Tuberculosis care models for children and adolescents: a scoping review

Abstract

Objective To map which tuberculosis care models are best suited for children and adolescents. Methods We conducted a scoping review to assess the impact of decentralized, integrated and family-centred care on child and adolescent tuberculosis-related outcomes, describe approaches for these care models and identify key knowledge gaps. We searched seven literature databases on 5 February 2021 (updated 16 February 2022), searched the references of 18 published reviews and requested data from ongoing studies. We included studies from countries with a high tuberculosis burden that used a care model of interest and reported tuberculosis diagnostic, treatment or prevention outcomes for an age group < 20 years old. Findings We identified 28 studies with a comparator group for the impact assessment and added 19 non-comparative studies to a qualitative analysis of care delivery approaches. Approaches included strengthening capacity in primary-level facilities, providing services in communities, screening for tuberculosis in other health services, co-locating tuberculosis and human immunodeficiency virus treatment, offering a choice of treatment location and providing social or economic support. Strengthening both decentralized diagnostic services and community linkages led to one-to-sevenfold increases in case detection across nine studies and improved prevention outcomes. We identified only five comparative studies on integrated or family-centred care, but 11 non-comparative studies reported successful treatment outcomes for at least 71% of children and adolescents. Conclusion Strengthening decentralized services in facilities and communities can improve tuberculosis outcomes for children and adolescents. Further research is needed to identify optimal integrated and family-centred care approaches.

Under-Reporting of Tuberculosis Disease among Children and Adolescents in Low and Middle-Income Countries: A Systematic Review

“…In addition, there are gaps between the number of bacteriologically confirmed TB cases from laboratories and notifications in the TB treatment register [ 15 , 36 ]. Various components of these systems such as decentralized services can be strengthened to improve TB outcomes [ 37 , 38 ]. Hospital length of stay is one health system factor that can be considered within the system of care delivery.…”

Clinical standards for drug-susceptible TB in children and adolescents

“…Decentralised models of care for detection and treatment are supported by the recent WHO recommendations, and these models have demonstrated improved treatment outcomes, in addition to increased case detection and uptake of TPT. 10 , 57 Home-based or community-based support for treatment of disease and infection that is coordinated with the facility-based clinic staff is much preferred over hospital/facility-based treatment support. Weight monitoring is important for following up treatment response and to make dose adjustments, especially in young children.…”

“…Decentralisation of child TB services is recommended and will facilitate access to and integration of care. 10 , 57 Diagnosis and treatment at healthcare facilities should be accessible (e.g., free access to TB medications vs. fee-for-medications, no medication stock outs). Using developmentally appropriate terminology, adequate education and counselling must be provided to children, adolescents and their caregivers at the time of diagnosis and with each follow-up visit.…”

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

“…Integrated and decentralised service delivery approaches could play a key role in identifying missing paediatric TB cases [17][18][19]. The role of such interventions is emphasised in the latest World Health Organization (WHO) guidelines on management of TB in children and adolescents [20], but programmatic implementation has been slow, with many countries experiencing operational challenges [21,22].…”