 0.17, 95% CI: [0.09, 0.26]). Psychological distress among Indian population during lockdown was prevalent. Poor coping ability and perceiving social distancing to have a serious impact was found to be significantly contributing to psychological distress. Appropriate measures to address these issues would be beneficial for the community mental health.