10 Apr

Delamanid Compassionate Use Patient Access Form

There have been some important changes to the delamanid compassionate use protocol.  Delamanid is available for compassionate use and can be obtained from the company at no charge on a patient-by-patient basis.

The company has made some changes to their access and eligibility criteria and these are summarized below.  Perhaps most exciting is that the pediatric formulation of delamanid (a 25mg dispersible tablet) will also be available via compassionate use.  This formulation is not yet on the market but is an important tool for younger children with RR-TB.  We are thrilled the company has now made this formulation available for the children who need it.

Please find additional information below.

Delamanid Compassionate Use Patient Access Form

Updates to Delamanid Compassionate Use Protocol

Eligibility criteria

  • Male and female patients ≥ 3 years of age are eligible for CU DLM enrolment
  • Prior delamanid use is no longer an exclusion criterion

DLM treatment duration

  • The current protocol 242-302-00014 allows treatment extension of CU DLM on a case by case basis. Re-application for a treatment extension with delamanid can be made in exceptional cases, in order to minimize the probability of a resistance development to anti-TB treatment and/or enhance the likelihood of a favourable treatment outcome in difficult to treat cases.

Pediatric formulation

  • IMP of the pediatric formulation (dispersible tablets of 25 mg) is undergoing final packaging and testing and shall become available for patients enrolled in the updated CU protocol 242-302-00014 shortly.

PV reporting timelines

  • The updated CU protocol 242-302-00014 requires reporting of all safety information within 24 hours (not just for SAE as in the previous CU protocol 242-12-401 but all AEs + safety information)
18 Feb

StopTB/GDF’s Paediatric Drug-Resistant TB (DR-TB) Donation Initiative (EN / RUS)

The Paediatric Drug-Resistant TB Donation Initiative is led and funded by the Stop TB Partnership’s Global Drug Facility in partnership and with financial support from USAID.

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Management of Multidrug-Resistant Tuberculosis in Children: A Field Guide / (Russian)

Standard Operating Procedures for Administration of Dispersible Formulations of Second-Line Drugs For Clinical/Nursing Personnel / (Russian)

Drug Sheets for Dispersible Formulations / (Russian)

DR-TB & Me: Caring for a child with drug resistant TB / (Russian)

Standard Operating Procedures for Storage and Administration of Dispersible Formulations of Second-Line for Pharmacy Personnel / (Russian)

Pediatric Formulations of Second-Line Drugs for the Treatment of Drug-Resistant Tuberculosis / (Russian)

Summary Points on Pediatric Formulations of Second-Line Drugs for Tuberculosis / (Russian)

11 Jul

Recommendations for Injectable-Free Regimens in Children with Rifampin-Resistant Tuberculosis

In June 2018, the South African National Department of Health announced that bedaquiline will now be used to replace the injectable agent in routine treatment of rifampin-resistant and multidrug resistant tuberculosis (RR/MDR-TB) in patients over 12 years of age. We congratulate the leadership of the South African National TB program for taking this important step.

We note with some concern that children under the age of 12 years may be precluded from accessing the benefits of an all-oral RR/MDR-TB regimen. As such, we call for policies to support all-oral regimens for patients under 12 years of age in South Africa and globally.  In partnership with the Desmond Tutu Tuberculosis Centre (DTTC) and Treatment Action Group (TAG), Sentinel Project has developed the following recommendations for injectable-free regimens for children under the age of 12 years.
Please download these recommendations here: Recommendations for Injectible-Free Regimens in Children with Rifampacin Resistant TB.

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.

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.

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.

16 May

Advancing Access for New TB Drugs for Children

The Sentinel Project’s Advocacy Task Force has developed “Rapid Clinical Advice” on the use of new TB drugs in children. This was produced by a global committee of 18 clinicians who are experts in the management of MDR-TB in children.

This document is meant to complement the Sentinel Project’s Field Guide on the management of MDR-TB in children (available here) and synthesize timely clinical guidance on the use of new drugs for providers who are caring for children with drug-resistant TB. Rapid Clinical Advice: The Use of Bedaquiline and Delamanid for Children with Drug-Resistant Tuberculosis  is available as a PDF here.