Abstract
BackgroundTuberculosis is among the top-10 causes of mortality in children with more than 1 million children suffering from TB disease annually worldwide. The main challenge in young children is the difficulty in establishing an accurate diagnosis of active TB.The INPUT study is a stepped-wedge cluster-randomized intervention study aiming to assess the effectiveness of integrating TB services into child healthcare services on TB diagnosis capacities in children under 5 years of age.MethodsTwo strategies will be compared: i) The standard of care, offering pediatric TB services based on national standard of care; ii) The intervention, with pediatric TB services integrated into child healthcare services: it consists of a package of training, supportive supervision, job aids, and logistical support to the integration of TB screening and diagnosis activities into pediatric services. The design is a cluster-randomized stepped-wedge of 12 study clusters in Cameroon and Kenya. The sites start enrolling participants under standard-of-care and will transition to the intervention at randomly assigned time points. We enroll children aged less than 5 years with a presumptive diagnosis of TB after obtaining caregiver written informed consent. The participants are followed through TB diagnosis and treatment, with clinical information prospectively abstracted from their medical records.The primary outcome is the proportion of TB cases diagnosed among children < 5 years old attending the child healthcare services. Secondary outcomes include: number of children screened for presumptive active TB; diagnosed; initiated on TB treatment; and completing treatment. We will also assess the cost-effectiveness of the intervention, its acceptability among health care providers and users, and fidelity of implementation.DiscussionStudy enrolments started in May 2019, enrolments will be completed in October 2020 and follow up will be completed by June 2021. The study findings will be disseminated to national, regional and international audiences and will inform innovative approaches to integration of TB screening, diagnosis, and treatment initiation into child health care services.Trial resistrationNCT03862261, initial release 12 February 2019.
Highlights
Tuberculosis is among the top-10 causes of mortality in children with more than 1 million children suffering from TB disease annually worldwide
Its use is limited by children’s difficulty to produce sputum. These challenges in case detection and diagnosis are the main reasons why only 39% of estimated pediatric TB cases are notified to national TB programs (NTPs), with the remaining children undiagnosed or unreported [2]
A study in Ethiopia examined intensive screening of children under-5 years old in MNCH clinics and the results demonstrated the feasibility of this approach, though its impact could not be assessed due to the absence of a comparison group [18]
Summary
Tuberculosis is among the top-10 causes of mortality in children with more than 1 million children suffering from TB disease annually worldwide. The main challenge in young children is the difficulty in establishing an accurate diagnosis of active TB. The main challenge in childhood TB is the difficulty in establishing an accurate diagnosis of active TB since symptoms are not specific, children cannot produce sputum, and they mostly develop paucibacillary disease [5, 7]. Its use is limited by children’s difficulty to produce sputum. These challenges in case detection and diagnosis are the main reasons why only 39% of estimated pediatric TB cases are notified to national TB programs (NTPs), with the remaining children undiagnosed or unreported [2]
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