Challenges in the implementation of tuberculosis contact screening and tuberculosis preventive therapy in the paediatric age group in rural South India.

INTRODUCTION: Tuberculosis remains a major cause of morbidity and death from infectious diseases in children of all ages globally, particularly in young children. In India, childhood Tuberculosis is a staggering problem, contributing to approximately 31% of the global burden. It is a good strategy for the early identification of children eligible for isoniazid preventive therapy (IPT) and for preventing susceptible children from developing the disease following a recent infection from household Sputum-positive TB patients.

AIM: This study aims to identify challenges faced by healthcare providers in implementing paediatric contact screening and chemoprophylaxis for household contacts of TB patients.

OBJECTIVES: 1) Assess knowledge of TB screening and preventive therapy among healthcare providers. 2) Identify factors influencing implementation. 3) Evaluate the level of contact tracing and TPT implementation through qualitative and quantitative analysis.

METHODS: We used a mixed-method study design, wherein the quantitative phase (secondary data analysis and house-to-house survey) was followed by the qualitative phase (Interviews). The present study was conducted in one TU (Srikakulam TU).

RESULTS: In our study, 77 primary index sputum-positive patients had 114 child contacts (<5 years). In 77 sputum-positive cases, 114 paediatric contacts were aged <5 years. So, in our study, we have 114 paediatric contact patients (<5 years) who were eligible for contact screening and Tuberculosis prevention therapy (TPT). In our study, we identified 114 eligible children who were in contact with primary index cases. Out of 114 children, screening was done in 110 children; in 4 children, screening was not done. Out of 4 children, 2 were newly diagnosed and yet to be screened, and the remaining 2 children's parents were not willing to undergo screening tests, but they are willing to take TPT therapy. Our healthcare supervisors were successful in initiating the TPT therapy in 112 cases.

CONCLUSION: Our study concluded that the implementation of TPT and screening of child contact were implemented properly in our district. Doctors play a major role in eliminating TB so NTEP needs to provide regular knowledge to the practicing doctors. Stigma-related disclosure of TB disease is to be reduced by individual and mass campaigns. As TPT is not under supervision so there is no clarification about TPT drug adherence. As doctors, we are the primary ones to diagnose a TB case and if a doctor advises the patient about screening and TPT, the entire scenario changes. As knowledgeable people, doctors should be the initial people in the implementation of TPT, and it is continued by peripheral health care workers. TB elimination can be achieved only by the active participation of NTEP-trained and committed doctors and healthcare workers.