Table 3. Examples of possible options analyses and recommendations to address gaps that are identified in the management of child contacts of adult TB cases.

Problem	Options	Evidence Analysis	Feasibility Analysis	Recommendation
Low screening attendance due to knowledge gap, distance, and cost issues	1. Educational video	Well received in relation to TB disease [26]	Subject to equipment and expertise availability	Develop and evaluate educational video for TB patients and contacts
	2. Decentralised symptom-based screening in the community and at community health centres	Decentralised provision of TB treatment improves uptake and completion [27]; symptom-based screening is safe [28]	Low cost; increased community clinic work load.	Symptom-based screening in the community; clinical evaluation and management at community clinics
	3. Cash transfer to stimulate attendance and subsequent adherence	Conditional cash transfer systems increase attendance at preventive treatment programmes [29]. Cost effectiveness is unclear.	Significant cost implications up front that need to be addressed	Pilot a cash transfer intervention with before and after evaluation, subject to finances
Over-diagnosis of TB disease in children	1. Specialised training in diagnosis of TB disease in children	Limited published evidence of effect on diagnostic accuracy	2 day centralised training courses are the most cost-effective	Introduce 2- to 5-day in-country training in diagnosis of child TB disease annually
	2. Remote interpretation of digital chest X-rays by WHO-accredited radiologists	Quality of X-rays and reading is acceptable and reliable	High cost of installation of digital X-ray machines	Consider digital X-ray and remote reading if high levels of over-diagnosis persist after training
Low adherence	1.Changing therapy from 6 months INH to 3 months RIF and INH	Efficacy is equivalent in adults but unclear if side effect profile is worse for 3-month regimen [30]. Some evidence of equivalent efficacy and improved adherence in children [8].	Lower cost; one extra medicine	Cohort study required for side effect profile in children before a change to 3-month regimen
	2. Parallel DOTs for children on preventive treatment with DOTs for index case	Some evidence that DOTs for preventive treatment would be effective [8]	Increased cost to provide DOTs, although economies of scale optimised if in parallel to index case DOTs	Introduce a modified DOTs programme for preventive treatment in parallel and overlapping with index case DOTs. Before and after evaluation.

DOT, directly observed therapy; INH, Isoniazid; RIF, rifampicin.