Impact of integrating tuberculosis and orphans and vulnerable children services on case-finding and treatment outcomes

BACKGROUND: Household poverty, malnutrition, overcrowding, and HIV infection place orphans and vulnerable children (OVC) at increased risk of tuberculosis (TB) disease and other adverse health outcomes. We integrated TB and OVC services in Uganda, comparing TB screening, diagnostic, and treatment outcomes before (October 2021-September 2022) and after (October 2022-September 2023) integration. METHODS: At baseline, TB services included passive TB screening for OVC program beneficiaries with HIV. During implementation, community-based staff conducted in-home TB screening and specimen collection, accompanied beneficiaries to health facilities, followed up diagnostic results, and provided adherence counselling. We compare screening, diagnosis, and treatment for TB before and after program integration using chi-square and Fisher's exact tests to assess strength of associations. RESULTS: Following integration, household members were three times more likely to be screened for TB [RR: 3.13, 95% CI: 3.06-3.2, P < 0.0001] and 10 times more likely to be diagnosed with TB (RR: 10.00, 95% CI: 3.61-27.68, P < 0.0001). Among 46 beneficiaries screening positive prior to integration, only four (9%) received TB diagnostic evaluation compared with 198/198 (100%) following integration ( P < 0.0001). At baseline, all beneficiaries evaluated (4/4, 100%) were diagnosed with TB, compared to 25% (49/198) following integration. All beneficiaries initiating treatment completed it during both time periods. CONCLUSION: Integrating TB services into OVC programming increased TB screening, diagnostic investigation, and case-finding among beneficiaries. These gains highlight the impact of harnessing OVC resources to address gaps in TB care, especially among populations that may face barriers to seeking care at a health facility.