Using timeliness metrics for household contact tracing and TB preventive therapy in the private sector, India
Pruthu Thekkur, Rajeswaran Thiagesan, Divya Nair, N Karunakaran, Mohammed Khogali, Rony Zachariah, Selma Dar Berger, Srinath Satyanarayana, A. M. V. Kumar, Aaron F. Bochner, Aaron McClelland, Ramya Ananthakrishnan, Anthony Harries
Abstract
<sec id="st1"><title>BACKGROUND</title>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.</sec><sec id="st2"><title>METHODS</title>This was an explanatory mixed-methods study (quantitative-cohort and qualitative-descriptive).</sec><sec id="st3"><title>RESULTS</title>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.</sec><sec id="st4"><title>CONCLUSIONS</title>Introduction of a timeliness metric is a workable intervention that adds structure to HHC screening and timely management.</sec>