#28 Examining Adherence to World Health Organization (WHO) Latent Tuberculosis Pediatric Infection Guidelines Among 30 High Tuberculosis Burden Countries

Abstract Background Approximately 1.2 million children are estimated to be infected with tuberculosis (TB) worldwide. The World Health Organization (WHO) routinely updates guidelines for the treatment to lateen tuberculosis infection (LTBI) in children with the last update provided in 2020. The objective of our study was to assess the impact of these updates on national LTBI guidelines devised by 30 high burden countries. Method We collected National LTBI guidelines from health ministries of high burden countries. Eleven countries had guidelines that were in English and published in the last 6 years out of the 30 high burden countries. The guidelines from the respective countries were compared for concordance with the most recent WHO guidelines on LTBI management in the pediatric population. Results We identified four subsections of the WHO guidelines: at-risk groups for LTBI testing, algorithms to rule out active TB disease, testing for LTBI, and TB preventive treatment options. Guidelines from Nigeria and Pakistan had the highest concordance in identifying at-risk groups for LTBI at 83.3% each, whereas Namibia had the lowest concordance for this subcategory at 16.67% . Nigeria had 100% concordance in defining an algorithm to rule out active TB disease. Pakistan and Uganda had 80% concordance for algorithms to rule out disease. Philippines, Nigeria and Pakistan had 100% concordance with testing for LTBI, with Ethiopia, Kenya and Myanmar having the lowest concordance with 0%. Namibia and Myanmar had the highest concordance in regards to TB preventive treatment options, with 64% and 50% concordance respectively; all other included guidelines had low concordance for TB preventive treatment options. Conclusion Our study examined general concordance of national LTBI guidelines with the WHO guidelines and in the domains of identification, testing, algorithms, treatment, and prevention. Most guidelines among the high burden countries had high concordance in identifying at-risk groups for LTBI testing and algorithms to rule out active TB disease. Further research is needed to assess factors that lead to discordance between national and WHO guidelines.