Implementation of tuberculosis contact investigation and preventive treatment in Papua, Indonesia

Papua has among the highest tuberculosis (TB) rates in Indonesia, including high child TB rates. Isoniazid Preventive Treatment (IPT) is recommended for TB contacts < 5 years. Research purpose: to implement preventive treatment for children in close contact with active TB patient. This study commenced in Mimika district, Papua province in September 2017. Implementation was evaluated using the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation and Maintenance). Chief interventions were training and continuous quality improvement workshops as tools for change and motivation for TB health workers. Three primary health centers (PHC) and two hospitals participated. All TB doctors and nurses participated in 14 trainings on contact investigation (CI), IPT and child TB management. 1681 contacts (271 (17.8%) < 5 years) of 458 index TB cases were investigated. 155 (57.2%) eligible children received IPT. Of those commencing IPT, 56.8% completed, 20.2% defaulted, 1.1% failed (switched to TB treatment), and 21.8% remain on treatment. All TB staff participated in CI activities, gaining positive perceptions of IPT. The commonest reason for default / non-adherence was rejection of IPT by parents. No adverse drug reactions were reported. The program is supported by the district health office. Six of 21 other PHCs have started to adopt it. Funding for CI has now been included in the district budget. Conclusions and key recommendations: CI and IPT can be implemented in a resource-limited setting and works best if management of TB cases is led by primary health centers.