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

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          Abstract

          Background

          Under 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.

          Objectives

          To 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.

          Methods

          A 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.

          Results

          Households 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)].

          Conclusion

          Contact 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.

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          Most cited references 9

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          Passive versus active tuberculosis case finding and isoniazid preventive therapy among household contacts in a rural district of Malawi.

          Thyolo district, rural Malawi. To compare passive with active case finding among household contacts of smear-positive pulmonary tuberculosis (TB) patients for 1) TB case detection and 2) the proportion of child contacts aged under 6 years who are placed on isoniazid (INH) preventive therapy. Cross-sectional study. Passive and active case finding was conducted among household contacts, and the uptake of INH preventive therapy in children was assessed. There were 189 index TB cases and 985 household contacts. Human immunodeficiency virus (HIV) prevalence among index cases was 69%. Prevalence of TB by passive case finding among 524 household contacts was 0.19% (191/100000), which was significantly lower than with active finding among 461 contacts (1.74%, 1735/100000, P = 0.01). Of 126 children in the passive cohort, 22 (17%) received INH, while in the active cohort 25 (22%) of 113 children received the drug. Transport costs associated with chest X-ray (CXR) screening were the major reason for low INH uptake. Where the majority of TB patients are HIV-positive, active case finding among household contacts yields nine times more TB cases and is an opportunity for reducing TB morbidity and mortality. The need for a CXR is an obstacle to the uptake of INH prophylaxis.
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            Adherence to anti-tuberculosis chemoprophylaxis and treatment in children.

             B Marais,  R. Gie,  N. Beyers (2005)
            Limited data exist on adherence to anti-tuberculosis treatment and chemoprophylaxis in children in high-burden settings. To determine the adherence to anti-tuberculosis chemoprophylaxis and treatment in children evaluated as household contacts of adult pulmonary tuberculosis (PTB) cases. A retrospective study, conducted from January 1996 to September 2003, in suburban Cape Town, South Africa, with a high TB incidence. A folder search was done on all children <5 years of age identified as household contacts of adult PTB cases between 1996 and 2003. Data on screening for TB and adherence to prescribed therapy in child contacts were analysed. Three hundred and sixty-one contact episodes with 243 adult PTB cases were identified in 335 children. The median age was 25 months. Adherence to anti-tuberculosis treatment was significantly better than adherence to chemoprophylaxis (82.6% vs. 44.2%; OR 6.83; 95%CI 3.6-12.96). Adherence to a 3-month chemoprophylaxis regimen of isoniazid and rifampicin (3HR) was significantly better than adherence to a 6-month chemoprophylaxis regimen of isoniazid only (69.6% vs. 27.6%; OR 4.97; 95%CI 2.40-10.36). Although adherence to treatment was good, adherence to unsupervised chemoprophylaxis was poor. We recommend that shorter chemoprophylaxis regimens such as 3HR should be considered to improve adherence, but further studies are required.
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              Contact screening and chemoprophylaxis in India's Revised Tuberculosis Control Programme: a situational analysis.

              India's Revised National Tuberculosis Control Programme (RNTCP) recommends screening of all household contacts of smear-positive pulmonary tuberculosis (PTB) cases for tuberculosis (TB) disease, and 6-month isoniazid preventive therapy (IPT) for asymptomatic children aged <6 years. To assess the implementation of child contact screening and IPT administration under the RNTCP. A cross-sectional study conducted in four randomly selected TB units (TUs), two in an urban (Chennai City) and two in a rural (Vellore District) area of Tamil Nadu, South India, from July to September 2008. The study involved the perusal of TB treatment cards of source cases (new or retreatment smear-positive PTB patients started on treatment), interview of source cases and focus group discussions (FGDs) among health care workers. Interviews of 253 PTB patients revealed that of 220 contacts aged <14 years, only 31 (14%) had been screened for TB, and that of 84 household children aged <6 years, only 16 (19%) had been initiated on IPT. The treatment cards of source cases lacked documentation of contact details. FGDs revealed greater TB awareness among urban health care workers, but a lack of detailed knowledge about procedures. Provision for documentation using a separate IPT card and focused training may help improve the implementation of contact screening and IPT.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1932-6203
                2011
                22 July 2011
                : 6
                : 7
                Affiliations
                [1 ]Department of Community Medicine, Siddhartha Medical College, Vijayawada, Andhra Pradesh, India
                [2 ]WHO-RNTCP Technical Assistance Project, Andhra Pradesh, India
                [3 ]Center for Operations Research, International Union against Tuberculosis and Lung Diseases, New Delhi, India
                [4 ]District Tuberculosis Centre, Machilipatnam, Krishna District, Andhra Pradesh, India
                [5 ]State TB Office, Directorate of Health, Government of Andhra Pradesh, Hyderabad, India
                [6 ]Office of the WHO Representative in India, World Health Organization, New Delhi, India
                University of Stellenbosch, South Africa
                Author notes

                Conceived and designed the experiments: MP SBN SK SS. Performed the experiments: MP SBN. Analyzed the data: MP SBN SK SS. Contributed reagents/materials/analysis tools: MP SBN SK SS. Wrote the paper: MP SBN SK SS S SB PKD FW.

                Article
                PONE-D-11-06401
                10.1371/journal.pone.0022500
                3142154
                21799875
                Pothukuchi et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
                Page count
                Pages: 4
                Categories
                Research Article
                Biology
                Population Biology
                Epidemiology
                Infectious Disease Epidemiology
                Medicine
                Epidemiology
                Infectious Disease Epidemiology
                Pediatric Epidemiology
                Infectious Diseases
                Bacterial Diseases
                Tuberculosis
                Tropical Diseases (Non-Neglected)
                Tuberculosis
                Infectious Disease Control
                Pediatrics
                Public Health
                Child Health
                Health Screening
                Preventive Medicine

                Uncategorized

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