1.4. Preferences of end-users regarding content and structure of this operational handbook

In preparation for the development of the WHO consolidated guidelines and operational handbook on the management of TB in children and adolescents, a survey was conducted among end-users to:

• collect perspectives on the barriers and facilitators for the implementation of WHO recommendations on the management of TB in children and adolescents; • understand respondents’ preferences regarding the content and structure of the operational handbook;
• inform dissemination approaches.

Respondents (N = 182) were from NTPs, United Nations organizations and technical organizations, with a limited number from national human immunodeficiency virus (HIV), nutrition, maternal, child and adolescent health, and PHC programmes. The majority of respondents worked in high TB burden, TB/HIV coinfection or multidrug-resistant tuberculosis (MDR-TB) countries.

Respondents indicated it would be useful for the operational handbook to include dosing and practical implementation guidance (e.g. standard operating procedures for tuberculin skin tests (TST) and specimen collection methods). Consolidation of all recommendations related to the prevention and management of TB in children and adolescents in one document was considered important. The following were indicated as priorities:

• specific guidance on management of vulnerable children, including children with comorbidities and malnutrition, with case studies and best practices;
• details on the differences in managing children and adults with or at risk of TB;
• practical advice on when and how to initiate TB treatment;
• guidance on managing comorbidities and side-effects of medicines;
• guidance on nutrition for children and adolescents with TB;
• alignment and harmonization with policy recommendations from guidelines in other programmes (e.g. HIV, maternal, newborn, child and adolescent health, nutrition);
• guidance on community involvement;
• optimal engagement of patients, parents and caregivers, and social support for families affected by TB.

Respondents requested translation of the guidelines and operational handbook into multiple languages and indicated that electronic versions of the consolidated guidelines and related operational handbook would be useful. They highlighted the importance of dissemination during webinars (e.g. on World TB Day), regional consultations involving national programmes and national paediatric associations, and international symposia and conferences. Development of user-friendly online training materials was considered useful to increase access.

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