{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T19:08:10Z","timestamp":1772219290511,"version":"3.50.1"},"reference-count":30,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T00:00:00Z","timestamp":1772150400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Tuberculosis (TB) remains a leading cause of death globally. India aims to eliminate TB by 2025; however, persistently high mortality rates suggest critical failures in early intervention, particularly among vulnerable populations. This study examined the clinical, social, and system factors associated with accelerated mortality among notified persons with TB (PwTB) in Western India.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross-sectional study was conducted in six districts of Gujarat, India, during 2023\u20132024 using Community-Based Verbal Autopsy (CBVA) among relatives of 149 deceased PwTB. Sociodemographic, clinical, and TB care cascade data were collected, and a retrospective time-to-event analysis was performed. A Cox proportional hazards model was used to assess the factors associated with a shorter time from diagnosis to death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Majority of deceased belonged to 26\u201350 years age group (40%), with a high male predominance (81.9%). Nearly half (48.3%) had comorbidities, and 65.8% had a history of addiction. A substantial median delay of approximately five weeks was observed between symptom onset and treatment initiation. Following a confirmed diagnosis, the majority of deaths (nearly 80%) occurred within the first 16 weeks. A comparable trend was noted after the start of treatment, with about 78% of fatalities occurring within 15 weeks. In the adjusted Cox regression model, key population status (HR\u2009=\u20091.5, p\u2009=\u20090.01), presence of comorbidities (HR\u2009=\u20092.0, p\u2009&lt;\u20090.001), and drug-resistant tuberculosis (HR\u2009=\u20091.7, p\u2009=\u20090.003) were independently associated with a shorter time from diagnosis to death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>The findings highlighted the convergence of clinical complexity, social vulnerability, and persistent system constraints that shorten survival, even after treatment initiation. Strengthening early case diagnosis, integrating comorbidity management, improving health system responsiveness, and implementing targeted strategies for vulnerable populations are critical. A systematic TB Death Surveillance and Response System (TBDSR), integrating facility-, community-based reviews, and digital reporting, would provide actionable insights to inform timely intervention and support progress towards TB elimination in India and other high-burden settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0343271","type":"journal-article","created":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T18:22:28Z","timestamp":1772216548000},"page":"e0343271","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Factors accelerating time to death among persons with Tuberculosis in Western India: Evidence from a community-based retrospective death audit"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3349-7562","authenticated-orcid":true,"given":"Harsh","family":"Shah","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1486-0821","authenticated-orcid":true,"given":"Jay","family":"Patel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Somen","family":"Saha","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bhavesh","family":"Modi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pankaj","family":"Nimavat","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,2,27]]},"reference":[{"issue":"3","key":"pone.0343271.ref001","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/S1473-3099(17)30703-X","article-title":"The global burden of tuberculosis: results from the global burden of disease study 2015","volume":"18","author":"GBD Tuberculosis Collaborators","year":"2018","journal-title":"Lancet Infect Dis"},{"key":"pone.0343271.ref002","author":"World Health Organization"},{"key":"pone.0343271.ref003","author":"World Health Organization","year":"2024"},{"key":"pone.0343271.ref004","author":"National Tuberculosis Elimination Programme CTD G of I"},{"issue":"2","key":"pone.0343271.ref005","doi-asserted-by":"crossref","first-page":"24","DOI":"10.15406\/jlprr.2021.08.00246","article-title":"Scenario of Tuberculosis in India","volume":"8","author":"JP Shrivastava","year":"2021","journal-title":"JLPRR"},{"issue":"1","key":"pone.0343271.ref006","doi-asserted-by":"crossref","first-page":"010423","DOI":"10.7189\/jogh.09.010423","article-title":"Health systems performance in managing tuberculosis: analysis of tuberculosis care cascades among high-burden and non-high-burden countries","volume":"9","author":"J Kim","year":"2019","journal-title":"J Glob Health"},{"issue":"1","key":"pone.0343271.ref007","doi-asserted-by":"crossref","DOI":"10.1186\/s12982-024-00209-7","article-title":"Analysis of errors in medical certificates of cause of death (MCCD) at a tertiary care institute in 2022","volume":"21","author":"N Sharma","year":"2024","journal-title":"Discov Public Health"},{"issue":"3","key":"pone.0343271.ref008","doi-asserted-by":"crossref","first-page":"163","DOI":"10.4103\/ijph.IJPH_433_19","article-title":"Mortality surveillance in India: Past, present, and future","volume":"63","author":"A Krishnan","year":"2019","journal-title":"Indian J Public Health"},{"key":"pone.0343271.ref009","doi-asserted-by":"crossref","first-page":"100155","DOI":"10.1016\/j.jctube.2020.100155","article-title":"Tuberculosis deaths are predictable and preventable: Comprehensive assessment and clinical care is the key","volume":"19","author":"A Bhargava","year":"2020","journal-title":"J Clin Tuberc Other Mycobact Dis"},{"issue":"1","key":"pone.0343271.ref010","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2019-002080","article-title":"Tuberculosis case fatality in India: a systematic review and meta-analysis","volume":"5","author":"S Huddart","year":"2020","journal-title":"BMJ Glob Health"},{"key":"pone.0343271.ref011","article-title":"NIKSHAY- A web-based solution for monitoring of TB patients","volume-title":"Health Informatics Division, NIC, Govt of India","author":"SK NIKSHAY","year":"2013"},{"issue":"4","key":"pone.0343271.ref012","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1016\/j.ijtb.2018.05.001","article-title":"Why are people dying due to tuberculosis? 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