TB Services Research Articles

Challenges in recruiting children to a multidrug-resistant TB prevention trial.

BACKGROUND: Recruitment to randomised clinical trials can be challenging and slow recruitment has serious consequences. This study aimed to summarise and reflect on the challenges in enrolling young children to a multidrug-resistant TB (MDR-TB) prevention trial in South Africa.METHODS: Recruitment to the Tuberculosis Child Multidrug-resistant Preventive Therapy Trial (TB-CHAMP) was tracked using an electronic recruiting platform, which was used to generate a recruiting flow diagram. Structured personnel questionnaires, meeting minutes and workshop notes were thematically analysed to elucidate barriers and solutions.RESULT: Of 3,682 (85.3%) adult rifampicin (RIF) resistant index cases with pre-screening outcomes, 1597 (43.4%) reported having no children under 5 years in the household and 562 (15.3%) were RIF-monoresistant. More than nine index cases were pre-screened for each child enrolled. Numerous barriers to recruitment were identified. Thorough recruitment planning, customised tracking data systems, a dedicated recruiting team with strong leadership, adequate resources to recruit across large geographic areas, and excellent relationships with routine TB services emerged as key factors to ensure successful recruitment.CONCLUSION: Recruitment of children into MDR-TB prevention trials can be difficult. Several MDR-TB prevention trials are underway, and lessons learnt from TB-CHAMP will be relevant to these and other TB prevention studies.

Adolescents in a tuberculosis hospital: Qualitative study of how relationships with doctors, caregivers, and peers mediate their mental wellbeing.

Lengthy hospitalization can impact adolescents’ mental wellbeing in a number of negative ways. Scholarship has indicated that a young patient’s relationships play an important role in reducing the amount of stress felt and in improving emotional state. In this article we turn to the experiences of adolescents with tuberculosis [TB] in Russia to explore how exactly hospitalization together with the TB diagnosis itself impact their mental wellbeing and how relationships with others mediate these impacts. We conducted a qualitative, interview-based study in Tomsk pediatric TB clinic. Interviews were conducted with three groups relevant for reaching the aim of this research: adolescent patients, their adult caregivers, and their treating physicians [17 informants in total]. Interview data were complemented with prolonged observations in the same clinic. The results of our study highlight that threats to mental wellbeing of adolescents with TB are multiple. Adolescents who are about to enter the in-patient treatment feel apprehensive and anxious about their future. They tend to have a hard time accepting their diagnosis, which they often feel is something shameful, and, consequently, may develop a negative attitude towards themselves. Most importantly, many undergo painful loss of personal relationships and expect or actually experience rejection by peers because of having tuberculosis. However, relationships with physicians, caregivers, and other patients in the clinic mediate negative impacts of TB diagnosis and hospitalization on adolescents’ mental wellbeing and can open ways for providing support. Supportive practices include physicians leaving it up to adolescents to decide what they want to discuss and when, caregivers remaining available for contact and keeping regular communication, and other adolescents with TB proactively seeking contact with the newcomers and behaving in a non-judgmental way. These results can inform design of adolescent-friendly TB services.

Experiences with latent TB cascade of care strengthening for household contacts in Calgary, Canada.

Identification, assessment, and treatment of latent TB infection (LTBI), collectively known as the LTBI cascade of care, is critical for TB prevention. The objective of this research, conducted within the ACT4 trial, was to assess and strengthen the LTBI cascade of care for household contacts at Calgary TB Services, a clinic serving a predominately foreign-born population in Western Canada. Baseline assessment consisted of a retrospective LTBI cascade analysis of 32 contact investigations, and questionnaires administered to patients and health care workers. Four solutions were implemented in response to identified gaps. Solution impact was measured for 6 months using descriptive statistics. Pre-implementation, 56% of household contacts initiated treatment. Most contacts were lost to care because the tuberculin skin test (TST) was not initiated, or physicians did not recommend treatment. Evening clinics, a patient education pamphlet, a nursing workshop, and treatment recommendation guidelines were implemented. Post-implementation, losses due to LTBI treatment non-recommendation were reduced; however, the overall proportion of household contacts initiating treatment did not increase. Close engagement between researchers and TB programmes can reduce losses in the LTBI cascade. To see sustained improvement in overall outcomes, long-term engagement and data collection for ongoing problem-solving are required.

Assessing the capacity of primary health care centres to provide tuberculosis services in Kaduna State, North-Western Nigeria

Background: Despite earlier successes achieved in combating it, cases of tuberculosis in Nigeria are now on the increase, affecting more people and communities. Primary health care in Nigeria is through ward health system, designed to provide minimum health package to the communities including TB services. This study aimed to ascertain the capacity of PHC centres to provide TB services in Kaduna North senatorial district, Kaduna State, Nigeria.Methods: Four out of eight local Government areas in the district were randomly selected and one PHC per ward was recruited in the study. In each facility, questionnaires developed from the TB tracer items of the WHO service availability and readiness assessment tool were administered to the facility in-charges and TB/DOTS focal persons.Results: Forty four facilities were selected from Zaria, Sabon Gari, Makarfi and Kudan LGAs. Almost all facilities (98%) diagnosed TB clinically and 39 (90%) had anti-TB drugs available. National TB guidelines were lacking in 23 (52%) facilities and only 5 (11%) had additional capacity for sputum microscopy. While 35 (80%) TB/DOTS focal persons had received training on TB diagnosis and treatment, only 24 (55%)received training on TB/HIV co-infection and only 8 (18%) received training on multi-drug resistant TB.Conclusions: While TB services are widely available in the district, urgent need exists for all stakeholders to work together towards equipping those facilities with critical infrastructure that will improve their overall capacity, particularly with regards to comprehensive TB guidelines, laboratory diagnosis and personnel training for effective TB management.

Impact of COVID 19 Pandemic on TB Control Programme in Nepal: An Overview

COVID19 pandemic is affecting worldwide. TB and COVID-19 both are infectious and primarily affect the lungs and show similar symptoms thus, it is essential to diagnose cases. Accurate diagnostic tests are essential for both TB and COVID-19. COVID 19 has reversed minimum five years of progress in fighting TB. The study is based on review of all available reports, literature, published studies in peer reviewed journal related to COVID-19 pandemic impact on TB control program in Nepal. PubMed, Google scholar, HINARI are the major search engines and or databases used for the review.COVID-19 led lockdown had a significant impact on TB services in Nepal. There is decline in the identification of new cases and had impacted on sputum courier, enrolment, diagnosis and follow up. People cantered delivery of TB prevention, diagnosis, treatment and care services should be ensured in tandem with the COVID-19 response. Health authorities should maintain support to essential TB services during emergencies.

Effects of COVID-19 on national tuberculosis elimination programme strategies during March to May 2020 on Tumkur district, India

Background: the nation-wide lockdown due global pandemic has disrupted a vital strategic intervention resulting in overall 60% decrease in presumptive and diagnostic TB cases during the lockdown period.Methods: A discrete choice experimental (DCE) exploratory operational research conducted during March to May 2020.Results: Health care services were affected 25% reduction in the outpatient department (OPD) in comparison to the previous year the same period. A gradual reduction in negative sputum cases undergoing chest radiography from 54% to 14%. Due to restricted movement LPA tests have been reduced 25% among the diagnosed TB cases, and private referrals to cartridge based nucleic acid amplification test (CBNAAT) services were reduced to 20%.Conclusions: Health services, including national programmes to combat TB, need to be actively engaged in ensuring an effective and rapid response to COVID-19 while ensuring that TB services are maintained. While experience on COVID-19 infection in TB patients remains limited, it is anticipated that people ill with both TB and COVID-19 may have poorer treatment outcomes, especially if TB treatment is interrupted. TB patients should take precautions as advised by health authorities to be protected from COVID-19 and continue their TB treatment as prescribed.

Innovative approaches to end TB in Pakistan: a review of TB REACH projects from 2010 to 2020

Background: TB REACH is a grant-making initiative launched by the Stop TB Partnership in January 2010 to support innovative approaches and technologies to find and treat people with active TB disease, drug-resistant TB, or TB infection. Since then, TB REACH has launched eight Waves of funding to pilot untested, but promising technologies, tools, and approaches. The objective of this paper was to review the grants implemented in Pakistan in the decade since TB REACH’s inception and to summarize the approaches used, document the results, and assess the impact of these projects on local and international policy. Methods: We searched the TB REACH’s Grant Management System (GMS), which is a database for information on all grants awarded through the initiative, for recipient organisations in Pakistan from 2010 until June 2020. Data was abstracted for the following topic areas: type of grant, focus of work, case finding strategies, risk groups screened and impact on case finding. Results: Through eight waves of funding, TB REACH has supported 28 grants for 21 different interventions in Pakistan worth a total of USD 13.4 million. Overall, 19 of these projects aimed to improve detection, linkage to treatment and reporting of TB and two were product innovation grants for developing resources and materials to aide TB service delivery. Conclusion: TB REACH support has facilitated the introduction of new technologies, establishment of innovative processes in both public and private sector and approaches for addressing TB in key populations. The TB response in Pakistan and globally will continue to require innovation and disruption of ‘business as usual' approaches if we are to End TB.

Feasibility and impact of near-point-of-care integrated tuberculosis/HIV testing in Malawi and Zimbabwe

Near-point-of-care (POC) testing for early infant diagnosis (EID) and viral load expedites clinical action and improves outcomes but requires capital investment. We assessed whether excess capacity on existing near-POC devices used for TB diagnosis could be leveraged to increase near-POC HIV molecular testing, termed integrated testing, without compromising TB services. Preimplementation/postimplementation studies in 10 health facilities in Malawi and 8 in Zimbabwe. Timeliness of EID and viral load test results and clinical action were compared between centralized and near-POC testing using Somers' D tests (continuous indicators) and risk ratios (RR, binary indicators); TB testing/treatment rates and timeliness were analyzed preintegration/postintegration. With integration, average device utilization increased but did not exceed 55%. Despite the addition of HIV testing, TB test volumes, timeliness, and treatment initiations were maintained. Although few HIV-positive infants were identified, near-POC EID testing improved treatment initiation within 1 month by 57% compared with centralized EID [Malawi RR: 1.57, 95% confidence interval (CI) 0.98-2.52], and near-POC viral load testing significantly increased the proportion of patients with elevated viral load receiving clinical action within 1 month (Zimbabwe RR: 5.26, 95% CI 3.38-8.20; Malawi RR: 3.90, 95% CI 2.58-5.91). Integrating TB/HIV testing using existing multidisease platforms is feasible and enables increased access to rapid diagnostics without disrupting existing TB services. Our results serve as an example of a novel, efficient implementation model that can increase access to critical testing services across disease silos and should be considered for additional clinical applications.

Community health workers augment the cascade of TB detection to care in urban slums of two metro cities in India.

BackgroundTuberculosis Health Action Learning Initiative (THALI) funded by USAID is a person-centered initiative, supporting vulnerable urban populations to gain access to TB services. THALI trained and placed 112 Community health workers (CHWs) to detect and support individuals with TB symptoms or disease within urban slums in two cities, Hyderabad and Bengaluru, covering a population of about 3 million.MethodsCHWs visited the slums once in a fortnight. They conducted TB awareness activities. They referred individuals with TB symptoms for sputum testing to nearest public sector laboratories. They visited those testing TB positive, once a fortnight in the intensive phase, and once a month thereafter. They supported TB patients and families with counselling, contact screening and social scheme linkages. They complemented the shortfall in urban TB government field staff numbers and their capacity to engage with TB patients. Data on CHWs’ patient referral for TB diagnosis and treatment support activities was entered into a database and analyzed to examine CHWs’ role in the cascade of TB care. We compared achievements of six monthly referral cohorts from September 2016 to February 2019.ResultsOverall, 31 617 (approximately 1%) of slum population were identified as TB symptomatic and referred for diagnosis. Among the referred persons, 23 976 (76%) underwent testing of which 3841 (16%) were TB positive. Overall, 3812 (99%) were initiated on treatment and 2760 (72%) agreed for regular follow up by the CHWs. Fifty-seven percent of 2952 referred were tested in the first cohort, against 86% of 8315 in the last cohort. The annualized case detection rate through CHW referrals in Bengaluru increased from 5.5 to 52.0 per 100 000 during the period, while in Hyderabad it was 35.4 initially and increased up to 118.9 per 100 000 persons. The treatment success rate was 87.1% among 193 in the first cohort vs 91.3% among 677 in the last cohort.ConclusionsCHWs in urban slums augment TB detection to care cascade. Their performance and TB treatment outcomes improve over time. It would be important to examine the cost per TB case detected and successfully treated.

Lessons from two SARS-CoV-2 waves in South Africa

Lessons from two SARS-CoV-2 waves in South Africa

One size does not fit all: reaching agricultural workers in South Africa with TB services

BACKGROUND: Despite decreasing incidence of TB in South Africa, people with TB continue to be missed by facility-based case-finding interventions, and agricultural workers suffer disproportionately from limited access to services. We implemented two community-based active case-finding strategies to engage agricultural workers and assessed the cost of these interventions.METHODS: We summarized costs for two interventions - one led by enrolled nurses and one by non-governmental organizations (NGOs) - from April 2017 to December 2019, and calculated cost per person reached by services, screened for TB, identified as having TB and started on TB treatment. We performed Mann-Kendall tests of monotonic trend and conducted a sensitivity analysis of intervention costs.RESULTS: The enrolled nurses-led implementation started 442 people on TB treatment at a cost of US$118 per person, with decreasing trend in costs over the implementation period (P = 0.005). The NGO-led intervention started 160 people on treatment at a cost of US$554 per person, with decreasing trend in costs over the implementation period (P = 0.004).CONCLUSION: Community-based case-finding strategies find TB patients who would be missed by the health system. These strategies should be scaled up to close the missing cases gap in South Africa and to meet UN targets for ending TB.

INFLUENCE OF PATIENT-RELATED FACTORS ASSOCIATED ON TB OUTCOMES AMONG TB PATIENTS IN MOMBASA COUNTY

Purpose: The purpose of the study was to determine patient-related factors associated with TB outcomes among TB patients in Mombasa County.
 Methodology: Study was conducted in Mombasa County which is one of the 47 counties in Kenya with an urban population of 1,063,854. The study used a cross-sectional research design. The study population was the total number of notified patients with tuberculosis in one quarter in the study area (Mombasa’s health care units) and this was found to be 1207 in the year 2017. It was from this population that a systematic random sample size of 292 patients were interviewed. Quantitative data were analyzed using SPSS version 20 Descriptive statistics frequency (%), mean, and standard deviation were used to express quantitative data. In bivariate analyses, odds ratios (OR) and 95% confidence intervals (CI) for the association between TB treatment outcome and health related factors, institutional factors and patient related factors was done using logistic regression.
 Results: The results revealed that patients who are educated about health are more likely to cure of TB than patients who are not (OR 1.716, 95% CI, 0.35 to 1.48). More so, patients who receive psychosocial support are more likely to get cured than those who don’t receive psychosocial support (OR 4.08, 95% CI, 2.00 to 8.32). The results of the study give evidence to, therefore, conclude patient related factors are critical to TB treatment outcome. 
 Unique contribution to theory, policy and practice: Strengthening TB adherence counselling for patients treated for the first time to improve treatment completion. Counselling service should also be enhanced for patients taking alcohol and those smoking cigarettes as both are associated with less likelihood of completing TB treatment. Implementation of TB work place program through sensitization of company managers on the importance of TB treatment support to reduce chances of loss to follow as sighted by focused group discussions. Patients centred TB services should be provided by all facilities by focusing on the needs of the patients by agreeing on the best time to pick drugs to reduce the risk of loss to follow ups.

THE QUALITY OF TUBERCULOSIS SERVICES IN PATIENTS’ PERSPECTIVES: A LITERATURE REVIEW

Background: The assessment from the patient's perspective is the assurance of TB service’ quality to achieve the "End TB" target. The information regarding TB services’ quality assessment in the dimensions of QUOTE TB Light is not widely found.Aims: The study aims to review TB services' quality from the patients’ perspective in the 7 dimensions of QUOTE TB Light.Methods: This literature review study searched from 3 databases, namely PubMed, Science-Direct, and Google Scholar since July - October 2020. The inclusion criteria were research on TB services quality, patients’ perspective, and patient assessment of 7 dimenssion. Articles assessed the other health services’ quality and published before January 2015 was excluded.Results: A total of 7 from 89 articles found were selected for review. The patients’ assessments are based on their experiences or satisfactions. Most of the studies are satisfied with service availability, communication, patient-provider interactions, competence, and affordability. The patients’ dissatisfactions about infrastructure and stigma acquired during treatment.Conclusion: Infrastructure and stigma are assessed negatively. The continously evaluation and training for health workers need to be improved so they can serve patients well. The patients’ perspectives can be the major consideration for providers to enhance the TB services’ quality.Keywords: Quality of TB services, QUOTE TB Light, patients’ perspectives, Tuberculosis

Operational Research to Assess the Real-Time Impact of COVID-19 on TB and HIV Services: The Experience and Response from Health Facilities in Harare, Zimbabwe.

When COVID-19 was declared a pandemic, there was concern that TB and HIV services in Zimbabwe would be severely affected. We set up real-time monthly surveillance of TB and HIV activities in 10 health facilities in Harare to capture trends in TB case detection, TB treatment outcomes and HIV testing and use these data to facilitate corrective action. Aggregate data were collected monthly during the COVID-19 period (March 2020–February 2021) using EpiCollect5 and compared with monthly data extracted for the pre-COVID-19 period (March 2019–February 2020). Monthly reports were sent to program directors. During the COVID-19 period, there was a decrease in persons with presumptive pulmonary TB (40.6%), in patients registered for TB treatment (33.7%) and in individuals tested for HIV (62.8%). The HIV testing decline improved in the second 6 months of the COVID-19 period. However, TB case finding deteriorated further, associated with expiry of diagnostic reagents. During the COVID-19 period, TB treatment success decreased from 80.9 to 69.3%, and referral of HIV-positive persons to antiretroviral therapy decreased from 95.7 to 91.7%. Declining trends in TB and HIV case detection and TB treatment outcomes were not fully redressed despite real-time monthly surveillance. More support is needed to transform this useful information into action.

Medication Compliance for Tuberculosis Patients with Quote TB Light at Public Health Center in 2020

Tuberculosis is a chronic disease that requires prolonged medication and slow recovery, hence the problem that often occurs is the patients’ medication compliance. This study is aimed to identify the Description of the Medication Compliance for Tuberculosis Patients with Quote TB Light in Public Health Center. The method of this study was quantitative descriptive using cross sectional design with 92 patients from February to March 2020. The results showed that 51% of tuberculosis patients had complied with the medication. Based on the dimensions of Quote TB Light, the majority of patients have a good perception regarding: TB services (93.65%); the information received is appropriate (100%); health workers when providing consultations (100%); the availability of infrastructures (66%); the service provided by health workers is appropriate (74.5%); the affordability of TB medication is good (100%); and the attitude of health workers (100%). The conclusion is that the description of the medication compliance of tuberculosis patients based on Quote TB Light is good, but it is necessary to improve the quality of services on health workers’ capability and competence, to make improvements and consistent interventions in waiting time, and to pay attention to the infrastructure in order to provide the comfort for patients.

Impact of COVID-19 Pandemic on Pre-Treatment Delays, Detection, and Clinical Characteristics of Tuberculosis Patients in Ningxia Hui Autonomous Region, China.

Background: To contain the pandemic of COVID-19, China has implemented a series of public health interventions that impacted the tuberculosis control substantially, but these impacts may vary greatly depending on the severity of the local COVID-19 epidemic. The impact of COVID-19 on TB control in Ningxia Hui Autonomous Region is little known.Methods: Based on the national TB Information Management System (TBIMS), this study accessed the actual impact of COVID-19 on TB by comparing TB notifications, pre-treatment delays, and clinical characteristics of TB cases between 2020 COVID-19 period and 2017–2019 baseline. The data were divided into three periods based on the response started to fight against COVID-19 in Ningxia Hui Autonomous Region, including the control period (10 weeks before the pandemic), intensive period (10 weeks during the Ningxia Hui Autonomous Region lockdown), and regular (10 additional weeks after Ningxia Hui Autonomous Region reopen).Results: TB notification dropped sharply in the first week of the intensive period but took significantly longer to return to the previous level in 2020 compared with the 2017–2019 baseline. Totally, the TB notification rates decreased by more than 60% in the intensive period of COVID-19 compared with the average level of 2017–2019. The sputum smear-positive rate of TB patients diagnosed in intensive period of COVID-19 was significantly higher than that in the corresponding periods of 2017–2019 (P < 0.001). The rate of cavity on X-ray inspection of TB cases diagnosed in the intensive period of COVID-19 was significantly higher than that in period 2 of 2017–2019 (23.5 vs. 15.4%, P = 0.004). The patients' delay in the intensive period was significantly longer than that before the pandemic (P = 0.047).Conclusions: The TB notification in Ningxia was impacted dramatically by the pandemic of COVID-19. To compensate for the large numbers of missed diagnosis as well as delayed diagnosis during the intensive period of COVID-19, an urgent restoration of normal TB services, and further emphasis on enhanced active case finding and scale-up of household contact tracing and screening for TB-related symptoms or manifestation, will be essential.

Assessing the Impact of COVID-19 on TB and HIV Programme Services in Selected Health Facilities in Lilongwe, Malawi: Operational Research in Real Time.

When the COVID-19 pandemic was announced in March 2020, there was concern that TB and HIV programme services in Malawi would be severely affected. We set up real-time monthly surveillance of TB and HIV activities in eight health facilities in Lilongwe to see if it was possible to counteract the anticipated negative impact on TB case detection and treatment and HIV testing. Aggregate data were collected monthly during the COVID-19 period (March 2020–February 2021) using an EpiCollect5 application and compared with monthly data collected during the pre-COVID-19 period (March 2019–February 2020); these reports were sent monthly to programme directors. During COVID-19, there was an overall decrease in persons presenting with presumptive pulmonary TB (45.6%), in patients registered for TB treatment (19.1%), and in individuals tested for HIV (39.0%). For presumptive TB, children and females were more affected, but for HIV testing, adults and males were more affected. During COVID-19, the TB treatment success rate (96.1% in pre-COVID-19 and 96.0% during COVID-19 period) and referral of HIV-positive persons to antiretroviral therapy (100% in pre-COVID-19 and 98.6% during COVID-19 period) remained high and largely unchanged. Declining trends in TB and HIV case detection were not redressed despite real-time monthly surveillance.

Assessing the Real-Time Impact of COVID-19 on TB and HIV Services: The Experience and Response from Selected Health Facilities in Nairobi, Kenya.

There was concern that the COVID-19 pandemic would adversely affect TB and HIV programme services in Kenya. We set up real-time monthly surveillance of TB and HIV activities in 18 health facilities in Nairobi so that interventions could be implemented to counteract anticipated declining trends. Aggregate data were collected and reported monthly to programme heads during the COVID-19 period (March 2020–February 2021) using EpiCollect5 and compared with monthly data collected during the pre-COVID period (March 2019–February 2020). During the COVID-19 period, there was an overall decrease in people with presumptive pulmonary TB (31.2%), diagnosed and registered with TB (28.0%) and in those tested for HIV (50.5%). Interventions to improve TB case detection and HIV testing were implemented from August 2020 and were associated with improvements in all parameters during the second six months of the COVID-19 period. During the COVID-19 period, there were small increases in TB treatment success (65.0% to 67.0%) and referral of HIV-positive persons to antiretroviral therapy (91.2% to 92.9%): this was more apparent in the second six months after interventions were implemented. Programmatic interventions were associated with improved case detection and treatment outcomes during the COVID-19 period, suggesting that monthly real-time surveillance is useful during unprecedented events.

Impact of COVID-19 on TB services in Korea.

Impact of COVID-19 on TB services in Korea.

Addressing gaps in adolescent tuberculosis programming and policy in Nigeria from a public health perspective

Tuberculosis (TB) is a leading infectious cause of death globally. Of the estimated 10 million people who developed active TB in 2019, 1.8 million (18%) were adolescents and young adults aged 15-24 years. Adolescents have poorer rates of TB screening, treatment initiation and completion compared to adults. Unfortunately, there is relatively less programme, research and policy focus on TB for adolescents aged 10-19 years. This article reviews the scope of health services and the relevant policy landscape for TB case notification and care/treatment, TB/HIV management, and latent TB infection for adolescents in Nigeria. Additionally, it discusses considerations for TB vaccines in this population. All Nigeria Federal Ministry of Health policy documents relevant to adolescent health services and TB, and published between 2000 and 2020 underwent narrative review. Findings were reported according to the service areas outlined in the Objectives. Nine policy documents were identified and reviewed. While multiple policies acknowledge the needs of adolescents in public health and specifically in TB programming, these needs are often not addressed in policy, nor in program integration and implementation. The lack of age-specific epidemiologic and clinical outcomes data for adolescents contributes to these policy gaps. Poor outcomes are driven by factors such as HIV co-infection, lack of youth-friendly health services, and stigma and discrimination. Policy guidelines and innovations should include adaptations tailored to adolescent needs. However, these adaptations cannot be developed without robust epidemiological data on adolescents at risk of, and living with TB. Gaps in TB care integration into primary reproductive, maternal-child health and nutrition services should be addressed across multiple policies, and mechanisms for supervision, and monitoring and evaluation of integration be developed to guide comprehensive implementation. Youth-friendly TB services are recommended to improve access to quality care delivered in a patient-centered approach.