Designing a community intervention for tuberculosis household child contact management and assessing the feasibility of its evaluation in Cameroon and Uganda ; Développement d'une intervention communautaire pour la prise en charge des enfants contact de tuberculose et analyse de la faisabilité de son évaluation au Cameroun et en Ouganda

The World Health Organization estimates that 10 million people had tuberculosis (TB) in 2019. Children are estimated to represent 15-20% of TB cases in high-prevalence countries but many go untreated, especially children under 5 years of age, due to difficulties in diagnosing TB in young children and poor implementation of routine TB screening in contact children. When children are exposed to TB in their homes, parents are asked to take them to a health center for TB testing. After ruling out TB, preventive tuberculosis treatment (TPT) is offered for children at high risk of developing severe forms, such as children under 5 or children living with HIV, regardless of their age. Many exposed children go undetected due to barriers such as cost of transport, other competing priorities, especially when children are well, and lack of communication between health workers and TB patients.My PhD thesis focuses on the design of a community-based approach for TB screening and TPT dispensing in contact children and on the conditions for its evaluation in the context of an international comparative study in two countries with a high prevalence of TB. and resource-poor sub-Saharan Africa, Cameroon and Uganda.We first confirmed the possibility of using a simplified symptom screening tool for the exclusion of TB before TPT initiation. I performed a systematic review and meta-analysis comparing symptomatic screening with radiological screening in contact children in resource-limited settings. The combined negative predictive value of the included studies is 98.7% (96.9–99.8) for children under 5 years and 98.1% (93.8–100) for children 5-14 years. These results confirmed our choice of a simple symptomatic screening tool at the community level. We developed the research protocol for a randomized controlled trial in clusters including a total of 20 clusters (health centers or hospitals and their catchment area) distributed between the 2 countries, the main objective of which was to compare the community intervention for TB contact ...