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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 Following the meetings and a review of published and unpublished evidence, the panel arrived at a set of seven principles summarized in this policy brief, along with the process employed to produce them.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.

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

10 Jul

Burden of childhood tuberculosis in 22 high-burden countries: a mathematical modeling study

Members of the Sentinel Project Network have published a paper titled, “Burden of childhood tuberculosis in 22 high-burden countries: a mathematical modelling study.” The paper was published in early online publication in the The Lancet Global Health on July 9, 2014. The aim of this paper is to estimate the incidence of infection and disease in children, the prevalence of infection, and household exposure in the 22 countries with a high burden of disease.

You can access an article highlighting the paper here.

Full Reference: Burden of childhood tuberculosis in 22 high-burden countries: a mathematical modelling study Dr Peter J Dodd PhD,Elizabeth Gardiner MSc,Renia Coghlan MPH,James A Seddon PhD The Lancet Global Health – 9 July 2014 DOI: 10.1016/S2214-109X(14)70245-1

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“

20 Sep

Administering second-line antituberculous medications to children with multidrug-resistant tuberculosis: A qualitative study

“I had one father tell me his boy eats more pills than food for breakfast.” TB physician, 32 years old, South Africa

There are more than 65,000 children living with multidrugresistant tuberculosis (MDR-TB) in the world today, and, while children have excellent outcomes from MDR-TB therapy, fewer than 1%
are diagnosed and treated for their disease. Even when a child is started on a regimen containing second-line drugs to treat MDR-TB, there are significant barriers to completing successful therapy and achieving cure. Almost none of these drugs is available in a child-friendly formulation.

We completed interviews with five nurses and four physicians from Peru, South Africa, Georgia, Romania and Bangladesh about the challenges of administering second-line drugs to
children. This poster presents data and quotes from those interviews.

“Administering Second-Line Antituberculous Medications to Children with Multidrug-Resistant Tuberculosis: A Qualitative Study” (September, 2013)

03 Jul

Novel pediatric delivery systems for second-line anti-tuberculosis medications: a case study

Members of the Advocacy Task Force have published a report entitled “Novel pediatric delivery systems for second-line anti-tuberculosis medications: a case study.” The paper was published online in the International Journal of Tuberculosis and Lung Disease. The aim of this paper is to present the development of a child-friendly delivery system for second-line medications.

Full reference: Furin J, Brigden G, Lessem E, Becerra MC. Novel pediatric delivery systems for second-line anti-tuberculosis medications: a case study. Int J Tuberc Lung Dis. 2013 Sep;17(9):1239-41. doi: 10.5588/ijtld.13.0196. Epub 2013 Jul 3.

11 Apr

Consensus statement on research definitions for drug-resistant tuberculosis in children

We are delighted to announce and share a new resource emerging from our network’s collaboration, “Consensus Statement on Research Definitions for Drug-Resistant Tuberculosis in Children.” The paper was published online in the Journal of Pediatric Infectious Diseases Society yesterday and the full reference is below. It was written by a Sentinel Project Task Force led by James Seddon. The aim of this paper is to advance a consistent terminology for use in research that we hope will result in more comparable data about children with DR-TB which can lead to more efficient syntheses and collective learning.

We also want to thank Professors Anneke Hesseling and Simon Schaaf of Stellenbosch University who provided funds to cover the costs of making this article immediately ‘Open Access.’

Full reference: Seddon JA, Perez-Velez CM, Schaaf HS, Furin JJ, Marais BJ, Tebruegge M, Detjen A, Hesseling AC, Shah S, Adams LV, Starke JR, Swaminathan S, Becerra MC, on behalf of the Sentinel Project on Pediatric Drug-Resistant Tuberculosis. Consensus statement on research definitions for drug-resistant tuberculosis in children. Journal of the Pediatric Infectious Diseases Society, first published online April 10, 2013. doi:10.1093/jpids/pit012

20 Mar

We Can Heal | Prevention, diagnosis, treatment, care and support: Addressing drug-resistant tuberculosis in children

This collection of 30 stories from 30 countries identifies what the TB community needs to achieve zero TB deaths, new infections, and suffering—a target recently called for by more than
500 individuals and organizations. Addressing the gaps in prevention, diagnosis, treatment, care, and support that this report outlines will bring us closer to realizing zero child deaths from
drug-resistant tuberculosis (DR-TB), a preventable and curable disease.

View a PDF version of the document here: “We Can Heal | Prevention, Diagnosis, Treatment, Care and Support: Addressing Drug-Resistant Tuberculosis in Children” (March, 2013)

02 Sep

Caring for children with drug-resistant tuberculosis: Practice-based recommendations

The management of children with drug-resistant tuberculosis (DR-TB) is challenging, and it is likely that in many places, the roll-out of molecular diagnostic testing will lead to more children being diagnosed. There is a limited evidence base to guide optimal treatment and follow-up in the pediatric population; in existing DR-TB guidelines, the care of children is often relegated to small “special populations” sections.

This article seeks to address this gap by providing clinicians with practical advice and guidance. This is achieved through review of the available literature on pediatric DR-TB, including research studies and international guidelines, combined with consensus opinion from a team of experts who have extensive experience in the care of children with DR-TB in a wide variety of contexts and with varying resources. The review covers treatment initiation, regimen design and treatment duration, management of comorbid conditions, treatment monitoring, adverse events, adherence promotion, and infection control, all within a multidisciplinary environment.