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Mahajan P, Soundappan K, Singla N, Mehta K, Nuken A, Thekkur P, Nair D, Rattan S, Thakur C, Sachdeva KS, Kalottee B. Test and Treat Model for Tuberculosis Preventive Treatment among Household Contacts of Pulmonary Tuberculosis Patients in Selected Districts of Maharashtra: A Mixed-Methods Study on Care Cascade, Timeliness, and Early Implementation Challenges. Trop Med Infect Dis 2023; 9:7. [PMID: 38251204 PMCID: PMC10818418 DOI: 10.3390/tropicalmed9010007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/14/2023] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
Tuberculosis preventive treatment (TPT) is an important intervention in preventing infection and reducing TB incidence among household contacts (HHCs). A mixed-methods study was conducted to assess the "Test and Treat" model of TPT care cascade among HHCs aged ≥5 years of pulmonary tuberculosis (PTB) patients (bacteriologically/clinically confirmed) being provided TPT care under Project Axshya Plus implemented in Maharashtra (India). A quantitative phase cohort study based on record review and qualitative interviews to understand the challenges and solutions in the TPT care cascade were used. Of the total 4181 index patients, 14,172 HHCs were screened, of whom 36 (0.3%) HHCs were diagnosed with tuberculosis. Among 14,133 eligible HHCs, 10,777 (76.3%) underwent an IGRA test. Of them, 2468 (22.9%) tested positive for IGRA and were suggested for chest X-ray. Of the eligible 2353 HHCs, 2159 (91.7%) were started on TPT, of whom 1958 (90.6%) completed the treatment. The median time between treatment initiation of index PTB patient and (a) HHC screening was 31 days; (b) TPT initiation was 64 days. The challenges in and suggested solutions for improving the TPT care cascade linked to subthemes were tuberculosis infection testing, chest X-ray, human resources, awareness and engagement, accessibility to healthcare facilities, TPT drugs, follow-up, and assessment. A systematic monitoring and time-based evaluation of TPT cascade care delivery followed by prompt corrective actions/interventions could be a crucial strategy for its effective implementation and for the prevention of tuberculosis.
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Affiliation(s)
- Palak Mahajan
- International Union Against Tuberculosis and Lung Disease, South-East Asia Office, New Delhi 110016, India; (A.N.); (S.R.); (C.T.); (K.S.S.); (B.K.)
| | - Kathirvel Soundappan
- Department of Community Medicine & School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India;
| | - Neeta Singla
- National Institute of TB & Respiratory Disease, New Delhi 110030, India;
| | - Kedar Mehta
- Department of Community Medicine, Gujarat Medical Education & Search Society Medical College, Vadodara 390021, India;
| | - Amenla Nuken
- International Union Against Tuberculosis and Lung Disease, South-East Asia Office, New Delhi 110016, India; (A.N.); (S.R.); (C.T.); (K.S.S.); (B.K.)
| | - Pruthu Thekkur
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, 2 Rue Jean Lantier, 75001 Paris, France; (P.T.); (D.N.)
| | - Divya Nair
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, 2 Rue Jean Lantier, 75001 Paris, France; (P.T.); (D.N.)
| | - Sampan Rattan
- International Union Against Tuberculosis and Lung Disease, South-East Asia Office, New Delhi 110016, India; (A.N.); (S.R.); (C.T.); (K.S.S.); (B.K.)
| | - Chaturanand Thakur
- International Union Against Tuberculosis and Lung Disease, South-East Asia Office, New Delhi 110016, India; (A.N.); (S.R.); (C.T.); (K.S.S.); (B.K.)
| | - Kuldeep Singh Sachdeva
- International Union Against Tuberculosis and Lung Disease, South-East Asia Office, New Delhi 110016, India; (A.N.); (S.R.); (C.T.); (K.S.S.); (B.K.)
| | - Bharati Kalottee
- International Union Against Tuberculosis and Lung Disease, South-East Asia Office, New Delhi 110016, India; (A.N.); (S.R.); (C.T.); (K.S.S.); (B.K.)
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