Tuberculosis poses a pressing threat to Tibetan refugee children and adolescents in Indian boarding schools. The alarming reality: 1.8 million Indians suffered from TB in 2022 (WHO), with children under 15 accounting for 12% of reported cases (Central TB Division). To combat this, the pioneering Zero TB Kids Project launched an ambitious screening and preventive treatment initiative. Targeting seven boarding schools in Himachal Pradesh, India, the program aimed to slash TB infection rates by 90% and disease incidence by 70% among 5,000-plus students and staff, aligning with India’s National TB Elimination Program 2025.
TB Screening and Preventive Treatment
Between 2017 and 2019, a mobile medical team visited the seven boarding schools yearly. They screened both children and staff for TB symptoms, conducted X-rays, performed molecular diagnostics, and used tuberculin skin tests. Those identified with TB infection (TBI) were treated with preventive therapy (TPT) to prevent the disease from becoming active TB. Two short-course regimens, isoniazid and rifampin, were used for preventive treatment.
Results of the Study
The study involved 6,582 schoolchildren and 807 staff members. Over a follow-up period of around two years, 69 cases of TB were found in children, while 4 cases were detected in staff. The incidence of TB among schoolchildren was 524 per 100,000 person-years, whereas it was 256 per 100,000 person-years for staff.
Out of 1,412 children diagnosed with TB infection, 1,192 received preventive therapy. Compared to those who did not receive it, children who received this therapy had a 79% lower risk of developing active TB. The preventive therapy proved incredibly effective for those in recent contact with a TB patient.
Significant Reduction in TB Rates
Between 2017 and 2019, the incidence of active TB in children decreased by 87%, from 837 to 110 per 100,000 person-years. Additionally, the prevalence of TB infection in children decreased by 42%, demonstrating the success of the screening and preventive treatment program.
Conclusion
This study highlights the effectiveness of school-wide TB screening and preventive treatment in reducing the burden of TB disease and infection among Tibetan refugee children and adolescents. The preventive therapy was particularly beneficial for children in close contact with TB patients. This approach could serve as a model for TB prevention in other vulnerable communities worldwide.