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Abstract
Although tuberculosis disease is a leading cause of global childhood mortality, there remain major gaps in diagnosis, treatment and prevention in children, as tuberculosis control programs rely predominantly on presentation of symptomatic children or contact tracing. We assessed the public health impact and cost-effectiveness of age-based routine screening and contact tracing in children in South Africa.We used a deterministic mathematical model to evaluate age-based routine screening in 1-year increments from ages 0 to 5, with and without contact tracing and preventive treatment. Screening incorporated symptom history and tuberculin skin testing, with chest X-ray and GeneXpert Ultra for confirmatory testing. We projected tuberculosis cases, deaths, disability-adjusted life years (DALYs) and costs (2021 U.S. Dollars) and evaluated the incremental cost-effectiveness ratios (ICERs) comparing each intervention.Routine screening at age 2 with contact tracing and preventive treatment averted 11,900 tuberculosis cases (95% confidence interval (CI), 6,160-15,730), 1,360 deaths (95% CI, 260-3,800), and 40,000 DALYs (95% CI, 13,000-100,000) in the South Africa pediatric population over 1 year compared with the status quo. This combined strategy was cost-effective (ICER $9,050 per DALY; 95% CI, 2,890-22,920) and remained cost-effective above an annual risk of infection of 1.6%. For annual risk of infection between 0.8% and 1.6%, routine screening at age 2 was the dominant strategy.Routine screening for tuberculosis among young children combined with contact tracing and preventive treatment would have a large public health impact and be cost-effective in preventing pediatric tuberculosis deaths in high incidence settings like South Africa.
View details for DOI 10.1093/cid/ciad449
View details for PubMedID 37542465