Abstract

The integration of newer tuberculosis preventive therapy regimens, which have shorter treatment duration, simpler dosing requirements, and improved safety profile, is being considered within India's national tuberculosis elimination program. However, a potential operational challenge in the successful rollout of the expanded TPT plan is the extent of its acceptability in adult household contacts of pulmonary tuberculosis patients due to possibility of lower risk perception and suboptimal perceived benefit. This study was conducted to determine the intention to accept Tuberculosis Preventive Therapy among adult household contacts of pulmonary tuberculosis patients in Delhi, India. This cross-sectional study was conducted from June-November 2020 in Delhi, India. Data were collected through face to-face interviews by trained field investigations from the high-risk adult household contacts of PTB patients. A total of 536 household contacts including 237 (44.2%) men and 299 (55.8%) women were recruited with median (IQR) age 40 (22-52) years. Risk factors for incident tuberculosis observed in the HHCs were undernourishment (32.3%), overweight (47.8%), and diabetes comorbidity (10.6%). Most of the participants had not heard of latent TB infection (97.3%) The intention to accept tuberculosis preventive therapy was reported by 394 (73.5%) participants with an absence of symptoms (33.1%), feeling completely healthy (42.9%), and drug adverse effects (27.5%) (n=142) being primary drivers of non-intention. Nearly three in four HHCs without TB disease expressed willingness to accept TPT if prescribed with caveat for the social desirability bias.

Highlights

  • The integration of newer tuberculosis preventive therapy regimens, which have shorter treatment duration, simpler dosing requirements, and improved safety profile, is being considered within India’s national tuberculosis elimination program

  • Latent tuberculosis infection (LTBI) is the persistent immune response generated through stimulation by Mycobacterium tuberculosis (MTb) infection [1]

  • This study found that most HHCs of pulmonary tuberculosis (PTB) patients had never heard of LTBI and lacked awareness on how to differentiate it from TB disease

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Summary

Introduction

The integration of newer tuberculosis preventive therapy regimens, which have shorter treatment duration, simpler dosing requirements, and improved safety profile, is being considered within India’s national tuberculosis elimination program. A potential operational challenge in the successful rollout of the expanded TPT plan is the extent of its acceptability in adult household contacts of pulmonary tuberculosis patients due to possibility of lower risk perception and suboptimal perceived benefit. This study was conducted to determine the intention to accept Tuberculosis Preventive Therapy among adult household contacts of pulmonary tuberculosis patients in Delhi, India. Close household contacts (HHCs) of pulmonary tuberculosis (PTB) patients on acquiring MTb infection have higher susceptibility of developing incident TB disease (TBD) especially if they are immunodeficient or undernourished [2,3]. TB preventive therapy (TPT) refers to the treatment of LTBI infection in these high-risk individuals to prevent TBD and is effective in reducing the risk of incident TBD in the HHCs of PTB patients by ~90% [1,4]. The national TB elimination program (NTEP) prescribes TPT only for HHCs below 6 years of age and the people living with HIV (PLHIV) evidence for expansion of its use in other groups is mounting [6-8]

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