C38-17 Readiness of Tanzanian Health Facilities to Implement Who-recommended Treatment Decision Algorithms for Pediatric Tuberculosis

Abstract Rationale Tuberculosis (TB) is a significant public health problem in sub-Saharan Africa, affecting individuals of all ages, including children. Tanzania, one of the countries with a high TB burden, faces persistent challenges in the timely diagnosis and treatment of pediatric TB due to resource limitations, underreporting, and diagnostic complexities. To address detection gaps, the World Health Organization (WHO) recommends the use of Treatment Decision Algorithms (TDAs) to improve TB diagnosis and management in children. This study was conducted to assess the readiness of Tanzania health facilities as part of a formative phase of the larger OPTIC-TB study, aimed at optimizing the implementation and scale-up of WHO-recommended TDAs for pediatric TB in Sub-Saharan Africa. Methodology A cross-sectional facility-based study was conducted in February 2025 in 40 purposively selected health facilities across Dar es Salaam and Pwani. Data were collected through structured questionnaires, interviews, and record reviews to assess TB diagnostic capacity, staffing, data systems, and integration with HIV and nutrition services. Descriptive statistics were generated using Stata version 15 to summarize facility readiness, service availability, and treatment outcomes. Results Of the 40 facilities assessed, 67.5% had GeneXpert machines and 97.5% had TB microscopy, but none had TB-LAM tests. Chest X-ray services were available in 70% of facilities, though costs limited use. Reliance on clinical diagnosis remained high, underscoring the need for standardized TDAs. A marked discrepancy existed between laboratory registers (43,483 presumptive cases) and presumptive TB registers (21,019), indicating underreporting and missed follow-up opportunities. Treatment success was 46.3%, 49.1% among children aged 2-9 years, and 47.0% among those under 2-years well below the global End TB target of 90%. Over 90% of notified cases received treatment, yet 15.6% were unevaluated. HIV and malnutrition services were available in nearly all-facilities (100% and 92.5%), though most required additional training. Staff shortages affected 67.5% of facilities, and 55% reported low-motivation. Although 85% used both paper and electronic systems, data delays (37.5%) and inaccuracies (25%) were frequent. Conclusion Tanzanian health facilities show moderate readiness to implement WHO TDAs for pediatric TB. However, gaps in diagnostics, staffing, and data systems persist. This study identified priority areas particularly staff training and system strengthening that should be addressed before implementation begins to ensure effective uptake of TDAs and improved pediatric TB case detection and management. This abstract is funded by: Global Health EDCTP3 Training Networks (HORIZON-JU-GH-EDCTP3-2023-01)