Children and Adolescents

Availability of a skilled workforce at the various health care levels is critical to provide high-quality TB services. The NTP should plan for capacity building of staff to undertake any new responsibilities, including task-shifting for functions such as TB screening, contact investigation, non-invasive methods of sample collection, use of treatment decision algorithms, and use of child-friendly formulations of TB medicines. This can be achieved via training, provision of equipment, supportive supervision and mentorship.

The availability of regulatory frameworks and policies that support the implementation of decentralized and integrated TB services is key to bringing TB services closer to children, adolescents and families and to creating and sustaining ownership and accountability at the national and subnational levels. The NTP, in partnership with other programmes, needs to review the existing health care structures and identify opportunities for decentralization and integration of TB services, or components thereof.

The NTP could consider conducting stakeholder consultations (including relevant programmes such as maternal and child health, HIV and nutrition, national paediatric associations, other professional bodies and the national regulatory authority) to identify opportunities and strategies for decentralization and integration of services and to address health system challenges that might hamper implementation. This could be done through an existing child and adolescent TB technical working group or another relevant platform.

For TB case detection and provision of TPT , the feasibility and effectiveness of decentralization and integration may vary by setting based on, for example, the local burden of TB disease, available resources, existing infrastructure, regulatory framework and structure of the NTP. The NTP should consider starting with an assessment of the feasibility and potential utility of decentralization or integration at different levels of care, or in urban versus rural settings, or in public versus private settings.

Decentralization includes the provision of, access to or capacity for child and adolescent TB services at a lower level of the health system than the lowest level where it is currently routinely provided. In most settings, decentralization applies to the district hospital level (first referral level), PHC level or community level.

In high TB burden countries, the capacity to manage TB in children and adolescents is often centralized at the tertiary or secondary level of health care rather than being decentralized at the PHC level where children and adolescents with TB or TB exposure commonly seek care (5, 157). Care at higher levels in the health system is often managed in a vertical, non-integrated way.

After a clinician has decided to start treatment in a child based on bacteriological testing or as a result of a treatment decision algorithm, the child should be registered with the NTP. This applies to all services and programmes where children and adolescents with TB are diagnosed, including public non-NTP services and private-sector facilities and practitioners. Underreporting of children and adolescents diagnosed with TB in these sectors contributes to the high proportion of missing children and adolescents with TB.