A Situational Analysis and an Untapped Opportunity for Tackling Challenges Associated with Coverage of Tuberculosis Preventive Treatment: A Multi-Centric Study in India

Abstract

Objectives: To assesses the coverage, adherence, reasons for non-initiation and non-completion of tuberculosis preventive treatment (TPT) among household child contacts (HHCC) of pulmonary tuberculosis (TB).

Methods: This cross-sectional study was conducted across eight sites in India. Estimated sample size was 200 per site. Information was collected through record review and house-to-house visits of HHCCs of notified pulmonary TB cases during January to March 2022. Coverage and adherence was assessed by proportion of eligible HHCC initiated and completed TPT, respectively.

Results: Of 2554 HHCCs eligible for TPT, initiation and completion rate was 34% and 22%, respectively. Across the sites the median time to conduct home visit was 14 d (IQR 9, 22) and TPT initiation was 7 d (IQR 1, 21). Reasons for the non-initiation were no information provided by paramedical workers (82%), information provided by paramedical workers but TPT was not given (19%), parents felt it's not important (9%), and fear of side-effects (3%). Reasons for non-completion were: TPT received for less than six months (from healthcare providers) (54%), advised for the lesser duration TPT by the doctors (4%), parents felt completion was not important (32%), parents' fear of side-effects or myth (5%), and HHCC complained of side-effect (0.7%).

Conclusions: Inadequate emphasis on home visits leads to TPT initiation in only one-third and completion in less than one-fourth of eligible HHCCs. This poor coverage was primarily due to the health system related issues. Rarely reported TPT side-effects highlighted its safety.

Keywords: Challenges; Compliance to treatment; HHCC; Pediatric TB; TPT.