Decentralising TB diagnosis and contact management: impact on detection and preventive treatment in children

BACKGROUND The 'CaP-TB' project enhanced paediatric TB care through decentralized services, including screening, specimen collection, chest X-rays and implementation of the three-month rifampicin-isoniazid regimen for TB preventive treatment (TPT). In Cameroon and Uganda, it also included community-based child contact management through the 'CONTACT' study. We assessed the impact of CaP-TB project on TB detection and TPT outcomes in children, focusing on facilities included in 'CONTACT' study. METHODS Using a before-after design with aggregated data, we compared the proportion of children among all notified TB patients and the TPT completion rate for child contacts RESULTS The proportion of children among all notified TB patients increased from 4.8% (113/2373) to 11% (276/2512) during the intervention (odds ratio [OR] = 2.25, 95% confidence interval [CI]: 1.79-2.84). The number of children initiated on TPT increased from 105 to 841 and TPT completion rate from 55.2% (58/105) to 94.9% (798/841), (OR = 33.4, CI: 16.39-68.06). CONCLUSION Decentralizing and strengthening diagnosis and contact management can help overcome barriers to effective TB detection and TPT coverage in children. .