Integrating chest radiography tuberculosis screening and preventive treatment for contacts in primary healthcare settings in Pakistan

Background Pakistan ranks fifth among countries with the highest tuberculosis (TB) incidence worldwide, yet only approximatively 70% of TB patients receive treatment. The World Health Organization (WHO) recommends active TB case finding and TB preventive treatment (TPT) for household contacts (HHCs) following exclusion of active TB disease. We piloted the integration of WHO-recommended chest X-ray (CXR) screening and TPT for HHCs, with data collection via PREVENT-TB app. Methods This pilot study was conducted in 19 healthcare facilities in Hafizabad and Nankana Sahib districts of Punjab, Pakistan, from December 2021 to September 2023. A mixed-method study was conducted to assess the acceptability and feasibility of the TB screening strategy among HHC, the initiation of TPT, and the feasibility of using PREVENT-TB application for documenting the intervention and its completeness. Descriptive statistics and binary logistic regression were used to analyze quantitative data. Thematic analysis was used to analyze semi-structured interviews with program staff, healthcare providers and patients. Digital and paper-based data collection approaches were compared. Results Among 694 index TB patients, 2817 HHCs were identified, of whom 50% underwent CXR and symptom screening. Eight percent of screened HHCs had TB symptoms and/or CXR abnormalities and 4% were diagnosed with TB. Of the 1416 HHCs eligible for TPT, 68% initiated TPT, and among these 94% completed their treatment. The most common reason for refusal of screening and TPT was perceived lack of need by HHCs. Digital data collection was found to satisfactorily support both implementation and monitoring. Conclusions Integrating CXR screening and TPT into routine primary healthcare with digital monitoring are feasible.