TB KaSPar
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A wide range of private health care providers exist in different settings, and the services they provide vary. It is important for NTPs to map the different private health care providers in their settings and implement flexible models of engagement guided by the scope of services they provide.
TB commonly affects people of lower socioeconomic status and exacerbates poverty and social deprivation through catastrophic costs25 and reduced household income. Most children with TB develop TB after contact with an adult family member with infectious PTB. A high number of TB notifications in children indicates an ongoing adult epidemic (170). TB in the family unit does not only result in transmission to children: it also poses a threat to household income and financial security.
Opportunities for integration of TB services at the health facility level exist in outpatient departments; nutrition, HIV, maternal and child health clinics (e.g. prevention of mother-to-child transmission, antenatal care, immunization clinics), general paediatric, adult TB and chest clinics; and inpatient departments. If resources are available, implementation of provider-initiated TB screening in relevant child health entry points and linkages to diagnosis or treatment may be considered by the NTP.
Health system costs are likely to increase in initial phases of decentralizing services, but they are then expected to reduce over time. Initial investment costs may include costs related to infrastructure enhancement and capacity-building of health care providers and community engagement (See web annex 4). Recurring costs may include salaries, incentives, administrative costs, expanded information systems costs, and supervision and mentoring costs.
Implementation of the recommendations related to treatment support should enable the provision of people-centred TB services. Treatment adherence interventions that may be offered for people on TB treatment may include material support (e.g. food, financial incentives, transport fees), psychological support, tracers such as home visits or digital health communication (e.g. SMS, telephone) and medicine monitoring (107). Interventions should be selected based on assessment of the individual’s needs and preferences as well as available resources.
Availability of a skilled workforce at the various health care levels is critical to provide high-quality TB services. The NTP should plan for capacity building of staff to undertake any new responsibilities, including task-shifting for functions such as TB screening, contact investigation, non-invasive methods of sample collection, use of treatment decision algorithms, and use of child-friendly formulations of TB medicines. This can be achieved via training, provision of equipment, supportive supervision and mentorship.
In high TB burden countries, the capacity to manage TB in children and adolescents is often centralized at the tertiary or secondary level of health care rather than being decentralized at the PHC level where children and adolescents with TB or TB exposure commonly seek care (5, 157). Care at higher levels in the health system is often managed in a vertical, non-integrated way.
Health-related quality of life is the perceived quality of a person’s daily life. It is an holistic way to quantify and measure illness-associated morbidity and the impact of health interventions. Examples of generic, non-disease-specific tools that can be used in young children, including those with TB, are EQ-5D-Y and TANDI (153, 154). EQ-5D-Y is a widely used self-report measure for children aged 8 years and over (155).
Although osteoarticular TB is uncommon (approximately 1–2% of all children with TB and 8% of children with EPTB), the potential long-term consequences of the disease, particularly in children, can be major (149).
