Integrating childhood TB: applying the care delivery value chain to improve pediatric HIV/TB services in Togo, West Africa

Melanie Dubois, Elissa Z. Faro, Diana S. Lee, Venance Katin, Komlan Kenkou, Kevin P. Fiori

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


The World Health Organization has prioritized integrating tuberculosis (TB) and human immunodeficiency virus (HIV) services. Diagnosis of HIV/TB coinfection in children remains a challenge worldwide for numerous reasons. The care delivery value chain (CDVC) is an effective tool that can be applied as a systemic framework for assessing health care delivery. Our objective was to apply the CDVC framework to improve pediatric HIV/TB care at an HIV center in northern Togo that serves over 130 children and 1000 adults living with HIV. Using the CDVC framework, gaps in HIV/TB care were identified, and services related to screening and diagnosis were prioritized to implement 3 distinct quality improvement cycles. Primary outcomes included percentage of children screened for TB by medical providers and percentage of diagnostic sample results received at the HIV clinic for children and adults. Improvements in the TB diagnostic process were observed, resulting in a change of sputum sample results received for both children and adults from 25% at baseline to >88% at 3 months. Given the relative low associated costs, this QI approach may be applicable and feasible in other settings to target screening and diagnosis of TB for children living with HIV worldwide.

Original languageEnglish (US)
Pages (from-to)1445-1450
Number of pages6
JournalAIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV
Issue number11
StatePublished - Nov 1 2020


  • Pediatric tuberculosis
  • Togo
  • West Africa
  • care delivery value chain
  • global health
  • pediatric HIV

ASJC Scopus subject areas

  • Social Psychology
  • Health(social science)
  • Public Health, Environmental and Occupational Health


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