Recommendations:
In TB high burden settings, decentralized models of care may be used to deliver TB services to children and adolescents with signs and symptoms of TB and/or those exposed to TB (conditional recommendation, very low certainty evidence).
Family-centred, integrated models of care to deliver TB services may be used in children and adolescents with signs and symptoms of TB and/or those exposed to TB, in addition to standard models of care (conditional recommendation, very low certainty evidence).
Remarks
- These recommendations are applicable to TB services along the full cascade of care with a focus on case detection and provision of TPT.
- They are applicable to children and adolescents with signs and symptoms of TB in terms of the impact on case detection. They also apply to children and adolescents who are exposed to TB (TB contacts) who are eligible for TPT, in terms of the impact on provision of TPT. Children and adolescents with signs and symptoms who need evaluation for TB disease may also have a history of exposure to TB (TB contacts). Children and adolescents who are TB contacts who do not have signs and symptoms need to be evaluated for TPT eligibility.
- The recommendation on decentralized services refers to enhancing child and adolescent TB services at peripheral levels of the health system and closer to the community, not to replacing specialized paediatric TB services at higher levels of the health system.
- Decentralization should be prioritized for settings and populations with poor access to existing services and/or in high TB prevalence areas.
- Family-centred, integrated approaches are recommended as an additional option to standard TB services, for example alongside specialized services that may have a limited level of integration with other programmes or linkages to general health services.
- Family-centred care is a cross-cutting principle of child care at all levels of the health system.