Identifying missed opportunities in tuberculosis preventive treatment care cascade: Analysis of programme data from Maharashtra, India

TL;DR

This study examines the gaps in tuberculosis preventive treatment delivery in Maharashtra, India, highlighting missed opportunities and suggesting improvements for better care.

Contribution

The paper provides a detailed analysis of the TPT care cascade in Maharashtra, identifying specific areas for improvement in program implementation.

Findings

Only 84% of notified TB patients had household contacts traced, and 45% of contacts were eligible for TPT.

TPT completion was low at 41%, with significant gaps in recording treatment outcomes.

Losses in the TPT cascade were higher for the 6H regimen and private sector cases.

Abstract

Tuberculosis infection is a condition when a person harbours the bacilli without having signs of active disease. In India, over 50% of household contacts of people with pulmonary tuberculosis have the infection. The national tuberculosis elimination programme recommends preventive treatment to such household contacts after ruling out active disease. Maharashtra is one of the bigger states in India with high tuberculosis burden. We analysed the programme data from Maharashtra to describe the tuberculosis preventive treatment care cascade for household contacts of all notified people with pulmonary tuberculosis for the year 2023. Contact tracing was done for 84% of the 133,167 notified people with pulmonary tuberculosis. A total of 406,291 household contacts were enlisted out of whom 386,224 (95%) were screened for symptoms of tuberculosis. 185,502 (45%) household contacts were listed as eligible for tuberculosis preventive treatment, of whom 101,325 (55%) were initiated on tuberculosis preventive treatment. While 41,480 (41%) of those initiated on treatment successfully completed it, treatment outcomes were not recorded for around 57,191 (56%) of them. Tuberculosis preventive treatment completion as well as recording of treatment outcomes was lesser for 6H regimen, among contacts of those seeking care from private sector and people with clinically diagnosed tuberculosis. There were considerable losses at all steps of the TPT cascade. Reasons for losses from the cascade need to be identified and addressed. Strengthening data capturing and reporting mechanisms and developing decentralized mechanisms for identification, evaluation and TPT provision are necessary for improvement in service delivery and utilization. Aligning the national TB report with the guidelines by including household contacts of all notified persons with pulmonary tuberculosis instead of only microbiologically positive ones may improve treatment outcome recording among clinically diagnosed cases. The capacity building, monitoring, and supportive supervision need further strengthening to improve the provision of tuberculosis preventive treatment care.

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