Operational Handbooks

Any child aged under 10 years who has had close contact with a person with TB disease should be screened for TB with a symptom screen or CXR as part of contact investigation. Symptoms used to screen for TB are cough for more than 2 weeks, fever for more than 2 weeks, and poor weight gain or weight loss in the past 3 months. In young children, reduced playfulness or lethargy should also be included, since prolonged cough may be absent in children with disseminated disease.

Screening serves to identify children and adolescents who may have TB disease (presumptive TB) and who need further evaluation to make or confirm a TB diagnosis (see Chapter 4). It also helps to identify children and adolescents who are eligible for and could benefit from TPT. A screening test is not intended to be a diagnostic tool. People with positive results on a screening test should undergo further diagnostic evaluation.

In addition to planning and budgeting, NTPs should consider the following key implementation steps in contact investigation:

About a quarter of the world’s population has been infected with Mycobacterium tuberculosis. The vast majority of these people do not have TB disease (10). It is estimated that 7.5 million children and young adolescents aged under 15 years are newly infected with M. tuberculosis each year (11). Cumulatively, about 67 million children and young adolescents aged under 15 years are infected with M.

The chapters in the handbook are structured around the pathway of TB infection and disease in an individual child or adolescent and the interface with and retention across sequential stages of care (cascade of care), as shown in Figure 1.1 (5).

Figure 1.1. Pathway through TB exposure, infection and disease

WHO provides guidance on the principles²⁹ and recommendations for nutritional care and support of people with TB as part of their regular TB care.

Five guiding principles are key for providing nutritional care and support as an integral part of TB care and prevention (105):

In people with TB/HIV coinfection, the dose of DTG needs to be doubled by giving it twice instead of once a day because of drug–drug interactions with rifampicin. This extra dose of DTG is well tolerated, with equivalent efficacy in viral suppression and recovery of CD4 cell count compared with EFV (182, 183).

Table 7.2 summarizes changes needed to ART regimens for neonates, children and adolescents who are on ART when TB treatment is started, or who start ART while on TB treatment.

A key challenge with rifamycin-based TPT regimens in people living with HIV is drug–drug interactions. Rifampicin and rifapentine can be co-administered with EFV or DTG without dose adjustment. In people on RAL and rifamycins, however, a higher dosage of RAL (800 mg twice a day instead of 400 mg twice a day) should be used.