TB KaSPar
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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.
The WHO consolidated guidelines on tuberculosis (28) and the WHO operational handbook on tuberculosis (15) identify two broad at-risk child and adolescent populations that need systematic assessment for eligibility for TPT:
Training of health care providers to administer BCG vaccination is important to ensure the correct technique is used. The standard dose of BCG vaccine is an intradermal injection of 0.05 mL of the reconstituted vaccine for infants aged under 1 year, and 0.1 mL for infants aged over 1 year. BCG vaccine can safely be given together with other routine childhood vaccines, including the hepatitis B birth dose. Although efforts should be made to use all doses in BCG multidose vials, children should be vaccinated even if this means part of the vial is wasted.
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.
