Background
TBMJA already handles the camp work up to the tests: household listing, registration, screening questions, Chest X-ray and the TrueNat test. After the camp, staff type the same people and results into Ni-kshay again by hand. This takes time, causes mistakes and is hard to track.

What happens today

• TBMJA covers the camp work up to the tests.
• Creating the Ni-kshay record, entering test results, adding contacts and transferring the patient are all done by hand in Ni-kshay.
• TBMJA cannot show who has been sent to Ni-kshay, who failed, or how many were enrolled and tested through it.

What we need
Once a person’s camp details are complete (registration, screening and tests done), TBMJA should do the following itself:

1. Create the Ni-kshay record. First check whether the person is already in Ni-kshay (name, age, gender, mobile). If not, create a new record. If yes, act on the status of the existing record:
   • Suspected TB, still open: use the existing record and add the camp tests.
   • Suspected TB, closed: start a new episode under the existing record and add tests.
   • Confirmed TB, not on treatment: do nothing except fetch the existing ID.
   • Confirmed TB, not on treatment, closed: start a new episode and add tests.
   • Already on treatment: do nothing except fetch the existing ID.
   • Outcome already recorded: start a new episode and add tests.
   • More than one match: hold for a supervisor to choose.
2. Send test results. Send TrueNat and Chest X-ray results to the person’s record. Allow corrected results to be updated. Mark each as “By TBMJA application”.
3. Add contacts and TB preventive treatment (TPT). If a household member is confirmed to have TB, add the other registered household members as their contacts. If someone is registered as a contact of a known TB patient, add them directly for TPT.
4. Transfer the patient. After tests are sent, transfer the person to the health centre assigned to their village, for treatment or TPT. This can be automatic or by hand.

Changes in TBMJA

• Five tabs in the MMU module: Generate Ni-kshay ID, X-ray Test, NAAT Test, Failed Beneficiaries, Transfer Out. Each shows only the people ready for that step.
• Logins: the single organisation login is dropped. The NAAT device and the X-ray device each get their own login, used only for TBMJA, and TBMJA picks the right one from the device ID. Nobody chooses a health centre.
• An admin screen to maintain each device’s details, the village links, and the assigned health centre for each village. Passwords are entered only here, shown hidden, and never written in logs or exports.
• For each step, Admin chooses automatic or manual. If the automatic run is late, keeps failing or is paused, Admin is alerted and a “Push now” option appears for supervisors and Admin.
• A Failed Beneficiaries tab showing the step, reason, details and attempts. Staff can fix the record and reprocess one person or many. If Ni-kshay is down, TBMJA tries 3 times before marking the person as failed.
• A status for each person and reports on enrolled, tested, contacts added, transferred and failed, with reasons, by camp, health centre and date.

Key rules

• Records are checked before anything is sent. If something is wrong, nothing is sent and staff see which fields to fix.
• A person is never enrolled twice, even on retry, reprocess or manual push.
• Only the details Ni-kshay requires are sent.
• Nothing is sent from an offline camp until its data has synced.
• Tests wait in a queue until the Ni-kshay record exists.

Not included

• Household listing, registration, screening, X-ray and TrueNat capture (already built).
• Starting treatment, giving medicines and follow-up in Ni-kshay.
• ABHA creation (still to be decided).
• Changes to the Ni-kshay website.

Depends on

• The programme team providing device health centres, device logins, services switched on, village links and assigned health centres.
• The configuration team adding villages to the mapping.
• Ni-kshay services for creating records, adding tests, adding contacts and transferring.

Still to be confirmed

• Which steps run automatically and which by hand, plus the schedule, batch size and the delay and failure limits.
• What happens for confirmed TB, and for X-ray results that suggest TB.
• The exact details the contact-adding service needs.
• How to handle a person with several possible matches in Ni-kshay.
• Fixed values still marked “to confirm”: case-finding type, ABHA default and “Type of case” for TrueNat.
• The rule for people with only one name word.

Reference
BRD: “Nikshay Enrollment Flow and test addition”, v1.1 (AMRIT space, Confluence page 189104168).