Active case finding (ACF) for tuberculosis (TB) was implemented in 60 selected high TB burden wards of Kolkata, India. Community volunteers called TOUCH (Targeted Outreach for Upliftment of Community Health) agents (TAs) identified and referred presumptive TB patients (PTBPs) to health facilities for TB diagnosis and treatment. We aimed to describe the “care cascade” of PTBPs that were identified during July to December 2018 and to explore the reasons for attrition as perceived by TAs and PTBPs. An explanatory mixed-methods study with a quantitative phase of cohort study using routinely collected data followed by descriptive qualitative study with in-depth interviews was conducted. Of the 3,86242 individuals that were enumerated, 1132 (0.3%) PTBPs were identified. Only 713 (63.0%) PTBPs visited a referred facility for TB diagnosis. TB was diagnosed in 177 (24.8%). The number needed to screen for one TB patient was 2183 individuals. The potential reasons for low yield were stigma and apprehension about TB, distrust about TA, wage losses for attending health facilities, and substance abuse among PTBPs. The yield of ACF was suboptimal with low PTBP identification rate and a high attrition rate. Interviewing each individual for symptoms of TB and supporting PTBPs for diagnosis through sputum collection and transport can be adopted to improve the yield.

Background: In India, challenges in pediatric TB contact screening and chemoprophylaxis initiation are still underexplored. Elucidating these challenges will help in better implementation of the programme at the grass-roots level thereby helping in early detection of pediatric cases and timely initiation of preventive therapy. This study aimed at exploring the challenges faced by the health care provider in contact screening and chemoprophylaxis initiation implementation of the pediatric household contacts. Methods: A qualitative study was conducted in the districts of Bengaluru and Udupi and in-depth interviews of key participants were adopted to explore the challenges. Qualitative data analysis was done after developing transcripts by generating themes and codes. Results: The key challenges were identified as stigma towards the disease, migrant patients with changing address, difficulty in sample collection, anxiety among parents due to long duration of the prophylactic treatment and adherence to IPT is not well documented, inadequate transportation from rural areas, and the ongoing COVID-19 pandemic. Conclusions: It is important for the National TB programme to address these challenges efficiently and effectively. Innovative solutions, feasible engagements, and massive efforts are to be taken by the programme to improve contact screening and isoniazid chemoprophylaxis implementation.

While tuberculosis (TB) preventive therapy among household contacts is effective at an individual level, its population-level impact on reducing TB incidence has been unclear. In this study, we aimed to assess, among the new tuberculosis patients started on treatment between 1 October, 2018 and 30 June, 2019 in the public health facilities of Udupi district (South India): i) the proportion with a ‘history of household TB exposure’ and ii) sociodemographic and clinical factors associated with it. We conducted a cross-sectional study involving record review and patient interviews. Of 565 TB patients, 273(48%) were interviewed. Of them, 71(26%, 95% CI: 21%–32%) patients had a ‘history of household TB exposure (ever)’ with about half exposed in the past five years of diagnosis. Considering a new TB case as a proxy for incident TB, and ‘history of household TB exposure’ a proxy for household transmission, and assuming 100% effectiveness of preventive therapy, we may infer that a maximum of 26% of the incident cases can be prevented by giving preventive therapy to all household contacts of TB patients. In multivariable analysis, females and tobacco users had a significantly higher prevalence of household TB exposure. If there are resource constraints, these subgroups may be prioritized.