Using timeliness metrics for household contact tracing and TB preventive therapy in the private sector, India
Although screening of household contacts (HHCs) of TB patients and provision of TB preventive therapy (TPT) is a key intervention to end the TB epidemic, their implementation globally is dismal. We assessed whether introducing a ‘7-1-7’ timeliness metric was workable for implementing HHC screening among index patients with pulmonary TB diagnosed by private providers in Chennai, India, between November 2022 and March 2023.
This was an explanatory mixed-methods study (quantitative-cohort and qualitative-descriptive).
There were 263 index patients with 556 HHCs. In 90% of index patients, HHCs were line-listed within 7 days of anti-TB treatment initiation. Screening outcomes were ascertained in 48% of HHCs within 1 day of line-listing. Start of anti-TB treatment, TPT or a decision to receive neither was achieved in 57% of HHC within 7 days of screening. Overall, 24% of screened HHCs in the ‘7-1-7’ period started TPT compared with 16% in a historical control (P < 0.01). Barriers to achieving ‘7-1-7’ included HHC reluctance for evaluation or TPT, refusal of private providers to prescribe TPT and reliance on facility-based screening of HHCs instead of home visits by health workers for screening.
Introduction of a timeliness metric is a workable intervention that adds structure to HHC screening and timely management.
Keywords: India; TB preventive therapy; household contact screening; private sector; ‘7-1-7’ timeliness metric
Document Type: Research Article
Affiliations: 1: International Union Against Tuberculosis and Lung Disease (The Union), Paris, France;, The Union South-East Asia Office, New Delhi, 2: Resource Group for Education and Advocacy for Community Health, Chennai, India; 3: Institute of Public Health, College of Medicine and Health Sciences, University of the United Arab Emirates, Al Ain, UAE; 4: United Nations Children Fund, United Nations Development Programme, World Bank Special Programme for Research and Training in Tropical Diseases, WHO, Geneva, Switzerland; 5: International Union Against Tuberculosis and Lung Disease (The Union), Paris, France; 6: International Union Against Tuberculosis and Lung Disease (The Union), Paris, France;, The Union South-East Asia Office, New Delhi, Yenepoya Medical College, Yenepoya (deemed University), Mangalore, India; 7: Resolve to Save Lives, New York, NY, USA; 8: International Union Against Tuberculosis and Lung Disease (The Union), Paris, France;, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
Publication date: March 1, 2024
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