Child Contact Case Management—A Major Policy-Practice Gap in High-Burden Countries

Abstract

The 2021 Global Tuberculosis (TB) report shows slow progress towards closing the pediatric TB detection gap and improving the TB preventive treatment (TPT) coverage among child and adolescent contacts. This review presents the current knowledge around contact case management (CCM) in low-resource settings, with a focus on child contacts, which represents a key priority population for CCM and TPT. Compelling evidence demonstrates that CCM interventions are a key gateway for both TB case finding and identification of those in need of TPT, and their yield and effectiveness should provide a strong rationale for prioritization by national TB programs. A growing body of evidence is now showing that innovative models of care focused on community-based and patient-centered approaches to household contact investigation can help narrow down the CCM implementation gaps that we are currently facing. The availability of shorter and child-friendly TPT regimens for child contacts provide an additional important opportunity to improve TPT acceptability and adherence. Prioritization of TB CCM implementation and adequate resource mobilization by ministries of health, donors and implementing agencies is needed to timely close the gap.

Improving TB detection among children in routine clinical care through intensified case finding in facility-based child health entry points and decentralized management: A before-and-after study in Nine Sub-Saharan African Countries

“…HCI is also a key component of paediatric TB case finding interventions. HCI contributed to 10% of the total number of children diagnosed through the project and was characterised by a high NNS, supporting prioritisation of implementation and scale-up of this intervention [ 41 , 42 ].…”

Integration of HIV Testing in a Community Intervention for Tuberculosis Screening Among Household Contacts of Patients with Tuberculosis in Cameroon and Uganda

“… 12 , 13 So far, national TB programs have focused their TPT strategies primarily on household contacts younger than 5 years, by asking TB index cases to bring their young child contacts to facility for TB screening and TPT eligibility assessment. 14 However, with this strategy, older children and adult contacts potentially infected with TB or HIV may not be reached. Community-based approaches for the identification and management of household TB contacts provide an ideal opportunity to identify TB-exposed HIV-infected people who otherwise would not have received TPT, making earlier linkage to care possible.…”

Community-based tuberculosis contact management: Caregiver experience and factors promoting adherence to preventive therapy

“…Despite these advances in drug technology, reductions in treatment duration, and symptom based eligibility criteria, numerous well-recognized barriers to child contact management persist, including poor access to care, inadequate health infrastructure, limited knowledge coupled with unfavorable attitudes and misperceptions in patients and health care workers, and stigma [12]. Community-based contact management addresses many of these structural barriers [18], and has been found to be feasible and acceptable to patients and health care workers [19]. Increasingly, the WHO emphasizes the need for decentralized models of care [20] informed by emerging data suggesting that community-based preventive services can dramatically increase uptake [21].…”