Decentralization of childhood TB diagnosis
at district health system level
Proper TB diagnosis evaluation is rarely implemented for children at district hospital level and primary health care level in high TB-burden settings. More evidence is needed to recommend the best approach to childhood TB diagnosis in district health systems. This operational research implemented in collaboration with the National Tuberculosis Programs (NTPs) will use an innovative diagnostic approach based on Xpert MTB/RIF performed on a combination of easy to collect samples (nasopharyngeal aspirate and stool), standardized symptoms screening and chest radiograph interpretation.
- To assess the impact on childhood TB case detection of decentralizing an innovative childhood TB diagnostic approach
- To compare the efficiency, feasibility and acceptability of two decentralization strategies
Evaluation of an early TB detection strategy in children with severe pneumonia
TB usually presents as a chronic disease in children, with symptoms such as cough lasting for several weeks. Recent studies have shown that it can also present as a pneumonia, a rapidly progressing disease with acute symptoms including cough, fever, and shortness of breath. In children with pneumonia, tuberculosis is poorly recognized or diagnosed late, which contributes probably to increased mortality.
- To assess the impact on 12-week mortality of adding systematic TB detection using Xpert MTB/RIF Ultra on nasopharyngeal aspirates (NPA) and stools to the WHO standard of care for children <5 years with severe pneumonia
HIV & SAM STUDIES
Validation of diagnostic tools and algorithms
in HIV-infected children and severely malnourished children
with presumptive tuberculosis
HIV-infected children and children with severe acute malnutrition are highly vulnerable population with regards to tuberculosis. Immunodepression due to HIV or to malnutrition exposes them to a higher risk of developing tuberculosis disease and higher mortality. In these children, diagnosis of tuberculosis is challenging because they do not present a lot of symptoms, or their symptoms are hard to differentiate form other infections, especially when they are HIV-infected.
- To develop and validate specific algorithms and diagnostic tools in children with HIV and children with SAM. Algorithms are standardized decision rules for diagnosis and treatment initiation.
STOOL PROCESSING STUDY
Specimen processing and collection methods optimization
This output involves microbiological and technological optimization work to identify and test simple and affordable specimen processing and collection methods for childhood TB diagnosis that can be deployed at low health care level in resource-limited countries. Indeed, stool is a very promising sample for diagnosis of TB in children but it requires to be processed before testing with Xpert MTB/RIF assay to remove factors that inhibit the molecular technique. This processing needs to be optimised and simplified to be used at low health care level. Nasopharyngeal aspirates, another promising method for specimen collection in children, requires equipment (aspirator) and device (mucus extractor) that can be expensive and difficult to procure. Therefore more work is needed to ensure secured access of robust and affordable equipment and devices for nasopharyngeal aspirate for limited resource countries.
- To optimize stool specimen processing for Xpert MTB/RIF testing and nasopharyngeal aspiration method for childhood TB diagnosis in resource-limited countries at low health care level.
HEALTH ECONOMIC ANALYSIS
Cost-effectiveness of the proposed diagnostic approaches
Cost effectiveness and budget impact analyses are needed to evaluate the long-term impact of improving pediatric TB diagnostic, guide health authorities’ decisions and support the implementation of TB-speed approach in resource limited settings.
- Evaluate the cost-effectiveness and budget impact of proposed diagnostic approaches
Dissemination, communication and stakeholders’ engagement
This includes communication on the project progresses, advocacy towards the relevant stakeholders, and dissemination of results to support future scaling-up.
- To increase project visibility, involve stakeholders, raise awarenes about paediatric TB, and disseminate project results to ensure policy change