StepOne’s TB work: telemedicine to fast-track TB elimination
We are applying the model that handled 40% of India’s Covid-19 caseload to tuberculosis: finding presumptive TB patients earlier and helping every diagnosed patient complete treatment. A programme of Project StepOne with the TB programme, Department of Health & Family Welfare, Government of Karnataka.
Karnataka — piloted in Bangalore Rural district (2024–25); pilots in Jammu & Kashmir
State TB departments, private doctors, presumptive and diagnosed TB patients and their caregivers
Early screening of presumptive TB patients, and adherence monitoring for everyone on treatment
A long-term programme — built to scale statewide and to more states
We expect our TB impact to exceed our Covid-19 impact
Two interventions, two measurable outcomes. These are StepOne’s projections for a statewide rollout in Karnataka.
Early screening of presumptive TB patients through technology
increase in early TB detection — 36,000–60,000 new cases a year in Karnataka alone.
Preventing illness and death by driving treatment adherence
better treatment compliance through monitoring — 4,000–8,000 patients a year.
The problem
Tuberculosis remains one of India’s biggest public health problems. By World Health Organization estimates, India has the world’s largest TB epidemic — about 26% of global cases in 2020 — with an incidence of around 192 cases per 1,00,000 people and roughly 2.2 lakh deaths a year.
The burden persists because of:
- Delays in diagnosis and treatment, often because symptoms are ignored
- Poor nutrition and general health
- Pollution, overcrowding and poor hygiene that spread infection
- Patients stopping medication early, leading to relapse
- Weak monitoring of treatment efficacy and adherence — especially in drug-resistant cases
What Covid-19 taught us that applies to TB
- A telemedicine helpline encourages people to seek care
- Surveillance for progression, remission and relapse is paramount
- Patient education is essential to effective care
- Technology significantly reduces the burden on facilities and providers
- Triage protocols are standard enough to train people on
- Referrals to labs and hospitals can be well coordinated
Proactive and reactive support, end to end
Treatment compliance monitoring
Using the line list of presumptive and notified TB patients, our volunteer network and IVRS calls check adherence, symptoms and general health. Patients at risk get consultations and counselling.
A statewide TB helpline in Kannada
Citizens can report symptoms that warrant testing or ask about TB; diagnosed patients can report worsening symptoms and trigger a tele-consultation with a nearby doctor.
Private provider outreach
Better communication with private providers for notification and coordinated treatment, with training and certification by the State TB division.
Patient and caregiver education
Tips and information on TB for patients, caregivers and community health workers, for better-informed patients and higher compliance.
From line list to completed treatment
Line list received
The state TB programme shares its list of presumptive and notified TB patients.
Scheduled calls
Manual and IVRS calls check symptoms, adherence and general health at set weeks.
Exceptions flagged
Patients at risk — new symptoms, missed doses, side effects — are flagged.
Counsel & escalate
A health worker counsels the patient and escalates to a doctor for tele-consultation.
Refer
The doctor refers to a hospital or lab as needed; the patient is followed to completion.
For presumptive TB patients
Calls in weeks 1, 2 and 4 raise awareness of TB symptoms and, for those still symptomatic without treatment, encourage testing and reduce delays in diagnosis. We ask whether symptoms persist, whether TB has been confirmed and treatment started, about diabetes, hypertension, smoking and alcohol, and about any barriers to care.
For patients on treatment
An onboarding call explains the treatment course, side effects, the government’s monthly nutrition support for TB patients, contact testing and the helpline. Manual compliance calls follow in the early weeks, IVRS check-ins every other week, and a pre-closure call before the patient completes treatment.
A platform and a volunteer movement tested at national scale
The same technology and people that ran StepOne’s Covid-19 response — enhanced since, and with clinical and process flows now extended to TB, dengue, Japanese encephalitis, diabetes and mental health.
- Phone calls & IVRS
- SMS
- Chatbots
- Workflow engine
- Task manager
- Patient interaction manager
- Role-based access control
- Volunteer app for doctors and health workers
- Public health workflows and government programme data, such as TB line lists
Our doctor volunteers are supported by leading doctor associations and medical universities, and StepOne recently brought India’s second-largest medical volunteer group into its network.
Designed to scale
- Local language for patients and health workers
- Standard protocols based on national programme guidelines
- Certified providers — every health worker trained on the protocols
- Distributed workforce that can work from anywhere, easing local staff shortages
- Tie-ups with PHCs, CHCs and hospitals for a smooth patient journey
Rolled out incrementally: tested at district level, then scaled as lessons are learned.
Expected outcomes
- Better detection of new TB cases through end-to-end tracking and an easy-to-reach helpline
- Robust data on symptoms, progression and adherence
- Direct, personal communication with every patient
- Lower morbidity, mortality and spread of disease
Status
Piloted in Bangalore Rural with positive results; preparing to scale across Karnataka, with interest from more states.
TB programme: common questions
How does StepOne's TB tele-monitoring work?
StepOne receives the government line list of presumptive and notified TB patients. Trained health workers and automated IVRS calls check each patient's symptoms and treatment compliance on a set schedule. Exceptions are triaged by a health worker who counsels the patient and, if needed, escalates to a doctor for a tele-consultation and referral to a hospital or lab.
Where has the TB programme been piloted?
The programme was piloted in Bangalore Rural district, Karnataka, in 2024–2025 with the state TB programme, with further pilots in Jammu & Kashmir. It is being prepared to scale across Karnataka.
What impact does StepOne expect from its TB programme?
For a statewide rollout in Karnataka, StepOne projects a 3–5% increase in early TB detection (36,000–60,000 new cases a year) and 5–10% better treatment compliance through monitoring (4,000–8,000 patients a year).
Who does the calling and consultations?
StepOne's volunteer network — about 7,000 active medical professionals and trained citizen volunteers — working through StepOne's Conductor platform, which routes calls, tasks and escalations and controls who can see patient data.
What languages does the TB helpline use?
The patient interface and the health workers' system are in the local language — in Karnataka, Kannada — because patients describe symptoms best in their own language.
Bring TB tele-monitoring to your district
We work with state and district TB programmes to set up tele-monitoring and helplines in the local language.