Complementary surveillance strategies and interventions to inform a tuberculosis care cascade for children

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dc.contributor.advisorHesseling, Anneke Catharinaen_ZA
dc.contributor.advisorSchaaf, Hendrik Simonen_ZA
dc.contributor.advisorNaidoo, Prenavumen_ZA
dc.contributor.authorDu Preez, Karenen_ZA
dc.contributor.otherStellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Paediatrics and Child Health.en_ZA
dc.date.accessioned2020-10-14T10:07:06Zen_ZA
dc.date.accessioned2021-02-01T07:54:10Zen_ZA
dc.date.available2020-10-14T10:07:06Zen_ZA
dc.date.available2021-02-01T07:54:10Zen_ZA
dc.date.issued2020-12en_ZA
dc.descriptionThesis (PhD)--Stellenbosch University, 2020.en_ZA
dc.description.abstractENGLISH ABSTRACT: Monitoring and evaluation is an integral component of tuberculosis (TB) control programmes. Children 0-14 years of age contribute substantially to the global TB epidemic, with an estimated 1 million cases and 233,000 deaths in 2017. The limited availability of age-disaggregated TB surveillance data for paediatric and adolescent populations and the lack of specific monitoring and evaluation approaches, hampers TB control efforts in these special populations. Challenges with the sources and the complexity of TB surveillance data in children compound the current limited monitoring and evaluation efforts for paediatric TB. Only 45% of the estimated number of children globally with TB were reported as diagnosed and treated by TB programmes in 2017. More than half of all paediatric TB cases globally were therefore either undiagnosed, or diagnosed but unreported to TB programmes. A TB care cascade framework has been used successfully in HIV and TB control efforts to identify specific gaps and to monitor the impact of targeted programmatic interventions and could also be useful for monitoring and evaluation of paediatric TB. In an effort to address the lack of monitoring and evaluation approaches for paediatric TB, I investigated the role of diagnostic and treatment surveillance strategies to inform two pillars of a paediatric TB care cascade for South Africa. My research quantified the overall paediatric TB reporting gap in South Africa, showing that nearly a third of South African children with TB are undiagnosed, or diagnosed but unreported. Age- and HIV-stratified analyses of a large national routine TB treatment surveillance dataset, spanning a 13-year period (2004-2016), identified young, HIV-infected children (0-4 years) and adolescents (10-19 years) as populations who require additional targeted TB control interventions in South Africa. Diagnostic surveillance conducted at a large tertiary referral hospital and a district-level hospital in Cape Town, South Africa, quantified the substantial burden and spectrum of paediatric TB routinely managed at these levels of care (~400 and ~170 children annually at each hospital, respectively). Surveillance of HIV-infected children and children with TB meningitis (TBM) proved valuable to monitor the impact of TB and HIV prevention strategies and of integrated TB/HIV care. Finally, my research addressed the hospital-reporting gap in a prospective hospital-based study, where an intervention consisting of a simple TB referral service significantly improved recording and reporting as well as linkage to care of children with TB. Including TB data from all hospitals in routine TB surveillance data will substantially reduce the hospital-reporting gap for paediatric TB in South Africa and improve the completeness of routine TB surveillance data. Mandating hospitals to report TB data will also assist with improving the accuracy of reporting on the spectrum of TB disease and HIV data in routine TB surveillance data, increasing the utility of surveillance data for monitoring and evaluation approaches. Together, this research highlights the importance of using multiple sources of data at different levels of health care to strengthen the accuracy and completeness of paediatric TB surveillance. The use of practical monitoring and evaluation approaches, such as a care cascade, can help to improve TB care and services for children and adolescents and will contribute towards achieving the ambitious global targets set for TB control.en_ZA
dc.description.abstractAFRIKAANS OPSOMMING: Monitering en evaluasie is ‘n integrale komponent van progamme om tuberkulose (TB) te beheer. Kinders 0-14 jaar dra substantieël by tot die globale TB epidemie, met ‘n geraamde 1-miljoen gevalle en 233,000 sterftes in 2017. Die beperkte beskikbaarheid van ouderdomsgestratifiseerde TB data vir kinders en adolessente en die afwesigheid van spesifieke benaderings tot monitering en evaluasie, belemmer huidige pogings om TB in hierdie spesiale populasies te beheer. Uitdagings rondom die bronne van en die kompleksiteit van TB oorsigdata in kinders vererger die huidige beperkte pogings tot monitering en evaluasie van pediatriese TB. In 2017 is slegs 45% van die geskatte aantal kinders wat wêreldwyd TB gehad het, deur TB programme as gediagnoseer en behandel gerapporteer. Meer as die helfte van alle pediatiese TB gevalle wêreldwyd word dus óf nie gediagnoseer nie, óf gediagnoseer maar nie aan TB programme gerapporteer nie. ‘n TB-sorgkaskade raamwerk is reeds suksesvol gebruik om spesifieke tekortkominge in TB en MIV-beheer te identifiseer, sowel as om die impak van geteikende intervensies te moniteer. ‘n Soortgelyke raamwerk kan ook waardevol wees vir die monitering en evaluasie van pediatriese TB. In ‘n poging om die gebrek aan benaderings tot monitering en evaluasie van pediatriese TB aan te spreek, het ek die rol van diagnostiese en behandelings oorsigstrategieë ondersoek om twee pillare van ‘n Suid-Afrikaanse pediatriese TB-sorgkaskade toe te lig. My navorsing het die totale kinder-TB rapporteringsgaping in Suid-Afrika gekwantifiseer en aangetoon dat feitlik ‘n derde van Suid-Afrikaanse kinders met TB nie gediagnoseer, of wel gediagnoseer maar nie gerapporteer word nie. Ouderdoms- en MIV-gestratifiseerde analises op ‘n groot, nasionale TB behandelings en oorsigsdatastel wat strek oor ‘n 13-jaar periode (2004 - 2016), het jong MIV-geïnfekteerde kinders (0-4 jaar) en adolessente (10-19 jaar) geïdentifiseer as populasies wat addisionele geteikende beheerintervensies vir TB in Suid-Afrika benodig. Diagnostiese oorsigstudies wat by ‘n groot tersiêre verwysingshospitaal en ‘n distrikshospitaal in Kaapstad, Suid-Afrika, uitgevoer is, het die noemenswaardige las en spektrum van pediatriese TB wat normaalweg by sulke fasiliteite behandel word, gekwantifiseer (~400 en ~170 kinders per jaar by die onderskeie hospitale). Oorsig van MIV-geïnfekteerde kinders en kinders met TB meningitis (TBM), was waardevol om die impak van TB en MIV-voorkomende stategieë, sowel as geintegreerde TB/MIV sorg, te moniteer. Laastens het my navorsing die gaping in hospitaalraportering in ‘n prospektiewe hospitaalgebaseerde studie aangespreek, waartydens ‘n intervensie wat die instel van ‘n eenvoudige TB verwysingsdiens behels het, die dokumentering en rapportering van, asook die kontinuïteit van sorg vir kinders met TB betekenisvol verbeter het. Deur TB data van alle hospitale in roetine TB oorsigdata in te sluit, sal die hospitaalrapporteringsgaping van pediatriese TB in Suid-Afrika aansienlik verminder en die volledigheid van roetine TB-oorsigdata verbeter. Die verpligte rapportering van TB data deur hospitale sal ook help om die akkuraatheid van rapportering oor die spektrum van TB-siekte en MIV in die roetine TB-oorsigsdata te verbeter, sowel as die bruikbaarheid van TB oorsigsdata vir monitering en evalusie doeleindes. Gesamentlik beklemtoon hierdie navorsing die belang van die gebruik van veelvuldige bronne van data van verskillende vlakke van gesondheidsorg om die akkurratheid en volledigheid van pediatriese TB oorsigdata te verbeter. Die gebruik van praktiese monitering- en evaluasiebenaderings, soos ‘n sorgkaskade, kan help om die TB sorg en dienste vir kinders en adolessente te verbeter, sowel as om tot die ambisieuese wêreldwye teikens vir TB beheer by te dra.af_ZA
dc.description.versionDoctorateen_ZA
dc.embargo.terms2021-12en_ZA
dc.format.extentx, 133 pages : illustrationsen_ZA
dc.identifier.urihttp://hdl.handle.net/10019.1/109412en_ZA
dc.language.isoen_ZAen_ZA
dc.publisherStellenbosch : Stellenbosch University, 2021en_ZA
dc.rights.holderStellenbosch University, 2022en_ZA
dc.subjectTuberculosis in childrenen_ZA
dc.subjectTuberculosis -- Interventionsen_ZA
dc.subjectTuberculosis -- Treatmenten_ZA
dc.subjectDiagnostic surveillanceen_ZA
dc.subjectPreventive health services for childrenen_ZA
dc.subjectHIV (Viruses) -- Preventionen_ZA
dc.subjectUCTDen_ZA
dc.titleComplementary surveillance strategies and interventions to inform a tuberculosis care cascade for childrenen_ZA
dc.typeThesisen_ZA
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