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.

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.


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

09 Nov

SAVE THE DATE – Pediatric DR-TB Symposia, Poster Sessions and More at the 46th Union World Conference on Lung Health

From December 2nd through 6th, 2015, TB researchers, practitioners, caregivers and advocates from around the world will be convening in Cape Town, South Africa for the 46th annual Union World Conference on Lung Health. Throughout the conference, experts in pediatric drug-resistant TB – including several Sentinel Project members and partners – will be hosting symposia, poster discussion sessions, oral abstract sessions, post-graduate courses and “Meet the Expert” sessions to discuss new developments in pediatric DR-TB.

We are excited to announce a symposium on Friday, December 4th entitled, “Research is needed to increase children’s access to drug-resistant TB care,” where several Sentinel Project members and colleagues will advocate for improvements in pediatric DR-TB research. For more information on this event, read our blog post here.

In addition to this symposium, Sentinel Project network members are conducting a post graduate course entitled “Best practices in the management of the second-line injectable drugs in children with multidrug-resistant TB,” scheduled from 09:00-16:00 on in Room MR 1.41 on Wednesday, December 2, 2015 during the conference. Click here to access the agenda for this event and see here for more information on pediatric DR-TB events.

We look forward to many productive discussions in Cape Town this December and hope to see many of you there!

For more information about the 46th annual Union World Conference on Lung Health, please visit their websitehttp://capetown.worldlunghealth.org/.

09 Dec

Dismantling the invisibility trap for children with drug-resistant tuberculosis

Tuberculosis (TB) is an airborne infectious disease that is both preventable and curable, yet it kills more than a million people every year. Children are highly vulnerable, but often invisible casualties. Drug-resistant forms of TB are on the rise globally, and children are as vulnerable as adult but less likely to be counted as cases of drug-resistant disease if they become sick. Four factors make children with drug-resistant TB ‘invisible’: first, the nature of the disease in children; second, deficiencies in existing diagnostic tools; third, overreliance on these tools; and fourth, our collective failure to deploy one effective tool for finding and treating children – contact investigation. Provisional annual targets, focused on children exposed at home to multidrug-resistant TB, to be updated every year, constitute a framework to focus attention and collective actions at the community, national and global levels. The targets tell us the number of: (i) children who require complete evaluation for TB disease and infection; (ii) children who require treatment for TB disease; and (iii) children who would benefit from preventive therapy.

Download full text here –  A targets framework: Dismantling the invisibility trap for children with drug-resistant tuberculosis

Full Citation:
Becerra MC, Swaminathan S. Dismantling the invisibility trap for children with drug-resistant tuberculosis. Journal of Public Health Policy (2014) 35, 425-454, published online 11 September 2014. doi:10.1057/jphp.2014.35

22 Oct

What’s in a number? Two recent reports on pediatric TB cases

This webinar recorded on October 09, 2014 reviews the following:

  • A 2014 report estimating global childhood TB disease incidence, including multidrug-resistant TB
  • A 2014 report estimating childhood TB infection and disease in high TB-burden countries
  • Practical implications for clinicians and other child health advocates

View a recording of the webinar here.

View a PDF version of the slides here.

21 Jun

MDR-TB weight-based dosing chart for children

This dosing chart provides recommendations for the acceptable doses of second-line TB drugs for children. This chart, available here, was developed by a team of experts in November 2013 based on published data as well as new PK data on the fluoroquinolones and aminoglycosides. The doses are based on weight bands and use tablet sizes currently available in most TB programs. Because children being treat for DR-TB often gain weight quickly, it is recommended that dose adjustments be considered on a regular basis (i.e. monthly).

For important disclaimers on the use of this dosing chart, please refer to the disclaimer section available in the Sentinel Project’s “Management of Drug-Resistant Tuberculosis in Children: A Field Guide