Tuberculosis Contact Screening and Isoniazid Preventive Therapy in a South Indian District: Operational Issues for Programmatic Consideration

Abstract

BackgroundUnder India's Revised National Tuberculosis Control Programme (RNTCP), all household contacts of sputum smear positive Pulmonary Tuberculosis (PTB) patients are screened for TB. In the absence of active TB disease, household contacts aged <6 years are eligible for Isoniazid Preventive Therapy (IPT) (5 milligrams/kilogram body weight/day) for 6 months.ObjectivesTo estimate the number of household contacts aged <6 years, of sputum smear positive PTB patients registered for treatment under RNTCP from April to June'2008 in Krishna District, to assess the extent to which they are screened for TB disease and in its absence initiated on IPT.MethodsA cross sectional study was conducted. Households of all smear positive PTB cases (n = 848) registered for treatment from April to June'2008 were included. Data on the number of household contacts aged <6 years, the extent to which they were screened for TB disease, and the status of initiation of IPT, was collected.ResultsHouseholds of 825 (97%) patients were visited, and 172 household contacts aged <6 years were identified. Of them, 116 (67%) were evaluated for TB disease; none were found to be TB diseased and 97 (84%) contacts were initiated on IPT and 19 (16%) contacts were not initiated on IPT due to shortage of INH tablets in peripheral health centers. The reasons for non-evaluation of the remaining eligible children (n = 56, 33%) include no home visit by the health staff in 25 contacts, home visit done but not evaluated in 31 contacts. House-hold contacts in rural areas were less likely to be evaluated and initiated on IPT [risk ratio 6.65 (95% CI; 3.06–14.42)].ConclusionContact screening and IPT implementation under routine programmatic conditions is sub-optimal. There is an urgent need to sensitize all concerned programme staff on its importance and establishment of mechanisms for rigorous monitoring.

Management of children exposed toMycobacterium tuberculosis: a public health evaluation in West Java, Indonesia

“…When the initiation of therapy was evaluated in children who had been screened, the reported rate was 50 to 84%. 5,24,32,33 Similarly, in our study, it was 40%. However, as in our study, adherence to therapy was poor in settings where the disease is endemic (range: 15 to 76%).…”

“…22,23 In contrast, the compliance rate in India for symptom-based screening conducted at the child's home was 67%. 24 Screening conducted in children's homes using symptom-based screening, which is recommended by WHO, 4 would be expected to improve the performance of child contact management systems.…”

Infection control in households of drug-resistant tuberculosis patients co-infected with HIV in Mumbai, India

“…Although the national TB programme conducts contact tracing to identify cases in the household, follow-up is inefficiently done. 17 Despite the importance of the household environment in TB transmission, very few experiences have been documented, particularly in resource-limited settings. One challenge has been the lack of simple tools for assessing the risk of transmission in the household environment and a set of standardised, non-sophisticated and inexpensive interventions that could be implemented to reduce such an assumed risk.…”

New WHO Guidelines on Symptom Based Childhood Contact Screening For Tuberculosis: Relevance to National Tuberculosis Program of India

“…The implementation of contact screening has been sub-optimal as reported by various studies [2][3][4], in resource constrained settings like India. Scarcity of diagnostic modalities at primary health care levels, lack of awareness among health workers regarding contact screening and low importance given to the reporting of screening related data in the routine reporting formats [2][3][4] were the common reasons reported for poor implementation of contact screening among childhood contacts. The recently released WHO guidelines on pediatric TB management recommends that symptom based approach alone is sufficient for screening child contacts [5] thus removing the dependence on TST for contact screening as per previous WHO recommendation.…”

“…WHO also recommended TST and chest radiography for screening childhood contacts for tuberculosis. The implementation of contact screening has been sub-optimal as reported by various studies [2][3][4], in resource constrained settings like India. Scarcity of diagnostic modalities at primary health care levels, lack of awareness among health workers regarding contact screening and low importance given to the reporting of screening related data in the routine reporting formats [2][3][4] were the common reasons reported for poor implementation of contact screening among childhood contacts.…”