Global efforts to control the co-epidemics of TB and HIV will benefit children and adolescents. They include the expansion of prevention of mother-to-child transmission programmes, which will reduce the number of new HIV infections in young children. In addition, all children living with HIV should be screened for TB, and all children and their families with TB should be offered HIV testing and counselling in settings of high HIV prevalence.
All children and adolescents living with HIV who are household contacts of people with infectious TB should be evaluated for TB disease and either treated for TB or given TPT if screening finds they are unlikely to have TB disease (see Chapter 3). Innovative approaches are needed to ensure coinfected children are identified and, where possible, disease is prevented. This requires integration of services and collaborative TB and HIV activities by national TB and HIV programmes and other stakeholders (167).
Infants and children living with HIV should not receive BCG vaccination because they are at increased risk of developing disseminated BCG disease. Infants and children living with HIV who are on ART, are clinically well and are immunologically stable should, however, be vaccinated (see Chapter 3) (31).
The approach to screening and management of children and adolescents living with HIV who are contacts of a person with TB is outlined in Chapter 2. A child living with HIV exposed to a person with infectious TB is at particularly high risk of developing TB disease (15, 22, 167). WHO recommendations are that household contacts of people with infectious TB should be screened for symptoms of TB. If TB is excluded, TPT should be offered to children aged under 5 years, irrespective of their HIV status and availability of TB infection testing. Children aged 5 years and over, adolescents and adults who are household contacts of people with bacteriologically confirmed PTB who are found not to have TB disease by an appropriate clinical evaluation or according to national guidelines may be given TPT, irrespective of their HIV status.
Adolescents and children aged 12 months and over living with HIV who are unlikely to have TB disease should receive TPT as part of a comprehensive package of HIV care, regardless of history of TB contact. TPT should also be given to adolescents and children aged 12 months and over on ART; to pregnant adolescents; and to adolescents and children aged 12 months and over who have previously been treated for TB, irrespective of the degree of immunosuppression or availability of TB infection testing. For infants aged under 12 months living with HIV, the recommendation is that they should receive TPT if they are in contact with a person with TB and if they are unlikely to have TB disease on an appropriate clinical evaluation or according to national guidelines (see Chapter 3) (15, 28).