TDR-supported studies in Burkina Faso, Democratic Republic of the Congo and Nigeria have been validating new treatment-decision algorithms (TDAs) that are designed to address the tuberculosis (TB) detection gap in children. The first results show high performance in closing the gap in young children and also enhancing case findings in older children and adults.
In 2022, the World Health Organization’s Global TB Programme (GTB) launched the TDAs for children under age 10 with presumptive TB. These TDAs are based on clinical criteria, diagnostic test results and chest X-ray findings, where available. Validation in real-life settings is necessary to ensure their performance across diverse populations and settings. In March 2023, in collaboration with GTB, TDR launched the “TB Treatment Decision Algorithms for Children” (TDA4Child) initiative, which includes a generic research package to support national tuberculosis control programmes (NTPs) conducting operational research to evaluate the TDAs.
TDA4Child has been customized by NTPs in several African countries for conducting studies that aim to describe the diagnostic accuracy, feasibility, healthcare worker acceptability and impact on TB case notifications.
In 2023, Burkina Faso reported 31% TB treatment coverage for children under age 15, compared with 88% for the overall population. The Democratic Republic of Congo reported 33,540 pediatric TB cases, representing 13% of all TB cases and 70% treatment coverage for children under age 15. Nigeria reported more than 361,000 TB cases, among which 9% were in children, highlighting a significant detection gap.
The NTPs of Burkina Faso, the Democratic Republic of the Congo and Nigeria were among the first to launch TDA4Child research projects with support from TDR, the United States Agency for International Development (USAID) and the Global Fund to Fight AIDS, Tuberculosis and Malaria in November 2023.
Preliminary Results
A total of 2300 children were recruited from 52 sites across the three countries. The TDAs demonstrated high performance, with sensitivity between 87% and 100% and specificity around 99%.
Burkina Faso: The use of TDAs resulted in an 86% increase in TB notifications among children between the ages of 0 and 9 compared with the previous year.
Democratic Republic of the Congo: Childhood TB notifications increased by 14% on average, with a higher increase in the 0-4 age group (25%).
Nigeria: TB notifications increased by 258% in the 0-9 age group, compared with the previous three years.
In all three countries, contact tracing around diagnosed young children helped identify new TB cases in adults and older children
|  Supervision visit in a primary healthcare structure of the Federal Capital Territory, Abuja, Nigeria (Credit: Emmanuelle Papot) |
Frontline workers who participated in the TDA4Child study in Burkina Faso during a workshop on implementation research led by the national TB programme. Credit: Adama Diallo
Scaling up the use of TDAs nationally
Ninety-eight frontline workers across the three countries agreed that TDAs facilitate the diagnostic process for childhood TB, speeding up diagnoses and treatment decisions. Several months after the pilot, healthcare workers in many primary healthcare structures continue to use the TDAs.
These studies also fostered collaboration among the study sites involved, raised awareness of the TDAs among frontline TB care providers and generated valuable evidence for national scale-up.
Systematic implementation of the TDAs could significantly reduce the number of undiagnosed and untreated children with TB. All three countries are currently scaling up the use of these TDAs nationally, and the data is being shared with GTB for recommendation updates.
For more information, please contact Dr Corinne Merle.