Identifying missed opportunities in tuberculosis preventive treatment care cascade: Analysis of programme data from Maharashtra, India

Abstract Tuberculosis infection is a condition when a person harbours the bacilli without having signs of active disease. In India, approximately 70% of household contacts of people with pulmonary tuberculosis have the infection. The national tuberculosis elimination programme recommends preventive treatment to household contacts of all people with pulmonary tuberculosis after ruling out active disease. Maharashtra is one of the bigger states in India with high tuberculosis burden. We analysed the state programme data to describe the tuberculosis preventive treatment care cascade for household contacts of all notified people with pulmonary tuberculosis for the year 2023 in Maharashtra. Contact tracing was done for 84% of the 1,33,167 notified people with pulmonary tuberculosis. A total of 4,06,291 household contacts were enlisted out of whom 3,86,224 (95%) were screened for symptoms of tuberculosis. 185502 (45%) household contacts were listed as eligible for tuberculosis preventive treatment, of whom 101325 (55%) were initiated on tuberculosis preventive treatment. While 41,480 (41%) of those initiated on treatment successfully completed it, treatment outcomes were not recorded for around 57,191 (56%) of them. Tuberculosis preventive treatment completion as well as recording of treatment outcomes was lesser for 6H regimen, among contacts of those seeking care from private sector and clinically diagnosed people with tuberculosis. Reasons for losses from the cascade need to be identified and addressed. Addressing missing data will further help in understanding programme performance. Frontline workers may be trained and utilized to capture real time data using simpler tools. Aligning the annual India TB report with the guidelines by including household contacts of all notified persons with pulmonary tuberculosis instead of only microbiologically positive ones may improve treatment outcome recording among clinically diagnosed cases. The capacity building, monitoring, and supportive supervision need further strengthening to improve the provision of tuberculosis preventive treatment care.