Consolidated Guidelines

In order of presentation:

WHO consolidated guidelines on tuberculosis. Module 2: screening - systematic screening for tuberculosis disease. Geneva: World Health Organization; 2021.

Recommendations for investigating contacts of persons with infectious tuberculosis in low- and middle-income countries. Geneva: World Health Organization; 2012.

WHO guidelines on tuberculosis infection prevention and control, 2019 update. Geneva: World Health Organization; 2019.

This chapter includes research gaps or priorities that were identified by the GDG members while considering the evidence related to each of the PICO questions. Addressing the identified research gaps has the potential to inform the development of future research questions that can improve TB prevention and care. This list of research priorities is not exhaustive; but it complements the existing research agenda outlined in Research priorities for paediatric tuberculosis (127) and other WHO guidelines.

Moving to decentralized, family-centred, integrated services requires careful planning and regular monitoring of implementation against the plan. The capacity needs of NTPs for implementing the proposed interventions need to be identified and addressed.

Health system requirements: Training of health care workers at peripheral levels of the health system is a critical requirement to ensure adequate implementation of decentralized approaches. Similarly, resources are needed at the peripheral level, especially initially to establish services. It is expected that as services are established and effectively implemented, the long-term impact will result in a decrease in TB incidence with an associated reduction in resource requirements.

Adolescents have a disease presentation that is similar to adults, and therefore may need different interventions than young children. Additional subgroup considerations for adolescents are included in the operational handbook, taking into account their specific health-seeking behaviour and the need for adolescent-friendly services.

PICO questions:

a. In children and adolescents with signs and symptoms of TB, should decentralization of child and adolescent TB services versus centralized child and adolescent TB services (at referral or tertiary hospital level) be used?

b. In children and adolescents exposed to TB, should decentralization of child and adolescent TB prevention and care services versus centralized prevention and care services (at referral or tertiary hospital level) be used to increase coverage of TPT in eligible children and adolescents?

Recommendations:

In TB high burden settings, decentralized models of care may be used to deliver TB services to children and adolescents with signs and symptoms of TB and/or those exposed to TB (conditional recommendation, very low certainty evidence).

Family-centred, integrated models of care to deliver TB services may be used in children and adolescents with signs and symptoms of TB and/or those exposed to TB, in addition to standard models of care (conditional recommendation, very low certainty evidence).

This chapter contains two new recommendations and other valid WHO recommendations that apply to patient support and models of care (section 6.2). The two new recommendations, on the implementation of decentralized models of care and integrated family-centred models of care to improve both case detection and the provision of TPT, are described in full detail as this information is being published for the first time.

Recommendation

In children with MDR/RR-TB aged below 3 years delamanid may be used as part of longer regimens (conditional recommendation, very low certainty of evidence).

Remarks

• This recommendation complements the current WHO recommendation on longer regimens that contain delamanid (9):

- Delamanid may be included in the treatment of MDR/RR-TB patients aged 3 years or more on longer regimens (conditional recommendation, moderate certainty in the estimates of effect).

Recommendation

In children with MDR/RR-TB aged below 6 years, an all-oral treatment regimen containing bedaquiline may be used(conditional recommendation, very low certainty of the evidence).

Remarks