There is limited literature available to characterize tuberculosis (TB) in adolescents despite them sharing a high burden of the disease. Ours is the first prospective study in India and worldwide to study the clinical profile of tuberculosis in adolescents aged 10–19 years.Methods: We enrolled 82 children and adolescents between March 2021 to March 2022. The diagnosis of TB was made on the basis of National Tuberculosis Elimination Program (NTEP) guidelines 2020. Adolescents were divided into 3 age groups: early (10–13 years), middle (14–17 years), and late adolescents (18–19 years)and the results were compared among the three groups. A two-sided p value of <0.05 was considered statistically significant.Results: The middle age adolescents comprised majority of our study population and females were more than males. The common presenting features were fever, chest pain, breathing difficulty with majority belonging to lower socioeconomic status. The pulmonary TB accounted for 56% and extrapulmonary constituted 44% of the cases. The notable extrapulmonary cases were disseminated TB with secondary lymphangiectasia, compressive myelopathy, sacroiliac joint arthropathy among others. Infiltrates/consolidation were the most frequent radiological findings in patients with pulmonary TB. The microbiological confirmation was available in 44% of the cases. The microbiological positivity was higher in histopathological specimens and in late adolescents. Two patients were rifampicin resistant. Conclusion: There was a varied clinical presentation of TB in this population. The extrapulmonary cases as well as the microbiological yield increased with increasing age of the cases.
{"title":"Clinical spectrum of tuberculosis in adolescents (10–19 years) in a tertiary care center of North India","authors":"Rajni Gurjar, Rashmi Hooda, Rekha Harish, Devki Nandan","doi":"10.1016/j.ijtb.2024.08.022","DOIUrl":"10.1016/j.ijtb.2024.08.022","url":null,"abstract":"<div><h3>Backgroundobjectives</h3><div>There is limited literature available to characterize tuberculosis (TB) in adolescents despite them sharing a high burden of the disease. Ours is the first prospective study in India and worldwide to study the clinical profile of tuberculosis in adolescents aged 10–19 years.Methods: We enrolled 82 children and adolescents between March 2021 to March 2022. The diagnosis of TB was made on the basis of National Tuberculosis Elimination Program (NTEP) guidelines 2020. Adolescents were divided into 3 age groups: early (10–13 years), middle (14–17 years), and late adolescents (18–19 years)and the results were compared among the three groups. A two-sided <em>p</em> value of <0.05 was considered statistically significant.Results: The middle age adolescents comprised majority of our study population and females were more than males. The common presenting features were fever, chest pain, breathing difficulty with majority belonging to lower socioeconomic status. The pulmonary TB accounted for 56% and extrapulmonary constituted 44% of the cases. The notable extrapulmonary cases were disseminated TB with secondary lymphangiectasia, compressive myelopathy, sacroiliac joint arthropathy among others. Infiltrates/consolidation were the most frequent radiological findings in patients with pulmonary TB. The microbiological confirmation was available in 44% of the cases. The microbiological positivity was higher in histopathological specimens and in late adolescents. Two patients were rifampicin resistant. Conclusion: There was a varied clinical presentation of TB in this population. The extrapulmonary cases as well as the microbiological yield increased with increasing age of the cases.</div></div>","PeriodicalId":39346,"journal":{"name":"Indian Journal of Tuberculosis","volume":"72 3","pages":"Pages 375-379"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144686640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.ijtb.2024.08.011
Malay Sarkar
Tuberculosis (TB) is the second leading infectious cause of death worldwide, only surpassed by corona virus infection (COVID-19). It is mainly transmitted by the airborne route via droplet nuclei of 1–5 μm in diameter. The four key pillars of TB elimination are “Detect–Treat–Prevent–Build.” There are enough evidences of healthcare-associated transmission of TB. Prevention of TB transmission in the healthcare settings is thus an important strategy. The goal of TB infection prevention and control (IPC) is to reduce the likelihood that populations may contract M.tuberculosis by using variety of strategies. The strategies include three levels hierarchy of controls. These include administrative controls, environmental controls, and respiratory protection. This review will discuss the various strategies for TB infection prevention and controls.
{"title":"Tuberculosis infection prevention and control","authors":"Malay Sarkar","doi":"10.1016/j.ijtb.2024.08.011","DOIUrl":"10.1016/j.ijtb.2024.08.011","url":null,"abstract":"<div><div>Tuberculosis (TB) is the second leading infectious cause of death worldwide, only surpassed by corona virus infection (COVID-19). It is mainly transmitted by the airborne route via droplet nuclei of 1–5 μm in diameter. The four key pillars of TB elimination are “Detect–Treat–Prevent–Build.” There are enough evidences of healthcare-associated transmission of TB. Prevention of TB transmission in the healthcare settings is thus an important strategy. The goal of TB infection prevention and control (IPC) is to reduce the likelihood that populations may contract M.tuberculosis by using variety of strategies. The strategies include three levels hierarchy of controls. These include administrative controls, environmental controls, and respiratory protection. This review will discuss the various strategies for TB infection prevention and controls.</div></div>","PeriodicalId":39346,"journal":{"name":"Indian Journal of Tuberculosis","volume":"72 3","pages":"Pages 394-400"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144686643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.ijtb.2024.08.014
Rajalakshmi M , Kalaiselvan G , Pajanivel R
Background
Extrapulmonary tuberculosis (EPTB) is also a public health problem and involves other parts of the body other than lung. During the quarterly review meeting of State Task Force (STF), Puducherry the members raised concern about the outcome of patients referred from the medical colleges. Even though we receive 60 % feedback of initiation of treatment from the PHI but the treatment outcome of EPTB is not clear. Hence primary agenda of this research was to identify the gap in adherence to diagnostic criteria and treatment.
Aim
To assess the methods adopted for diagnosis of EPTB and to find out the compliance and outcome of the treatment and to identify the patient and health providers related factors that contribute to the outcome of the treatment.
Material and method
Study design: An explanatory mixed method study. Data collection: The information on methods adopted for diagnosis and category of treatment followed in EPTB was extracted from TB register and patient record sheets from the Medical College. House visits was made to trace the patients and the information related to duration of treatment and the outcome of treatment was found. Free listing was conducted to explore the reasons (facilitating and barriers) contributed to the outcome of the EPTB patients. Data analysis: Using EpiData (version 3.1, EpiData Association, Odense, Denmark), data was entered and analysed. The qualitative data was entered and analysed using Visual Anthropac (Ver_1.0.1.36; Analytic Technologies, Inc., USA) software package.
Results
More than three-fourth (83.6%) of the patients completed extrapulmonary tuberculosis treatment. The site of EPTB emerged as significant predictor for disease outcome. The most salient facilitating factors and barriers contributed to the outcome of treatment were “periodic reminders and care by the family members” and Side effects such as giddiness, loss of sleep and appetite, discolouration of urine, gastritis, difficulty in breathing and walking, swelling of legs, weight and hair loss and myalgia” respectively.
Conclusion
The study found that there is good compliance and outcome in treatment outcome. Efforts should be made to overcome the barriers to the outcome of treatment.
{"title":"Evaluation of treatment outcome in extrapulmonary tuberculosis: A mixed method study from Puducherry","authors":"Rajalakshmi M , Kalaiselvan G , Pajanivel R","doi":"10.1016/j.ijtb.2024.08.014","DOIUrl":"10.1016/j.ijtb.2024.08.014","url":null,"abstract":"<div><h3>Background</h3><div>Extrapulmonary tuberculosis (EPTB) is also a public health problem and involves other parts of the body other than lung. During the quarterly review meeting of State Task Force (STF), Puducherry the members raised concern about the outcome of patients referred from the medical colleges. Even though we receive 60 % feedback of initiation of treatment from the PHI but the treatment outcome of EPTB is not clear. Hence primary agenda of this research was to identify the gap in adherence to diagnostic criteria and treatment.</div></div><div><h3>Aim</h3><div>To assess the methods adopted for diagnosis of EPTB and to find out the compliance and outcome of the treatment and to identify the patient and health providers related factors that contribute to the outcome of the treatment.</div></div><div><h3>Material and method</h3><div>Study design: An explanatory mixed method study. Data collection: The information on methods adopted for diagnosis and category of treatment followed in EPTB was extracted from TB register and patient record sheets from the Medical College. House visits was made to trace the patients and the information related to duration of treatment and the outcome of treatment was found. Free listing was conducted to explore the reasons (facilitating and barriers) contributed to the outcome of the EPTB patients. Data analysis: Using EpiData (version 3.1, EpiData Association, Odense, Denmark), data was entered and analysed<strong>.</strong> The qualitative data was entered and analysed using Visual Anthropac (Ver_1.0.1.36; Analytic Technologies, Inc., USA) software package.</div></div><div><h3>Results</h3><div>More than three-fourth (83.6%) of the patients completed extrapulmonary tuberculosis treatment. The site of EPTB emerged as significant predictor for disease outcome. The most salient facilitating factors and barriers contributed to the outcome of treatment were “<em>periodic reminders and care by the family members</em>” <em>and Side effects such as giddiness, loss of sleep and appetite, discolouration of urine, gastritis, difficulty in breathing and walking, swelling of legs, weight and hair loss and myalgia</em>” respectively.</div></div><div><h3>Conclusion</h3><div>The study found that there is good compliance and outcome in treatment outcome. Efforts should be made to overcome the barriers to the outcome of treatment.</div></div>","PeriodicalId":39346,"journal":{"name":"Indian Journal of Tuberculosis","volume":"72 3","pages":"Pages 362-366"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144686760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.ijtb.2024.08.007
Chandana Krishna , Manoj Babu , Krishna Iyengar
Introduction
Tuberculosis (TB) is a major health hazard in India and is one of the leading causes of death worldwide. Airborne transmission of infectious disease is a major public health concern. Adherence to the airborne infection control (AIC) is crucial to prevent spread of TB among patients who visit health care facilities and among the health care staff.
Objectives
To assess the airborne infection control practices at health care facilities of Tumkur.
Method
ology: This descriptive study was conducted in 85 public health institutes in 5 TB units of Tumkur. Data was collected using pre-tested; semi-structured questionnaire through personal interview, verification of records and inspection using WHO check-list.
Results
The present study showed infection control committee and infection control plan were present in 97.65% and 90.59%, clinical staff underwent periodic TBIC training in 91.76% of PHIs. Waiting area and sputum sample collection area were well-ventilated in 97.65% & 97.65% of PHIs. Health workers practiced hand hygiene in 90.59%, PPEs were available in 85.06% PHIs.
Conclusion
The study concludes that, airborne infection control measures which includes administrative, environmental, and use of personal protective equipment were satisfactory among the PHIs but still there is scope for improvement.
{"title":"Assessment of airborne infection control practices at health care facilities of Tumkur District, Karnataka: A descriptive study","authors":"Chandana Krishna , Manoj Babu , Krishna Iyengar","doi":"10.1016/j.ijtb.2024.08.007","DOIUrl":"10.1016/j.ijtb.2024.08.007","url":null,"abstract":"<div><h3>Introduction</h3><div>Tuberculosis (TB) is a major health hazard in India and is one of the leading causes of death worldwide. Airborne transmission of infectious disease is a major public health concern. Adherence to the airborne infection control (AIC) is crucial to prevent spread of TB among patients who visit health care facilities and among the health care staff.</div></div><div><h3>Objectives</h3><div>To assess the airborne infection control practices at health care facilities of Tumkur.</div></div><div><h3>Method</h3><div>ology: This descriptive study was conducted in 85 public health institutes in 5 TB units of Tumkur. Data was collected using pre-tested; semi-structured questionnaire through personal interview, verification of records and inspection using WHO check-list.</div></div><div><h3>Results</h3><div>The present study showed infection control committee and infection control plan were present in 97.65% and 90.59%, clinical staff underwent periodic TBIC training in 91.76% of PHIs. Waiting area and sputum sample collection area were well-ventilated in 97.65% & 97.65% of PHIs. Health workers practiced hand hygiene in 90.59%, PPEs were available in 85.06% PHIs.</div></div><div><h3>Conclusion</h3><div>The study concludes that, airborne infection control measures which includes administrative, environmental, and use of personal protective equipment were satisfactory among the PHIs but still there is scope for improvement.</div></div>","PeriodicalId":39346,"journal":{"name":"Indian Journal of Tuberculosis","volume":"72 3","pages":"Pages 337-341"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144686754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The quality of care that patients receive in the private sector has been reported to be poor. Madhya Pradesh began adopting the PPSA model in September 2020, initially covering 44 districts. By April 2022, the state achieved 100% coverage, becoming the first state in the country to implement PPSA across all 52 districts. Although PPSA is now operational in every district, health indicators in the private sector have shown little improvement, and notifications from the private sector remain significantly below the annual targets The patient provider support agency (PPSA) pilot program has demonstrated newer strategies for private sector engagement to be able to deliver significant outcomes. the study explores the strengths and limitations of the private sector engagement model from the healthcare providers’ perspective.
Methods
This was a mixed–methods study in which both quantitative and qualitative data were simultaneously collected. Quantitative data collection (using routinely collected programmatic data) is supported by qualitative data collection (in-depth interviews).
This study was conducted to study the impact of the PPSA service implementation model on notification status, patient care activities and outcomes through record review among all 52 districts of Madhya Pradesh between October 2020–December 2022 as well as to explore the strengths and limitations of the PPSA model from the healthcare providers’ perspectives using a mixed-methods approach.
Result
There was a increase in the number of TB patients notified in the private sector (62%), number of patients receiving benefits of the Nikshay Poshan Yojna through Direct Bank Transfer (91%), number of patients tested for Human Immunodeficiency Virus (100%), Diabetes, and universal drug susceptibility testing (25%), as well as successful treatment outcomes in the post-PPSA period as compared to the pre-PPSA period. Seventeen in-depth interviews of health care providers from the public (n = 8) and private sector (n = 9) highlighted the operational challenges and solutions to implementation of the PPSA. Inadequate Human resource, poor coordination with NTEP Staff, poor mapping of PP's, mobile based counselling & limited home visit to TB patients were the perceived challenges and regular support to the private health facilities and MIS data, trainings and hand-holding, supportive supervision from the State, and strict need based tendering policies were few of the suggestions to improve the PPSA model were some of the solutions.
Conclusion
The implementation of the Patient Provider Support Agency (PPSA) model in Madhya Pradesh has not only improved notification rates and successful treatment outcomes but also strengthened the overall engagement of private healthcare providers in TB management. Enhanced collaboration, regular facility mapping, and s
{"title":"Enhancing tuberculosis care in Madhya Pradesh through public-private partnerships: An evaluation of the patient provider support agency (PPSA) model","authors":"Jeetesh Kourav , Kalpita Shringarpure , Chinmay Laxmeshwar , Akash Ranjan , Varsha Rai , Adesh Kourav , Akash kumar","doi":"10.1016/j.ijtb.2024.08.010","DOIUrl":"10.1016/j.ijtb.2024.08.010","url":null,"abstract":"<div><h3>Background</h3><div>The quality of care that patients receive in the private sector has been reported to be poor. Madhya Pradesh began adopting the PPSA model in September 2020, initially covering 44 districts. By April 2022, the state achieved 100% coverage, becoming the first state in the country to implement PPSA across all 52 districts. Although PPSA is now operational in every district, health indicators in the private sector have shown little improvement, and notifications from the private sector remain significantly below the annual targets The patient provider support agency (PPSA) pilot program has demonstrated newer strategies for private sector engagement to be able to deliver significant outcomes. the study explores the strengths and limitations of the private sector engagement model from the healthcare providers’ perspective.</div></div><div><h3>Methods</h3><div>This was a mixed–methods study in which both quantitative and qualitative data were simultaneously collected. Quantitative data collection (using routinely collected programmatic data) is supported by qualitative data collection (in-depth interviews)<strong>.</strong></div><div>This study was conducted to study the impact of the PPSA service implementation model on notification status, patient care activities and outcomes through record review among all 52 districts of Madhya Pradesh between October 2020–December 2022 as well as to explore the strengths and limitations of the PPSA model from the healthcare providers’ perspectives using a mixed-methods approach.</div></div><div><h3>Result</h3><div>There was a increase in the number of TB patients notified in the private sector (62%), number of patients receiving benefits of the Nikshay Poshan Yojna through Direct Bank Transfer (91%), number of patients tested for Human Immunodeficiency Virus (100%), Diabetes, and universal drug susceptibility testing (25%), as well as successful treatment outcomes in the post-PPSA period as compared to the pre-PPSA period. Seventeen in-depth interviews of health care providers from the public (n = 8) and private sector (n = 9) highlighted the operational challenges and solutions to implementation of the PPSA. Inadequate Human resource, poor coordination with NTEP Staff, poor mapping of PP's, mobile based counselling & limited home visit to TB patients were the perceived challenges and regular support to the private health facilities and MIS data, trainings and hand-holding, supportive supervision from the State, and strict need based tendering policies were few of the suggestions to improve the PPSA model were some of the solutions.</div></div><div><h3>Conclusion</h3><div>The implementation of the Patient Provider Support Agency (PPSA) model in Madhya Pradesh has not only improved notification rates and successful treatment outcomes but also strengthened the overall engagement of private healthcare providers in TB management. Enhanced collaboration, regular facility mapping, and s","PeriodicalId":39346,"journal":{"name":"Indian Journal of Tuberculosis","volume":"72 3","pages":"Pages 347-353"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144686756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.ijtb.2024.11.003
Sarah Clare Pinto, Yohaan Shirali, Karan Gherwada, Zarir F. Udwadia
{"title":"Nikshay Poshan Yojana for all TB patients: Difficulties in access for multidrug-resistant TB patients","authors":"Sarah Clare Pinto, Yohaan Shirali, Karan Gherwada, Zarir F. Udwadia","doi":"10.1016/j.ijtb.2024.11.003","DOIUrl":"10.1016/j.ijtb.2024.11.003","url":null,"abstract":"","PeriodicalId":39346,"journal":{"name":"Indian Journal of Tuberculosis","volume":"72 3","pages":"Page 282"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144686420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.ijtb.2024.05.010
Revadi G , Johann Aibantyllilang Blah , Manoj Verma , Arun M. Kokane
Introduction
Latent Tuberculosis infection (LTBI) care cascade involves identification of high-risk individuals, testing, identification of LTBI, initiation of Tuberculosis Preventive therapy (TPT) and documentation of outcomes. There is a dearth of such evidence in Indian setting which needs to be further explored. Hence, this feasibility study with public private engagement was conducted with the primary objective of estimating the prevalence of LTBI among household contacts (HHCs) of pulmonary tuberculosis patients using Interferon gamma release assay (IGRA). Secondary objective was to determine the treatment outcomes among the patients of LTBI initiated on TPT.
Methods
This longitudinal community-based study was conducted in wards 47–51 at urban field practice area of our Tertiary Teaching Institute at Bhopal, Madhya Pradesh. The household contacts of pulmonary tuberculosis patients diagnosed from January–June 2022 and those who satisfied the study criteria were recruited. Those who gave consent for IGRA testing and TPT initiation were followed up for a period of 6 months to assess the treatment outcomes. Data was analyzed using R software.
Results
Of the 64 HHCs screened, 29 were the contacts of microbiologically positive and 35 were the contacts of clinically diagnosed index Tb patients including 4 under five children. Prevalence of LTBI using IGRA was 74.5%. The Contact Investigation Coverage in the urban setting was 77.1% with TPT completion of 72.4% and TPT Coverage of 55.7%. The median time for screening the HHCs since the diagnosis of index case was 14 days while screening to diagnosis was 2.5 days and that of TPT initiation from diagnosis was 22 days.
Conclusion
More than half of those who were tested using IGRA were positive for LTBI. Th public private coordination helped in narrowing the time interval from diagnosis of index tb case to contact tracing and improving the TPT adherence among the HHCs. However, intensive efforts are required to narrow the screening gap of HHCs and TPT initiation. Also, reasons for loss to follow up and missed doses needs to be qualitatively explored.
{"title":"Latent tuberculosis infection care cascade among the household contacts of pulmonary tuberculosis patients – Findings from an urban feasibility study","authors":"Revadi G , Johann Aibantyllilang Blah , Manoj Verma , Arun M. Kokane","doi":"10.1016/j.ijtb.2024.05.010","DOIUrl":"10.1016/j.ijtb.2024.05.010","url":null,"abstract":"<div><h3>Introduction</h3><div>Latent Tuberculosis infection<span><span> (LTBI) care cascade involves identification of high-risk individuals, testing, identification of LTBI, initiation of Tuberculosis Preventive therapy (TPT) and documentation of outcomes. There is a dearth of such evidence in Indian setting which needs to be further explored. Hence, this feasibility study with public private engagement was conducted with the primary objective of estimating the prevalence of LTBI among household contacts (HHCs) of pulmonary tuberculosis patients using </span>Interferon gamma release assay (IGRA). Secondary objective was to determine the treatment outcomes among the patients of LTBI initiated on TPT.</span></div></div><div><h3>Methods</h3><div>This longitudinal community-based study was conducted in wards 47–51 at urban field practice area of our Tertiary Teaching Institute at Bhopal, Madhya Pradesh. The household contacts of pulmonary tuberculosis patients diagnosed from January–June 2022 and those who satisfied the study criteria were recruited. Those who gave consent for IGRA testing and TPT initiation were followed up for a period of 6 months to assess the treatment outcomes. Data was analyzed using R software.</div></div><div><h3>Results</h3><div>Of the 64 HHCs screened, 29 were the contacts of microbiologically positive and 35 were the contacts of clinically diagnosed index Tb patients including 4 under five children. Prevalence of LTBI using IGRA was 74.5%. The Contact Investigation Coverage in the urban setting was 77.1% with TPT completion of 72.4% and TPT Coverage of 55.7%. The median time for screening the HHCs since the diagnosis of index case was 14 days while screening to diagnosis was 2.5 days and that of TPT initiation from diagnosis was 22 days.</div></div><div><h3>Conclusion</h3><div>More than half of those who were tested using IGRA were positive for LTBI. Th public private coordination helped in narrowing the time interval from diagnosis of index tb case to contact tracing and improving the TPT adherence among the HHCs. However, intensive efforts are required to narrow the screening gap of HHCs and TPT initiation. Also, reasons for loss to follow up and missed doses needs to be qualitatively explored.</div></div>","PeriodicalId":39346,"journal":{"name":"Indian Journal of Tuberculosis","volume":"72 3","pages":"Pages 312-318"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144686254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tobacco use is a leading preventable cause of morbidity and mortality. In India, tobacco cessation training is rarely integrated into healthcare education. This study evaluates the effectiveness of the Aacharya Tobacco Treatment Specialist Training Program, India's first accredited program by the Council for Tobacco Treatment Training Programs (CTTTP), USA, in enhancing healthcare professionals (HCPs) knowledge, self-efficacy, attitudes, and counselling skills for tobacco cessation.
Methods
In 2022, a pre-and post-evaluation study was conducted across eight cities in five Indian states with 803 HCPs nominated by state health departments. Participants underwent 24 h of training via 12 pre-recorded modules and 3 live sessions, including role-plays, case discussions, and quizzes. Five domains—barriers, self-efficacy, attitudes, counselling approach, and knowledge—were assessed. Qualitative feedback was analyzed using thematic analysis. Paired data were analyzed using the Wilcoxon signed-rank test (p < 0.05).
Results
Training significantly reduced perceived barriers to counselling, with a 2.7-point decrease (p = 0.001). Self-efficacy scores rose by 6.4 points (p = 0.001), indicating greater confidence in delivering tobacco cessation interventions. Attitude scores improved with a 0.9-point positive shift (p = 0.001). Counselling approaches saw a 1.0-point enhancement, emphasizing patient-centred techniques and motivational interviewing (p = 0.001). Knowledge scores increased by 4.1 points (p = 0.001), reflecting better comprehension of key concepts.
Conclusion
The Aacharya program effectively improves HCPs’ skills, confidence, and knowledge in tobacco cessation. Its flexible, scalable format can bridge critical training gaps, supporting sustainable tobacco control and reducing associated health and economic burdens in India.
{"title":"Developing skilled professionals to combat tobacco use: Evaluating the impact of \"Aacharya – A Tobacco Treatment Training Program\"","authors":"Surabhi Somani , Ruchi Ladda , Vikrant Omprakash Kasat","doi":"10.1016/j.ijtb.2025.01.011","DOIUrl":"10.1016/j.ijtb.2025.01.011","url":null,"abstract":"<div><h3>Aim</h3><div>Tobacco use is a leading preventable cause of morbidity and mortality. In India, tobacco cessation training is rarely integrated into healthcare education. This study evaluates the effectiveness of the Aacharya Tobacco Treatment Specialist Training Program, India's first accredited program by the Council for Tobacco Treatment Training Programs (CTTTP), USA, in enhancing healthcare professionals (HCPs) knowledge, self-efficacy, attitudes, and counselling skills for tobacco cessation.</div></div><div><h3>Methods</h3><div>In 2022, a pre-and post-evaluation study was conducted across eight cities in five Indian states with 803 HCPs nominated by state health departments. Participants underwent 24 h of training via 12 pre-recorded modules and 3 live sessions, including role-plays, case discussions, and quizzes. Five domains—barriers, self-efficacy, attitudes, counselling approach, and knowledge—were assessed. Qualitative feedback was analyzed using thematic analysis. Paired data were analyzed using the Wilcoxon signed-rank test (p < 0.05).</div></div><div><h3>Results</h3><div>Training significantly reduced perceived barriers to counselling, with a 2.7-point decrease (p = 0.001). Self-efficacy scores rose by 6.4 points (p = 0.001), indicating greater confidence in delivering tobacco cessation interventions. Attitude scores improved with a 0.9-point positive shift (p = 0.001). Counselling approaches saw a 1.0-point enhancement, emphasizing patient-centred techniques and motivational interviewing (p = 0.001). Knowledge scores increased by 4.1 points (p = 0.001), reflecting better comprehension of key concepts.</div></div><div><h3>Conclusion</h3><div>The Aacharya program effectively improves HCPs’ skills, confidence, and knowledge in tobacco cessation. Its flexible, scalable format can bridge critical training gaps, supporting sustainable tobacco control and reducing associated health and economic burdens in India.</div></div>","PeriodicalId":39346,"journal":{"name":"Indian Journal of Tuberculosis","volume":"72 3","pages":"Pages 444-450"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144686256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tuberculosis (TB) remains a significant global health issue, ranking as the 13th leading cause of death worldwide. Management of tuberculosis requires administration of multiple drugs for varied duration which increases the risk of developing adverse reactions. Among various adverse reactions are cutaneous adverse reactions (CARs) which can be immune mediated or non immune mediated.
Aim
1. To study the clinical, epidemiological, and morphological characteristics of cutaneous adverse reactions resulting from antitubercular treatment. 2. To study the outcomes of cutaneous adverse reactions to antitubercular therapy using the Modified Hartwig and Seigel severity assessment scale and rechallenge protocol, and assess the effectiveness of management strategies.
Method
ology: A longitudinal observational study was conducted over a period of 1 year at department of Pulmonology and Dermatology at tertiary care institute to assess CARs in patients on antitubercular treatment. Rechallenge was done in eligible patients.
Results
Among 3164 TB patients on anti-tubercular treatment (ATT), 56 developed CARs, yielding an incidence rate of 1.77% per year. The study found female preponderance, with the most affected age groups being 21–30 and 41–50 years. Most CARs occurred within the first 30 days of ATT initiation, predominantly manifesting as maculopapular rash. Factors such as multiple medication use, diabetes, elderly age, and positive HIV status were associated with CARs. Ethambutol was identified as the most frequently implicated drug in the occurrence of cutaneous adverse reactions (CARs) upon rechallenge.
Conclusion
Effective management of CARs involves appropriate treatment, careful monitoring, and rechallenge protocols to identify culprit drugs while minimizing the risk of severe reactions.Upon complete resolution of initial adverse reaction, one must do rechallenge meticulously to pinpoint culprit drug and ensuring effective tuberculosis treatment.
{"title":"An observational study on the spectrum of cutaneous adverse reactions to antitubercular drugs and their management","authors":"Seema Goel , Aurelia Goyal , Vishal Chopra , Ritu Mittal , Sharang Gupta , Rajat Deep Sidhu , Nimarbir Kaur Dhanju","doi":"10.1016/j.ijtb.2024.10.010","DOIUrl":"10.1016/j.ijtb.2024.10.010","url":null,"abstract":"<div><h3>Introduction</h3><div>Tuberculosis (TB) remains a significant global health issue, ranking as the 13th leading cause of death worldwide. Management of tuberculosis requires administration of multiple drugs for varied duration which increases the risk of developing adverse reactions. Among various adverse reactions are cutaneous adverse reactions (CARs) which can be immune mediated or non immune mediated.</div></div><div><h3>Aim</h3><div>1. To study the clinical, epidemiological, and morphological characteristics of cutaneous adverse reactions resulting from antitubercular treatment. 2. To study the outcomes of cutaneous adverse reactions to antitubercular therapy using the Modified Hartwig and Seigel severity assessment scale and rechallenge protocol, and assess the effectiveness of management strategies.</div></div><div><h3>Method</h3><div>ology: A longitudinal observational study was conducted over a period of 1 year at department of Pulmonology and Dermatology at tertiary care institute to assess CARs in patients on antitubercular treatment. Rechallenge was done in eligible patients.</div></div><div><h3>Results</h3><div>Among 3164 TB patients on anti-tubercular treatment (ATT), 56 developed CARs, yielding an incidence rate of 1.77% per year. The study found female preponderance, with the most affected age groups being 21–30 and 41–50 years. Most CARs occurred within the first 30 days of ATT initiation, predominantly manifesting as maculopapular rash. Factors such as multiple medication use, diabetes, elderly age, and positive HIV status were associated with CARs. Ethambutol was identified as the most frequently implicated drug in the occurrence of cutaneous adverse reactions (CARs) upon rechallenge.</div></div><div><h3>Conclusion</h3><div>Effective management of CARs involves appropriate treatment, careful monitoring, and rechallenge protocols to identify culprit drugs while minimizing the risk of severe reactions.Upon complete resolution of initial adverse reaction, one must do rechallenge meticulously to pinpoint culprit drug and ensuring effective tuberculosis treatment.</div></div>","PeriodicalId":39346,"journal":{"name":"Indian Journal of Tuberculosis","volume":"72 3","pages":"Pages 386-393"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144686642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.ijtb.2024.08.021
Subalakshmi S , Kalaiselvan G , Rajalakshmi M , Badrinath AK
<div><h3>Background</h3><div>For ending the epidemic of TB by the year 2030, along in line with Sustainable Development Goals, it is essential to address the TB associated co-morbidities. Prevalence of diabetes influencing TB incidence and mortality is higher when compared to other co-morbidities like HIV infection, smoking, alcoholism and malnutrition. Therefore, this study was conducted with the following objectives: 1.To evaluate the effectiveness of the intervention on implementation of TB-DM collaborative activity using four symptom complex strategy and to explore the patient and healthcare providers related factors that contribute in implementation of the activity.</div></div><div><h3>Material and methods</h3><div>The present study was undertaken by Department of Community Medicine, Sri Manankula Vinayagar Medical College and Hospital, Puducherry for a period of 18 months in the Out Patient Departments of General Medicine, General Surgery, Obstetrics and Gynecology, Orthopedics, DOTS center and Designated Microscopy Centre. It was an embedded sequential experimental study, done among the health care professionals (CRRI, Postgraduates and staff nurse) who were involved in process of 4s complex screening for DM patients and the stakeholders who were involved in implementation of NTEP activity. The study was conducted in three phases. Phase I: baseline survey and identification of intervention strategies, Phase II: implementation of the intervention and Phase III: end line survey.</div></div><div><h3>Data entry and analysis</h3><div>Manual content analysis was done for Qualitative data. The Quantitative data were entered into Epi Info software (version 7.2.2.6) and analyzed in SPSS software (version 24). Comparison of knowledge among the health care professionals before and after sensitization was calculated using Mc nemar test. It was considered statistically significant when the p value was <0.005. The analysis of free list and pile sort data was undertaken using Anthropac 4.98.1/X software.</div></div><div><h3>Results</h3><div>Challenges obtained from stakeholders in implementing the activity were categorized as patient related factor, health care professional related factor and screening and reporting related factor. Suggested solutions were generating awareness at patient level, display of IEC tools, periodical sensitization for the staff, inter-departmental co-ordination, monitoring and re-enforcing the activity in core-committee meetings. After sensitization, the knowledge on joint TB-DM collaborative activity was significantly improved among the health care professionals. By implementing the four symptom complex screening activity in NCD clinic, 6480 DM patients were screened and 176 (2.7%) presumptive TB cases were identified. Of which, 136 of them reached DMC for sputum examination. Among them 44 (35.4%) had active TB infection. The Number Needed to Screen to yield a case of TB was 147.</div></div><div><h3>Conclusion and recommend
{"title":"“Intensified case finding of tuberculosis among diabetes mellitus patients attending non-communicable disease clinic in a tertiary care hospital – An implementation research”","authors":"Subalakshmi S , Kalaiselvan G , Rajalakshmi M , Badrinath AK","doi":"10.1016/j.ijtb.2024.08.021","DOIUrl":"10.1016/j.ijtb.2024.08.021","url":null,"abstract":"<div><h3>Background</h3><div>For ending the epidemic of TB by the year 2030, along in line with Sustainable Development Goals, it is essential to address the TB associated co-morbidities. Prevalence of diabetes influencing TB incidence and mortality is higher when compared to other co-morbidities like HIV infection, smoking, alcoholism and malnutrition. Therefore, this study was conducted with the following objectives: 1.To evaluate the effectiveness of the intervention on implementation of TB-DM collaborative activity using four symptom complex strategy and to explore the patient and healthcare providers related factors that contribute in implementation of the activity.</div></div><div><h3>Material and methods</h3><div>The present study was undertaken by Department of Community Medicine, Sri Manankula Vinayagar Medical College and Hospital, Puducherry for a period of 18 months in the Out Patient Departments of General Medicine, General Surgery, Obstetrics and Gynecology, Orthopedics, DOTS center and Designated Microscopy Centre. It was an embedded sequential experimental study, done among the health care professionals (CRRI, Postgraduates and staff nurse) who were involved in process of 4s complex screening for DM patients and the stakeholders who were involved in implementation of NTEP activity. The study was conducted in three phases. Phase I: baseline survey and identification of intervention strategies, Phase II: implementation of the intervention and Phase III: end line survey.</div></div><div><h3>Data entry and analysis</h3><div>Manual content analysis was done for Qualitative data. The Quantitative data were entered into Epi Info software (version 7.2.2.6) and analyzed in SPSS software (version 24). Comparison of knowledge among the health care professionals before and after sensitization was calculated using Mc nemar test. It was considered statistically significant when the p value was <0.005. The analysis of free list and pile sort data was undertaken using Anthropac 4.98.1/X software.</div></div><div><h3>Results</h3><div>Challenges obtained from stakeholders in implementing the activity were categorized as patient related factor, health care professional related factor and screening and reporting related factor. Suggested solutions were generating awareness at patient level, display of IEC tools, periodical sensitization for the staff, inter-departmental co-ordination, monitoring and re-enforcing the activity in core-committee meetings. After sensitization, the knowledge on joint TB-DM collaborative activity was significantly improved among the health care professionals. By implementing the four symptom complex screening activity in NCD clinic, 6480 DM patients were screened and 176 (2.7%) presumptive TB cases were identified. Of which, 136 of them reached DMC for sputum examination. Among them 44 (35.4%) had active TB infection. The Number Needed to Screen to yield a case of TB was 147.</div></div><div><h3>Conclusion and recommend","PeriodicalId":39346,"journal":{"name":"Indian Journal of Tuberculosis","volume":"72 3","pages":"Pages 367-374"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144686763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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