From Challenges to Solutions: Identifying Barriers and Enablers in Tuberculosis Preventive Treatment among Adult Household Contacts of Drug-susceptible Pulmonary Tuberculosis Patients in Urban Ahmedabad
Bhargav Prahaladbhai Patel, Arman Meman, Krish N. Dabhoya, Ratneel Trambadia, Himanshu Giya, Nishita Sarvaiya, Parimal Patel, Atul TrivediAbstract
Background:
Household contacts of pulmonary tuberculosis (TB) patients are at increased risk of TB disease. Although tuberculosis preventive treatment (TPT) reduces this risk, uptake and completion remain suboptimal in many high-burden settings, including India. This study examined the TPT cascade among household contacts of drug-susceptible pulmonary TB patients and factors associated with initiation and completion.
Methods:
A mixed-methods cross-sectional study was conducted between September and December 2023 among 251 household contacts of drug-susceptible pulmonary TB index cases in an urban field practice area in Ahmedabad, India. Quantitative data were collected using a structured questionnaire and analyzed using logistic regression. In-depth interviews explored experiences with TPT; qualitative data were analyzed thematically.
Results:
All 251 eligible contacts were offered TPT; 153 (61.0%) initiated treatment. Among initiators, 118 (77.1%) met the adherence definition and 110 (71.9%) completed the regimen. Higher education and motivation by health staff were associated with initiation, whereas current tobacco/alcohol use (addiction) and fear of side effects were associated with lower uptake. Among initiators, completion was more likely among those without side effects and those receiving home delivery of medicines, while addiction was associated with noncompletion. Qualitative findings identified protecting family members and trust in health workers as facilitators, whereas symptoms, logistical barriers, and low perceived need were important barriers.
Conclusions:
Although TPT initiation exceeded national averages in this urban cohort, substantial attrition occurred. Strengthening counseling, proactively managing adverse effects, and improving access to medicines may be associated with better TPT outcomes within the National TB Elimination Programme.