Factors influencing tuberculosis preventive treatment implementation in India: A hybrid inductive-abductive thematic analysis using implementation framework

BACKGROUND: India has committed to achieving 'Eliminate Tuberculosis (TB)' by 2025. The Government of India issued guidelines regarding the crucial strategy of Tuberculosis Preventive Treatment in July 2021. OBJECTIVES: To identify factors influencing tuberculosis preventive treatment program implementation and acceptance of tuberculosis preventive treatment. METHODS: We conducted the study in the Pune district from April to August 2024. It was a qualitative study using Focus Group Discussions (FGD) with Medical Officers (MO) and adult contacts of the index case, and In-depth Interviews (IDI) with senior health officers. We conducted eight FGDs with MOs and six with adult contacts, and conducted in-depth interviews with senior health officers. Data were transcribed, translated, and analyzed using MAXQDA. RESULTS: Eighty-six health/medical officers and 43 adult contacts participated in FGD and IDI. Some health officers have received training in tuberculosis but not in preventive treatment. Knowledge about tuberculosis preventive treatment and duration was minimal. Medical officers minimally briefed contacts. Stigma mainly from contacts perspectives, migration from health personnels perspectives and lack of awareness from both the groups emerged as important factors influencing screening and treatment of adult contacts. Very few underwent blood/ X-ray/ sputum testing, and fewer received treatment for varied durations. Medical officers knew only the isoniazid regimen, and interferon-gamma release assay testing was either unknown or unavailable. There is a shortage of trained human resources. The supply of diagnostic kits and medicines was disrupted. Health personnel and contacts recommended non-pharmacological measures such as mask use, cleanliness, and good nutrition. All officers perceived that elimination may linger until 2030. Training, counselling, community awareness, and multi-sectoral collaboration were strategies suggested by health officers. CONCLUSIONS: Health personnel capacity building, strengthening infrastructure and logistics, multiple strategies to mitigate stigma, and multi-sectoral collaboration are needed to satisfactory implementation of TB preventive treatment.