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In 2014, World Health Assembly Resolution WHA67.19 called upon WHO and Member States to improve access to palliative care as a core component of health systems, with an emphasis on PHC and community- and home-based care (197). WHO is supporting integration of palliative care into all relevant global disease control and health system plans and is promoting improved access to palliative care for children, in collaboration with the United Nations Children’s Fund.
Routine safety monitoring of treatment should generally follow the recommended approach in adults and should be guided by the known adverse effect profile of the medicines included in the regimen.
Table 5.14 summarizes the most common adverse effects of the medicines used for MDR/RR-TB.
This section covers the standardized shorter all-oral bedaquiline-containing regimen and individualized regimens for children and adolescents not eligible for the shorter all-oral bedaquiline-containing regimen. It also includes other important considerations, including treatment of EPTB and TB/HIV coinfection, and dosing and formulations.
Sensitivity for TB of “any abnormality” as reported on CXR in close contacts aged under 15 years is 84%, and specificity is 91% (25). It is thus more specific than symptom screening alone. Estimates of the accuracy of CXR are not disaggregated by age group, and significant differences in CXR findings between younger and older children may lead to important differences in sensitivity and specificity by age group.
TB contact investigation can be implemented at the health care facility or at the community level, or as a combination. This section contains some examples of approaches to contact investigation, including lessons learnt.
The 10 main areas in implementing a new test are listed in Box 4.1. The following sections describe the steps within each of the 10 areas.
QA: quality assurance; QC: quality control; TB: tuberculosis.
As with any diagnostic test, correct technique in administration and reading of the test is essential for accurate, reproducible and valid test results. Therefore, personnel require initial training, mentoring and ongoing supervision to maintain quality (42). Training for reading of tuberculin reactions is ideally done at a large centre where large numbers of people receive TB infection skin tests regularly. In this way, in a relatively short amount of time, trainees can practise the reading of indurations of different sizes and consistency.
To avoid barriers or delays created by TB infection testing, and to minimize associated losses in the TB infection care cascade, an integrated person-centred care model is preferred for TB infection diagnosis and treatment. Here, “integrated” means carrying out screening for TB disease and testing for TB infection in parallel, and “person-centred care” means coordination of multiple care activities during the same visits.