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

被引:1
|
作者
Samudyatha, U. C. [1 ]
Soundappan, Kathirvel [2 ]
Ramaswamy, Gomathi [3 ]
Mehta, Kedar [4 ]
Kumar, Chandan [5 ]
Jagadeesh, M. [5 ]
Prasanna Kamath, B. T. [1 ]
Singla, Neeta [6 ]
Thekkur, Pruthu [7 ]
Miller, Cecily R.
机构
[1] Sri Devaraj Urs Acad Higher Educ & Res SDUAHER, Sri Devaraj Urs Med Coll, Dept Commun Med, Kolar 563101, India
[2] Postgrad Inst Med Educ & Res, Sch Publ Hlth, Dept Commun Med, Chandigarh 160012, India
[3] All India Inst Med Sci, Dept Commun Med & Family Med, Hyderabad 508126, India
[4] GMERS Med Coll, Dept Commun Med, Vadodara 390021, India
[5] Dist Hlth Off, Kolar 536101, India
[6] Natl Inst TB Res & Resp Dis, New Delhi 110030, India
[7] Int Union TB & Lung Dis, Ctr Operat Res, 2 Rue Jean Lantier, F-75001 Paris, France
关键词
isoniazid preventive therapy; tuberculin skin test; contact management; contact investigation; latent tuberculosis; QuantiFERON-TB Gold test; IFN-gamma; operational research; structured operational research and training initiative;
D O I
10.3390/tropicalmed8120512
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
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.
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页数:21
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