Prevention Versus Treatment: Barriers to Tuberculosis Prevention and Treatment in Urban Areas

Background and Objective: Tuberculosis preventive treatment (TPT) is thought to be one of the game changers of Tuberculosis (TB) elimination. The success of the TPT program lies in the coverage rate. Anecdotal evidence suggested that there are a few areas in West Bengal where TPT coverage is low. The study aimed to find the barriers to the TPT program in the urban TB units of a district in West Bengal. Methods: This was a mixed-methods study. Quantitative data were collected and analyzed from the Nikshay portal, which is India’s TB information management portal. Qualitative data were collected through interviews with key informants, including doctors, paramedical staff, TB patients, and their household contacts (HHCs). Results: Among the eligible HHCs, 48% were initiated with TPT. Of those who were initiated with TPT, 85.1% completed the treatment. The major reasons for unsuccessful outcomes were ‘lost to follow-up’ (58.5%) and ‘Not evaluated’ (34.5%). Refusal due to long duration of TPT, fear of side effects, lack of awareness, and stigma associated with TB were the main reasons for the poor TPT initiation rate. Poor adherence mechanisms, unaddressed adverse reactions, inadequate knowledge of health care workers, and migration of beneficiaries were the reasons for the poor TPT completion rate. Conclusion and Implications for Translation: For TPT implementation in urban areas, there are a few unique challenges such as inadequate health workforce and infrastructure, impeding influence of the private sector, and population migration. Long duration of TPT was one of the most significant barriers that can be addressed by the availability of shorter TPT regimens across the age groups.