Challenges for Programmatic Implementation of Tuberculosis Preventive Treatment amongst Household Contacts of Pulmonary Tuberculosis Patients: A Study of Valsad Block

Abstract Background: Tuberculosis preventive treatment (TPT) is important to halt the evolution of latent tuberculosis (TB) infection to active disease in household contacts (HHCs) of TB patients suffering from pulmonary type. Despite the various programmatic efforts, there are still gaps in TPT uptake. Objective: The objective of the study was to evaluate the TPT cascade and identify the barriers to TPT provision amongst HHCs of pulmonary TB patients in Valsad block, Gujarat. Materials and Methods: A mixed-methods approach was used, involving 263 HHCs and 76 index patients. Quantitative measures evaluated TPT cascade performance, and qualitative interviews investigated barriers based on patients, HHCs and healthcare workers viewpoints. Results: The TPT cascade implementation had several gaps. Although 50.6% of HHCs were informed about TPT, 33.8% initiated the treatment and 15.2% completed it. Stigma, lack of knowledge, poor counselling, believing there was no need amongst asymptomatic individuals, side effects, money concerns and system issues such as failure to complete contact tracing and insufficient medication were the main problems. Conclusion: Very few HHCs are treated with TPT because of social, cultural, informational and system barriers. Improving patient counselling, reducing stigma, tracing all contacts and reinforcing healthcare delivery systems are essential to enhance TPT implementation and meet TB elimination goals.