Decentralising TB diagnosis and contact management: impact on detection and preventive treatment in children

BACKGROUND

The ‘CaP-TB’ project enhanced paediatric TB care through decentralized services, including screening, specimen collection, chest X-rays and implementation of the three-month rifampicin-isoniazid regimen for TB preventive treatment (TPT). In Cameroon and Uganda, it also included community-based child contact management through the ‘CONTACT’ study. We assessed the impact of CaP-TB project on TB detection and TPT outcomes in children, focusing on facilities included in ‘CONTACT’ study.

METHODS

Using a before-after design with aggregated data, we compared the proportion of children among all notified TB patients and the TPT completion rate for child contacts <5 years old between a pre- (March 2018–March 2019) and per-intervention (September 2020–September 2021) periods. During the intervention, half of the facilities implemented community-based child contact management.

RESULTS

The proportion of children among all notified TB patients increased from 4.8% (113/2373) to 11% (276/2512) during the intervention (odds ratio [OR] = 2.25, 95% confidence interval [CI]: 1.79–2.84). The number of children initiated on TPT increased from 105 to 841 and TPT completion rate from 55.2% (58/105) to 94.9% (798/841), (OR = 33.4, CI: 16.39–68.06).

CONCLUSION

Decentralizing and strengthening diagnosis and contact management can help overcome barriers to effective TB detection and TPT coverage in children.