Evaluating tuberculosis preventive treatment (TPT) outcomes, perspectives and implementation barriers: A mixed-methods study in BRAC covered areas under the Badda TB Diagnostic Center in Dhaka, Bangladesh

Abstract

Background and objectives: Tuberculosis (TB), a major global health problem, with Bangladesh occupying for 3.6% of the world's TB burden. While active case finding is common, scaling up Tuberculosis Preventive Treatment (TPT) is essential to eliminate the reservoir of potential cases. Currently, there is a significant gap in TPT coverage in Bangladesh, with only 32% of eligible household contacts starting treatment as of 2024. This study aimed to evaluate leakages in the TPT care cascade, compare the effectiveness of weekly (3HP) versus daily (3HR) treatment regimens and identify the barriers to successful implementation in urban Dhaka.

Methods: A mixed-methods study was carried out at the Badda TB Diagnostic Center, analyzing data from five branch offices in Dhaka between January 2024 and December 2025. The quantitative component used a census of 3,341 household contacts to track the TPT care cascade and a matched-pair cohort of 278 participants to compare treatment completion. The qualitative component involved 12 in-depth and key informant interviews with household contacts of TB patients and healthcare providers to explore behavioral and systemic challenges. Quantitative (bivariate and regression analysis using Stata 17.0) and qualitative (thematic analysis using ATLAS.ti 6.1) data analysis were performed to explore TPT cascade of care, attrition and treatment completion.

Results: The study found that while 89% of identified household contacts underwent investigation, only 70% of those declared eligible actually initiated TPT. A major demographic gap was identified: adults (15 years and above) were more likely to register for treatment than children under 15 (aOR = 9.2, 95% CI = 7.5–11, p < 0.001). Regarding treatment success, both the weekly 3HP and daily 3HR regimens achieved an identical completion rate of 97.12%. Qualitative findings highlighted barriers such as social stigma (fear of lost marriage or business prospects), the misconception that healthy people do not need medicine and systemic issues like medicine stock-outs and high staff workloads.

Conclusion: The TPT programme shows high success once treatment starts, but a critical leakage exists between being declared eligible and actually registered for preventive treatment. To meet national targets, the programme should prioritize paediatric registration, ensure stable medicine buffer stocks and utilize visual counseling tools with dedicated counsellors to address community misconceptions and lack of awareness.