DEWG Meeting Geneva 14 October 2009

1. DEWG Meeting Geneva 14 October 2009 TB in children Report from the breakout session

2. Current situation in childhood TB detection • General situation • Childhood TB – neglected disease – poorly reflected in national guidelines and strategic plans; not all HBC are implementing • Poor recording and reporting - new age groups 0-4 and 5-15 not implemented in many countries • Children diagnosed in hospitals and not reported; ineffective referral system • No clear diagnostic algorithm at health centre level (health workers are afraid to diagnose TB) • Contact tracing not implemented routinely; IPT not implemented • Limited access to tuberculin – an excuse to not implement contact tracing

3. Current situation in childhood TB detection • Initiatives • Small scale initiatives to detect TB and HIV in pregnant women • Active case funding in CAM – double case detection rate • Revision of guidelines and subsequent training • Childhood TB sub-working group in Stop TB Partnership UGA – revised the guidelines and strategic plan • Child friendly formulations provided by GDF • Working groups in international organizations providing TA

4. Main issues to be addressed • Unknown burden – obstacle in advocating for childhood TB at country level • TB needs to be demystified and need for knowledge transfer • Targeted household contact tracing will improve case detection of active cases and prevention • Limited human resources (and financial) to implement contact investigation • IPT not implemented – fear of not being able to distinct active disease from latent infection

5. What can NTPs do?5 steps action oriented • Revise recording and reporting system to capture childhood TB • Advocate for access to existing diagnostic tools (X-ray, culture, tuberculin) and ensure availability of child-friendly formulations drugs at health centre level • Include childhood TB in ACSM and establish childhood TB working groups engaging several stakeholders (medical schools, professional associations, influential clinicians, NTPs, NGOs, etc) to adopt and implement childhood TB and ISTC • Comprehensive approach needs to include childhood TB in all levels of health system in collaboration with primary health care level • Facilitate development of algorithms for the use at different care levels (including PHC and community level) • Use community health workers for active contact tracing and IPT • PPM schemes to include paediatricians working in hospitals and private sector and set up an efficient referral system, including feed-back and follow up • Include childhood TB in the operational research agenda;

6. What can partners do? 5 steps action oriented • Assist in development of national guidelines and training material focussing on different level of care providers (based on revised WHO and Union's guidance and ISTC) • Encourage targeted screening in very high risk groups (HIV infected children, pregnant mothers and their babies, etc) • WHO to work on national estimates of childhood TB • WHO to integrate child TB guidelines into IMCI and maternal health and Regional TB advisers need to prioritize childhood TB • Invest more in developing better diagnostic tests in a coordinated manner (child friendly, non-sputum based to be applicable to point of care level) • Assist in awareness campaigns and resource mobilization • Include Childhood TB experts in NTP reviews • Organize international conference on child lung health and include TB in the programme • Include Childhood TB in international congresses and conferences on child health in general (i.e. IPA and other) • Childhood TB subgroup should try capture other initiatives and invite other partners (including UNICEF, maternal health, etc) • Report on all suggested actions at next year's DEWG meeting