Tuberculosis (TB) remains a leading cause of morbidity and mortality worldwide. Considering the World Health Organization recommendation to implement child contact management (CCM) for TB, we conducted a mixed-methods systematic review to summarize CCM implementation, challenges, predictors, and recommendations. We searched the electronic databases of PubMed/MEDLINE, Scopus, and Web of Science for studies published between 1996–2017 that reported CCM data from high TB-burden countries. Protocol details for this systematic review were registered on PROSPERO: International prospective register of systematic reviews (#CRD42016038105). We formulated a search strategy to identify all available studies, published in English that specifically targeted a) population: child contacts (<15 years) exposed to TB in the household from programmatic settings in high burden countries (HBCs), b) interventions: CCM strategies implemented within the CCM cascade, c) comparisons: CCM strategies studied and compared in HBCs, and d) outcomes: monitoring and evaluation of CCM outcomes reported in the literature for each CCM cascade step. We included any quantitative, qualitative, mixed-methods study design except for randomized-controlled trials, editorials or commentaries. Thirty-seven studies were reviewed. Child contact losses varied greatly for screening, isoniazid preventive therapy initiation, and completion. CCM challenges included: infrastructure, knowledge, attitudes, stigma, access, competing priorities, and treatment. CCM recommendations included: health system strengthening, health education, and improved preventive therapy. Identified predictors included: index case and clinic characteristics, perceptions of barriers and risk, costs, and treatment characteristics. CCM lacks standardization resulting in common challenges and losses throughout the CCM cascade. Prioritization of a CCM-friendly healthcare environment with improved CCM processes and tools; health education; and active, evidence-based strategies can decrease barriers. A focused approach toward every aspect of the CCM cascade will likely diminish losses throughout the CCM cascade and ultimately decrease TB related morbidity and mortality in children.

underdiagnosis of active TB disease during the antenatal and postnatal periods. HIV and TB co-infection during pregnancy have a multiplier effect on maternal morbidity and mortality, and result in poorer pregnancy outcomes. 1,11 In Pune, India, TB increased the probability of death by 2.2-fold among HIV-infected women who developed TB and by 3.4-fold for their infants compared to women who did not develop TB. 11 In Johannesburg, South Africa, 70% of obstetric deaths in HIV-infected women were mainly attributed to TB. 12 These fi gures suggest that routine screening of pregnant women for TB in endemic settings would be helpful, particularly those who are HIV-infected.The World Health Organization (WHO) recommends ruling out active TB and identifying those in need of further testing among HIV-infected adults using specifi c symptoms (current cough of any duration, fever, weight loss or night sweats). 13 Although these recommendations were not specifi c for pregnancy, Gupta et al. used this recommendation and found a 1.4% (11/799) prevalence of active TB among HIVi nfected pregnant women who were part of a clinical trial in India. 14 Another study of cough of >2 weeks, performed in Kenya by the same clinical team and by the same fi rst author in a routine setting similar to the target population for this study, failed to identify those with TB disease (n = 187). 15 The current study differs from the earlier one in its larger sample size and because it compares HIV-infected and non-infected pregnant women.Data on the utilization of symptom screening among pregnant women in routine settings are scarce. This has been attributed to signifi cant fi nancial and logistical challenges in the implementation of screening in this group of patients. 1 The objectives of the present study were 1) to explore the utility of TB symptom screening using symptoms of ⩾2 weeks' duration in a routine setting, and 2) to compare differences in diagnosis of TB among HIV-infected and non-infected pregnant women in western Kenya. METHODS Study designThis was a descriptive cohort study among HIV-infected and non-infected pregnant women. R eduction of tuberculosis (TB) transmission, morbidity and mortality relies largely on intensifi ed case fi nding, with consequent early initiation of adequate treatment. 1,2 This is particularly important among pregnant women in resource-limited settings where TB is a cause of non-obstetrical (indirect) maternal deaths. 3,4 This burden is higher in settings with a high prevalence of human immunodefi ciency virus (HIV) infection. 5,6 Kenya has an adult HIV prevalence of 6.2%, 7 with an unacceptably high maternal mortality ratio of 488 per 100 000 live births; 25% of these deaths are attributed to indirect causes such as TB, anaemia, HIV and malaria. 8 TB case notifi cation data are not stratifi ed for pregnancy, but women of reproductive age bear a higher burden of TB in sub-Saharan Africa than their male counterparts. 1,9 Data from Western Cape, South Africa, indicate that there is a 24.2-fold higher incidenc...

Background Untreated latent tuberculosis infection (LTBI) is a major source of active tuberculosis disease in the United States. In 2016, the United States Preventive Services Task Force (USPSTF) recommended that screening for latent tuberculosis infection among individuals at increased risk be performed as routine preventive care. Traditionally, LTBI management–including both testing and treatment–has been conducted by specialists in the United States. It is believed that knowledge gaps among primary care team members and discomfort with LTBI treatment are significant barriers to LTBI management being conducted in primary care. Methods and objectives This qualitative study sought to evaluate the knowledge, attitudes, and skills of primary care team members regarding the LTBI care cascade, and to identify each stepwise barrier limiting primary care teams in following the USPSTF recommendations. Results We conducted 24 key informant interviews with primary care providers and nurses in Rhode Island. Our results demonstrate that overall, few primary care providers and nurses felt comfortable with LTBI management, and their confidence and comfort decreased throughout the cascade. Participants felt least confident with LTBI treatment and held misconceptions about LTBI testing, such as high cost. Although participants were not confident about LTBI treatment, most were enthusiastic about treating patients if provided additional training. Participants suggested that their lack of knowledge regarding LTBI treatment led to high rates of referral to specialist providers. Conclusion The gaps revealed in this study can inform training curricula for primary care team members in Rhode Island and nationally to shift the USPSTF policy into practice, and, ultimately, contribute to TB elimination in the United States.