Tuberculosis remains a major cause of morbidity and death from infectious diseases in children of all ages globally, particularly in young children. In India, childhood Tuberculosis is a staggering problem, contributing to approximately 31% of the global burden. It is a good strategy for the early identification of children eligible for isoniazid preventive therapy (IPT) and for preventing susceptible children from developing the disease following a recent infection from household Sputum-positive TB patients. This study aims to identify challenges faced by healthcare providers in implementing paediatric contact screening and chemoprophylaxis for household contacts of TB patients. 1) Assess knowledge of TB screening and preventive therapy among healthcare providers. 2) Identify factors influencing implementation. 3) Evaluate the level of contact tracing and TPT implementation through qualitative and quantitative analysis. We used a mixed-method study design, wherein the quantitative phase (secondary data analysis and house-to-house survey) was followed by the qualitative phase (Interviews). The present study was conducted in one TU (Srikakulam TU). In our study, 77 primary index sputum-positive patients had 114 child contacts (<5 years). In 77 sputum-positive cases, 114 paediatric contacts were aged <5 years. So, in our study, we have 114 paediatric contact patients (<5 years) who were eligible for contact screening and Tuberculosis prevention therapy (TPT). In our study, we identified 114 eligible children who were in contact with primary index cases. Out of 114 children, screening was done in 110 children; in 4 children, screening was not done. Out of 4 children, 2 were newly diagnosed and yet to be screened, and the remaining 2 children's parents were not willing to undergo screening tests, but they are willing to take TPT therapy. Our healthcare supervisors were successful in initiating the TPT therapy in 112 cases. Our study concluded that the implementation of TPT and screening of child contact were implemented properly in our district. Doctors play a major role in eliminating TB so NTEP needs to provide regular knowledge to the practicing doctors. Stigma-related disclosure of TB disease is to be reduced by individual and mass campaigns. As TPT is not under supervision so there is no clarification about TPT drug adherence. As doctors, we are the primary ones to diagnose a TB case and if a doctor advises the patient about screening and TPT, the entire scenario changes. As knowledgeable people, doctors should be the initial people in the implementation of TPT, and it is continued by peripheral health care workers. TB elimination can be achieved only by the active participation of NTEP-trained and committed doctors and healthcare workers.
Tuberculosis has been one of the biggest issues of public health in India with constant diagnostic delays, stigma, and poor treatment-seeking behaviour serve as barriers to Disease elimination process. Although the diagnostic and surveillance technologies have been improved at a rapid pace. The society is still Stemming from lagging in community engagement and thus the awareness cannot be converted to action. This research explores the opportunities of tele-education as a scaled process to enhance the community involvement in the issue of the control of tuberculosis in opposite high-case environments in an urban slum cluster and a tribal village network. An intervention based on the use of four videos, audio modules, quizzes, and ASHA-promoted reinforcement was implemented on 112 households over a period of four weeks via tele-education. The results showed that both sites had great improvements in TB literacy in addition to behaviour change that was observed through the self-initiated referrals, increased uptake of screening, and the facilitation of information with peers. Despite the fact that the urban slum had a higher level of digital participation, the tribal community acquired knowledge the same way by a hybrid offline-based model. The findings highlight the relevance of contextual differentiation, trusted intermediaries and blended learning methods in realizing the maximum impact of tele-education. Tele-education as a potential solution to speed up eliminating TB nationally can be viewed offenders by considering communities as active participants not as passive recipients, through a reformulation of communities as active partners, which facilitates population health initiatives beyond biomedical innovation.
Tuberculosis (TB) remains a critical global health concern, with India contributing nearly one-fourth of the total global burden. Although significant progress has been made in diagnostic innovations and therapeutic strategies, the rising incidence of multidrug-resistant TB (MDR-TB), coupled with treatment-associated adverse effects, continues to hinder effective disease management. These challenges not only complicate therapeutic outcomes but also pose a substantial threat to global TB elimination efforts. These factors substantially impair health-related quality of life (HRQoL), affecting physical, psychological, social, and environmental domains. Yet, evidence from Indian tertiary care settings using standardized QoL tools remains limited. A holistic assessment that combines clinical, radiological, and microbiological findings with psychological and QoL measures is essential for capturing the full impact of TB on patients' lives. This study was designed to comprehensively evaluate the QoL among patients with TB by employing the WHOQOL-BREF instrument within a tertiary care hospital setting. Furthermore, it aimed to investigate the influence of key determinants, including sociodemographic characteristics, treatment regimens, therapy-induced adverse events, and drug resistance patterns on QoL across the physical, psychological, social, and environmental domains. A six-month observational study was performed at a tertiary care hospital, enrolling 220 TB patients aged 20 years and above. QoL was assessed using the WHOQOL-BREF questionnaire, which evaluates four domains: physical, psychological, social, and environmental. Data were collected and analyzed using SPSS version 26, applying descriptive statistical methods to summarize the findings. The Physical Health domain demonstrated the greatest impairment (mean score: 36.35 ± 5.34), followed by the Psychological (44.49 ± 9.30), Environmental (48.17 ± 9.59), and Social (52.95 ± 19.61) domains. QoL varied significantly across sociodemographic and clinical factors, including education, occupation, and income. While adverse drug reactions (ADRs) were commonly reported, they did not show a significant association with diminished QoL (p > 0.05). Conversely, patients with drug-resistant TB demonstrated markedly lower scores in the environmental domain (p = 0.024) as well as overall QoL (p = 0.001) when compared to individuals with drug-sensitive TB. TB profoundly affects patients' QoL, with the greatest burden observed in the physical and psychological domains. Lower socioeconomic status, limited education, and drug-resistant TB are key determinants of poorer QoL. Incorporating patient-centred care with integrated psychological support alongside routine clinical management may improve overall treatment outcomes and well-being.
National Tuberculosis Elimination Programme focuses more on open (pulmonary) cases of tuberculosis. In addition to pulmonary tuberculosis, extrapulmonary tuberculosis cases also contribute to the tuberculosis burden and spread of infection among household contacts. This study aims to estimate the incidence of tuberculosis disease among household contacts of extrapulmonary tuberculosis cases and to describe the associated risk factors. This retrospective cohort study was done in Mandya, Ramanagar, Mysuru, and Chamarajanagar districts of South-west Karnataka covering household contacts of 1428 extrapulmonary tuberculosis cases registered in the study districts between 2017 and 2018. Data was collected by telephonic interviews from 4705 household contacts. Descriptive statistics, inferential statistics and Kaplan-Meier survival analysis were used. Among 4705 household contacts, 48(1%) study participants had developed active tuberculosis. Of them, 35(73%) had pulmonary tuberculosis and 13(27%) had extra pulmonary tuberculosis. Among the newly diagnosed, 31(65%) were males and 17(35%) were females. Risk factors like diabetes and alcohol intake were found to be associated with increased tuberculosis incidence in household contacts of extrapulmonary tuberculosis. Maximum TB incidence occurred during the first 12 months i.e., 24(50%). 39 out of 48 cases did not have any other known case of tuberculosis as common contact. Five-year incidence of tuberculosis among household contacts of extrapulmonary tuberculosis cases was 1% and diabetes mellitus, alcohol intake were main risk factors for tuberculosis incidence.
Tuberculosis (TB) is an ongoing international health issue, which is particularly common among the communities who live in poverty, marginalization and social disparity. Understanding that purely biomedical strategies are unable to reach those settings, national TB initiatives are turning to community engagement strategies to expand reach, enhance the early detection process, encourage treatment compliance, and aid in eliminating stigma. This paper critically evaluates the aspects on ethics which determine the involvement of communities in the TB prevention programs and argues that community involvement is not always good, unless the design and implementation of the activities based on the principles of ethics are applied to protect the rights, dignity and agency of the suffering populations. Creating a conceptual frameworks and model analysis under different circumstances, including informal settlements within cities, migrant worker locations and distant tribal locations, the research outlines significant ethical prospects and threats, which are incorporated in community engagement. Results show that community-based interventions usually lead to substantial screening, adherence, and trust gains though they also show persisting dilemma concerning breach of confidentiality, fuzzy consent, unequal loss of power, and risk transfer onto volunteers and peer supporters. The graphical analysis and an example of the field further promote the fact that there are differences in ethical issues in the different social contexts, which require adaptive and participatory governance rather than standardized solutions. The paper is summarized as having made the case that ethically informed community engagement is not just a moral requirement but also an empirical necessity of sustainable TB control and requires continuing ethical reflexivity, improved safeguards and policy frameworks that should foster partners in the community as co-producing health and not supporting Labour. The introduction of ethics into the design, implementation, and monitoring of TB programs will enable the public health agencies to take a step towards more equitable, legitimate, and community-owned avenues to TB elimination.
Timely diagnosis and prompt initiation of treatment are crucial for the effective management of tuberculosis (TB), particularly in People living with HIV (PLHIV). A delay in diagnosing TB,in this special population, not only postpones the start of appropriate treatment but also increases the risk of poor clinical outcomes and TB transmission. In resource-limited settings, where advanced diagnostic tests such as Xpert-MTB assay and mycobacterium culture may be unavailable, there is a notable lag in diagnosing smear-negative pulmonary TB among PLHIV. Empiric anti-TB treatment is a widely utilized strategy to address this challenge. However, there has been limited research evaluating its impact on mortality. Given this knowledge gap, it becomes imperative to conduct a systematic review that can provide evidence-based management strategies for healthcare professionals working with PLHIV. A systematic search strategy was conducted using various databases including MEDLINE, EMBASE, SCOPUS, Cochrane Library, and ClinicalTrials.gov up until May 2023. Observational and interventional studies involving adults with HIV and clinically suspected (unconfirmed) pulmonary TB were included. Due to clinical and methodological heterogeneity, a narrative synthesis was performed. Findings were categorized by the effect of empiric TB treatment on mortality. The search strategy identified seven eligible studies (including 2,352 patients) meeting the inclusion criteria. Two studies revealed higher long-term mortality rates among PLHIV who received empiric tuberculosis treatment compared to those who did not. However, most of these patients had more advanced HIV disease and a higher likelihood of having TB. A statistically significant increase in mortality was observed in only one of these two studies (adjusted HR: 3.7, 95% CI 92.2-6.3, P = 0 .115). On the other hand, two studies suggested that there may be a potential benefit of empiric treatment for those with signs of severe TB resulting in approximately 17% reduction in mortality (ARR: 17%; 95% CI: 5.5%-29%; p = 0.004). No mortality benefit was observed among stable patients without signs of severe TB who were empirically treated. A separate study focusing on severely ill HIV patients, showed a numerically lower mortality rate in the group who received empiric treatment compared to the untreated group but not reaching statistical significance. The effectiveness of empiric TB treatment for PLHIV remains uncertain. Multiple studies included in this systematic narrative review have yielded conflicting results, indicating the complexity of managing TB-HIV co-infection in resource-limited settings. Current evidence points toward risk-stratification when taking the decision to initiate empiric TB treatment for PLHIV. Empiric treatment may reduce mortality in critically ill patients with danger signs and should be initiated promptly. However, it should be avoided in clinically stable patients where further diagnostic evaluation is preferred.
Complex and long-term TB treatment increases the risk of drug-related problems (DRPs). Optimal TB treatment requires a multidisciplinary team, but most hospitals do not see this condition. This study aimed to analyze the impact of telecare-based IPC practices on reducing the incidence of DPRs in patients with TB. A Randomized Control Trial was conducted in a single-masked group with a study population of 300. Randomization was performed using a computer-generated sequence with 1:1 allocation ratio. Blinding was maintained by ensuring that the intervention and control treatments were identical in appearance with 55 participants in each group. The intervention group received telecare-based interprofessional collaboration services, whereas the control group received standard hospital services. The data were collected using an observational sheet. According to Cipolle et al. (2012), the primary outcome measured was the incidence of DRP, including unnecessary drug therapy, need for additional drug therapy, ineffective drug therapy, too high dose, too low dose, adverse drug reactions (ADR), and non-compliance. Next, the difference in the incidence of DRPs in the control and experimental groups after the IPC-based telecare practice was examined. Data were analyzed by an independent statistician blinded to group assignments using intention-to-treat principles. The research results showed that telecare-based interprofessional collaboration practices can reduce the incidence of DRPs with a significant p-value <0.05, especially in the criteria of adverse drug reactions, drug interactions, and nonadherence in TB patients, thereby increasing patient safety efforts.
The analogues of nitrogen particularly compounds containing two nitrogen atoms like Quinazolines, Imidazoles and hydrazides are important type of precursors to the most drugs. Moreover, compounds with two nitrogen atoms showed versatile biological activities such as anti-tubercular activity, antibacterial (gram + ve and gram-ve), anti-HIV, antifungal, anticancer, antibiotic, etc activities. So, based on the literature profile of the Quinazolines, Imidazoles, and hydrazides it is proposed to design a novel hybrid moiety by the combination of above three moieties for possible antitubercular agents. A string of new Imidazole-benzohydrazide derivatives (6a-n) were synthesized starting from a chloro-substituted quinazolin(1) in three consecutive steps. All the 14 synthesized compounds were well characterized by 1H NMR, 13C NMR and Mass spectral data and then screened for their anti-tuberculosis activity. Further, In silico studies were carried out for uncovering the probable structure-based mechanism of action. Among the synthesized compounds, compound 6k with m-bromo, m-methoxy and p-hydoxy substitutions has given highest MIC of 7.81 μg/mL and compounds 6a(p-hydroxy), 6d(o-,m-,p-hydroxy), and 6j (m- and p-hydroxy) were also showed good sensitivity up to 15.62 μg/mL (6i, 6b, 6j). Further, the antitubercular activity was compared with the standards Para-aminosalicilic acid and Rifampicin. In silico studies has given a good correlation of in vitro activity with better binding energy and interaction profile of 6i compound along with 6j and 6d and they might hold the potential to be anti-mycobacterial hit compounds which requires structural optimization to refine the ADME properties in the further exploratory studies.
Central nervous system (CNS) tuberculosis is one of the most severe forms of extrapulmonary TB, often leading to substantial morbidity and mortality owing to its complex clinical presentation and frequent diagnostic delays. Despite global TB control efforts, CNS TB continues to present unique difficulties owing to its nonspecific clinical manifestations, the paucibacillary nature of cerebrospinal fluid (CSF), and the limitations of conventional diagnostic methods. The diagnostic dilemma is further compounded in resource-limited settings where advanced molecular tools and neuroimaging may not be readily available. Timely and accurate diagnosis remains a cornerstone in reducing mortality and neurological sequelae. Clinically, CNS TB can present as tuberculous meningitis (TBM), tuberculoma, abscess, or spinal TB, each with overlapping features with other infectious and non-infectious conditions. This spectrum makes early clinical diagnosis particularly elusive. Traditional diagnostic methods such as CSF smear for acid-fast bacilli (AFB), culture, and routine biochemistry often fail to provide definitive answers. AFB smear sensitivity is dismal (less than 10 %), and culture, although considered a reference standard, takes weeks, during which the disease may progress rapidly. In recent years, advances in molecular diagnostics have brought hope. Nucleic acid amplification tests (NAATs), including GeneXpert MTB/RIF and the more sensitive GeneXpert Ultra, have enhanced detection compared to smear microscopy; however, their diagnostic yield in cerebrospinal fluid (CSF) remains suboptimal due to the typically low bacillary burden in CNS tuberculosis. WHO's 2021 Module 3 guidelines emphasize that despite these advances, NAAT sensitivity for CNS TB remains suboptimal and cannot replace clinical judgment and imaging. CSF Xpert positivity in TBM varies between 50 and 70 %, with a negative result not excluding disease. LAMP (loop-mediated isothermal amplification) and multiplex PCR assays are also emerging but lack standardization for CNS specimens. Neuroimaging techniques like MRI, MR spectroscopy, and diffusion tensor imaging (DTI) play an essential adjunctive role in diagnosis, particularly when CSF results are inconclusive. However, findings are often non-specific and require integration with clinical and laboratory data. Advanced imaging and artificial intelligence (AI)-based radiomic analysis are being explored for pattern recognition in neuro-TB, showing promise but are not yet widely applicable in clinical practice. Biomarkers like adenosine deaminase (ADA) along with interferon gamma, neopterin, and IP-10 in CSF have been studied, but none have yet replaced microbiological confirmation. Furthermore, diagnosis in specific populations-such as extremes of age, people living with HIV, and elderly individuals-presents additional complexities due to atypical presentations and altered immune responses. This review comprehensively discusses the multifaceted challenges in diagnosing CNS TB and the emerging diagnostic tools and strategies. It evaluates the sensitivity, specificity, and utility of conventional and advanced modalities and highlights evidence from WHO guidelines and recent literature. Addressing diagnostic barriers and integrating novel technologies into practice, particularly in high-burden countries, is essential to improving outcomes.
Diagnostic algorithm, till last decade have contravened the center principle of End TB Strategy. Isoniazid monoresistance (IMR) has been denied attention, most probably due to dearth of molecular diagnostic facilities in majority of microbiology labs all over our country and also diagnostic implications of the IMR have not been explained as yet. We analyzed the burden and trend of IMR at our rural catering health facility by retrospective studying the data of TB patients registered at our DOTS catering center over a decade. A total of 772 samples, both pulmonary (58.8%) & extrapulmonary (41.2%) were received at our central lab for IMR profile drug susceptibility testing. The policy of screening of IMR is in place at our tertiary care center from 2012. A gradual reduction in IMR was observed with 28.5% in the first biennial followed by 14.2%,10.5%, 8.8% and 5.9% in the second, third, fourth and fifth biennial of study period respectively. A cumulative percentage of IMR was 8.7% with surprisingly 5.1% in new cases and 3.6% in previously treated fully recovered cases of tuberculosis disease. The diagnostic implications of our findings are that screening of IMR need to be incorporated in diagnostic algorithm and further intensified. However, further studies need to be conceptualized to analyze IMR implications on treatment of TB patients.
The impact of pulmonary tuberculosis persists despite successful treatment and poses a significant burden on healthcare. Post-tuberculosis lung disease (PTLD) is defined as "evidence of a chronic respiratory abnormality, with or without symptoms, attributable at least in part to prior tuberculosis". The abnormalities include residual lung lesions on imaging, lung function abnormalities, and complications such as haemoptysis, relapse, bronchiectasis and destroyed lung among others. These lung disorders have been studied independently but a comprehensive approach to PTLD has not yet been studied. Our research was conducted to emphasise the burden of PTLD and correlate this with comorbidities. A hospital based cross sectional observational study was conducted in Department of Respiratory Medicine, MMIMSR using a self-designed proforma. A total of 150 patients with history of previously treated tuberculosis were enrolled for this study over 2 years based on the inclusion/exclusion criteria. Patient demographic information, symptomatology, comorbidities and smoking status were entered in the proforma. Chest Xray, CT chest, PFT and 2D echo findings were also collected. Data was analysed and statistically correlated using SPSS PC 25 version. P value < 0.05 was considered significant. The mean age of the patients was 50.25 ± 15.89 years with more males (55 %) than females (45 %). Comorbidities included anaemia (43 %), diabetes (28 %) and COPD (24 %) among others. Radiological sequelae were found in 147/150 patients. These included pulmonary fibrosis (79 %%), total collapse (13.6 %) multiple cavities (34.7 %), pleural involvement (44.2 %), bronchiectasis (40 %) and destroyed lung (10.2 %). On spirometry 48 % showed a restrictive pattern, while a mixed obstructive and restrictive pattern was seen in 34 % of cases. Tuberculosis associated obstructive pulmonary disease (TOPD) was observed in 49 %, haemoptysis in 25 % and relapse in 13.6 % patients. Significant associations included diabetes with haemoptysis (p < 0.01), hypertension with type II respiratory failure (p = 0.01) and haemoptysis with bronchiectasis (p < 0.01) and aspergilloma (p = 0.001). our study underscores the wide range of lung disorders and dysfunction experienced by TB survivors, which are exacerbated by comorbidities. Hence, patient care and follow up must not end with successful treatment of TB. Digitalization of patient records is emphasized to enable follow up for identifying sequalae that may arise in future. Moreover, management of PTLD should be standardised and included in national guidelines by policy makers.
Out-of-Pocket Expenditure (OOPE) refers to the direct payments made by individuals for healthcare services and non-medical expenses, excluding health taxes or insurance premiums. Although the National Tuberculosis Elimination Program (NTEP) provides free laboratory services and medications, tuberculosis continues to impose a financial burden on underprivileged populations. This is due to increased healthcare costs, loss of daily wages, and dependency on others. Therefore, this study was conducted with the objectives to determine OOPE for smear-positive tuberculosis patients who are currently under treatment or diagnosed and enrolled within last 1 year under NTEP. 2. To assess the coverage and completeness of Direct Benefit Transfer (DBT). A mixed method study using a tool-based questionnaire was conducted amongst the patients registered under NTEP in Papum-pare district during a period of June 2022 till May 2023. Total of 320 patients were eligible for the study and were interviewed. The data was collected from the patient card and by using a Questionnaire from the WHO's "The Tool to estimate patients' costs". Mean and median costs were used for comparison. The overall estimated mean total costs expended from the onset of symptoms and till treatment completion were Rs.41481.04 under NTEP. Among direct medical costs, investigation fee (Rs.14, 415.16) and direct non-medical costs, hospitalisation cost (Rs. 47,614.49) were maximum.29.95 % patients stopped working less than 1 month and had average per capita income Rs.6701.25. 28.44 % patients borrowed money to cover expenses and 0.31 % sold their land. 55.78 % patients enrolled under Nikshay Scheme received DBT. Compliance to treatment was good and an overall cost incurred by TB patients was low. However, still there is a huge burden of expenses among lower economic section due to scarcity of medicine in DOTS centres and delayed transfer of DBT. The role of NIKSHAY SCHEME in such settings requires further study.
Digital support, like mobile applications, improve treatment results in tuberculosis. However, the dearth of knowledge on these applications have led to their limited use in India. Our study aims to fill this lacuna by assessing the functionality and intended use of mobile applications related to tuberculosis in India. An extensive search was done on Google Play Store, Apple Store and Amazon. Apps were included if they focused on tuberculosis and were excluded if they were not for the Indian population or were related to other diseases. Each app was assessed for 7 functional categories and 4 subcategories, accuracy and intended use. Data was entered into Epicollect and was extracted onto Excel and analyzed. Of 459 apps identified from the search, 32 were included in the study. Maximum apps provided e-Learning information (66 %), while least apps provided telemedicine consultation and assistance for individualized dosing (16 % each). Regarding functionalities, most apps recorded information (72 %) and least provided reminder alerts (22 %). About 56 % of the apps showed good functionality. 12 apps contained wrong or outdated information. Given the digital advancements available, there is further scope to leverage the use of technology to help India eliminate tuberculosis.
The Census of India 2011 defines 'houseless household' as, "households who do not live in buildings or census houses but live in the open on roadside, pavements, under flyovers and staircases, or in the open in places of worship, mandaps, railway platforms, etc." India had 17.73 lakh unhoused people, with over 700,000 of them being women. Tuberculosis (TB) affected an estimated 8.7 million people ….globally in 2011, including 0.5 million women. The WHO has set targets to end the global TB epidemic by 2035. In India Revised National Tuberculosis Control Program [called National TB Elimination Program (NTEP) since 2020] set out National Strategic Plan for Tuberculosis: 2017-25 for Elimination By 2025. Humana People to People India (HPPI) newer projects -TASA (TB Affected Street Activist) and SWEET (Street Women Empowered and Engaged to Stop TB)-specifically focus on homeless and street-dwelling women. The objectives of study on two projects: 1. To understand the determinants of Tuberculosis and assess barriers to TB care faced by homeless people, poor migrant workers and people living in unauthorized slums of Delhi. 2. To assess the effectiveness of community-based interventions-specifically the TASA and SWEET projects-in empowering homeless and other vulnerable and marginalised people in Delhi to increase TB awareness, enhanced community-level engagement, improved participation of women, better access to social entitlements, and reduction in TB-related stigma. 3. To demonstrate that trained homeless women can function as effective health advocates by identifying presumptive TB cases, facilitating testing, supporting treatment adherence, and addressing TB-related stigma and discrimination in their communities. This community-based interventional study analyzed retrospectively by both quantitative and qualitative methods i.e. mixed method, was conducted on above mentioned projects. These projects were implemented between May 2023 and April 2024 and December 2023 to January 2025 respectively. The study was conducted between 30.11.24 and March 30, 2025. The study included 7994 homeless people of 2 districts and 5142 Homeless Women, from 5 districts of Delhi who were staying either on streets, Ran Basera (Night Shelters), under the fly-overs, slums etc. For qualitative part a Focus Group Discussion (FGD) of 12 TASAs and 20 In-Depth Interviews (IDI) were conducted. HPPI trained 20 TASAs on TB, National Tuberculosis Elimination Program, violation of human rights, stigma and discrimination of TB patient and how to address these issues. Each TASA made 10 Sahelies/friends in the homeless communities, and passed on this knowledge to Sahelies. TASAs organized 8 TB rallies, 10 meetings to solve issues of homeless PwTB under TASA project. Twenty-six and 46 advocacy meetings were held and 93 and 51 PwTB helped with treatment under TASA and SWEET projects respectively. TASAs and Sahelies held 54 Communities, Rights and Gender Meetings, helped 772 homeless by linking to Social Welfare Schemes. The FGD and IDIs showed that about 50 % TB has been controlled and about 68 % Sahelies will surely take care of TB patients in their community, in future. Solutions to barriers to TB care, enhanced community-level engagement, and better access to social entitlements can be achieved through empowered homeless women's i.e. TASAs and Sahelies.
Achieving successful treatment outcomes for tuberculosis (TB) is essential in reaching the End TB goals. However, adherence to anti-TB treatment remains a significant challenge, leading to poor treatment outcomes, including drug resistance, relapse, and increased mortality. This study aimed to explore the barriers and facilitators influencing adherence to TB treatment in the western Indian population. A cross-sectional study design was undertaken in the Gandhinagar area of Gujarat, comprising people with tuberculosis on treatment. The data was collected through a quantitative questionnaire to investigate adherence prevalence and explore the association of factors affecting adherence behaviour. Descriptive and inferential statistics were utilized to identify key barriers to adherence among persons with TB. The prevalence of non-adherence was 31.6 % among the study population. Bivariate and multivariate analyses revealed significant associations between adherence and several factors. Primary challenges to adherence comprised the occurrence of adverse drug reactions (ADR), as individuals reporting ADRs exhibited significantly lower adherence (p = 0.001). Tobacco consumption was another significant barrier, with tobacco users 1.35 times more likely to be non-adherent (AOR = 1.354, p = 0.001). Additionally, retreatment cases had higher odds of non-adherence compared to new cases (AOR = 1.171, p = 0.016). While facilitators of adherence included higher educational levels, with literate individuals showing better adherence (77.8 %) compared to illiterate individuals (61.7 %) (p = 0.037). Urban residents had better adherence (76.4 %) compared to those living in urban slums (55.0 %) (p = 0.003). These findings highlight the critical role of both individual and health system factors in influencing adherence to anti-TB treatment. These findings underscore the need for targeted interventions to address the specific barriers and leverage facilitators to improve adherence rates and TB treatment outcomes. Strategies focusing on improving healthcare access, patient education, and social support systems to vulnerable populations could enhance treatment adherence and ultimately improve TB control efforts in the region. This study provides insights into patient-related (demand side) and healthcare system-related (supply side) aspects affecting adherence. By addressing the identified challenges and utilizing the facilitators, public health interventions can be formulated to promote treatment adherence, resulting in enhanced TB control outcomes.
Tuberculosis is one of the major infectious diseases that result in a significant morbidity and mortality, especially in the resource-limited communities with a lack of health literacy that hinders the early detection and the compliance with the treatment. Health education through technology is an up-and-coming method of bettering community empowerment in the TB control programs. In this paper, the researcher compared the robustness of a holistic technology-based health education framework using interventions of mobile applications, interactive voice response systems, and digital kiosks in communities to empower the communities with TB. The study was a cluster-randomized controlled trial in 24 communities (12 intervention and 12 control) and used on 1847 adults above 12 months. The main outcomes were TB knowledge levels, health-seeking behavior levels, community-engagement levels, and TB case detection rates. Community empowerment was conceptualized as a multidimensional construct encompassing knowledge acquisition, proactive health-seeking behavior, collective engagement, and stigma reduction. Findings showed that communities that were equipped with technology scored higher in terms of TB knowledge (76.8 ± 12.4 vs. 52.3 ± 14.7, p < 0.001) and index of health-seeking behavior (3.82 ± 0.67 vs. 2.41 ± 0.84, p < 0.001) than control communities. The score of community engagement in intervention communities scored 156 percent higher than in controls, which scored 23 percent higher. It is interesting to note that the rate of TB cases detection in the intervention communities was 34.2 percent as opposed to 8.7 percent in the control community (p = 0.002). The platform that had been enabled by the technology proved to be very effective when it came to empowering communities to undertake the TB control process and provided a model that could be expanded to enable the introduction of digital health education into the public health programs aimed at protecting against the spread of infectious diseases in the endemic areas.
Tuberculosis (TB) is a significant health issue in the world, and lack of health literacy has resulted in delayed care-seeking practices, non-compliance with treatment regimens, and subsequent stigma in communities with the infection. The objective of the study was to determine whether multi-platform digital media campaigns enhance health literacy of the community on TB. The study involved a cluster-randomized controlled trial with sixteen communities in four districts in twelve months with intervention communities (n = 8) having targeted digital media campaigns and control communities (n = 8) having regular health education materials. Digital intervention consisted of orchestrated content dissemination via social media, short video messages, interactive mobile applications, and community WhatsApp groups to contact an approximated number of 47,832 people. Primary endpoint was TB knowledge score; attitudes, stigma perception, and care-seeking intention were prespecified key secondary outcomes. Analyses used mixed-effects models accounting for community-level clustering (ICC assumed 0.05. TB knowledge scores, attitude indices, stigma perceptions and care-seeking intentions were assessed by using validated instruments at pre- and post-intervention using a 2156 population (1084 with intervention and 1072 with control). The outcomes showed that the post-intervention TB knowledge scores were significantly higher in intervention communities (74.8 ± 12.3 vs. 52.4 ± 15.7, p < 0.001), the positive attitude toward the TB patients were also better (68.2% vs. 41.6%, p < 0.001), the scores on stigma perception were lower (2.3 ± 0.9 vs. 4.1 ± 1.2, p < 0.001), and the intentions to seek care were more favorable The metrics of digital content engagement showed that 78.3% of the messages were recalled and 2.4 million videos have been viewed in total. These results indicate that carefully planned digital media campaigns have a great impact on increasing the level of TB health literacy, which is a scalable and cost-effective method of health communication at the community level.
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. 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. 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. 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.
Mortality remains high among undernourished patients with tuberculosis (PwTB). This study aims to improve the utilization of "Nikshay Poshan Yojana" by providing a reference tool for PwTB and their household contacts. The present study developed a malnutrition management tool in the form of recipes, formulated from the ration available in the household, designed within the patient's financial incentives to meet the nutritional requirements. A daily meal plan comprising three major (550 kcal, 18g protein) and three minor meals (300 kcal, 8g protein) were formulated. Energy and nutrient-dense recipes were planned and standardized for cultural acceptability. Each recipe was evaluated by an expert panel for sensory attributes using a 5-point Likert scale. Subsequently, one of the Nikshay-Mitra implemented the recipes with patients. The patients' feedback was recorded using a structured questionnaire. Cost analysis was performed to assess the affordability across socioeconomic groups. Nutrient-dense recipes (N = 57) were planned and standardized to address the dietary needs of PwTB. Considering nutritional adequacy, palatability, and patient acceptability, the recipes were divided into 11 categories. Ingredients were selected based on their contribution to nutrient requirements, with a focus on affordability (Rs.5-30) and seasonal availability. Recipe evaluation ensured high acceptability, leading to the development of a patient-friendly tool (ISBN: 978-81-963616-00). One of the Nikshay-Mitra implemented the recipes with 6 PwTB and found them to be affordable, easily accessible, and simple to prepare. PwTB need empowerment through tested, culturally-accepted, cost-effective home-based nutrition strategies. This tool is a self-reliant resource for patients, their household contacts, and policymakers to utilize benefits under Nikshay Poshan Yojana.
In 2017, the Revised National Tuberculosis Control Program (RNTCP), now known as the National Tuberculosis Elimination Program (NTEP), introduced a major change in its treatment guidelines, shifting from an alternate-day regimen to daily dosing to improve treatment outcomes. Studies conducted on adults indicate that there are minimal differences in treatment failure or recurrence rates between the regimens, however, patients who received three times weekly dosing throughout the therapy exhibited higher rates of acquired drug resistance.This study was undertaken due to the significant lack of available data in the literature regarding recurrence rates among pediatric patients who were undergoing daily drug regimens. Children and adolescents up to 18 years old, who completed pulmonary tuberculosis treatment at least 2 years prior, were included in the study. A detailed history was asked, and old medical records and investigations were assessed. Nutritional status was assessed using anthropometric parameters. Pulmonary function tests were performed in children over 7 years old, excluding those with contraindications or inability to produce acceptable PFT graphs. In total, there were 165 patients divided into different age groups: 33 patients (20.0 %) were below 7 years old, 61 patients (37 %) were between 7 and 12 years, and 71 patients (43.0 %) were between 12 and 18 years of age. The gender distribution showed 61.8 % females and 38.2 % males. Around 52.6 % were underweight cases, which decreased to only 10.2 % on follow-up after completion of treatment. The recurrence rate post-treatment was 7.9 %. Urban areas showed higher recurrence rates (9.3 %) and urban slums (6.3 %) compared to rural (0 %) areas. Children with failure to gain weight had a higher recurrence rate (p = 0.001), indicating a bidirectional relationship between TB and undernutrition. The mortality rate due to TB was 2.42 %. Pulmonary function tests showed abnormalities in 9 patients(26.47 %) (19 % restrictive pattern, 7.47 % obstructive pattern)out of 34 cases who could perform spirometry. Despite completing daily drug therapy successfully, the average recurrence rate was found to be 7.9 %. This is similar to the recurrence rate found in the studies involving adult patients treated with the thrice-weekly/alternate days regimens.