Main changes to the 2014 guidance in the 2022 update
1. Introduction
1.7. Publication, dissemination, evaluation and expiry
The electronic version of the consolidated guidelines on the management of TB in children and adolescents will form part of the WHO TB KSP, which features the following components for each TB module: (i) consolidated guidelines, (ii) operational handbooks with implementation guidance; as well as (iii) a catalogue of WHO e-learning materials.
Further dissemination strategies include global, regional and country webinars and consultations, development of training materials based on the guideline and the operational handbook, and technical support for countries during programme reviews and other in-country missions, as well as review of national strategic plans and funding applications.
Data collected for the annual global TB reports will be evaluated to monitor TB notification rates for children (0–4 and 5–9 years) and adolescents (10–14 and 15–19 years), the proportion of notified TB cases that are children and young adolescents under 15 years (for both DS-TB and DR-TB, and TB treatment coverage rates for children under 5 years, children and young adolescents 5–14 years of age. Other indicators that will be monitored include TB treatment outcomes for children and young adolescents under the age of 15 years as well as coverage of TPT among eligible contacts under the age of 5 years, as well as older contacts.
The recommendations included in the 2022 consolidated guidelines will be considered for updating in five years’ time, or earlier if new evidence becomes available. For the interim recommendation on the use of treatment decision algorithms, new data will be generated and reviewed within a two- year time period.
1. Introduction 7
Î Chapter 1 is the introduction and provides background information, an overview of the scope (including PICO and background questions), the rationale, objectives and target audience for the guidelines.
Î Chapter 2 includes WHO recommendations on TB screening and contact investigation that are relevant to children and adolescents. While no new recommendations were made in these areas by the GDG on the management of TB in children and adolescents, new recommendations on TB screening in children and adolescents were issued by WHO in 2021. These include recommendations on the populations to be screened (persons living with HIV infection and close contacts) and the screening tools that can be applied. The other recommendations in this chapter relate to contact investigation.
Î Chapter 3 focuses on TB prevention. It includes existing recommendations on TB infection prevention and control as well as TPT. The recommendations on TPT relate to the identification of populations who should be tested for TB infection, algorithms to rule out TB disease, tests for TB infection and TPT regimens. This chapter also includes recommendations on BCG vaccination that were published in a WHO position paper in 2018.
Î Chapter 4 includes WHO recommendations on diagnostic approaches. Two new recommendations were made in the 2021 GDG meeting on: (i) the use of Xpert Ultra in gastric aspirate and stool specimens to diagnose pulmonary TB and rifampicin resistance; and (ii) the use of integrated treatment decision algorithms in children with presumptive pulmonary TB. Other recommendations in this chapter include existing WHO recommendations on rapid diagnostic tests including Xpert MTB/RIF, Xpert Ultra, Truenat MTB, MTB Plus and Truenat MTB-RIF Dx, lateral flow urine lipoarabinomannan (LF-LAM) assays, low complexity automated nucleic acid amplification tests, line probe assays and high complexity reverse hybridization-based nucleic acid amplification tests.
Î Chapter 5 focuses on TB treatment. Four new recommendations were made by the child and adolescent TB GDG on TB treatment: (i) a 4-month regimen for children and adolescents 3 months to 16 years of age with non-severe drug-susceptible TB; (ii) a 6-month intensive regimen to treat TB meningitis composed of isoniazid, rifampicin, pyrazinamide and ethionamide; (iii) use of bedaquiline as part of shorter or longer regimens for children of all ages to treat MDR/RR-TB; and (iv) use of delamanid as part of longer regimens for children of all ages to treat MDR/RR-TB. A summary of other valid treatment recommendations is also consolidated in this chapter, including for drug susceptible and DR-TB and for severe forms of EPTB.
Î Chapter 6 includes WHO recommendations on models of care. Two new recommendations on models of care arose in 2021 including one on decentralized care and another on integrated family-centred care. Other WHO recommendations in this chapter include existing recommendations on health education and counselling, treatment adherence interventions, treatment support and decentralized care for people with MDR/RR-TB.
Î Chapter 7 includes existing WHO recommendations on several specific situations such as care of the child or adolescent living with TB and HIV, care of children with TB and malnutrition, and optimal feeding of infants born to mothers with TB. The recommendations on HIV include those on HIV testing, eligibility for and timing of antiretroviral therapy (ART), co-trimoxazole prophylaxis and treatment regimens for ART.
Î Chapter 8 describes research priorities that were identified at the GDG meeting in 2021.
These signal areas where additional evidence is needed to improve the prevention, management and care of TB in children and adolescents.
Box 1: Structure of the 2022 consolidated guidelines
2. TB screening and contact investigation 9