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South Africa

1. Adopt and implement WHO TB guidelines as relevant for infants and children in case-finding, screening, and testing.


2. Scale up available, appropriate, timely, quality assured pediatric TB diagnostics, using comprehensive diagnostic network mapping and optimized use of all diagnostic resources to maximise paediatric case detection.


3. Ensure follow-up, screening and appropriate care for children who are a household contact of a person living with TB, and that pediatric case-finding is prioritized.


4. Implement rapid molecular assays for detection of TB in infants and children, including use of stool and other non-sputum specimens endorsed by WHO.


5. Implement the TB-LAM assay and/or similar urine-based lateral flow assays for routine use in both TB and HIV national programs in line with the latest WHO recommendations to support identification of TB in all HIV-infected infants and children.


6. Incorporate costed and budgeted requests for interventions for pediatric TB diagnosis, including procurement, training, and case-finding interventions, into Global Fund and PEPFAR requests.


7. Optimize infant and children case-finding approaches to ensure increased and equitable access to screening and testing as well as linkage to treatment, including preventive treatment.


8. Work with researchers and relevant experts to develop pediatric specimen banks/repositories to support faster studies of new TB diagnostics and ensure open access to academic groups and manufacturers.


9. Work with national regulatory authorities to register diagnostic assays and streamline procedures while ensuring the use of WHO approved products when considering national regulatory approval.


10. Support sharing of available diagnostic platforms and associated networks across programs to attain wider access to testing, for more optimal utilization of available platforms, more efficient systems, and improved sustainability.


11. Remove barriers to accessing screening and preventive treatment for healthy children who are exposed to TB (e.g. provide transport vouchers, home-based screening and treatment, etc.).


12. Support optimal access and supply to TB diagnostics through efficient registration of WHO recommended diagnostics and not taxing public goods.


13. Implement pre-qualification assessments of TB in vitro diagnostics to assess quality, safety and performance of specific products, as a quality assurance mechanism complementing WHO policy recommendations.


14. Streamline national regulatory approval of TB diagnostic products that have been assessed according to stringent standards for quality, safety and performance.


15. Develop and implement post market surveillance of diagnostic products




92. Accelerate transition to more optimal regimens and formulations as described in WHO Guidelines by: 

  • Adopting and implementing new WHO TB guidelines relevant for children within one year of their release 

  • Revising national procurement plans to align with WHO recommended regimens and the EML-C 

  • Scaling-up use of dispersible fixed-dose combinations and single drug formulations for drug-sensitive and drug-resistant TB (including rifampicin + isoniazid + pyrazinamide [RHZ] and rifampicin + isoniazid [RH], INH dispersible single, ethambutol dispersible single and child-friendly second-line formulations)

  • Supporting the provision of shorter TB Prevention Treatment regimens for children when these regimens have appropriate data and are available in child-friendly formulations (i.e., 3RH, 3HP, 1 HP)

  • Strengthening reporting and recording systems for TB infection, contact tracing and provision and completion of TPT for children

  • Strengthening PSM systems for TPT medicines.


93. Prioritize funding for paediatric TB prevention, diagnosis (including DST), and treatment in national budgets and requests to donors, including to provide these services free of charge and to support improved models of care for children and for training of HCWs.


94. Create a plan of action to reduce stigma and discrimination in health care systems and communities and support civil society and community generated initiatives focused on pediatric TB.


95. Collect data on TB-HIV co-infection and TB treatment outcomes in children living with HIV.



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