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.

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.

27 Jan

Setting priorities for a research agenda to combat drug-resistant tuberculosis in children

In the December 2015 edition of Public Health Action, a Sentinel Project task force published the results of their work. In this original report, they aimed to systematically identify and rank research priorities in childhood drug-resistant TB through a survey of the Sentinel Project network. Research priorities identified in the study include the best combination of existing diagnostic tools for early diagnosis, reasons for and interventions to improve treatment outcomes, adverse effects of drugs and optimal treatment duration, prevalence of drug-resistant TB, and interventions for optimal diagnosis, treatment and modalities for treatment delivery.

We thank all of the colleagues who participated in the survey.

To read the complete Open Access article, visit the Public Health Action website here or download the PDF here.

27 Jan

Proceedings: Global Consultation on Best Practices in the Delivery of Preventive Therapy for Households Exposed to Drug-Resistant Tuberculosis

On April 12-13, 2015, members of the Sentinel Project participated in the “Global Consultation on Best Practices in the Delivery of Preventive Therapy for Households Exposed to Drug-Resistant Tuberculosis” held in Dubai, UAE at the Harvard Medical School Center for Global Health Delivery–Dubai. A global panel of 51 tuberculosis practitioners from 33 cities in 19 countries gathered to synthesize evidence and produce practical guidance for the management of children and adults who are household contacts of patients with DR-TB. 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.

A policy brief outlining principles and recommendations for the management of children and adults who are household contacts of patients with DR-TB was also produced from the meeting. Download the policy brief “Post-Exposure Management of Multidrug-Resistant Tuberculosis Contacts: Evidence-Based Recommendations” as a PDF here.