29 Mar

How to Care for People Exposed to Drug-Resistant Tuberculosis: A Practical Guide

The Sentinel Project resource, “How to Care for People Exposed to Drug-Resistant Tuberculosis: A Practical Guide” is now available.

This Guide builds on World Health Organization (WHO) recommendations for the management of individuals who have been exposed to TB and DR-TB, but focuses more on the practical implementation of interventions that should take place in the post-exposure setting. While the WHO policies stress that investigating household contacts of TB patients must be done on an “urgent” basis for all contacts of a patient with DR-TB, there is limited information available on what these evaluations and interventions should include. Furthermore, many of the recommendations and tools that do exist only focus on medical issues, omitting other pressing psychosocial needs that must be routinely assessed as well. DR-TB affects not only individuals but their households as well. Even when only one person has become sick, the whole household requires some intervention to reduce discrimination, improve patient support, and avoid unnecessary morbidity and mortality. This Guide aims to provide a way of thinking about the challenges around those exposed to DR-TB. It also aims to provide guidance on DR-TB prevention and management strategies needed to address the enormous health threat presented by DR-TB, as well as the tools necessary to carry them out.

This Guide is available in English and Spanish.

For additional translations of the Field Guide, please send a note to Sentinel_Project@hms.harvard.edu.

08 Mar

Webinar | MDR-TB Treatment with Bedaquiline in Children and Adolescents: Global Recommendations and Program Experience in Belarus

On November 21, 2017, the Sentinel Project co-sponsored a webinar with DR-TB STAT, entitled “MDR-TB Treatment with Bedaquiline in Children and Adolescents: Global Recommendations and Program Experience in Belarus.” Dr. Alena Skrahina, MD, PhD, DSc, presented interim results of bedaquiline use in the treatment of children and adolescents with multi-drug resistant tuberculosis in Belarus. Dr. Skrahina discussed the acceptability of bedaquiline-containing regimens, culture conversion results, and the occurrence of adverse events. Dr. Skrahina was joined by Dr. Jennifer Furin as commentator and moderator.

08 Mar

Webinar | Recent Developments in the Field of Pediatric MDR-TB

On October 26, 2017, the Sentinel Project sponsored a presentation by Dr. Anthony Garcia-Prats and Dr. Anja Reuter entitled “Recent Developments in the Field of Pediatric MDR-TB.” Dr. Garcia-Prats reviewed emerging pharmacokinetic data on repurposed and novel second-line antituberculosis drugs in children, with a focus on implications for pediatric dosing.  He reviewed ongoing pediatric trials and discuss expected data from these trials. Dr. Reuter discussed early experience with new TB drugs in early adolescents and children. She presented clinical cases of adolescents on treatment with new DR-TB drugs in a primary health care setting in Khayelitsha, South Africa. Dr. Garcia-Prats and Dr. Reuter were joined by Dr. Jennifer Furin as commentator and moderator. Slides from the webinar are available here.

11 Apr

Webinar | Injectable-Sparing Regimens for Children

On April 7, 2017 the Sentinel Project co-sponsored a webinar with DR-TB STAT, entitled “The Time Has Come: The Case for Injectable-Sparing Treatment Regimens for Children with MDR-TB.” Dr. Ethel Weld reviewed evidence and experience that supports the treatment of children with MDR-TB disease using regimens that do not require an injectable agent. Dr. Weld was joined by Dr. Kelly Dooley as commentator and Dr. Jennifer Furin as moderator. Slides from the webinar with Dr. Weld are available here, and the corresponding article published on March 23, 2017 in the Lancet Respiratory Medicine is available here.

11 Apr

Use of Bedaquiline in Adolescents

On March 13, 2017, the World Health Organization issued a meeting report that included evidence on the use of bedaquiline in 537 individuals treated for MDR-TB disease, including adolescents. In light of this new data, a group of clinical experts from the Sentinel Project developed a brief update on bedaquiline, with recommendations to clinical providers and national TB programs. Please see the summary and recommendations here.

13 Dec

Management of Multidrug-Resistant Tuberculosis in Children: A Field Guide (Third Edition)

The Sentinel Project resource “Management of Multidrug-Resistant Tuberculosis in Children: A Field Guide, Third Edition” is now available.

This field guide is meant to serve as a tool for practitioners working with children at risk of infection or becoming sick with MDR-TB. This guide was developed by a team of experts who jointly have treated hundreds of children with MDR-TB over the last two decades in every region of the world. We hope it will be used in the field to rapidly increase the number of children receiving effective care for MDR-TB.

The guide focuses on issues relevant in clinical and programmatic practices and does not offer extensive background materials on management of MDR-TB, which can be found here. Case examples are included throughout the guide to demonstrate how the recommendations put forth in the field guide can be translated into practice. The third edition features updated information and incorporates two new anti-tubercular agents, bedaquiline and delamanid.

The third edition of the Field Guide is available in English and Spanish.

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For additional translations of the Field Guide, please send a note to Sentinel_Project@hms.harvard.edu.

09 Nov

Post-Exposure Management of Multidrug-Resistant Tuberculosis Contacts: Evidence-Based Recommendations

The Harvard Medical School Center for Global Health Delivery–Dubai celebrated its inaugural symposium on Sunday, October 25, 2015 at the Mohammed Bin Rashid Academic Medical Center in Dubai Healthcare City. At the launch, the Center distributed a policy brief, “Post-Exposure Management of Multidrug-Resistant Tuberculosis Contacts: Evidence-Based Recommendations,” which was written by Sentinel Project members.

The principles and recommendations outlined in this policy brief were developed by a global panel of 51 tuberculosis practitioners from 33 cities in 19 countries who gathered at the Harvard Medical School Center for Global Health Delivery–Dubai on April 12 and 13, 2015. This global consultation provided a forum for TB practitioners to synthesize evidence and produce practical guidance for the management of children and adults who are household contacts of patients with DR-TB. Following the meetings and a review of published and unpublished evidence, the panel arrived at a set of seven principles summarized in this policy brief, along with the process employed to produce them.

Download “Post-Exposure Management of Multidrug-Resistant Tuberculosis Contacts: Evidence-Based Recommendations” as a PDF here.

Download the full meeting proceedings “Global Consultation on Best Practices in the Delivery of Preventive Therapy for Households Exposed to Drug-Resistant Tuberculosis” as a PDF here.