2.3.2. Considerations for implementation of screening of child close contacts

Once the contacts of a person with TB have been identified, the contacts should be screened for TB symptoms and/or undergo CXR, followed by appropriate diagnostic evaluation (15, 28). Contact investigation can be expensive and time-consuming for HCWs. Additionally, TB is a highly stigmatized disease in some settings, and the visit of a health worker to a person’s home may risk discrimination against the household. HCWs can ask people with TB to bring their contacts, including children, to a health facility for TB screening; however, parents and caregivers may not be able to take children for evaluation, for a variety of reasons, including financial and time constraints, lack of appreciation of the importance of screening, and distrust of health care services (4). These issues should be considered carefully when determining the best local approach. Health care providers, health care managers and health programmes should consider the preferences and concerns of parents and caregivers when deciding how to implement screening.

Children and adolescents exposed to a person with TB but found not to have TB disease should be assessed for TB infection and eligibility for TPT as per national guidelines and aligned to WHO recommendations (15, 28). Asymptomatic close contacts aged 5 years and over should undergo CXR if available, and must complete a detailed evaluation for TB if CXR is abnormal. CXR is not a requirement before starting TPT in asymptomatic close contacts aged under 5 years. If CXR is not available, a child can be started on TPT if TB disease is ruled out based on a negative symptom screen.

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