Mukherjee Ophelia, Das Dilip Kumar, Adhikary Mrinmoy, Ghosh Ritu
Department of Community Medicine, Murshidabad Medical College, West Bengal, India.
Indian J Tuberc. 2025 Jul;72(3):325-331. doi: 10.1016/j.ijtb.2024.06.002. Epub 2024 Jun 6.
India started implementing tuberculosis preventive treatment (TPT) among all household contacts of Tuberculosis (TB) cases, as a globally accepted strategy for elimination of TB.
We aimed to assess the extent of TPT coverage and adherence; ascertain the reasons for non-initiation and non-adherence; and to determine the correlates of coverage.
We conducted a cross-sectional study in a block of Murshidabad district, West Bengal during September-November'2023. A calculated sample of 301 eligible household contacts of 'index cases' (microbiologically-confirmed drug-sensitive pulmonary TB) registered during October'22 to March'23 were studied. We interviewed the participants/respondents with pre-designed schedule and prior informed consent. Descriptive and inferential statistics were applied through Statistical Package for Social Sciences (version 20).
Of 301 contacts, 179(59.5%) individually traced/counseled at the household; 238 (79.1%) were screened for TB symptoms. TPT initiation was 74.8% (225/301) with 47.1% within seven days of treatment initiation of index case; TPT not offered by health personnel (59.2%) being major reason for non-initiation. Completion rate with adherence to full course was 69.3% (156/225); perceived lack of need (50.7%) and migration (21.7%) being major reasons for non-adherence. Overall coverage of full course TPT among total eligible contacts was only 51.8% (156/301). On multivariable logistic regression; male gender (aOR = 1.982; 95% CI = 1.004-3.915), contacts with individual tracing/counseling (aOR = 13.507; 95% CI = 6.781-26.906) and who had symptoms screening (aOR = 5.694; 95% CI = 2.223-14.587) predicted significantly higher TPT coverage.
Cascade of care indicators for TPT remains suboptimal in the area and indicates need for further strengthening of programmatic aspects of its implementation.
作为全球公认的结核病消除战略，印度开始在所有结核病病例的家庭接触者中实施结核病预防性治疗（TPT）。
我们旨在评估TPT的覆盖范围和依从性；确定未开始治疗和未坚持治疗的原因；并确定覆盖范围的相关因素。
2023年9月至11月期间，我们在西孟加拉邦默沙达巴德区的一个街区进行了一项横断面研究。对2022年10月至2023年3月期间登记的301名符合条件的“索引病例”（微生物学确诊的药物敏感型肺结核）家庭接触者进行了抽样研究。我们按照预先设计的时间表并在获得事先知情同意的情况下对参与者/受访者进行了访谈。通过社会科学统计软件包（版本20）应用描述性和推断性统计方法。
在301名接触者中，179名（59.5%）在家庭中被单独追踪/咨询；238名（79.1%）接受了结核病症状筛查。TPT启动率为74.8%（225/301），其中47.1%在索引病例开始治疗的七天内启动；卫生人员未提供TPT（59.2%）是未开始治疗的主要原因。全程依从的完成率为69.3%（156/225）；认为缺乏必要性（50.7%）和迁移（21.7%）是未坚持治疗的主要原因。在所有符合条件的接触者中，全程TPT的总体覆盖率仅为51.8%（156/301）。在多变量逻辑回归分析中；男性（调整后比值比 = 1.982；95%置信区间 = 1.004 - 3.915）、接受单独追踪/咨询的接触者（调整后比值比 = 13.507；95%置信区间 = 6.781 - 26.906）以及接受症状筛查的接触者（调整后比值比 = 5.694；95%置信区间 = 2.223 - 14.587）预测TPT覆盖率显著更高。
该地区TPT的级联护理指标仍然不理想，表明需要进一步加强其实施的规划方面。
