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Results of Union pilot project show simple model for significantly improving child TB services

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Results from The Union's DETECT Child TB project show that TB diagnoses doubled as a result.

Results of DETECT Child TB, a Union pilot project in Uganda that decentralised health services to detect and treat tuberculosis (TB) in children and conducted household contact tracing to ensure those at-risk received TB preventive therapy, show that TB diagnoses doubled as a result of the project.

Findings – published in the International Journal of Tuberculosis and Lung Disease – from the two districts covered by DETECT Child TB show a 140 percent increase in TB notifications in children and a 41 percent increase in TB notifications overall. TB diagnoses doubled, as did the proportion of children diagnosed with TB among all TB cases – supporting estimations of a startling gap in child TB detection. TB preventive therapy for children at risk of developing TB increased from five percent to 74 percent by the end of the pilot phase. In addition, treatment completion – in both children and adults – increased from 65 percent to 82 percent.

Children under the age of 15 years represent nearly half of the total population in Uganda, yet child TB makes up only nine percent of the total burden. Data suggest the percentage of children with TB is likely closer to 17 percent of the total, meaning thousands of children are potentially going undiagnosed and untreated.

To address these challenges, The Union’s DETECT Child TB (Decentralise Tuberculosis services and Engage Communities to Transform lives of Children with Tuberculosis) was established in 2015 in two contrasting districts in Uganda –Kabarole, a rural district in western Uganda, and Wakiso, an urban or peri-urban setting in central Uganda. The project aimed to strengthen diagnosis, treatment and prevention of child TB in local health centres. Project staff trained healthcare workers at local health facilities to diagnose and treat child TB, and community healthcare workers were trained to screen people on TB treatment to ensure children in the household were identified for preventive therapy.

These simple strategies brought about a significant increase in TB notifications and improved treatment outcomes. Globally, one million children under the age of 15 become sick with TB and 239,000 – nearly one in four – die every year. Yet children who receive standard TB treatment rarely die. The results of DETECT Child TB provide a model for simple and effective approaches to protecting this vulnerable population.

Earlier this year, The Union brought a group of international journalists and a delegation of parliamentarians to Uganda to visit districts that are implementing the DETECT Child TB project.

The pilot phase was conducted in collaboration with Uganda’s National Tuberculosis and Leprosy Programme with funding from the ELMA Foundation. The Union has secured financing to continue DETECT Child TB past the pilot phase, thanks to a generous personal donation from Professors Jeffrey Starke and Joan Shook, and the US Centers for Disease Control and Prevention.

Read more about The Union’s work in child TB: the TITI study, which presented encouraging preliminary results at the 49th Union World Conference on Lung Health, investigated household contact tracing to ensure children at risk of developing TB received preventive treatment.