The feasibility of expansion of TB Preventive Therapy among adult household contacts of patients with TB in India

Nandini Sharma1, Saurav Basu1, Pragya Sharma1

1 Maulana Azad Medical College, New Delhi, India

Background

India experiences one fourth of the global burden of Tuberculosis (TB) [1] but has a TB elimination goal for 2025. Currently, as per the National TB Elimination Program, Isoniazid based TB Preventive Therapy (IPT) is provided to only children <6 years and people living with HIV [2]. However, the feasibility of expansion of TB Preventive Therapy including newer Rifapentine containing regimens (3HP/1HP) [3] among susceptible adult contacts of index TB cases have not been ascertained previously. 

Objective

To assess the acceptability of TB Preventive Therapy in adult household contacts of microbiologically confirmed drug sensitive TB cases on anti-tubercular (DOTS) therapy.

Methods

Adult index TB cases currently on treatment were contacted at DOTS clinics in the Central District of Delhi, India from June-July 2020. We excluded the patients with MDR-TB and extra-pulmonary-TB, non-disclosure of TB status to household due to felt-stigma, and those living alone. A trained field investigator visiting the household of the TB patient and collected data from the family members through face-face interviews. The perceived risk of TB was measured on a 10 point continuous rating scale (1: low risk; 10: high risk) 

Results

We recruited a total of 119 high-risk household contacts of index TB cases having at-least one high-risk factor for development of active TB (low BMI, obesity, age >=70, diabetes comorbidity). Only 9 (7.6%) contacts had heard of Latent TB infection. The median (IQR) TB disease severity score was 8 (8-9). However, the median (IQR) perceived risk of TB in the absence of preventive therapy was 6 (4-8).

A majority (61.9%) of the contacts were unwilling to accept TB preventive therapy. The reasons for this treatment hesitancy were asymptomatic status (23.7%), feeling healthy (23.7%), and concerns over drug adverse effects (13.6%).

Conclusion

Perceived risk of developing active TB among high-risk close household contacts of index TB cases is low indicating the need for development of a comprehensive behaviour change communication package.

REFERENCES

1. World Health Organization. Global Tuberculosis Report 2019. Geneva: WHO; 2019.

2. Government of India. National Strategic Plan for HIV/AIDS and STI — 2017.

3. Latent tuberculosis infection: updated and consolidated guidelines for programmatic

management. Geneva: World Health Organization; 2018