Improving screening and chemoprophylaxis among child contacts in India's RNTCP: a pilot study

Area of Science:

• Public Health
• Infectious Disease Control
• Pediatric Tuberculosis

Background:

• India's national tuberculosis program recommends contact screening and chemoprophylaxis for child contacts of infectious tuberculosis cases.
• Suboptimal implementation of these guidelines has been a persistent challenge in preventing childhood tuberculosis.

Purpose of the Study:

• To assess the impact of an isoniazid preventive therapy (IPT) register and card system on healthcare worker adherence to tuberculosis control program guidelines.
• To evaluate the effectiveness of a structured documentation system in improving the management of child contacts of smear-positive pulmonary tuberculosis patients.

Main Methods:

• A prospective study was conducted in two South Indian Tuberculosis Units.
• Healthcare workers received training on using an IPT register and card for managing child contacts.
• The study involved screening child contacts, initiating IPT for eligible asymptomatic children, and evaluating the process through interviews.

Main Results:

• Out of 87 identified child contacts, 71 (82%) were traced, and 53 were initiated on IPT.
• 39 children successfully completed their IPT treatment.
• Healthcare workers reported satisfaction with the IPT register and card, noting improved task completion and recall.

Conclusions:

• The introduction of an IPT register and card, coupled with healthcare worker training, significantly improved the implementation of contact tracing and chemoprophylaxis for child tuberculosis contacts.
• The program's success rate for contact tracing and chemoprophylaxis increased from 19% to 61% in the study setting.