Abstract
In high TB/HIV settings, the increased risk for TB amongst children exposed to HIV has been established through biomedical tests. Screening HIV exposed children for TB can improve early childhood TB detection and treatment. This study assessed the utility of a modified World Health Organization (WHO) tool by including HIV variables, to determine TB exposure amongst HIV exposed children presenting to a "Well Child" Clinic (CWC). Clinical data were obtained from medical records and/or from the caregivers of children presenting to CWC. Data was analyzed to explore factors associated with positive screening for TB, including being exposed to HIV and current HIV status. Five percent (55/1100) screened reported a close TB contact and 21% (n=231) had positive TB symptom screen. History of close TB contact was a risk factor for positive screening for TB symptoms (OR 1.89 CI 1.05-3.4) while being HIV negative was protective (OR 0.3, Cl 0.19-0.62). HIV exposure was associated with increased risk of TB exposure (OR 2.9 CI 1.61-5.19). Integrating HIV variables in the existing WHO screening tool for childhood TB can be useful in early detection and treatment of TB in HIV exposed children in resource limited settings.
Highlights
Community studies in the region, have shown a strong association between household exposure to an adult TB case and infection amongst young children.11-15. This risk is even higher in HIV exposed but HIV uninfected children (HEU) and HIV infected children who may be in close contact with a sputum negative or sputum positive caregiver. 16-18 HIV exposed uninfected (HEU) children have a higher risk for TB infection compared to children born to HIV uninfected mothers due to increased exposure to active TB and immunological factors affecting BCG vaccine response and increasing susceptibility to TB infection
Definition A person with TB, living in the same compound or household with the child in the past 6 months A child born to a HIV positive mother, as recorded in the under-5 card A child born to an HIV negative mother, as recorded in the under-5 card Screening positive for TB symptoms as per World Health Organization (WHO) guidelines, as having any of the following symptoms; cough of any duration, fever, fatigue, failure to thrive or enlarged lymph nodes Having a close household TB contact
Being HIV negative was associated with being less likely to screen for TB symptoms. This cross-sectional survey revealed that there is a 5% prevalence of TB exposure in the children presenting to this urban Children present to the “well clinic” (CWC) in a high burden TB/HIV are in Gaborone, during the study period
Summary
Introduction the World HealthOrganization (WHO) estimated 1Childhood Tuberculosis (TB) is considered a silent ep- million new childhood TB cases, out of the reported idemic since cases are often missed or underreported 10 million TB cases. In sub-Saharan Africa, the burdue to their unique presentations with atypical symp- den of TB is further fueled by Human Immunodefitoms leading to diagnostic difficulties and the challeng- ciency Virus (HIV), with 70% of all people living with es of bacteriological confirmation. Globally in 2017, HIV/TB co-infection worldwide. Though there has African Health SciencesAfrican Health Sciences Vol 21, May, 2021During the same period, PMTCT program was scaledup and the country saw a decline in mother to child transmission rate from 42% in 2008 to 2.54% in 2018.810 Even though Botswana is considered a high burden TB country, case reporting of childhood TB cases remains relatively low, with only 6% of annual TB notifications being children aged 0-14 years. This discrepancy between the high TB rates and low childhood TB cases, suggests that there may be underreporting of the burden of childhood TB cases nationally. PMTCT program was scaledup and the country saw a decline in mother to child transmission rate from 42% in 2008 to 2.54% in 2018.810 Even though Botswana is considered a high burden TB country, case reporting of childhood TB cases remains relatively low, with only 6% of annual TB notifications being children aged 0-14 years.. Community studies in the region, have shown a strong association between household exposure to an adult TB case and infection amongst young children.11-15 This risk is even higher in HIV exposed but HIV uninfected children (HEU) and HIV infected children who may be in close contact with a sputum negative or sputum positive caregiver. Objective: This study assessed the utility of a modified World Health Organization (WHO) tool by including HIV variables, to determine TB exposure amongst HIV exposed children presenting to a “Well Child” Clinic (CWC). Afri Health Sci. 2021;21: 64-71. https://dx.doi.org/10.4314/ ahs.v21i1.11S
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