Consolidated Guidelines

2. TB screening and contact investigation

This chapter includes current WHO recommendations that apply to children and adolescents on TB screening and contact investigation. They have been consolidated from current WHO guidelines on systematic screening for TB disease and contact investigation, namely the WHO consolidated guidelines on tuberculosis. Module 2: screening - systematic screening for tuberculosis disease (11) and Guidance for national tuberculosis programmes on the management of tuberculosis in children (second edition) (8).

1.6.1. PICO questions

Question PICO 1. Approches de dépistage de la tuberculose chez les enfants âgés de moins de 10 ans

Quels outils de dépistage faut-il utiliser pour le dépistage systématique de la tuberculose-maladie chez les enfants âgés de moins de 10 ans qui ont accès aux soins de santé?

2.6.1 Develop and implement training programmes for pre-service, in-service and continuing education on TB and HIV prevention, treatment and care services, integrating with existing programmes and including managers and worker representatives as well as health workers.

This statement has several components which underline the importance of training programmes and include ongoing education concerning prevention, treatment and care.

2.5.1 In conjunction with health workers’ representatives, develop and implement programmes for regular, free, voluntary, and confidential counselling and testing for HIV and TB, including addressing sexual and reproductive health issues, as well as intensified case finding in the families of health workers with TB.

This statement has several components. The focus of the discussion below will begin with the issue of involving health workers' representatives. The issues of addressing reproductive health issues and intensified case findings in the families of health workers with TB will be addressed afterwards. It should be noted, however, that both phrases in this statement are supported by existing guidelines, as well as evidence from the literature.

2.12.1 In the context of preventing co-morbidity, provide universal availability of a comprehensive package of prevention and care for all HIV positive health workers, including IPT and CTX prophylaxis, with appropriate information on the benefits and risks

Much of the discussion related to the above statements emphasized the importance of a comprehensive approach. Elaboration on the costs of a comprehensive package are presented below.

2.11.1 Provide free HIV and TB treatment for health workers in need, facilitating the delivery of these services in a non-stigmatizing, gendersensitive, confidential, and convenient setting even where there is no staff clinic, and/or the health worker’s own facility does not offer ART.

Makombe and colleagues (2007), visited all 95 ART facilities in the public sector and all 28 ART facilities in the private sector in Malawi, in 2006, constituting the first study from sub-Saharan Africa examining the important interaction between ART scale-up for health workers at a national level. Of the 1024 health workers studied, TB was a common stage-defining condition in 192 (18.8%) health workers, and was significantly more common in ward support staff (23.3%) compared with all other cadres.

2.6.2 Key References and Supporting WHO Guidelines

Baleta, A. (2008) Swaziland nurses the wellbeing of its health workers. Lancet. 371;1901-1902.

Charalambous, S., Grant, A. D., Day, J. H., Pemba, L., Chaisson, R. E., Kruger, P., et al. (2007a). Establishing a workplace antiretroviral therapy programme in South Africa. AIDS Care, 19(1), 34-41.

EngenderHealth: Reducing stigma and discrimination related to HIV and AIDS: training for health care workers. New York: EngenderHealth; 2004.