TB Preventive Treatment (TPT) for Household Contacts in India: What has Changed?

Dear Editor, It is observed that on average, 5–10% individuals infected while in contact with a pulmonary TB case (Index case) will develop tuberculosis (TB) disease over the course of their lives.[1,2] About 75% of people who develop TB disease are estimated to get it within one year and 97% within two years after diagnosis of the index case.[3] TB preventive treatment (TPT) is recommended for all groups who may have the latent TB infection. These include children below and >5 years of age, adolescents, and adult household contacts. TPT remains a vital component of the active case finding strategy. Under India’s National TB Elimination Program (NTEP), conventionally TPT is given to children below 5 years of age within a week after the detection of the index case and TPT for other contacts is now being implemented in a phased manner. Unfortunately, a clear guidance was lacking on whether to give TPT to those who missed it for any reason, and if it is to be given, then what should be the timeline. A clear guidance on this issue became available since June 2022. It is now incorporated as a Frequently Asked Question 49 within the supplement to India’s national policy guideline.[4] It says, “contacts of pulmonary TB patients who missed receiving TPT for any reasons during the treatment phase of the index TB patients can still be provided TPT services (repeat screening, ruling out active TB, evaluation and provision of TPT) up to at least 2 years (i.e. during the post-treatment follow up of index TB patient) post TB exposure.” Kudos to the guidance and action of the officials. This is going to be one of the crucial steps toward controlling TB and will be useful guidance to other TB high-burden countries [Table 1]. Nevertheless, the operational implementation of TPT will have further important considerations such as assessment of the drug susceptibility profile of the index case to decide on an appropriate TPT, involvement of pediatricians, regular supply of medicines, acceptance at the community level, monitoring of compliance, and management of side effects, if any.Table 1: TB preventive therapy (TPT) recommendationFinancial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.