Feedback
Because of their increased risk for TB, children aged under 10 years living with HIV should be screened for TB at every encounter with a HCW, with the following screen: cough, fever, poor weight gain or close contact with a person with TB (see Chapter 2 on screening). For recommendations on screening tools for adolescents aged 10–19 years living with HIV, see Box 2.7 in Chapter 2 (13).
Children and adolescents living with HIV have an increased risk of TB exposure, infection, progression to disease, and TB-related morbidity and mortality. This risk is influenced by the degree of immune suppression. Childhood HIV infection is particularly common in settings where antenatal HIV prevalence is high and interventions for prevention of vertical transmission are not implemented widely. In these settings, the prevalence of HIV is particularly high among infants and young children, an age group that is also at risk for TB.
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.
Generally, integration of TB care and treatment into DSD models requires adaptations at multiple levels of the health system, including national, facility and community levels (177). This includes enhancement of leadership and coordination, adaptation of guidelines, capacity-building, adjustments in logistics management, alignment of existing recording and reporting tools, and community engagement. Other factors to consider include the local burden of HIV and TB disease, existing infrastructure and
human resources.
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.
The concept of DSD (previously referred to as differentiated care) is increasingly being applied during the provision of comprehensive HIV services (78). In the context of HIV, DSD is a people-centred approach that simplifies and adapts HIV services to better serve the needs of people living with HIV and to optimize the available resources in health systems. DSD is premised on the fact that delivery of services is not a one-size-fits-all model but rather recognizes the diversity of people who seek the services.
