The National TB Elimination Programme (NTEP) of India is implementing tuberculosis preventive treatment (TPT) for all household contacts (HHCs) of pulmonary tuberculosis patients (index patients) aged 5 years with TB infection (TBI). We conducted an explanatory mixed-methods study among index patients registered in the Kolar district, Karnataka during April-December 2022, to assess the TPT cascade and explore the early implementation challenges for TPT provision. Of the 301 index patients, contact tracing home visits were made in 247 (82.1%) instances; a major challenge was index patients’ resistance to home visits fearing stigma, especially among those receiving care from the private sector. Of the 838 HHCs, 765 (91.3%) were screened for TB; the challenges included a lack of clarity on HHC definition and the non-availability of HHCs during house visits. Only 400 (57.8%) of the 692 eligible HHCs underwent an IGRA test for TBI; the challenges included a shortage of IGRA testing logistics and the perceived low risk among HHCs. As HHCs were unaware of their IGRA results, a number of HHCs actually eligible for TPT could not be determined. Among the 83 HHCs advised of the TPT, 81 (98%) initiated treatment, of whom 63 (77%) completed treatment. Though TPT initiation and completion rates are appreciable, the NTEP needs to urgently address the challenges in contact identification and IGRA testing.

Background: India has launched Ayushman Bharat Digital Mission (ABDM), to provide an integrated digital health infrastructure. The success of digital health systems lies in their ability to achieve universal healthcare and incorporate all levels of disease prevention. The objective of this study was to develop an expert consensus on how Community Medicine (Preventive and Social Medicine) can be integrated into ABDM. Methods: A total of 17 and 15 participants, who were Community Medicine professionals with more than 10 years experience in the Public Health Sector and/or Medical Education in various parts of India, participated in round 1 and 2 of this Delphi study respectively. The study explored three domains: 1. Advantages and challenges of ABDM, and possible solutions; 2. Intersectoral convergence in Unified Health Interface (UHI) and 3. Way ahead in medical education and research. Results: Participants envisaged improved accessibility, affordability, and quality of care due to ABDM. However, awareness generation, reaching out to marginalized populations, human resource constraints, financial sustainability, and data security issues were anticipated challenges. The study identified plausible solutions addressing six broad challenges of ABDM and classified them based on the priority of implementation. Participants listed out nine key roles of Community Medicine professionals in digital health. The Study identified about 95 stakeholders who play direct and indirect roles in public health and can be connected to the general public through the Unified Health Interface of ABDM. Further, the study explored the future of medical education and research in the digital era. Conclusion: The Study contributes to broadening the scope of India’s digital health mission, with elements of Community Medicine in its cornerstone.

Epidemiological, and laboratory features of derivation cohort (1216 suspected leptospirosis cases) admitted at a tertiary care hospital of south Gujarat (2007–2015) that significantly correlated with confirmed leptospirosis were used in binary logistic regression to derive scoring models and receiver operating characteristic to determine cutoff values. Validity and net reclassification improvement (NRI) were estimated in validation cohort (82 cases, 2016–2017) and algorithm for diagnosis was prepared. Results: Screening model consisted of the presence of conjunctival suffusion, calf tenderness, raised serum creatinine, headache with conjunctival suffusion and/or jaundice, and dyspnea/meningism. Area under curve (AUC) for screening model was 0.590 (standard error [SE] ±0.017) and cutoff score ≥9 gave sensitivity 79.16%, specificity 50%. The confirmatory model consisted of laboratory parameters, namely polymerase chain reaction, immunoglobulin M ELISA, and microscopic agglutination test and gave AUC 0.998 (SE ± 0.001), sensitivity 89.58%, specificity 85.29%, positive predictive value 89.58%, and negative predictive value 85.29% at cutoff score ≥100. Net sensitivity of algorithm was 98.27% at the point of screening (screening model and rapid test) and net specificity 87.89% at the point of confirmation (screening followed by confirmatory model) in validation cohort. Conclusions: Simultaneous use of screening model and rapid test gave NRI 81.25% and sequential use of confirmatory test gave NRI 47.18% compared to corresponding parts of the modified Faine's criteria....

In India, the nationwide lockdown was implemented from March to May 2020 due to COVID-19 pandemic. As of March 2020, there were 13.08 lakh PLHIV availing ART free of cost from Government run ART centres, To maintain the continuum of care, National AIDS Control Programme (NACP) of India adopted Multi Months Dispensation (MMD) through ART centres and Community Dispensation of ART through the various Targeted Interventions (TI) and Community Based Organizations (CBO). A mixed methods study was designed, with desk review of programmatic data, semi qualitative interviews of 250 PLHIV and 15 In-Depth Interviews of ART centre and TI/CBO staff to document the process, strengths and challenges of these strategies in Surat city of South Gujarat. While administrative, technical and networking strengths were documented, manpower constraints, interrupted laboratory services, migration and relatively passive role of PLHIV in availing services were major challenges described in this study among several others.

This study aimed to document caregivers’ perceptions and preferences regarding coronavirus disease-19 (COVID-19) vaccination among children. This cross-sectional study analyzed 272 caregivers with 347 children (aged 1-18 years) attending a subdistrict rural hospital in February-March 2022. Vaccine acceptance was high (93.4%). Although fear of side effects was the most common reason not to vaccinate, a higher proportion of caregivers willing to vaccinate children had consulted healthcare personnel to clarify queries related to side effects. Familiar vaccination sites, where children had previously received routine immunization (RI), such as government hospitals, and Anganwadis (community-based childcare centers) where vaccines were available free of cost on all working days, were the most preferred for COVID-19 vaccination, followed by schools. Only 5.5% of the caregivers preferred private hospitals. Vaccination at home was desired for chronically ill and out-of-school children. RI as per age was associated with the willingness to vaccinate. In addition to protection from COVID-19, other benefits identified by willing parents were being able to attend schools, recreation, and travel. Out-of-school children, children left or missed out in RI, and children with chronic illness can be at risk of being left out for COVID-19 vaccination and can be included by expanding vaccination services house-to-house as in adults. Media engagement and communication must be interactive to address issues, such as fear of side effects, and promote additional benefits of vaccination.