WHO algorithms could double number of children treated for TB

The WHO algorithms are guided scoring systems that allow physicians to put a child on TB treatment if their symptoms are strongly indicative of TB, even if laboratory tests are unavailable or test results appear negative. This is especially important in places without laboratories, which is the case in many of the places where MSF works.

This study was conducted with Test Avoid Cure Tuberculosis in Children (TACTiC), a project in MSF that aims to improve TB care for children. It evaluated the WHO algorithms in 1,846 children under 10 years old with symptoms suggestive of pulmonary TB between August 2023 and October 2025 across five countries: Uganda, Niger, Nigeria, Guinea, and South Sudan, including children facing severe acute malnutrition and children living with HIV. The MSF data showed that the WHO algorithms identified the majority of children with TB correctly and, on average, doubled the number that can be initiated on TB treatment—giving them a better shot at surviving the disease.

“Before, health workers relied on coughing,” said Dr. Angeline Dore, focal point for MSF’s TACTiC project in Guinea. “And as long as children weren't coughing, they thought they didn't have tuberculosis. The WHO algorithms now tell us not to rely on coughing since there are other signs for TB as well.”

An estimated 1.2 million children and young adolescents under the age of 15 years old fell ill with TB in 2024. Although the disease can be cured, TB in children often remains undiagnosed as the currently available laboratory tests are designed for adults and do not work sufficiently well in children. In addition, most laboratory tests require a sputum sample which children struggle to produce. Even when they do, the low bacterial levels in their lungs often make detection by laboratory tests impossible. The WHO Global Tuberculosis Report published last week showed that a staggering 43 percent of the children with TB missed diagnosis in 2024 and could not access lifesaving treatment.

In 2022, WHO revised its guidance for the diagnosis, treatment, and prevention of TB in children to be in line with the most recent scientific evidence. Among several important updates, the new WHO guidelines recommend the use of treatment decision algorithms for the diagnosis of TB in children for settings with and without access to X-ray. However, despite being recommended by the WHO, many countries have not yet adopted these algorithms into their national guidelines nor facilitated their implementation in health care facilities.

“Too many children with TB are still slipping through the cracks in the absence of effective diagnostic tools,” said Dr. Helena Huerga, principal investigator of the TACTiC research study conducted by MSF. “Our findings prove that WHO’s treatment decision algorithms, for which we do not need lab test results to initiate TB treatment in children, work in real-world settings and can potentially save many more children’s lives if implemented. The science is clear—what’s now missing is the political will to put it into practice.”

With the recent global aid funding cuts that threaten to widen gaps in identifying and treating people with TB, MSF is calling on countries and their stakeholders, including international donors, to step up and ensure sustained funding for TB care for all, especially young children as they already face the largest gaps in accessing treatment.

“In addition to timely adoption and implementation of the WHO algorithms, policymakers, donors, and implementers must also anticipate and plan for an increase in supply of medicines needed to treat children to ensure that all children who are diagnosed with TB can access TB treatment without any delay,” said Daniel Martinez Garcia, project leader of MSF’s TACTiC project.