Awareness and Implementation Challenges of Tuberculosis Preventive Treatment among Public Health Providers in Kerala, India

Abstract Background: Tuberculosis (TB) remains a major public health problem in India with a high burden of latent TB infection (LTBI). The National TB Elimination Program (NTEP) advocates the Tuberculosis Preventive Treatment (TPT) strategy for high-risk populations, including household contacts of pulmonary TB patients. Despite national NTEP programmatic efforts, the uptake and completion of TPT remains low. This study explores the awareness of community health workers on TPT and examined the implementation challenges in Kerala’s public health system. Understanding awareness and identifying implementation challenges are critical for strengthening TPT delivery. Materials and Methods: A qualitative exploratory design was employed to conduct this study in two districts of Kerala (Thiruvananthapuram and Kasaragod). In-depth interviews with 42 grassroots-level community health workers (CHWs) and public health providers, including ASHAs, CHOs, Anganwadi workers, Medical officers, and district TB officials, were conducted. Purposive sampling and snowball sampling were used. Data were thematically analyzed using a hybrid coding approach. Results: Awareness of contact tracing, eligibility screening, IGRA testing, and follow-up treatment varied across caders of CHWs. Key implementation challenges included irregular IGRA testing, lack of fixed-dose drug formulations, lack of counseling facilities, overburdened workforce, and sporadic training. Patient reluctance due to asymptomatic status and stigma also impeded TPT uptake. Conclusion: Our findings underscore the need for standardized training, supportive supervision of health workers, alternative screening techniques, child-friendly drug formulations, and targeted community engagement to strengthen TPT implementation and support India’s TB elimination goals.