2022 The Union World Conference on Lung Health (Union)

The World Health Organization released consolidated guidelines on the management of tuberculosis (TB) in children and adolescents in March 2022, along with an operational handbook which contains practical guidance on how to implement the WHO recommendations. The new guidance covers the full cascade of care for children and adolescents at risk of TB and with TB.

The objectives of this course are to provide an in-depth orientation on the practical implementation guidance on the management of TB in children and adolescents included in the operational handbook, spanning the entire cascade of care, as well as to share experiences and perspectives from implementing partners.

Martina Casenghi, Technical Director, CaP TB at EGAPF, will present on ‘Closing the pediatric TB case finding and preventive treatment gaps: the role of decentralized and integrated models of care.’ This presentation will review the contribution to pediatric TB case detection and TPT coverage of the integrated and decentralized approaches implemented and will discuss practical lessons learnt.

Progress in addressing the paediatric TB detection gap and TB preventive treatment (TPT) coverage among child and adolescent contacts has been slow. Despite supportive global- and national-level policies, as well as compelling evidence demonstrating that contact investigation interventions are a key gateway to both case-finding and identification of those in need of TPT, effective prioritisation and scale-up of contact case management approaches remains challenging in TB-endemic countries. This session will review and discuss implementation of promising strategies, adapted for delivery in high-burden settings, including experiences on decentralised and family-centred models of care recommended by the recently released WHO paediatric TB guidelines.

Martina Casenghi, Technical Director, CaP TB at EGPAF, will co-chair this session.
Maryline Bonnet will present ‘Decentralized model of care for child contact investigation and TPT management in Cameroon and Uganda: CONTACT study results’.

In March 2022, the World Health Organization released new consolidated guidelines on the management of TB in children and adolescents. The guidelines include recommendations that cover the entire pathway of TB infection and disease in children and adolescents and the interface with and retention across sequential stages of care (the care cascade). This session provides background data and implementation considerations for the new recommendations on integrated treatment decision algorithms, shorter treatment for children with non-severe drug-susceptible TB, a short intensive treatment regimen for TB meningitis, and decentralised and family-centred, integrated models of care for TB case detection and prevention in children and adolescents.

Boris Tchounga, Associate Director of Public Health Evaluation at EGPAF, will present on ‘Implementing decentralized and integrated TB services for children under 5 years: evidence and lessons learned generated by the INPUT study in Cameroon’.

The satellite session will present key outcomes from the five-year TB-Speed project, funded by Unitaid and L’Initiative. TB-Speed aimed to contribute to reducing childhood mortality from tuberculosis by delivering a feasible, cost-effective, and decentralized childhood tuberculosis diagnostic approach to enhance case-finding and access to treatment. TB-Speed will share a) effectiveness and implementation research outcomes on decentralizing pediatric TB diagnosis down to primary health centres in six high TB incidence countries, b) results of systematic TB detection in highly vulnerable children with severe acute malnutrition, c) experience of developing and validating TB treatment decision algorithms. In addition, the Unitaid-funded CapTB project will present data on the impact of decentralized and integrated models of care for childhood TB. This symposium will be a great opportunity to discuss perspectives beyond the TB-Speed project on how to increase access to better diagnosis of TB in children living in high burden and resource constrained countries.

EGPAF’s Martina Casenghi will present on ‘Finding the missing children: can decentralised and integrated models of care contribute to address the gap?’.

Civil society organizations (CSOs) and communities play a critical and broad range of roles to reach national, regional and global targets for tuberculosis elimination. From demand creation to monitoring TB services, CSOs and communities are essential to address inequities in the TB response. For this to be a reality, CSO and community work should receive proper political and financial support. This symposium will share specific experiences of building demand for and monitoring the implementation of TB services. It will increase awareness of the broad range of community interventions—from TB preventive treatment, to TB diagnosis, to innovative care models for childhood TB—will present ways in which CSOs and communities work in collaboration with other relevant stakeholders to maximize impact, building on successful examples from different partners. This session will be an opportunity to call on stakeholders to increase political and financial attention to CSOs in the TB response.

Papy Ndjibu Tshishikani will present on ‘Addressing inequities faced by children in the TB response – Monitoring national childhood TB policies’.

Nyashadzaishe Mafirakureva will present on ‘Household costs incurred under two TB preventive therapy service-delivery models for children in Cameroon and Uganda’.

‘Effects of integrating paediatric TB services into child healthcare on treatment outcomes: results of the INPUT stepped-wedge cluster-randomised study’ presented by Lise Denoeud-Ndam, Senior Research Officer – CaP TB at EGPAF.

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