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Children living with HIV aged under 10 years should be screened for TB at every encounter with a HCW for current cough, fever, poor weight gain or close contact with a person with TB (see Figure 2.8). The systematic review conducted for the 2021 WHO screening guidelines showed that presence of any one of these conditions has a sensitivity of 61% and a specificity of 94%. Children who are positive on this screen should undergo further diagnostic evaluation for TB disease (25). Adolescents aged 10–19 years should be screened in the same way as adults.
Screening for TB can be difficult in a child living with HIV. Even older children, who may otherwise be expected to have more typical adult-type TB disease if they are living with HIV, frequently have extrapulmonary disease and atypical symptoms (30). HCWs should maintain a strong clinical suspicion of TB in any child living with HIV, even in the absence of classic symptoms of TB, especially in high TB burden areas.