Pune, Maharashtra Aug 17: A landmark tuberculosis (TB) research project conducted through a collaboration between Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, Johns Hopkins University, and India’s National Tuberculosis Elimination Programme (NTEP) has generated important new evidence on the long-term health risks faced by individuals who have completed TB treatment. The findings, published in The Lancet Global Health, show that TB survivors and their household contacts continue to face a substantial risk of developing tuberculosis even after successful completion of treatment.
The TB Aftermath (TBAM) study followed 1,076 TB survivors and 3,309 household contacts across six government TB clinics in Pune, Maharashtra, including both urban and rural settings. Conducted from 21 January 2021 to 4 September 2023, the study followed 1,076 TB survivors and their 3,309 household contacts for 18 months after treatment completion. The research compared two practical approaches to post-treatment screening—phone-based follow-up and home-based screening—across six government TB clinics in Pune, Maharashtra, to identify an effective and scalable model for routine implementation under NTEP.
The study was funded by the US National Institute of Allergy and Infectious Diseases (NIAID) and led by Dr. Jonathan E. Golub of Johns Hopkins University, Baltimore. Dr. Vidya Mave served as India Principal Investigator, while Prof. M. S. Barthwal, Professor of Respiratory Medicine at Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pimpri, and Prof. A. L. Kakrani, Professor of Clinical Eminence in Medicine and Director, Academic Collaborations at Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, served as India Site Investigator and India Site Co-Investigator, respectively.
The trial found that phone-based screening was non-inferior to home-based screening for detecting TB among TB survivors and their household contacts combined, suggesting that telephone follow-up could provide a practical and resource-efficient strategy for large public health programmes. However, for detecting recurrent TB among TB survivors specifically, home-based screening identified significantly more cases, indicating that in-person follow-up may be particularly valuable in high-burden settings such as India where TB recurrence remains common. Overall, 75 TB survivors (7%) experienced recurrent TB during the follow-up period, while 30 household contacts (1%) were newly diagnosed with TB. The study also found that the median time to diagnosis was less than six months after treatment completion, highlighting that the post-treatment period is a critical window for active surveillance.
One of the most innovative aspects of this study was bringing portable spirometry directly into participants’ homes, enabling assessment of lung health without requiring TB survivors to travel to a hospital. The findings show that comprehensive post-TB care—including monitoring for recurrent TB and long-term lung damage—can be delivered closer to where people live, reinforcing the need to make structured post-treatment follow-up a routine part of TB care.
The researchers hope these findings will help guide policy decisions on post-treatment TB surveillance and screening and support the development of practical, patient-centred follow-up strategies in high-burden countries such as India.
Dr M. S. Barthwal, India Site Investigator at Dr. D. Y. Patil Medical College, Hospital & Research Centre and Professor in the Department of Respiratory Medicine, said “One of the most important messages from this study is that successful completion of TB treatment should not mark the end of clinical follow-up. Our study demonstrates the importance of actively looking for TB recurrences after treatment completion. When recurrent disease goes undetected, patients continue to suffer, and the resulting lung damage can significantly impact their quality of life. Early identification and treatment can help reduce both transmission and long-term morbidity.”
Dr Vidya Mave, Director of the Centre for Infectious Diseases in India (CIDI) and Principal Investigator for the TB Aftermath Study, said ,” An interesting finding was the increasing contribution of prior extrapulmonary tuberculosis among people who had altered lung function tests and developed recurrence. Although the route of transmission remains the same, the disease may manifest outside the lungs, emphasizing the need for comprehensive follow-up of all TB survivors and greater attention to detecting recurrences regardless of the initial disease presentation.“
“Completing treatment is a major milestone, but for many people, the journey with TB does not end there.,” said Dr. Jonathan Golub, Principal investigator from Johns Hopkins University, Baltimore. “Our study offers strong evidence that TB survivors in high-incidence settings like India are a high–risk group that would benefit from recurrence screening. These findings have important policy implications that extend beyond India.”
Dr. Samyra Cox from Johns Hopkins University, Baltimore, added that, “We showed that by altering just one component of the post-TB screening intervention—the delivery method—we can double recurrence detection. But there’s more work to be done to further optimize the intervention, including when we should screen TB survivors and which screening tools we should use to find recurrences earlier. “
Prof. A. L. Kakrani, Professor of Clinical Eminence in Medicine and Director, Academic Collaborations, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, said: With optimal use of the existing healthcare workforce, structured telephone-based follow-up after TB treatment can identify many cases that might otherwise remain undetected. Telephone-based screening is a practical and scalable option for resource-limited health systems. However, our findings also show that home-based screening is significantly more effective for detecting recurrent TB among survivors, underscoring the value of targeted in-person follow-up for this high–risk group.”
Hon’ble Dr. (Mrs.) Bhagyashree P. Patil, Pro-Chancellor, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pimpri, Pune, added, “What makes this study especially significant is its focus on the period after patients are declared cured. Many TB survivors continue to face health risks that often go unnoticed. By highlighting the importance of ongoing screening and follow-up, the TB Aftermath study reinforces the need for a more comprehensive, patient-centred approach to tuberculosis care that includes prevention, surveillance, and long-term support for survivors and their families.”
Dr. Rekha Arcot, Dean, Dr. D.Y. Patil Medical College,Hospital & Research Centre, Pimpri, Pune, said , “We are proud that our institution has contributed to research published in The Lancet Global Health, one of the world’s leading medical journals. The TB Aftermath study reflects our commitment to advancing evidence-based healthcare that addresses not only the treatment of disease, but also the long-term wellbeing of patients after therapy is completed. Such collaborative research has the potential to influence public health policy and improve the quality of TB care across India.”
According to the authors, TB Aftermath is the first published individually randomised trial evaluating systematic TB screening after treatment completion. The findings provide strong evidence that TB survivors remain a high–risk group that would benefit from structured post-treatment surveillance and could help inform future NTEP policy decisions on follow-up care.
Tuberculosis remains one of the world’s leading infectious disease killers, yet the health of individuals after they are declared cured has received relatively little attention. The TB Aftermath Study demonstrates that systematic follow-up can enable earlier detection of recurrent TB, improve patient outcomes, reduce onward transmission, and lessen the long-term burden of post-tuberculosis lung disease (PTLD). The researchers hope these findings will support stronger post-treatment surveillance policies and more practical, patient-centred follow-up strategies in India and other high-burden countries.