Children and Adolescents

This section outlines how to screen for, prevent and manage TB/HIV coinfection in children and adolescents living with HIV (CALHIV).

This chapter covers a range of special situations related to the management of TB in children and adolescents:

Health emergencies, such as the COVID-19 pandemic, are associated with a disruption in health service delivery, either directly due to the focused attention given to the emergency or indirectly due to measures implemented to control the emergency.

Countries may have DSD policies in place, but children, adolescents and people living with HIVassociated TB are often excluded. DSD has primarily focused on people living with HIV who are established on ART (79). It is therefore important that the NTP works closely with the national HIV programme to ensure children and adolescents are able to access these patient-centred approaches.

Engaging health care providers within the private sector aims to improve access to TB care and treatment for people who prefer to seek care within the private setting, including children and adolescents (174).

In most low- and middle-income countries, private providers are an important source of health care for the whole population. Typically, less poor people make more use of formal, qualified providers, while poor people often turn first to informal, unqualified providers. Private providers often account for 50–70% of care, especially outpatient primary care (175).

In many high TB burden countries, the majority of missing people with TB, including children, seek treatment from private providers or other care providers not linked to the public sector at least once (174). The private sector is also a common point of care for children presenting with common illnesses, such as cough, fever and diarrhoea, especially in countries with a large private sector (175).

Health care facilities that offer TB services should have access to supplies for sample collection such as nasogastric tubes, spatulas and specimen containers, and access to child-friendly formulations of TB medicines. Sample referral systems need to be established if access to mWRDs is not available on site (76).