INTRODUCTION
On an average, 5%–10% of the infected population will develop tuberculosis (TB) disease within the first 2 years.[ 1 ] Latent TB infection (LTBI) is a state of persistent immune response to the stimulation by Mycobacterium tuberculosis antigens with no evidence of clinically manifest active TB.[ 2 ] Hence, the timely and accurate identification and prophylactic treatment of people with LTBI are important for controlling M . tuberculosis globally. Once infected with LTBI, most people remain asymptomatic and are not contagious. Nonetheless, 5%–10% of those infected may progress to active TB in their lifetime and become infectious.[ 3 ] Targeted testing is an essential TB prevention and control strategy that is used to identify and treat individuals with LTBI who are at high risk for developing TB disease. Identifying individuals with LTBI is essential to the goal of TB elimination because the treatment of LTBI can prevent infected individuals from developing TB disease and thereby stop the further spread of TB to others.[ 4 ]
There is no gold standard test for LTBI. Available screening tests provide indirect information on the presence of LTBI. Historically, the diagnosis of LTBI has relied on the use of the tuberculin skin test (TST).[ 5 ] Interferon-gamma release assays (IGRAs) may overcome some of the limitations of TST.[ 5 , 6 ]
It is important that the health-care workers have the latest and adequate knowledge about these diagnostic modalities. However, knowledge among health-care workers has been found to be lacking, which could stagger the goal to stop TB in the country.[ 7 ] By considering all these factors, this study was intended to assess the baseline knowledge of the participants (health-care workers) about the screening tests for LTBI and to identify the knowledge gaps.
MATERIAL AND METHODS
This hospital-based cross-sectional study was conducted at a tertiary care teaching hospital in Karnataka, India. Approval was obtained from Institutional Ethics and Research Committee (RRMCH-EIC/96/2021), dated 27 December 2021. A total of 260 health-care workers (40 technicians, 120 nurses, 60 interns and 40 postgraduate students) were sensitised in four batches from December 2021 to January 2022. An oral informed consent was obtained from the participants before their participation in the study. Participants were asked to respond to a 25-item questionnaire before the sensitisation programme (workshop) regarding knowledge, procedure and interpretation of screening tests for LTBI; the workshop consisted of different modules to orient the study participants on the technical aspects of screening tests for LTBI. The same questionnaire was repeated on the completion of the workshop to assess its impact on the study participants. Annexures I and II show (supplementary material available online) the pre- and post-test questionnaire items to assess the health-care workers’ knowledge.
Annexure I
Annexure II
The questionnaire was pre-designed, self-administered consisting of questions related to technical aspects of screening tests for LTBI. The questions were centred mainly on TST (14 questions) and IGRA (11 questions). Confidentiality of the participants was maintained during data acquisition and analysis.
Statistical analysis
Data were presented in percentages and mean ± standard deviation for correct answers from the total answers received. A paired t -test was employed to compare the knowledge level among participants before and after the workshop. A P < 0.05 was considered statistically significant. Data were compiled and analysed using the statistical software SPSS version 20 (IBM Corp, Armonk, NY, USA).
RESULTS
The study participants included 40 technicians, 120 nurses, 60 interns and 40 postgraduate students (Table 1 ). All participants had answered all the questions and there were no duplicates and missing data. The baseline mean number of correct answers for nurses (10.5 ± 3.4) was lower when compared to other health-care workers (Table 2 ). Table 2 represents the overall pre- and post-workshop percentages of answers attempted correctly by study participants. Statistically, a significant difference was observed between pre- and post-workshop percentages of all health-care workers with respect to knowledge of screening tests for LTBI indicating that the training increased the knowledge of all the study participants significantly (Tables 3 and 4 ).
Table 1: Demographic details of the participants
Table 2: Pre- and post-workshop answers attempted correctly by the study participants*
Table 3: Pre- and post-workshop answers attempted correctly regarding tuberculin skin test*
Table 4: Pre- and post-workshop answers attempted correctly regarding interferon-gamma release assay
The mean percentages among all health-care workers were found to have improved significantly post-workshop (Figure 1 ). In comparison, it was observed that interns and post-graduates had a higher baseline knowledge than other health-care workers. However, improvement in percentages was best among nurses, followed by technicians, post graduates and interns (Figure 1 ).
Figure 1: Distribution of pre- and post-workshop percentages of answers attempted correctly by overall, tuberculin skin test, and interferon gamma release assay among various health-care workers IGRA = Interferon gamma release assay; TST = Tuberculin skin test
DISCUSSION
This questionnaire-based study was conducted to determine the impact of sensitisation program on various health-care workers regarding the knowledge of screening test for LTBI. To the best of our knowledge, this is the first Indian questionnaire-based study assessing the knowledge of screening tests for LTBI among various health-care workers. It has been hypothesised that tailored and culturally appropriate LTB infection screening and treatment programmes, including interventions against TB stigma, are needed to reduce TB.[ 8 ] The authors[ 8 ] confirmed that continuous culturally sensitive education activities, among different health-care workers hierarchy will help to reduce TB incidence.[ 8 ] A study from India showed the requirement of the appropriate knowledge regarding TB to reduce the burden. They concluded that there is an urgent need to review the messages and strategies currently used for disseminating knowledge regarding TB. The disseminated knowledge should include medical, psycho-social and economic aspects of TB that not only informs people about medical aspects of TB disease but also removes stigma and discrimination and create awareness about different diagnostics.[ 9 ]
It was found that various gaps were present in the baseline mean knowledge for technicians, nurses, postgraduates and interns (42.9%, 42.1%, 51.9% and 53.6%, respectively), which increased significantly post-workshop. Similar to our study findings, a significant improvement in knowledge parameters after the training of medical interns was reported in another study.[ 10 ]
A higher percentage of the studies found knowledge variables among doctors (post-graduates and interns) to be higher than nurses, which was in concordance with our study findings.[ 11–14 ] In contrast to our study findings, many studies were reported that nurses were found to have slightly better baseline knowledge than interns and postgraduate students.[ 7 ] A cross-sectional study among health-care workers in India, China, Iran and Mexico reported that very few respondents correctly answered all knowledge questions with respect to TB care; India (5%), China (5%), Iran (19%) and Mexico (22%).[ 15 ] A study[ 16 ] from Udaipur, India, showed the total mean percentage of correct answers for TB knowledge was 48.6 ± 20.4 which improved to 69.3 ± 17.7 post-training among undergraduate medical students. The authors[ 16 ] had documented that medical students had poor knowledge. A simple TB education session had a positive influence on knowledge, attitude and preventive practices about TB among them.[ 16 ]
An Indian study[ 17 ] proved that TST remains the best method in high TB burden, low resource setting, as it is cost effective. However, this study[ 17 ] does not discuss the awareness among the different groups of people. Some Indian studies[ 4 , 18 ] among nurses have demonstrated significant knowledge gaps. In Punjab, 64% had below-average knowledge scores, whereas in Haryana, 62.2% had satisfactory knowledge.[ 4 , 18 ] In contrast, mean knowledge was found to be 63.1% in Delhi, whereas another study reported only 40.2% had TB-related knowledge at satisfactory level.[ 19 , 20 ] In the current study, the mean baseline knowledge among nurses was 42.1%. In a study[ 10 ] conducted among medical interns, baseline knowledge on general and clinical facts of the infection was comparatively higher than our study among interns.[ 10 ] In a study[ 21 ] from Nepal the authors had reported that the level of knowledge on TB infection control among almost half (45.8%) of the health-care workers was poor.
The current study had its own limitations. First, findings cannot be generalised to the health-care workers of other hospitals since this study is not multi-centric. This questionnaire-based study highlights the importance of training various health-care workers on diagnostic modalities for LTBI since the current study findings revealed that training increased the knowledge scores of the participants significantly. Future larger cross-sectional studies should confirm our study findings by focussing more on diagnostic modalities.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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