title: Tuberculosis contact screening and isoniazid preventive therapy in a South Indian district: operational issues for programmatic consideration.
abstract: BACKGROUND
  Under India's Revised National Tuberculosis Control Programme (RNTCP), all household contacts of sputum smear positive Pulmonary Tuberculosis (PTB) patients are screened for TB. In the absence of active TB disease, household contacts aged <6 years are eligible for Isoniazid Preventive Therapy (IPT) (5 milligrams/kilogram body weight/day) for 6 months.
  
  
  OBJECTIVE
  To estimate the number of household contacts aged <6 years, of sputum smear positive PTB patients registered for treatment under RNTCP from April to June'2008 in Krishna District, to assess the extent to which they are screened for TB disease and in its absence initiated on IPT.
  
  
  METHODS
  A cross sectional study was conducted. Households of all smear positive PTB cases (n = 848) registered for treatment from April to June'2008 were included. Data on the number of household contacts aged <6 years, the extent to which they were screened for TB disease, and the status of initiation of IPT, was collected.
  
  
  RESULTS
  Households of 825 (97%) patients were visited, and 172 household contacts aged <6 years were identified. Of them, 116 (67%) were evaluated for TB disease; none were found to be TB diseased and 97 (84%) contacts were initiated on IPT and 19 (16%) contacts were not initiated on IPT due to shortage of INH tablets in peripheral health centers. The reasons for non-evaluation of the remaining eligible children (n = 56, 33%) include no home visit by the health staff in 25 contacts, home visit done but not evaluated in 31 contacts. House-hold contacts in rural areas were less likely to be evaluated and initiated on IPT [risk ratio 6.65 (95% CI; 3.06-14.42)].
  
  
  CONCLUSIONS
  Contact screening and IPT implementation under routine programmatic conditions is sub-optimal. There is an urgent need to sensitize all concerned programme staff on its importance and establishment of mechanisms for rigorous monitoring.
authors.affiliation: Department of Community Medicine, Siddhartha Medical College, Vijayawada, Andhra Pradesh, India.
authors.forename: Madhavi
authors.initials: M
authors.lastname: Pothukuchi
authors.forename: Sharath Burugina
authors.initials: SB
authors.lastname: Nagaraja
authors.forename: Santosha
authors.initials: S
authors.lastname: Kelamane
authors.forename: Srinath
authors.initials: S
authors.lastname: Satyanarayana
authors.lastname: Shashidhar
authors.forename: Sai
authors.initials: S
authors.lastname: Babu
authors.forename: Puneet
authors.initials: P
authors.lastname: Dewan
authors.forename: Fraser
authors.initials: F
authors.lastname: Wares
mesh_terms: D000328:Adult; D002675:Child, Preschool; D002947:Cities / Q000706:statistics & numerical data; D016358:Contact Tracing / Q000379:methods*; D006798:Housing; D006801:Humans; D007194:India; D007538:Isoniazid / Q000494:pharmacology*; D015980:Public Health Practice / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data; D013183:Sputum / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000517:prevention & control* / Q000635:transmission*
chemical_list: D007538:Isoniazid