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

BACKGROUND: While contact screening and chemoprophylaxis is recommended by India's Revised National Tuberculosis Control Programme for asymptomatic children aged <6 years who are household contacts of smear-positive pulmonary tuberculosis (PTB) patients, implementation is suboptimal. OBJECTIVE: To evaluate the effectiveness of an isoniazid preventive therapy (IPT) register and card in improving the adherence of health care workers (HCWs) to programmatic guidelines. METHODOLOGY: This prospective study was conducted in two Tuberculosis Units in South India. Child contacts of smear-positive PTB patients initiated on treatment between November 2009 and January 2010 were screened, and IPT was initiated in asymptomatic children. HCWs were trained in the use of the IPT register and card. The process was evaluated using patient and HCW interviews. RESULTS: Of 87 children identified aged <6 years, 71 (82%) were traced by HCWs; 53 were screened for TB and initiated on IPT, and 39 completed treatment. HCWs expressed satisfaction with the use of the IPT card and register, saying that it helped them to remember to complete required tasks. CONCLUSION: In a programme setting, with HCW training and introduction of specific documentation (IPT card and register), implementation of contact tracing and chemoprophylaxis for child contacts improved from 19% to 61%.

Contact screening and chemoprophylaxis in India's Revised Tuberculosis Control Programme: a situational analysis.

BACKGROUND: India's Revised National Tuberculosis Control Programme (RNTCP) recommends screening of all household contacts of smear-positive pulmonary tuberculosis (PTB) cases for tuberculosis (TB) disease, and 6-month isoniazid preventive therapy (IPT) for asymptomatic children aged <6 years. OBJECTIVE: To assess the implementation of child contact screening and IPT administration under the RNTCP. METHODS: A cross-sectional study conducted in four randomly selected TB units (TUs), two in an urban (Chennai City) and two in a rural (Vellore District) area of Tamil Nadu, South India, from July to September 2008. The study involved the perusal of TB treatment cards of source cases (new or retreatment smear-positive PTB patients started on treatment), interview of source cases and focus group discussions (FGDs) among health care workers. RESULTS: Interviews of 253 PTB patients revealed that of 220 contacts aged <14 years, only 31 (14%) had been screened for TB, and that of 84 household children aged <6 years, only 16 (19%) had been initiated on IPT. The treatment cards of source cases lacked documentation of contact details. FGDs revealed greater TB awareness among urban health care workers, but a lack of detailed knowledge about procedures. CONCLUSION: Provision for documentation using a separate IPT card and focused training may help improve the implementation of contact screening and IPT.