Abstract
BackgroundIndia plans to eliminate tuberculosis (TB) by 2025, and has identified screening and prevention as key activities. Household contacts (HHCs) of index TB cases are a high-risk population that would benefit from rapid implementation of these strategies. However, best practices for TB prevention and knowledge gaps among HHCs have not been studied. We evaluated TB knowledge and understanding of prevention among tuberculin skin-test (TST) positive HHCs. While extensive information is available in other high-burden settings regarding TB knowledge gaps, identifying how Indian adult contacts view their transmission risk and prevention options may inform novel screening algorithms and education efforts that will be part of the new elimination plan.MethodsWe approached adult HHC to administer a questionnaire on TB knowledge and understanding of infection. Over 1 year, 100 HHC were enrolled at a tertiary hospital in Pune, India.ResultsThe study population was 61% (n = 61) female, with a mean age of 36.6 years (range 18–67, SD = 12). Education levels were high, with 78 (78%) having at least a high school education, and 23 (24%) had at least some college education. Four (4%) of our participants were HIV-infected.General TB knowledge among HHC was low, with a majority of participants believing that you can get TB from sharing dishes (70%) or touching something that has been coughed on (52%). Understanding of infection was also low, with 42% believing that being skin-test positive means you have disease. To assess readiness for preventive therapy, we asked participants whether they are at a higher risk of progressing to active disease because of their LTBI status. Fifty-four (55%) felt that they are at higher risk. Only 8% had heard of preventive therapy.ConclusionOur TB knowledge survey among HHCs with evidence of recent exposure found that knowledge is poor and families are confused about transmission in the household. It is imperative that the Indian program develop tools and incentives that can be used to educate TB cases and their families on what infected HHCs can do to prevent disease, including preventive therapy.
Highlights
India plans to eliminate tuberculosis (TB) by 2025, and has identified screening and prevention as key activities
While extensive information is available in other high-burden settings regarding TB knowledge gaps, identifying how Indian adult contacts view their transmission risk and prevention options may inform novel screening algorithms and education efforts that will be part of the new elimination plan
We approached 100 sequentially enrolled skin-test positive adult household contacts (HHC) of newly diagnosed adult pulmonary TB (PTB) patients who lived in the same household at least 3 months prior to index TB diagnosis in a cohort study at the Byramjee Jeejeebhoy Government Medical College (BJGMC), in Pune, India for participation in a sub-study
Summary
India plans to eliminate tuberculosis (TB) by 2025, and has identified screening and prevention as key activities. We evaluated TB knowledge and understanding of prevention among tuberculin skin-test (TST) positive HHCs. While extensive information is available in other high-burden settings regarding TB knowledge gaps, identifying how Indian adult contacts view their transmission risk and prevention options may inform novel screening algorithms and education efforts that will be part of the new elimination plan. The National Strategic Plan for Elimination identifies treatment of latent TB infection (LTBI) as a component, stating, ‘Treating 40 per cent of the population for LTBI is neither rational nor practicable, emphasizing the need for a focused approach’ [2] As part of their Prevent strategy, the plan recommends treatment for LTBI for contacts of bacteriologically-confirmed cases. While extensive information is available in other high-burden settings regarding TB knowledge gaps, identifying how Indian adult contacts view their transmission risk and prevention options may inform novel screening algorithms and education efforts that will be part of the new elimination plan. We surveyed household contacts of pulmonary TB cases in India with a focus on understanding the perceptions of TB infection and prevention among skin-test positive individuals
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