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.
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.
For additional translations of the Field Guide, please send a note to Sentinel_Project@hms.harvard.edu.
Did you miss the webinar “An Update on the Use of Bedaquiline and Delamanid in Children with MDR-TB,” which provided an update and synthesized timely clinical guidance on the use of bedaquiline and delamanid in children with MDR-TB? Slides from the webinar with Dr. Jennifer Furin are available here, and the resource referred to in the webinar “Rapid Clinical Advice: The use of Bedaquiline and Delamanid in Children with MDR-TB” is available as a PDF here.
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.
In collaboration with the Global TB Program at Texas Children’s Hospital, Sentinel Project members wrote, illustrated, and designed an activity book for children affected by TB. The activity book, “We can defeat TB! A book of stories and activities to learn about tuberculosis,” is currently available for download in English and SiSwati. This resource is not available in print at this time.
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.
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.
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!
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
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