title: Decentralised care for the management of child contacts of multidrug-resistant tuberculosis.
abstract: METHODS
  Cape Town, South Africa.
  
  
  OBJECTIVE
  To determine the number of multidrug-resistant tuberculosis (MDR-TB) child contacts routinely identified by health services, and whether a model of decentralised care improves access.
  
  
  METHODS
  All MDR-TB source cases registered in Cape Town from April 2010 to March 2011 were included. All child contacts assessed at hospital and outreach clinics were recorded from May 2010 to June 2011. Electronic probabilistic matching was used to match source cases with potential child contacts; the number of children accessing decentralised (Khayelitsha) and hospital-based care was compared.
  
  
  RESULTS
  Of 1221 MDR-TB source cases identified, 189 (15.5%) were registered in Khayelitsha; 31 (16.4%) had at least one child contact assessed. In contrast, 95 (9.2%) of the 1032 source cases diagnosed in the other Cape Town subdistricts (hospital-based care) had at least one child contact assessed (P = 0.003). Children in Khayelitsha were seen at a median of 71 days (interquartile range [IQR] 37-121 days) after source case diagnosis compared to 90 days (IQR 56-132 days) in other subdistricts (P = 0.15).
  
  
  CONCLUSIONS
  Although decentralised care led to an increased number of child contacts being evaluated, both models led to the assessment of a small number of potential child MDR-TB contacts, with considerable delay in assessment.
authors.affiliation: Desmond Tutu TB Centre, Faculty of Health Sciences, Stellenbosch University, Tygerberg, South Africa ; Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: J A
authors.initials: JA
authors.lastname: Seddon
authors.affiliation: Desmond Tutu TB Centre, Faculty of Health Sciences, Stellenbosch University, Tygerberg, South Africa.
authors.forename: A C
authors.initials: AC
authors.lastname: Hesseling
authors.affiliation: Desmond Tutu TB Centre, Faculty of Health Sciences, Stellenbosch University, Tygerberg, South Africa.
authors.forename: R
authors.initials: R
authors.lastname: Dunbar
authors.affiliation: Médecins Sans Frontières, Cape Town, South Africa.
authors.forename: H
authors.initials: H
authors.lastname: Cox
authors.affiliation: Médecins Sans Frontières, Cape Town, South Africa.
authors.forename: J
authors.initials: J
authors.lastname: Hughes
authors.affiliation: Department of Infectious Diseases Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: K
authors.initials: K
authors.lastname: Fielding
authors.affiliation: Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: P
authors.initials: P
authors.lastname: Godfrey-Faussett
authors.affiliation: Desmond Tutu TB Centre, Faculty of Health Sciences, Stellenbosch University, Tygerberg, South Africa ; Tygerberg Children's Hospital, Tygerberg, South Africa.
authors.forename: H S
authors.initials: HS
authors.lastname: Schaaf
keywords: access; care; child; decentralised; drug-resistant; paediatric; tuberculosis