Improving the early diagnosis of extrapulmonary tuberculosis through fine needle aspiration training and telepathology support for primary healthcare doctors.

INTERVENTION: Intervention1: Multiphase FNAC training aided by telepathology: The intervention consists of Multiphase FNAC Training Aided by Telepathology (MFAT), a structured competency‐based training program for primary care physicians aimed at improving the diagnosis of extrapulmonary tuberculosis presenting as lymphadenopathy. The intervention includes simulation‐based training on FNAC techniques, supervised observation of FNAC procedures, supervised independent FNAC practice, and telepathology support through remote expert interpretation of cytology images. Following training, physicians perform FNAC at selected Community Health Centers (CHCs) using standardized operating procedures, with telepathology consultation available to facilitate timely and accurate diagnosis. Control Intervention1: Not Applicable: Not Applicable CONDITION: Health Condition 1: A182‐ Tuberculous peripheral lymphadenopathy PRIMARY OUTCOME: Mean diagnostic delay, including mean patient delay and mean health‐system delay, measured in days from symptom onset to first healthcare consultation and from first healthcare contact to confirmed diagnosis/initiation of anti‐tubercular treatment, respectively.Timepoint: Baseline, 4 weeks and 8 weeks after enrolment: final diagnostic delay will be calculated at the time of confirmed diagnosis/initiation of anti‐tubercular treatment SECONDARY OUTCOME: FNAC diagnostic yield: sensitivity, specificity, PPV, NPV & agreement of cytological diagnosis with the reference standard & feasibility & acceptability of MFAT‐assisted FNAC at the primary‐care level.Timepoint: Baseline, 4 weeks, & 8 weeks after enrollment. diagnostic accuracy will be assessed when the reference‐standard result is available feasibility & acceptability will be assessed during the intervention & at completion of follow‐up. INCLUSION CRITERIA: Adult patients ages 18 years and above and pediatric patients aged 5 years and above presenting with cervical, axillary, or inguinal lymphadenopathy clinically suspected of extrapulmonary tuberculosis.