Outcomes and Challenges in the Programmatic Implementation of Tuberculosis Preventive Therapy among Household Contacts of Pulmonary TB Patients: A Mixed-Methods Study from a Rural District of Karnataka, India

U C Samudyatha; Kathirvel Soundappan; Gomathi Ramaswamy; Kedar Mehta; Chandan Kumar; M Jagadeesh; B T Prasanna Kamath; Neeta Singla; Pruthu Thekkur

doi:10.3390/tropicalmed8120512

Outcomes and Challenges in the Programmatic Implementation of Tuberculosis Preventive Therapy among Household Contacts of Pulmonary TB Patients: A Mixed-Methods Study from a Rural District of Karnataka, India

Trop Med Infect Dis. 2023 Nov 30;8(12):512. doi: 10.3390/tropicalmed8120512.

Authors

U C Samudyatha¹, Kathirvel Soundappan², Gomathi Ramaswamy³, Kedar Mehta⁴, Chandan Kumar⁵, M Jagadeesh⁵, B T Prasanna Kamath¹, Neeta Singla⁶, Pruthu Thekkur⁷

Affiliations

¹ Department of Community Medicine, Sri Devaraj Urs Medical College, Sri Devaraj Urs Academy of Higher Education and Research (SDUAHER), Tamaka, Kolar 563101, India.
² Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
³ Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bibinagar, Hyderabad 508126, India.
⁴ Department of Community Medicine, GMERS Medical College, Gotri, Vadodara 390021, India.
⁵ District Health Office, Kolar 536101, India.
⁶ National Institute for Tuberculosis Research and Respiratory Diseases, New Delhi 110030, India.
⁷ Centre for Operational Research, International Union against Tuberculosis and Lung Disease, 2 Rue Jean Lantier, 75001 Paris, France.

Abstract

The National TB Elimination Programme (NTEP) of India is implementing tuberculosis preventive treatment (TPT) for all household contacts (HHCs) of pulmonary tuberculosis patients (index patients) aged <5 years and those HHCs aged >5 years with TB infection (TBI). We conducted an explanatory mixed-methods study among index patients registered in the Kolar district, Karnataka during April-December 2022, to assess the TPT cascade and explore the early implementation challenges for TPT provision. Of the 301 index patients, contact tracing home visits were made in 247 (82.1%) instances; a major challenge was index patients' resistance to home visits fearing stigma, especially among those receiving care from the private sector. Of the 838 HHCs, 765 (91.3%) were screened for TB; the challenges included a lack of clarity on HHC definition and the non-availability of HHCs during house visits. Only 400 (57.8%) of the 692 eligible HHCs underwent an IGRA test for TBI; the challenges included a shortage of IGRA testing logistics and the perceived low risk among HHCs. As HHCs were unaware of their IGRA results, a number of HHCs actually eligible for TPT could not be determined. Among the 83 HHCs advised of the TPT, 81 (98%) initiated treatment, of whom 63 (77%) completed treatment. Though TPT initiation and completion rates are appreciable, the NTEP needs to urgently address the challenges in contact identification and IGRA testing.

Keywords: IFN-γ; QuantiFERON-TB Gold test; contact investigation; contact management; isoniazid preventive therapy; latent tuberculosis; operational research; structured operational research and training initiative; tuberculin skin test.

Grants and funding

The Global Fund provided funding through Project Axshya Plus, The Union South-East Asia, Office New Delhi, for the SORT-IT training program that served as the basis for this paper’s development as well as the publication costs. The funding source played no part in the planning of the study, collecting and analysing the data, choosing to publish, or writing the manuscript. The views expressed herein are those of the authors and do not necessarily represent the Global Fund’s official stance or policy.