Each year, nearly one million children develop TB, and a quarter die. Over 60% of cases go undiagnosed, especially in sub-Saharan Africa, where diagnostic challenges and limited laboratory capacity hinder detection. In 2022, WHO issued an interim recommendation for using Treatment-Decision Algorithms (TDAs) to diagnose TB in children under ten, based on limited evidence. Our project will assess the effectiveness, cost-effectiveness, feasibility, and acceptability of implementing TDAs in routine care settings in Tanzania, Uganda, and the Democratic Republic of Congo. The goal is to increase case detection, reduce delays, and improve treatment outcomes, while strengthening research capacity and regional collaboration.
Pathways toward impact
The project will be implemented in 120 primary health facilities and will involve screening of 60,000 children across the three countries. Healthcare workers will be trained to improve clinical practice, and we will engage policymakers, District Health Management Teams, communities, and other key stakeholders to support uptake. Evidence from the project will inform integration of TDAs into national TB guidelines. The project will also promote technology transfer, knowledge sharing, and stronger South–South and North–South collaboration. Empowering primary facilities to provide timely pediatric TB care with the new TDAs will reduce dependence on unavailable diagnostic services such as chest X-ray.
Integration of social sciences and humanities
We will use social sciences and humanities to answer five broad research questions: 1) What are the barriers and facilitators to the uptake and implementation of the TDAs in routine healthcare settings, and how can these be addressed? 2) What strategies can be employed to train healthcare workers on the effective use of TDAs, considering limited resources, diverse cultural contexts, and varying levels of healthcare infrastructure? 3) How can community engagement and involvement be effectively incorporated into the implementation of the TDA strategy to enhance acceptability, ownership, and sustainability? 4) What financing models and policy interventions can be developed or strengthened to support the availability, affordability, and accessibility of TDAs? 5) How can the research findings from the project be effectively communicated to key stakeholders to promote its adoption and integration into clinical practice?
