FeedbackOpportunities for integration of TB services at the health facility level exist in outpatient departments; nutrition, HIV, maternal and child health clinics (e.g. prevention of mother-to-child transmission, antenatal care, immunization clinics), general paediatric, adult TB and chest clinics; and inpatient departments. If resources are available, implementation of provider-initiated TB screening in relevant child health entry points and linkages to diagnosis or treatment may be considered by the NTP. If resources are limited, entry points or services designed to care for sick children could be prioritized.
The WHO policy on collaborative TB/HIV activities recommends the delivery of integrated TB/HIV services, preferably at the same time and location (167). The policy further recommends that HIV programmes and NTPs should collaborate with other programmes to ensure access to integrated and quality-assured services, including for children and adolescents. Quality statement 1.8 of the Standards for improving the quality of care for children and young adolescents in health facilities recommends that all children at risk for TB or HIV are correctly assessed and investigated and receive appropriate management according to WHO guidelines (168).
Many health care providers at the PHC level in high TB burden countries have been comprehensively trained on assessing and caring for children with pneumonia, diarrhoea and malnutrition using the IMCI and integrated community case management (iCCM) service delivery packages. These packages are centred around the most common childhood illnesses, such as pneumonia and malnutrition, which have a clinical presentation similar to TB (80, 169). Therefore, they offer an opportunity to strengthen integrated symptom-based screening for TB in sick children aged under 5 years. Specifically, the 2014 WHO IMCI chart booklet (80) caters for referral of children with a cough for more than 14 days; assessment of TB infection among children with acute malnutrition; and TB assessment and TPT among children living with HIV (80, 169).
Table 6.3 summarizes opportunities for integration of TB services.
