Evaluation of effect of introducing monitoring cards on Isoniazid prophylaxis therapy uptake among child contacts of Tuberculosis patients in selected Tuberculosis Units of Bangalore Urban district: A mixed methods study.

BACKGROUND

Children less than 6 years who come in contact with Sputum positive TB patients (adults) are frequently infected with Mycobacterium TB bacilli and once infected are at increased risk of moving gradually towards full blown TB disease when compared to adults. Even after introducing contact tracing and IPT in children aged less than 6 years, the coverage rate is found to be suboptimal. Therefore, this research was focused to evaluate effectiveness of IPT monitoring cards in improving INH initiation and completion rates among child contacts of newly diagnosed smear positive TB cases.

METHODS

A mixed methods study was conducted with a prospective design in the quantitative component to estimate IPT initiation and completion rates among child contacts prior to and subsequent introduction of IPT monitoring cards. The qualitative component included in depth interviews to explore facilitators and barriers in implementation of cards as perceived by HCWs and caregivers.

RESULTS

Among 180 child contacts (of 106 index TB cases), 54 out of 88 (61.3 %) were initiated on IPT in pre intervention period and 60 out of 92 (65.2 %) were initiated during post intervention. INH completion rate was 42.6 % in pre intervention and it improved to 86.7 % (p < 0.05) following introduction of IPT cards. Content analysis of interviews revealed additional work burden for HCWs, inadequate understanding and subjective judgment of potential consequences and likelihood of risk as perceived by parents as the barriers in implementation of IPT cards. IPT cards proved to enhance monitoring and documentation of IPT status and improve the adherence rates.

CONCLUSION

IPT monitoring cards if implemented under NTEP will be a very useful tracking tool in improving contact tracing as well as chemoprophylaxis of child household contacts.