The reliance on mobile X-ray vans, availability of radiographers to read X-rays, adequate facilities for collecting and transporting sputum, and sufficient laboratories to process the samples posed challenges to implementing the Tamil Nadu TB prevalence survey.

Issues with Internet connectivity hindered data syncing.

In some areas, low participation and lack of community engagement posed additional challenges. Adapting the survey to the convenience of the community, involving local leadership in the survey, and providing training on community engagement strategies increased participation.

Stakeholders can learn from this experience in conducting large-scale TB surveys in endemic settings within the framework of existing systems to plan ahead for potential challenges.

Strong monitoring by an expert technical group during survey implementation can help identify and resolve operational challenges in a timely manner.

Estimating the burden of TB at the subnational level is critical to planning and prioritizing resources for TB control activities according to the local epidemiological situation. We report the experiences and operational challenges of implementing a TB prevalence survey at the subnational level in India. Information was collected from research reports that gathered data from periodic meetings, informal discussions with study teams, letters of communication, and various site visit reports. During the implementation of the survey, several challenges were encountered, including frequent turnover in human resources, lack of survey participation and community engagement, breakdown of X-ray machines, laboratory issues that delayed sputum sample testing, delays in X-ray reading, and network and Internet connectivity issues that impeded data management. To help ensure the survey was implemented in a timely manner, we developed several solutions, including planning ahead to anticipate challenges, ensuring timely communication, having a high commitment from all stakeholders, having strong team motivation, providing repetitive hands-on training, and involving local leaders to increase community engagement. This experience may help future states and countries that plan to conduct TB prevalence surveys to address these anticipated challenges and develop alternative strategies well in advance.

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