Integrating Pediatric TB Services Into Child Healthcare Services in Africa

NCT ID: NCT03862261

Last Updated: 2022-03-23

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

1715 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-05-10

Study Completion Date

2021-12-31

Brief Summary

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Under-diagnosis of TB in children is a critical gap to address. The INPUT study is a multinational stepped-wedge cluster-randomized intervention study aiming to assess the effect of integrating TB services into child healthcare services on TB diagnosis capacities in children under 5 years of age.

Detailed Description

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Study clusters (district-level hospitals and their health centers) will start under standard-of-care and transition to the intervention at randomly assigned time points.

In this study two strategies will be compared: i) The standard of care, offering pediatric TB services based on current routine approach; ii) The intervention, with pediatric TB services integrated into child healthcare services.

The primary objective will be to assess the effect of the intervention compared to standard of care on the proportion of TB cases diagnosed among children \<5 years old (that is the number of children who are clinically or bacteriologically diagnosed with TB over the total number of children attending the child healthcare services). Secondary objectives are detailed in the protocol.

Study sites will include six hospital in each participating country (Cameroon and Kenya) along with selected attached health centers.

The study population will be children aged less than five years of age with a presumptive diagnosis of TB.

Study enrollment will start in March 2019, last enrollments until July 2020 and follow up will be completed by August 2021.

Conditions

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Tuberculosis Children, Only Diagnosis Delivery of Health Care

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

SEQUENTIAL

Cluster-randomized stepped-wedge model, where intervention will be randomly allocated to the different study sites at different time points.
Primary Study Purpose

DIAGNOSTIC

Blinding Strategy

NONE

Study Groups

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Standard-of-Care

Pediatric TB services based on current routine approach (national standard of care)

Group Type NO_INTERVENTION

No interventions assigned to this group

Intervention

Integrated pediatric TB services

Group Type EXPERIMENTAL

Integrated pediatric TB services

Intervention Type OTHER

pediatric TB services will be integrated into key child healthcare services: maternal neonatal and child health (MNCH) services, under-5 clinic, pediatric outpatient services, nutrition services, pediatric antiretroviral therapy (ART) services and primary health care:

* Integration of the screening into all the child health care services with introduction of a specific case detection tool and updated presumptive TB register.
* Improvement of diagnosis capacities and their integration in all levels of care and all services.

Interventions

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Integrated pediatric TB services

pediatric TB services will be integrated into key child healthcare services: maternal neonatal and child health (MNCH) services, under-5 clinic, pediatric outpatient services, nutrition services, pediatric antiretroviral therapy (ART) services and primary health care:

* Integration of the screening into all the child health care services with introduction of a specific case detection tool and updated presumptive TB register.
* Improvement of diagnosis capacities and their integration in all levels of care and all services.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Children \< 5 years old.
* TB diagnosis investigations initiated.
* Other infectious diseases are not suspected or have already been ruled out.
* Commitment to take treatment in the clinic of enrolment or another INPUT study site.
* Parental/caregiver consent for the child to participate in the study.

Exclusion Criteria

* Children who are TB contacts but without symptoms or signs of active TB
Maximum Eligible Age

5 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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UNITAID

OTHER

Sponsor Role collaborator

University of Sheffield

OTHER

Sponsor Role collaborator

Kenya Ministry of Health

OTHER_GOV

Sponsor Role collaborator

Cameroon Ministry of Public Health

UNKNOWN

Sponsor Role collaborator

Elizabeth Glaser Pediatric AIDS Foundation

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Appolinaire Tiam, MBChB, MMed

Role: PRINCIPAL_INVESTIGATOR

Elizabeth Glaser Pediatric AIDS Foundation

Locations

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Hopital de District Akonolinga

Akonolinga, Centre Region, Cameroon

Site Status

Hopital de District Soa

Okoa, Centre Region, Cameroon

Site Status

Hopital de District Loum

Loum, Littoral Region, Cameroon

Site Status

Hopital de District Foumban

Mbanga, Littoral Region, Cameroon

Site Status

Hopital de District Dschang

Dschang, West Region, Cameroon

Site Status

Hopital de District Mbouda

Mbouda, West Region, Cameroon

Site Status

Kendu Sub County Hospital

Kendu Bay, Homa Bay County, Kenya

Site Status

Ndhiwa Sub county Hospital

Ndhiwa, Homa Bay County, Kenya

Site Status

Kakuma Mission Hospital

Kakuma, Turkana County, Kenya

Site Status

Lokitaung sub-county hospital

Lokitaung, Turkana County, Kenya

Site Status

Lopiding Sub County Hospital

Lopiding, Turkana County, Kenya

Site Status

Homa Bay County Referral Hospital

Homa Bay, , Kenya

Site Status

Countries

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Cameroon Kenya

References

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Tchounga B, Tiam A, Masaba RO, Herrera N, Mbunka M, Siamba S, Goura AP, Ouma M, Petnga SJ, Tchakounte Youngui B, Zemsi A, Zoung-Kanyi Bissek AC, Okomo G, Simo L, Casenghi M, Tchendjou P, Ditekemena J, Rakhmanina N, Denoeud-Ndam L. Assessing tuberculosis clinical presentation, diagnosis and treatment outcomes among children under 5 years old: results from a cohort of children with presumptive TB in Cameroon and Kenya. BMJ Public Health. 2025 Jun 26;2(Suppl 1):e001566. doi: 10.1136/bmjph-2024-001566. eCollection 2024 Jul.

Reference Type DERIVED
PMID: 40740312 (View on PubMed)

Katirayi L, Masaba R, Tchounga B, Ndimbii J, Mbunka M, Ouma M, Olughu K, Siehien J, Petnga SJ, Casenghi M, Okomo G, Zoung-Kanyi Bissek AC, Tiam A, Denoeud-Ndam L; INPUT study team. 'We did not even know it was tuberculosis': a qualitative evaluation of integrating tuberculosis services into paediatric entry points in the CaP-TB programme in Cameroon and Kenya. BMJ Public Health. 2024 Jul 2;2(Suppl 1):e001001. doi: 10.1136/bmjph-2024-001001. eCollection 2024 Jul.

Reference Type DERIVED
PMID: 40017705 (View on PubMed)

Powell L, Denoeud-Ndam L, Herrera N, Masaba R, Tchounga B, Siamba S, Ouma M, Petnga SJ, Machekano R, Pamen B, Okomo G, Simo L, Casenghi M, Rakhmanina N, Tiam A. HIV matters when diagnosing TB in young children: an ancillary analysis in children enrolled in the INPUT stepped wedge cluster randomized study. BMC Infect Dis. 2023 Apr 17;23(1):234. doi: 10.1186/s12879-023-08216-w.

Reference Type DERIVED
PMID: 37069518 (View on PubMed)

Denoeud-Ndam L, Otieno-Masaba R, Tchounga B, Machekano R, Simo L, Mboya JP, Kose J, Tchendjou P, Bissek AZ, Okomo GO, Casenghi M, Cohn J, Tiam A; INPUT Study Group. Integrating pediatric TB services into child healthcare services in Africa: study protocol for the INPUT cluster-randomized stepped wedge trial. BMC Public Health. 2020 May 6;20(1):623. doi: 10.1186/s12889-020-08741-2.

Reference Type DERIVED
PMID: 32375741 (View on PubMed)

Other Identifiers

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EG0214

Identifier Type: -

Identifier Source: org_study_id

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