Prevention Of Tuberculosis In Children Research Articles

Peer group support and motivational interviewing interventions impact parents’ behavior in preventing tuberculosis among children

Background: Tuberculosis (TB) serves as a key indicator for assessing public health at the population level. The infection of children and toddlers with TB often stems from the lack of involvement by family members in adhering to proper hygiene practices aimed at preventing TB transmission.Objective: This study aimed to assess the impact of peer group support and motivational interviewing on parental behaviors in preventing TB transmission among children residing in the same household as a TB patient. Methods: Employing a quasi-experimental design (pre-post test with a single group), this study involved 30 parents selected through accidental sampling. The independent variables included peer group support and motivational interviewing, while the dependent variable was parental behavior concerning TB prevention in children. Data collection utilized a questionnaire assessing parents’ behaviors in preventing TB in children, which was then analyzed using the paired t-test.Results: The implementation of peer group support and motivational interviewing significantly influenced the enhancement of parental behaviors in preventing TB in children (p < 0.001).Conclusion: Both peer group support and motivational interviewing demonstrated their efficacy in altering parental behavior to prevent TB in children residing with a TB patient. These interventions could be effectively incorporated by nurses to complement ongoing tuberculosis treatment therapies.

Pilot study to identify missed opportunities for prevention of childhood tuberculosis

Tuberculosis (TB) in exposed children can be prevented with timely contact tracing and preventive treatment. This study aimed to identify potential barriers and delays in the prevention of childhood TB in a low-incidence country by assessing the management of children subsequently diagnosed with TB. A pilot retrospective cohort study included children (< 15 years) treated for TB between 2009 and 2016 at a tertiary care hospital in Berlin, Germany. Clinical data on cases and source cases, information on time points of the diagnostic work up, and preventive measures were collected and analyzed. Forty-eight children (median age 3 years [range 0.25–14]) were included; 36 had been identified through contact tracing, the majority (26; 72.2%) being < 5 years. TB source cases were mostly family members, often with advanced disease. Thirty children (83.3%) did not receive prophylactic or preventive treatment, as TB was already prevalent when first presented. Three cases developed TB despite preventive or prophylactic treatment; in three cases (all < 5 years), recommendations had not been followed. Once TB was diagnosed in source cases, referral, assessment, TB diagnosis, and treatment were initiated in most children in a timely manner with a median duration of 18 days (interquartile range 6–60, range 0–252) between diagnosis of source case and child contact (information available for 35/36; 97.2%). In some cases, notable delays in follow-up occurred.Conclusion: Prompt diagnosis of adult source cases appears to be the most important challenge for childhood TB prevention. However, improvement is also needed in the management of exposed children.What is Known:• Following infection with Mycobacterium tuberculosis, young children have a high risk of progression to active and severe forms of tuberculosis (TB).• The risk of infection and disease progression can be minimized by prompt identification of TB-exposed individuals and initiation of prophylactic or preventive treatment.What is New:• We could show that there are avoidable time lags in diagnosis in a relevant proportion of children with known TB exposure.• Delayed diagnosis of adult source cases, losses in follow-up examinations, and delay in referral to a specialized TB clinic of TB-exposed children, especially among foreign-born children, appear to be the main issue in this German pediatric study cohort.

Strengthening Tuberculosis Services for Children and Adolescents in Low Endemic Settings.

In low tuberculosis-burden countries, children and adolescents with the highest incidence of tuberculosis (TB) infection or disease are usually those who have immigrated from high-burden countries. It is, therefore, essential that low-burden countries provide healthcare services to immigrant and refugee families, to assure that their children can receive proper testing, evaluation, and treatment for TB. Active case-finding through contact tracing is a critical element of TB prevention in children and in finding TB disease at an early, easily treated stage. Passive case-finding by evaluating an ill child is often delayed, as other, more common infections and conditions are suspected initially. While high-quality laboratory services to detect Mycobacterium tuberculosis are generally available, they are often underutilized in the diagnosis of childhood TB, further delaying diagnosis in some cases. Performing research on TB disease is difficult because of the low number of cases that are spread over many locales, but critical research on the evaluation and treatment of TB infection has been an important legacy of low-burden countries. The continued education of medical providers and the involvement of educational, professional, and non-governmental organizations is a key element of maintaining awareness of the presence of TB. This article provides the perspective from North America and Western Europe but is relevant to many low-endemic settings. TB in children and adolescents will persist in low-burden countries as long as it persists throughout the rest of the world, and these wealthy countries must increase their financial commitment to end TB everywhere.

Vaccine Prevention of Tuberculosis in Children: Outstanding Issues Family Medicine Systems in Ukraine

The main aspects of the problems of childhood vaccination in Ukraine are studied and the ways of their solution are presented. The results of the survey on the degree of awareness of parents and future parents about the feasibility of vaccination in childhood and determining the main reason for refusal of vaccination are presented and analyzed. A SWOT analysis was conducted and the strengths and weaknesses, advantages and disadvantages of the process of children &rsquo;s vaccination in the opini

The role of vitamin D deficiency in antituberculous protection

BACKGROUND. The main task of modern phthysiology is a comprehensive search for ways to optimize the etiotropic and the pathogenetic treatment of tuberculosis (TB). The search for improved treatment in addition to etiotropic antimicrobial therapy lies in the plane of improving pathogenetic therapy. Analysis of the available scientific sources suggests that the efficacy of TB treatment can be improved by adding vitamin D to the pathogenetic treatment, as vitamin D metabolites support the innate immune response to Mycobacterium tuberculosis.&#x0D; OBJECTIVE. To determine the role of vitamin D in the immunopathogenesis of the inflammatory response in pulmonary TB and to assess the prospects of its impact on improving the effectiveness of treatment by analyzing information from available scientific sources on this topic.&#x0D; MATERIALS AND METHODS. The study was performed for the period December 2020 – August 2021. The search was conducted by&#x0D; Keywords:&#x0D; pulmonary tuberculosis, vitamin D, mechanism of action, pathogenesis, treatment. Access to various full-text and abstract databases was used as the main source of research.&#x0D; RESULTS AND DISCUSSION. A large number of studies conducted so far prove the link between vitamin D deficiency and the occurrence of pulmonary TB. Vitamin D receptors have been found to be present on various surfaces of immune cells, including T and B cells, indicating that they need vitamin D to perform cellular functions. Vitamin D has been shown to increase the phagocytic activity of macrophages, and that monocytes incubated with cholecalciferol (vitamin D3) metabolites induce anti-TB activity. A number of studies have shown that vitamin D increases the body’s production of the antimicrobial/antimycobacterial peptide LL-37, a member of the cathelicidin petelide family. Therefore, the narrowly analyzed analysis according to the literature suggests that in the conditions of full vitamin D status of the human body the course of TB will be favorable, and in case of vitamin D deficiency – which is primarily associated with genetic polymorphisms, the course of TB may be unfavorable.&#x0D; CONCLUSIONS. Vitamin D functionates as one of the activators of macrophages and plays a role in the immune defense of the human body against mycobacterial TB. The inclusion of vitamin D in the program of complex treatment of TB infection is promising, as it enhances the production of antimicrobial/antimycobacterial peptide LL-37. It can be used as one of the components of TB prevention in children.

Sustaining Togetherness; Family Engagement in Tuberculosis Prevention in Children Living in Tuberculosis Households in Indonesia

BACKGROUND: Preventing tuberculosis (TB) in children needs the family to be engaged; however, limited studies about how the family engages in TB prevention. AIM: This aimed of study was to develop the process of family engagement in TB prevention for children with household contact of TB patient. METHODS: Guided by Straussian grounded theory, we developed a substantive theory from 14 primary caregivers in West Java-Indonesia as the key participants of families whose child ≤5 years old received TB screening and preventive therapy, and have had an adult in the household with active TB diagnosis. Data were collected by in-depth interviews and analyzed by coding procedures. RESULTS: Sustaining togetherness aimed to maintain the children’s health, which underpinned three main stages that consisted of “moving from fear to realization,” “making the family’s collective decision,” and “holding on together.” CONCLUSION: Implications for nursing practice in providing optimum care of preventing TB among children through engagement of family.

Hubungan Faktor Lingkungan, Kebijakan Pemerintah Dan Pengetahuan Orang Tua Dengan Pencegahan Penyakit TBC Pada Anak

Introduction: The prevalence of TB cases was recorded to increase in 2019 in Jambi City reaching 3,423 cases, while the incidence of TB in children was 84 (confirmed).Objectives: The purpose of this study was to determine the relationship between environmental factors, government policies, and parental knowledge with the prevention of TB in children in Jambi City. Methods: This research is a quantitative study with a cross-sectional design, the sample is the parents who have children aged 0 years to 18 years in Jambi City with a purposive sampling technique, the number of samples is 82 people. Data collection using online questionnaires, namely environmental factors, government policies, knowledge, and prevention of tuberculosis in children, the data were analyzed univariately and bivariate with the Spearman Correlation test Results: The univariate results of environmental factors met the requirements of 56.1% of respondents, getting information on government policies was 53.7%, moderate knowledge was 43.9%, good TB prevention was 65.9%. The results of the bivariate analysis, there is a relationship and correlation between environmental factors P-value 0.007 and r = 0.296, government policy 0.019 and r = 0.259, and knowledge of p-value 0.043 and r-0.224 with the prevention of TP in children. Conclusions: in this study is the prevention of pulmonary TB in children is supported by environmental factors, government policies, and parental knowledge.

Implementation of an Effective Decentralised Programme for Detection, Treatment and Prevention of Tuberculosis in Children.

Childhood tuberculosis (TB) is consistently under-detected in most high-burden countries, including Uganda, especially in young children at high risk for severe disease and mortality. TB preventive treatment (TPT) for high-risk child contacts is also poorly implemented. The centralised concentration of services for child TB at the referral level is a major challenge in the prevention, detection and treatment of TB in children. In 2015, the DETECT Child TB Project was implemented in two districts of Uganda and involved decentralisation of healthcare services for child TB from tertiary to primary healthcare facilities, along with establishing linkages to support community-based household contact screening and management. The intervention resulted in improved case finding of child and adult TB cases, improved treatment outcomes for child TB and high uptake and completion of TPT for eligible child contacts. A detailed description of the development and implementation of this project is provided, along with findings from an external evaluation. The ongoing mentorship and practical support for health workers to deliver optimal services in this context were critical to complement the use of training and training tools. A summary of the project’s outcomes is provided along with the key challenges identified and the lessons learnt.

Safety and feasibility of 1 month of daily rifapentine plus isoniazid to prevent tuberculosis in children and adolescents: a prospective cohort study

Shorter regimens for tuberculosis prevention can improve completion rates and protection against developing active tuberculosis disease after tuberculosis exposure. We aimed to assess the safety and feasibility of 1 month of daily isoniazid and rifapentine (1HP) in children and adolescents in a low-resource setting in south Asia with low prevalence of HIV. This prospective cohort study was done in eight tuberculosis facilities in Karachi, Pakistan. Eligible participants were aged 2-19 years and were household contacts of patients with drug-susceptible tuberculosis infection. After clinical, radiological, and laboratory evaluation to rule out tuberculosis disease, participants were prescribed 1HP as a preventive regimen. Isoniazid was administered as 100 mg or 300 mg oral tablets and rifapentine was administered as 150 mg oral tablets. Dosing was according to participant bodyweight. The primary endpoints were the cumulative probability of a household contact completing all stages of the preventive care cascade, assessed in all eligible participants, and the proportion of household contacts completing 1HP, assessed among all those who initiated the regimen. Safety was assessed in all household contacts who initiated the 1HP regimen. Between Dec 21, 2019, and March 20, 2020, 1395 household contacts of 253 patients with tuberculosis were identified, including 678 household contacts who were eligible to participate. 628 (93%) completed evaluation, of whom ten (2%) had active tuberculosis disease. Of the 618 individuals eligible for tuberculosis prevention, 408 (66%) initiated 1HP, 385 (94%) of whom completed the regimen. The median duration of 1HP was 31 days (IQR 30-32) in those who completed the regimen. The cumulative probability of completing all steps of the tuberculosis prevention cascade was 58%. A girl aged 11 years developed tuberculosis disease within 6 months of completing 1HP. A boy aged 14 years developed a burning sensation during 1HP therapy and discontinued the regimen. No other adverse events were observed. 1HP can be safely and feasibly implemented as tuberculosis prevention in children and adolescents in programmatic settings. The Global Fund to Fight AIDS, Tuberculosis and Malaria.

Community intervention for child tuberculosis active contact investigation and management: study protocol for a parallel cluster randomized controlled trial

BackgroundThere are major gaps in the management of pediatric tuberculosis (TB) contact investigation for rapid identification of active tuberculosis and initiation of preventive therapy. This study aims to evaluate the impact of a community-based intervention as compared to facility-based model for the management of children in contact with bacteriologically confirmed pulmonary TB adults in low-resource high-burden settings.Methods/designThis multicenter parallel open-label cluster randomized controlled trial is composed of three phases: I, baseline phase in which retrospective data are collected, quality of data recording in facility registers is checked, and expected acceptability and feasibility of the intervention is assessed; II, intervention phase with enrolment of index cases and contact cases in either facility- or community-based models; and III, explanatory phase including endpoint data analysis, cost-effectiveness analysis, and post-intervention acceptability assessment by healthcare providers and beneficiaries. The study uses both quantitative and qualitative analysis methods. The community-based intervention includes identification and screening of all household contacts, referral of contacts with TB-suggestive symptoms to the facility for investigation, and household initiation of preventive therapy with follow-up of eligible child contacts by community healthcare workers, i.e., all young (< 5 years) child contacts or older (5–14 years) child contacts living with HIV, and with no evidence of TB disease. Twenty clusters representing TB diagnostic and treatment facilities with their catchment areas are randomized in a 1:1 ratio to either the community-based intervention arm or the facility-based standard of care arm in Cameroon and Uganda. Randomization was stratified by country and constrained on the number of index cases per cluster. The primary endpoint is the proportion of eligible child contacts who initiate and complete the preventive therapy. The sample size is of 1500 child contacts to identify a 10% difference between the arms with the assumption that 60% of children will complete the preventive therapy in the standard of care arm.DiscussionThis study will provide evidence of the impact of a community-based intervention on household child contact screening and management of TB preventive therapy in order to improve care and prevention of childhood TB in low-resource high-burden settings.Trial registrationClinicalTrials.gov NCT03832023. Registered on 6 February 2019

Tuberculosis prevention in children: a prospective community-based study in South Africa.

Tuberculosis (TB) preventive therapy reduces TB risk in children. However, the effectiveness of TB preventive therapy in children living in high TB burden settings is unclear.In a prospective observational community-based cohort study in Cape Town, South Africa, we assessed the effectiveness of routine TB preventive therapy in children ≤15 years of age in a high TB and HIV prevalence setting.Among 966 children (median (interquartile range) age 5.07 (2.52–8.72) years), 676 (70%) reported exposure to an adult with TB in the past 3 months and 240 out of 326 (74%) eligible children initiated isoniazid preventive therapy under programmatic guidelines. Prevalent (n=73) and incident (n=27) TB were diagnosed among 100 out of 966 (10%) children. Children who initiated isoniazid preventive therapy were 82% less likely to develop incident TB than children who did not (adjusted OR 0.18, 95% CI 0.06–0.52; p=0.0014). Risk of incident TB increased if children were <5 years of age, living with HIV, had a positive Mycobacterium tuberculosis-specific immune response or recent TB exposure. The risk of incident TB was not associated with sex or Mycobacterium bovis bacille Calmette–Guérin vaccination status. Number needed to treat (NNT) was lowest in children living with HIV (NNT=15) and children <5 years of age (NNT=19) compared with children of all ages (NNT=82).In communities with high TB prevalence, TB preventive therapy substantially reduces the risk of TB among children who are <5 years of age or living with HIV, especially those with recent TB exposure or a positive M. tuberculosis-specific immune response in the absence of disease.

Contact Investigation and Preventive Therapy as Tuberculosis prevention in Children with Tuberculosis Household Contact: A Systematic Review

Introduction: The increasing tuberculosis cases in children showed management of Tuberculosis itself. There was a finding of TB case in children according to WHO TB report 2019 that not all childrens being well diagnosed, treated or reported each year. This systematic review aims to describes implementation of TB prevention often missed in children with adult TB household contacts.Method: This study uses based on PICO, which contains Participants are family who living household with adult TB, Interventions are CI followed by PT, no comparison, Outcomes are improving the implementation of CI and PT. Searching for article is using the Scopus, PubMed, and Science Direct and found 15 articles in final which limited to the last 3 years (2017-2020). Keywords used in searching are” Tuberculosis”, “Transmission”, and “Preventive Therapy”. The population included were respondents identified as family having child aged ≤ 15 years with TB Household Contacts. The study design varied in rigorousness form of quantitative and mixed studies.Result: Household Contact (HHC) contribute to TB cases in children.Conclusion: Contact Investigation (CI) and Preventive Therapy (PT) could be succesfull strategies to prevent TB transmission to children provided not only by Health Care Workers (HCWs) but also public concerned to community-based approach in order to encouraged family members of TB affected

Contact Investigation and Preventive Therapy as Tuberculosis prevention in Children with Tuberculosis Household Contact: A Systematic Review

Contact Investigation and Preventive Therapy as Tuberculosis prevention in Children with Tuberculosis Household Contact: A Systematic Review

Academician Timofey Petrovich Krasnobayev (1865–1952) (on the 155&lt;sup&gt;th&lt;/sup&gt; anniversary of the birthday)

Academician Timofey Krasnobayev was born on March 6, 1865 in Smolensk, in a poor hairdresser ‘s family. After graduating from the gymnasium, Timofey Petrovich entered the Medical Faculty of the Moscow University. After graduated from the University in 1888, T. P. Krasnobayev worked for a year as an external student at the Smolensk provincial hospital and then returned to Moscow. At the very beginning of 1903, the Moscow City Administration sent Timofey Petrovich on a 6-month scientific mission to Western Europe to familiarize with children’s hospitals and their surgical departments and to study orthopaedic surgery. T. P. Krasnobayev was the ideologist of the system of prevention of secondary intra-hospital diseases in children. T. P. Krasnobayev made the greatest contribution to the development of child traumatology and orthopaedics. Timofey Petrovich had given more than 50 years to study the issues of diagnosis, treatment and prevention of bone-joint tuberculosis in children and is undoubtedly a luminary and a gene rally recognized authority in this section of pediatrics. T. P. Krasnobayev has a great merit in the organization of the X-ray service at the children’s hospital. He published about 70 scientific papers on pediatric surgery and made more than 150 reports. Academician Timofey Petrovich Krasnobayev died on October 11, 1952.

New vaccine candidates as a scientific solution against the dream of tuberculosis vaccine

Tuberculosis (TB) is accounted for as one of the most important destructive infectious diseases for humans, which is caused by Mycobacterium tuberculosis. Studies have shown the severe effects of tuberculosis in patients, especially sensitive groups. Emergence and distribution of both multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains have caused failure in the infection eradication. At present, BCG vaccine is the only most effective vaccine for the prevention of TB in childhood but its protection level in pulmonary TB in adult is very variable. Therefore, the need for an appropriate alternative vaccine instead of BCG is urgent. On the basis of the studies, cell-mediated immune (CMI) is known as the best immune response against TB infection. For this purpose, a desirable CMI response should be along with a balance between Th1, Th17, and T-reg cells. Several vaccine candidates have been evaluated in vitro and in vivo examinations, such as recombinant BCG (rBCG), DNA vaccines, and subunit vaccines. Factors, such as applicability of vaccine candidates in all individuals, cost-effectiveness, long-term immunity and stimulation of a wide range of responses are important factors. Now, most of these vaccines have entered in the phases of clinical trial (even IIB and III); however, these trials are complex, need a large number of individuals and need a long time. Funding for TB vaccine trials is an important issue, especially in poor countries. With preclinical safety precision studies, it is likely that at least one of these vaccines will develop into early clinical trials in the next few years.

Moving from fear to realization: Family engagement in tuberculosis prevention in children living in tuberculosis Sundanese households in Indonesia

ObjectiveChildren living in tuberculosis households need protection. However, families need to be engaged to prevent tuberculosis transmission to children. This study aimed to analyze the details of “moving from fear to realization,” which is one category of a substantive theory of family engagement in tuberculosis prevention in children. MethodsFourteen family caregivers participated as key informants after their families met the criteria. The participants were recruited at a lung clinic in West Java, Indonesia and followed up at their homes. The data were gathered using in-depth interviews and analyzed following the coding procedures of the Straussian grounded theory. Findings“Moving from fear to realization” was the main category that emerged from the experiences of the Sundanese families to begin engaging in tuberculosis prevention in children living in tuberculosis households. It was composed of four sub-categories, namely, fear of tuberculosis, seeking information, following God's will, and awareness of tuberculosis transmission risks. ConclusionsThis study showed how a family moves from fear to the realization of tuberculosis transmission risks. Its findings are useful for nurses to provide optimum care in order to prevent tuberculosis transmission to children with household contact by providing both education and counseling for families.

ПРЕВЕНТИВНОЕ ЛЕЧЕНИЕ ТУБЕРКУЛЕЗА У ДЕТЕЙ ИЗ КОНТАКТА С ЛЕКАРСТВЕННОЙ УСТОЙЧИВОСТЬЮ МИКОБАКТЕРИЙ

The aim of the study was to study the clinical and immunological efficacy of meglumine acrydon acetate immunomodulator in the preventive treatment of tuberculosis in children from tuberculous contact with drug resistance of mycobacterium tuberculosis (MBT). Material and methods. The evaluation of the effectiveness of the immunomodulator was performed in 34 children from contact with drug resistant tuberculosis (LUTB) in comparison with the effectiveness of traditional chemoprophylaxis using isoniazid in 40 children. Results. Both methods of preventing tuberculosis in children equally reduce the tuberculin sensitivity, and meglumine acridon acetate also prevents a hyperergic reaction to tuberculin. The immunomodulatory effect of meglumine acridon acetate, manifested by the increase in the level of T cells, activation of the phagocytic activity of neutrophils and their bactericidal activity is very important for the prevention of tuberculosis in children from TB contact. Conclusions. In conditions of contact of children with patients who release drug-resistant MBT, when chemoprophylaxis with isoniazid does not have the desired effect, an alternative method of preventing tuberculosis is the use of meglumine acridon acetate.

Epidemiological aspects, clinical manifestations, and prevention of pediatric tuberculosis from the perspective of the End TB Strategy.

ABSTRACTTuberculosis continues to be a public health priority in many countries. In 2015, tuberculosis killed 1.4 million people, including 210,000 children. Despite the recent progress made in the control of tuberculosis in Brazil, it is still one of the countries with the highest tuberculosis burdens. In 2015, there were 69,000 reported cases of tuberculosis in Brazil and tuberculosis was the cause of 4,500 deaths in the country. In 2014, the World Health Organization approved the End TB Strategy, which set a target date of 2035 for meeting its goals of reducing the tuberculosis incidence by 90% and reducing the number of tuberculosis deaths by 95%. However, to achieve those goals in Brazil, there is a need for collaboration among the various sectors involved in tuberculosis control and for the prioritization of activities, including control measures targeting the most vulnerable populations. Children are highly vulnerable to tuberculosis, and there are particularities specific to pediatric patients regarding tuberculosis development (rapid progression from infection to active disease), prevention (low effectiveness of vaccination against the pulmonary forms and limited availability of preventive treatment of latent tuberculosis infection), diagnosis (a low rate of bacteriologically confirmed diagnosis), and treatment (poor availability of child-friendly anti-tuberculosis drugs). In this review, we discuss the epidemiology, clinical manifestations, and prevention of tuberculosis in childhood and adolescence, highlighting the peculiarities of active and latent tuberculosis in those age groups, in order to prompt reflection on new approaches to the management of pediatric tuberculosis within the framework of the End TB Strategy.

The PREVENT study to evaluate the effectiveness and acceptability of a community-based intervention to prevent childhood tuberculosis in Lesotho: study protocol for a cluster randomized controlled trial

BackgroundEffective, evidence-based interventions to prevent childhood tuberculosis (TB) in high TB/HIV-burden, resource-limited settings are urgently needed. There is limited implementation of evidence-based contact management strategies, including isoniazid preventive therapy (IPT), for child contacts of TB cases in Lesotho.Methods/designThis mixed-methods implementation science study utilizes a two-arm cluster-randomized trial design with randomization at the health facility level. The study aims to evaluate the effectiveness and acceptability of a combination community-based intervention (CBI) versus standard of care (SOC) for the management of child TB contacts. The study includes three phases: (I) exploratory phase; (II) intervention implementation and testing phase; (III) post-intervention explanatory phase. Healthcare provider interviews to inform intervention refinement (phase I) were completed in December 2015. In phase II, 10 health facilities were randomized to deliver the CBI or SOC, with stratification by facility type (i.e., hospital vs. health center). CBI holistically addresses the complex provider-related, patient-related, and caregiver-related barriers to prevention of childhood TB through nurse training and mentorship; health education for caregivers and patients by village health workers; adherence support using text messaging and village health workers; and multidisciplinary team meetings, where programmatic data are reviewed and challenges and solutions are discussed. SOC sites follow country guidelines for child TB contact management. Routine TB program data will be abstracted for all adult TB cases newly registered during the study period and their child contacts from TB registers and cards. The anticipated sample size is 1080 child contacts. Primary outcomes are yield (number) of child contacts, including children < 5 years of age and HIV-positive children < 15 years of age; IPT initiation; and IPT completion. Secondary outcomes include HIV testing; yield of active prevalent TB among child contacts; and acceptability and utilization of CBI components. Intervention implementation began in February 2016 and is ongoing. Post-intervention interviews with healthcare providers and caregivers (phase III) commenced in February 2017.DiscussionThe PREVENT study tests the effectiveness and acceptability of a novel combination CBI for child TB contact management in Lesotho. If effective, CBI will have important implications for addressing childhood TB in Lesotho and elsewhere.Trial registrationClinicalTrials.gov, NCT02662829. Registered on 15 January 2016.

Regional initiatives to address the challenges of tuberculosis in children: perspectives from the Asia-Pacific region

Increasing attention is being given to the challenges of management and prevention of tuberculosis in children and adolescents. There have been a number of recent important milestones achieved at the global level to address this previously neglected disease. There is now a need to increase activities and build partnerships at the regional and national levels in order to address the wide policy-practice gaps for implementation, and to take the key steps outlined in the Roadmap for Child Tuberculosis published in 2013. In this article, we provide the rationale and suggest strategies illustrated with examples to improve diagnosis, management, outcomes and prevention for children with tuberculosis in the Asia-Pacific region, with an emphasis on the need for greatly improved recording and reporting. Effective collaboration with community engagement between the child health sector, the National Tuberculosis control Programmes, community-based services and the communities themselves are essential.