The purpose of this study is to assess TB treatment outcomes and post-TB lung function and quality of life for children. We will use a TB care cascade – a series of ‘steps’ including the diagnostic rate of TB, bacteriologic confirmation, linkage to treatment, treatment success, and recurrence-free survival – to assess when and why children have different TB treatment outcomes. Specifically, we will assess the TB care cascade and treatment outcomes among children <15 years in the Sarah Baartman district, Eastern Cape, South Africa from 2023-2025.

We will determine gaps in the TB care cascade among children of different age groups and identify risk factors for outcomes along the TB care cascade (including HIV status, age, sex, and other confounders). Second, we will assess lung function and quality of life for children to develop a child-specific definition of post-TB lung disease (PTLD) to comprehensively expand the TB care cascade. Finally, we will assess air pollutant exposure (i.e., volatile organic compounds), nutritional status, and distance to clinic and associations with gaps in the TB care cascade and development of PTLD.

As more children successfully complete TB treatment, it is imperative we understand long-term survival and what constitutes PTLD. Little research has examined long-term care of TB survivors, especially among children. From the research we do have, 60-90% of adult patients have post-TB sequelae, so this is likely in children too. Understanding the burden of PTLD and quality of life in children is important so that interventions and rehabilitation programs can be tailored and targeted for those at highest risk. Finally, children have long lives ahead of them to look forward to, therefore minimizing their morbidity and optimizing their health is imperative.

This proposal is relevant and significant to child health – specifically among children in low resource, high TB/HIV burden settings and for children at-risk for considerable morbidity. Defining PTLD in children has the potential to change the landscape for comprehensive TB care for two reasons. First, because what gets measured, gets managed; and second, because it prioritizes morbidity and improvement in health rather than the status quo of mortality.