The potential impact of household contact management on childhood tuberculosis: a mathematical modelling study

Background Tuberculosis is now recognized as a major cause of morbidity and mortality in children, with a majority of cases in children going undiagnosed and suffering poor outcomes. Household contact management, aiming to identify children with active tuberculosis and use preventive therapy for children with HIV or under five, has long been recommended but has very low coverage globally. New guidelines include widespread provision of preventive therapy to tuberculin skin-test positive children over five. Methods We provide the first global and national estimates of the impact of moving from zero to full coverage of household contact management (with and without preventive therapy for tuberculin skin-test positive children over five). We used a mathematical model to estimate households visited, children screened and treatment courses given for active and latent tuberculosis. We calculate the tuberculosis cases, deaths, and life-years lost due to tuberculosis for each intervention scenario and country. Findings Full implementation of household contact management would prevent 159,500 (75% Uncertainty Interval [UI] 147,000 – 170,900) cases and 108,400 (75% UI 98,800 – 116,700) deaths in children (representing the loss of 7 million life-years). On average, preventing one child death from tuberculosis would require visiting 48 households, screening 77 children, 48 extra preventive therapy courses, and around 2 more tuberculosis treatments compared to no household contact management. Interpretation Household contact management could substantially reduce childhood disease and death caused by tuberculosis globally. Funding and research to optimize its implementation should be prioritized. Funding UK MRC, US NIH, Fulbright Commission, Janssen Global Public Health.