Method: We developed a decision analysis model to compare the yield, outcome, and cost incurred both to family and health sector of three child contact screening strategies: 1) tuberculin skin test (TST) and chest X-ray (CXR) were performed to all child contacts at initial screening (TST and CXR approach), 2) TST was performed to all child contacts at initial screening, and those with positive TST would have CXR performed (TST approach), and 3) TST and CXR were only performed to child contacts who have TB symptom at initial screening (symptom based). A child contact was assessed as having TB disease if having TB symptom and CXR suggestive TB, irrespective of TST result; latent TB infection (LTBI) if a child had positive TST but no TB disease. In the two previous strategies, isonoazid preventive therapy (IPT) was given to a child contact with LTBI, whereas in the symptom based strategy it was given to all child contacts who did not have TB disease.
Result: Symptom based screening strategy was most cost effective to prevent TB disease among child contacts aged less than five years. The cost for preventing TB disease among child contacts was USD 79.5 compared to USD 105.4 and USD 89.3 for “TST and CXR” and “TST” approaches, respectively. Symptom based screening was as effective as the other approaches in identifying TB disease among child contacts with the lowest cost.
Conclusion: Symptom based screening provides a simple, effective and low cost approach to child TB contact management that can be implemented at the primary health care setting.