Contact screening and chemoprophylaxis in India's Revised Tuberculosis Control Programme: a situational analysis.
BACKGROUND
India's Revised National Tuberculosis Control Programme (RNTCP) recommends screening of all household contacts of smear-positive pulmonary tuberculosis (PTB) cases for tuberculosis (TB) disease, and 6-month isoniazid preventive therapy (IPT) for asymptomatic children aged <6 years.


OBJECTIVE
To assess the implementation of child contact screening and IPT administration under the RNTCP.


METHODS
A cross-sectional study conducted in four randomly selected TB units (TUs), two in an urban (Chennai City) and two in a rural (Vellore District) area of Tamil Nadu, South India, from July to September 2008. The study involved the perusal of TB treatment cards of source cases (new or retreatment smear-positive PTB patients started on treatment), interview of source cases and focus group discussions (FGDs) among health care workers.


RESULTS
Interviews of 253 PTB patients revealed that of 220 contacts aged <14 years, only 31 (14%) had been screened for TB, and that of 84 household children aged <6 years, only 16 (19%) had been initiated on IPT. The treatment cards of source cases lacked documentation of contact details. FGDs revealed greater TB awareness among urban health care workers, but a lack of detailed knowledge about procedures.


CONCLUSIONS
Provision for documentation using a separate IPT card and focused training may help improve the implementation of contact screening and IPT.
Banu Rekha
V V
VV
Tuberculosis Research Centre, Chennai, India.
Jagarajamma
K
K
Wares
F
F
Chandrasekaran
V
V
Swaminathan
S
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003140:Communicable Disease Control / Q000379:methods*; D016358:Contact Tracing; D003430:Cross-Sectional Studies; D003625:Data Collection; D004282:Documentation / Q000379:methods; D005192:Family Health; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000592:standards; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D007538:Isoniazid / Q000627:therapeutic use*; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D019035:Rural Health Services / Q000458:organization & administration / Q000592:standards; D012424:Rural Population; D013183:Sputum / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000517:prevention & control* / Q000635:transmission; D019037:Urban Health Services / Q000458:organization & administration / Q000592:standards; D014505:Urban Population; D055815:Young Adult
D000995:Antitubercular Agents; D007538:Isoniazid