PATH has worked collaboratively with countries to improve childhood TB diagnosis and management. In Tanzania, national guidelines, training, and ongoing support helped providers accurately diagnose and treat more children for TB. Screening tools and algorithms were introduced to facilities. In the DRC, an assessment informed a pediatric TB pilot launching in 7 sites, focusing on improving screening, co-management of TB/HIV, and use of cotrimoxazole and ART for children. Lessons highlighted the need for strong national commitment, partnerships, collaborative approaches, and long-term investment to sustainably address childhood TB.

1. A collaborative approach to
improve management of childhood
TB – PATH’s field
experiences
Fozo Alombah (MD)
Global HIV/TB Program
PATH

2. We can find the missing cases
A Collaborative approach to diagnosing TB in
children……..

3. National Average
Tanzania – Implementation Phase
Onset of interventions

4. National
guidelines
and
training
materials
developed
Providers
trained to
recognize
TB in
children
Providers
receive
ongoing
mentorship
and
consultation
on
challenges
More
children
accurately
diagnosed
with TB
More children
treated for TB
and living
healthier lives
How did we do it?
Assessment

5. Steps
• Guidelines training materials & Job
Aids developed
• Training: 49 TOT and 812 HCWs
• Active TB screening introduced
among children in 258 health facilities
• Increased supervision and on-the-job
training
• Screening tool (score chart)
introduced with simple algorithm

6. Tools
• A ten-module, five-day training curriculum.
• A manual for in-country master trainers.
• Easy-to-read posters and job aids that guide health
care providers through the steps of diagnosing TB in
children.
• A screening tool, score chart, and algorithms.
• Registers known as “counter books” in which
providers track screenings and results.

7. Truly collaborative endeavor
• NTLP in collaboration with
PATH & ICAP
• A multidisciplinary
technical expert group
(central level)
– pediatricians, PH
physicians, clinicians,
nurses,
– monitoring and evaluation
officers
– experts from Dartmouth's
Geisel School of Medicine.
• A cadre of 49 master
trainers trained 812
providers from
– pediatric wards
– reproductive and child
health departments
– care and treatment clinics,
and
– TB clinics at the district and
regional hospitals.
• Community health
workers

8. Helen, a clinician from the Kitunda Health Center dispensary started
using the score chart for diagnosis of pulmonary TB after training.
“I might have missed many
children because of lack of
awareness on pediatric TB. If I
had known this scoring chart
before, I would have saved many
lives.”

9. Any impact?
• 8-year-old Aisha Aisha living with
HIV
• 3 months history lethargy and
swelling node
• Helen used score chart to
diagnosed TB lymphadenitis
• started her on anti-TB drugs the
same day
• 3 weeks after put on ARV
• Completed TB treatment
• returned to school and lives a
happy life after

10. Community Health Management Team member,
“Having received this
sensitization, we do follow-up of
all cases reported as pneumonia
or bronchitis to know exactly
whether they are diagnosed
correctly and [clinicians] don’t
miss TB. We do this during our
routine supportive supervisions

11. • A five year Pediatric TB project is planned by NTP in DRC (SP)
• An assessment of 73 facilities was conducted in 2012 to inform the pilot.
Key findings:
Burden
 Children comprised 14.17%
of total TB cases
 Lack of implication of childcare
providers
Screening: N=73
 Screening TB (all): 3%
 Screening TB (cough): 62%
 HIV Screening TB: 48%
Training
 65 (4.2%) of 1554 doctors
trained
 43 (1%) of 4165 nurses trained
Management: N=73
 Co-management TB/HIV : 53%
 Cotrimoxazole: 67%
 ARV: 26%
 IPT: 0%
Democratic Republic of Congo – Pilot Phase

12. Democratic Republic of Congo
Interventions:
• Collaborative framework
• National guidelines and algorithm
• Training curriculum Developed
• One year pilot launched on 7 sites
in December 2013
• Focus on PMTCT, IMCI, HIV care &
support

13. Lessons learned
• A good situational analysis is important to adequately identify the issues
to be addressed
• Lifting childhood TB out of the shadows requires strong national
commitment (central & peripheral)
• A partnership between TB community and research institutions
increases buy-in
• A truly collaborative approach between the health system, key
stakeholders and community creates ownership
• Long-term investment by governments and the entire child health
community is necessary for sustainability

14. Challenges
• Lack of tools in the field to adequately disaggregate and
track child TB cases
• Lack of adequate incentives to retain trained local
expertise
• Organizing systematic contact tracing (cost, geography)
• Lack of appropriate diagnostics and drug formulations
• Emergent drug resistant TB among children

15. Thank You

16. Acknowledgements
Funding for this work came from United States Agency for
International Development (USAID) under USAID’s TB IQC Task Order
01
Special thanks to:
• NTP - Tanzania
• PNLT - DRC
• Dartmouth College - Children's Hospital
• National Pediatrics Society - DRC