Table 1

A child contact’s journey through the CCM cascade in commonly available models and an example of challenges that could be overcome by a flexible model

	Facility	Community	Example of challenges overcome by a flexible framework
Identification	An adult with TB is invited to bring child contacts aged <5 years into the facility for TB screening by HCWs.	A household where the adult with TB resides is visited by HCWs to investigate if any child contacts aged<5 years lives in the household.	An adult with TB reveals that they only see their children over the weekend in a rural area. The HCW confirms that the adult with TB’s partner would be open to a household visit and communicates this with a colleague at the closest facility to the partner’s home. This communication and identification of the child contact is tracked in an electronic system.
Screening	Child contacts are screened in the facility. Several evaluation algorithms exist globally so screening and diagnostic testing may vary.	Child contacts are screened in the community, that is, household or community centre. Several evaluation algorithms exist globally so screening and diagnostic testing may vary. Some programmes may have the capacity to conduct mobile diagnostics in the community.	A community health volunteer (CHV) from the partner’s nearby facility visits the child’s home. It becomes clear that this family cannot afford bringing the asymptomatic child to the health facility for evaluation. The CHV seeks guidance the following week through mentors via a virtual telementoring programme and receives affirmation that TPT can be started given the child is asymptomatic.
TPT initiation	TPT is initiated at the facility.	TPT is initiated in the community, that is, household or community centre. If in the household, HCWs carry medication and a light-weight scale to the home. If in a community centre, medication is stored there.	Since the family has limited funds, shared-decision making among the adult with TB, their partner, their HCW, and the CHV at the nearby facility leads to a plan for the adult with TB to pick up medications (based on child’s weight) for the child at their healthcare facility, and bring the medication home for the child over the weekend to initiate TPT. The CHV visits the household to confirm initiation.
TPT completion	TPT follow-up occurs monthly in the facility to monitor adherence and side effects and distribute medication refills. This can happen via child contacts reporting monthly with adults with TB/caregivers or with careful verbal reporting via adults with TB/caregivers so that child contacts do not need to come into the facility every month.	TPT follow-up occurs monthly in the community, that is, household or community centre, to monitor adherence and side effects and distribute medication refills.	The CHV visits the household monthly to monitor for side effects and weigh the child. This weight is reported to the healthcare worker at the adult with TB’s facility who checks the dosing and prescribes the appropriate TPT monthly. The adult with TB picks up the medication at their visits eliminating unnecessary travel and decreasing financial burden on the family.

HCWs, Healthcare workers including doctors, nurses, community health volunteers, or lay workers, who are associated with health facilities and provide care to patients.
CMM, child contact management; TB, tuberculosis; TPT, TB preventive treatment.