{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T16:42:17Z","timestamp":1787071337386,"version":"build-2736575974"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>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\u2019s public health system. Understanding awareness and identifying implementation challenges are critical for strengthening TPT delivery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>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\u2019s TB elimination goals.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/ijcm.ijcm_364_25","type":"journal-article","created":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T18:00:24Z","timestamp":1774548024000},"page":"392-404","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Awareness and Implementation Challenges of Tuberculosis Preventive Treatment among Public Health Providers in Kerala, India"],"prefix":"10.4103","volume":"51","author":[{"given":"M. S.","family":"Neethu","sequence":"first","affiliation":[{"name":"Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. M.","family":"Balasankar","sequence":"additional","affiliation":[{"name":"Health Systems Research India Initiative, Thiruvananthapuram, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sibasis","family":"Hense","sequence":"additional","affiliation":[{"name":"Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rakesh","family":"Ramachandran","sequence":"additional","affiliation":[{"name":"John Snow India Private Limited, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,3,26]]},"reference":[{"key":"R2-20260416","doi-asserted-by":"crossref","first-page":"62","DOI":"10.14745\/ccdr.v43i34a01","article-title":"Latent tuberculosis infection: An overview","volume":"43","author":"Kiazyk","year":"2017","journal-title":"Can Commun Dis Rep"},{"key":"R3-20260416","article-title":"Global Tuberculosis Report 2024","year":"2024","journal-title":"World Health Organization"},{"key":"R4-20260416","doi-asserted-by":"crossref","first-page":"2058","DOI":"10.1016\/j.jiph.2023.10.009","article-title":"Prevalence and factors associated with tuberculosis infection in India","volume":"16","author":"Selvaraju","year":"2023","journal-title":"J Infect Public Health"},{"key":"R5-20260416","first-page":"e44087","article-title":"Impact on Tuberculosis Notification During COVID-19 Pandemic in India: A Narrative Review","volume":"15","author":"Sahu","year":"2023","journal-title":"Cureus"},{"key":"R7-20260416","doi-asserted-by":"crossref","first-page":"e0236743","DOI":"10.1371\/journal.pone.0236743","article-title":"Tuberculosis preventive treatment should be considered for all household contacts of pulmonary tuberculosis patients in India","volume":"15","author":"Paradkar","year":"2020","journal-title":"PLoS One"},{"key":"R8-20260416","doi-asserted-by":"crossref","first-page":"1704540","DOI":"10.1080\/16549716.2019.1704540","article-title":"To start or to complete? \u2013 Challenges in implementing tuberculosis preventive therapy among people living with HIV: A mixed-methods study from Karnataka, India","volume":"13","author":"Reddy","year":"2020","journal-title":"Glob Health Action"},{"key":"R9-20260416","doi-asserted-by":"crossref","first-page":"1838","DOI":"10.1186\/s12889-020-09902-z","article-title":"Evaluation of the uptake of tuberculosis preventative therapy for people living with HIV in Namibia: A multiple methods analysis","volume":"20","author":"Roscoe","year":"2020","journal-title":"BMC Public Health"},{"key":"R11-20260416","doi-asserted-by":"crossref","first-page":"47","DOI":"10.4103\/lungindia.lungindia_336_23","article-title":"Preventive treatment for latent tuberculosis from Indian perspective","volume":"41","author":"Hashim","year":"2024","journal-title":"Lung India"},{"key":"R15-20260416","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.ijtb.2016.11.007","article-title":"Patients\u2019 perception towards directly observed treatment \u2013 A qualitative study from Kollam district, Kerala, southern India","volume":"64","author":"Rakesh","year":"2017","journal-title":"Indian J Tuberc"},{"key":"R17-20260416","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1186\/s13690-017-0221-9","article-title":"Using the World Health Organization health system building blocks through survey of healthcare professionals to determine the performance of public healthcare facilities","volume":"75","author":"Manyazewal","year":"2017","journal-title":"Arch Public Health"},{"key":"R18-20260416","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1007\/s10488-013-0528-y","article-title":"Purposeful sampling for qualitative data collection and analysis in mixed method implementation research","volume":"42","author":"Palinkas","year":"2015","journal-title":"Adm Policy Ment Health"},{"key":"R19-20260416","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1177\/1525822X05279903","article-title":"How many interviews are enough? 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