Operational Handbooks

PTB refers to any bacteriologically confirmed or clinically diagnosed case of TB involving the lung parenchyma or tracheobronchial tree. Tuberculous mediastinal and/or hilar intrathoracic lymphadenopathy is also classified as PTB, following an expert consultation convened by WHO in September 2021.¹⁵ Miliary TB is classified as PTB because there are lesions in the lungs. Tuberculous pleural effusion without radiographic abnormalities in the lungs constitutes EPTB. A person with both PTB and EPTB should be classified as having PTB (71).

Young children have a higher risk of developing TB compared with other age groups (4). Risk of TB disease is more pronounced among children and adolescents who:

Diagnostic evaluation is the step in the care cascade after screening. Children and adolescents who screen positive during contact investigation or at health facility-based screening, and those who present to a health care facility with signs and symptoms of TB and who are identified as having presumptive TB must be evaluated further for TB disease.

The End TB Strategy emphasizes the need for prevention across all efforts to end the TB epidemic, including infection prevention and control in health care services and other high-transmission settings (7). Infection prevention and control practices are critical to reduce the risk of M. tuberculosis transmission, by reducing the concentration of infectious droplet nuclei in the air and the exposure of susceptible people to such aerosols.

The management of babies born to women with TB is covered in Section 7.2. The main implications of TPT for the choice of ART in children and adolescents living with HIV are covered in Section 7.1. 

Infants and children are dependent on caregivers to administer medicines. Barriers faced by adult caregivers can contribute to children missing doses. Considerations for adherence in adolescents are covered in Section 7.4.

Potential barriers for children include the following:

Adherence to any course of treatment is a complex behaviour influenced by many factors, such as personal motivation, beliefs about health, perceived risks and benefits of treatment, comorbidities, competing demands that conflict with taking medicines, the family environment, complexity of the treatment regimen, toxicity of medicines, and trust and relationship with providers. Effective person-centred strategies to promote adherence to TPT may include the following (15):

Children and adolescents on TPT should be reviewed every month for those on a 3-month regimen (e.g. 3HR or 3HP), or every 2 months for those on a 6-month regimen (e.g. 6H) or DR-TB TPT, ideally at a health care facility or by treatment supporters (see Section 6.4) or by using digital tools such as video-supported treatment (69).

Household contacts of people with MDR-TB or isoniazid monoresistance are at higher risk of TB infection than contacts exposed to people with drug-susceptible TB. The risk of progression to TB disease does not differ among contacts in either group (67). Studies have reported approximately 90% reduction in MDR-TB incidence with TPT after known exposure (68). WHO recommends using TPT for contacts exposed to people with MDR-TB following consideration of the intensity of exposure, confirming the source patient and their drug resistance pattern (i.e.