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Article

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

by
U. C. Samudyatha
1,*,
Kathirvel Soundappan
2,
Gomathi Ramaswamy
3,
Kedar Mehta
4,
Chandan Kumar
5,
M. Jagadeesh
5,
B. T. Prasanna Kamath
1,
Neeta Singla
6 and
Pruthu Thekkur
7
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
*
Author to whom correspondence should be addressed.
Trop. Med. Infect. Dis. 2023, 8(12), 512; https://doi.org/10.3390/tropicalmed8120512
Submission received: 25 October 2023 / Revised: 27 November 2023 / Accepted: 29 November 2023 / Published: 30 November 2023
(This article belongs to the Special Issue New Insights in Screening and Preventive Treatment for Tuberculosis)
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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: isoniazid preventive therapy; tuberculin skin test; contact management; contact investigation; latent tuberculosis; QuantiFERON-TB Gold test; IFN-γ; operational research; structured operational research and training initiative isoniazid preventive therapy; tuberculin skin test; contact management; contact investigation; latent tuberculosis; QuantiFERON-TB Gold test; IFN-γ; operational research; structured operational research and training initiative

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MDPI and ACS Style

Samudyatha, U.C.; Soundappan, K.; Ramaswamy, G.; Mehta, K.; Kumar, C.; Jagadeesh, M.; Prasanna Kamath, B.T.; Singla, N.; Thekkur, P. 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, 8, 512. https://doi.org/10.3390/tropicalmed8120512

AMA Style

Samudyatha UC, Soundappan K, Ramaswamy G, Mehta K, Kumar C, Jagadeesh M, Prasanna Kamath BT, Singla N, Thekkur P. 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. Tropical Medicine and Infectious Disease. 2023; 8(12):512. https://doi.org/10.3390/tropicalmed8120512

Chicago/Turabian Style

Samudyatha, U. C., Kathirvel Soundappan, Gomathi Ramaswamy, Kedar Mehta, Chandan Kumar, M. Jagadeesh, B. T. Prasanna Kamath, Neeta Singla, and Pruthu Thekkur. 2023. "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" Tropical Medicine and Infectious Disease 8, no. 12: 512. https://doi.org/10.3390/tropicalmed8120512

APA Style

Samudyatha, U. C., Soundappan, K., Ramaswamy, G., Mehta, K., Kumar, C., Jagadeesh, M., Prasanna Kamath, B. T., Singla, N., & Thekkur, P. (2023). 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. Tropical Medicine and Infectious Disease, 8(12), 512. https://doi.org/10.3390/tropicalmed8120512

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