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Addressing gaps in childhood TB case detection and management through targeted contact management in South Africa

Addressing gaps in childhood TB case detection and management through targeted contact management in South Africa
Publication date: 
Nov 2019
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Background and challenges to implementation

Childhood TB is a marker for ongoing TB transmission in the community and an indicator of the level of adult TB control within the population.  Despite a well-functioning National TB control programme in South Africa (NTP), children with TB remain grossly under-detected in South Africa. According to the NTP, the proportion of childhood TB among all reported cases is only 10-12% compared to 15-20% estimated for other high-burden countries. Children with TB, if not appropriately identified and treated, create a pool from which future adult cases can arise which poses a significant threat for South Africa as a TB high burden country.

Intervention

Targeted contact management among children of TB index patients were conducted by the USAID TB South Project between October 2017 and August 2018, in 15 of the 20 TB high burden districts of South Africa. To strengthen the efforts of the National Department of Health (NDoH) government, the project contracted 39 civil society organizations to provide targeted contact management which includes TB awareness and education, TB screening and intensified case finding, improved linkage to care and treatment, initiation for diagnosed patients as well as treatment adherence support to improve TB outcomes.

Results

A total of 3006 children were reached of which 97% (2928) were screened for TB. Of those screened 1067 were found presumptive and tested for TB according to the guidelines of the NDoH.  A total of 75 patients were detected and 72 (96%) initiated on treatment a case notification rate of 2459/100,000 children screened.  The results of the interventions represent a six-times TB notification rate above the national rate of 398/100,000.

Conclusion

These observations highlight the need to strengthen screening of children from historical index cases. Targeted contact management conducted through community structures is a highly effective strategy for TB case finding among children. This intervention should be scaled up in areas with high TB burden to increase yield among children.