Author Archives: Sentinel Project

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“

06 Jun

Adverse effects and adherence in children treated for MDR-TB

This webinar recorded on June 6, 2014 covers the following topics:

  • Adverse effects of the TB medications commonly used to treat MDR-TB;
  • Management of the most frequent and clinically relevant adverse effects in children with MDR-TB; and
  • Adherence challenges and strategies to support optimal treatment adherence.

View a recording of the webinar here. View a PDF version of the slides here.

21 May

Household considerations in the management of children with DR-TB: Contact tracing and infection control

Because DR-TB is a disease of families, this webinar recorded on May 21, 2014 focuses on the impact of DR-TB on the household, specifically:

  • Active case-finding strategies for DR-TB, including household contact surveys;
  • Results of published DR-TB household contact studies;
  • Approaches to DR-TB prevention in households and the community, including preventive therapy and infection control.

View a recording of the webinar here. View a PDF version of the slides here.

25 Apr

Regimen design and dosing for children with drug-resistant TB: A case-based discussion

This webinar recorded on April 25, 2014 was presented by Drs. Jennifer Furin and James Seddon, members of the Sentinel Project on Pediatric Drug-Resistant Tuberculosis. This case-based discussion covers key principles for regimen construction in children with DR-TB, the latest dosing recommendation and PK data on second-line drugs in children, and the use of new TB drugs and regimens in children with DR-TB.

View a recording of the webinar here. View a PDF version of the slides here.

14 Mar

Demonstration of gastric aspiration technique in children

The Sentinel Project on Pediatric Drug-Resistant Tuberculosis (www.sentinel-project.org) has developed an 18 minute video on the gastric aspirate technique in children.

This webinar recorded on March 14, 2014 includes the video and a Q & A session on the technique with members of the Sentinel Project.

View a recording of the webinar here. View a PDF version of the Standard Operating Procedure here.

31 Oct

Post-graduate course 04: Managing children with drug-resistant tuberculosis: a practical approach

Post-graduate Course 04. Managing children with drug-resistant tuberculosis: a practical approach

Thursday, 31 October 2013, 9:00 – 17:00, Room: 341

44th Union World Conference on Lung Health, 30 October – 3 November 2013, Paris, France

Description

Despite some advances in expanding access to effective treatment for drug-resistant tuberculosis (DR-TB), children remain largely neglected. Diagnosis of DR-TB in children is perceived to be challenging and few providers have experience managing children with DR-TB. This course aimed to provide workers with practical advice and guidance to manage children with DR-TB. It addressed diagnosis, prevention, treatment, delivery of medication doses, management of adverse events, and approaches to the programmatic management of DR-TB in children.

This course was aimed at any health care worker who may manage children with drug-resistant tuberculosis. The course’s strong clinical and practical components were of use to those working in the community, clinic, hospital, or TB programme.

Presentations

  1. Overview of the epidemiology of DR-TB in children
    Soumya Swaminathan (India)
  2. Family-centered approach: framework for managing children exposed to DR-TB
    Jeffrey Starke (USA)
  3. Diagnosis of DR-TB disease in children
    Carlos Perez-Velez (USA)
  4. Treatment of DR-TB disease in children and preventive therapy for children exposed to DR-TB
    H. Simon Schaaf (South Africa)
  5. Pharmacokinetics of second-line TB drugs
    Helen McIlleron (South Africa)
  6. Practical approach to weight-based dosing
    Carole Zen Ruffinen (Switzerland)
  7. Co-morbidities, monitoring and adverse events, nutritional support and adherence
    Jennifer Furin (USA)
  8. Program monitoring and evaluation, including registers and forms
    Florian Marx (Germany)
  9. Implementing a protocol to evaluate child contacts of DR-TB patients
    Farhana Amanullah (Pakistan)
  10. Managing DR-TB in pregnancy, mothers and newborns
    James Seddon (UK)

Coordinators: Mercedes Becerra (USA), James Seddon (UK)

Chairs: Mercedes Becerra (USA), James Seddon (UK)

 

 

31 Oct

The inclusion of children in national TB prevalence surveys: a critical step towards achieving zero TB deaths

Thursday, 31 October 2013, 13:30 – 17:00, Room: 251

44th Union World Conference on Lung Health, 30 October – 3 November 2013, Paris, France

Workshop sponsored by The Stop TB Partnership

Description

Prevalence surveys are important for measuring the burden of, and trends in, TB disease. With these data, national tuberculosis programmes (NTPs) can assess the impact of their efforts,and identify the reasons why cases may not have been diagnosed. This information can then be used to identify strategies for improving the rate of case detection, attaining more timely diagnosis, and providing better treatment. However, the majority of countries continue to not include children less than 15 years of age in their national surveys of TB disease, even though they constitute approximately a third of their population.

This symposium was targeted at health policy-makers, public health officials, epidemiologists, technical advisors, patient advocates, implementers, clinicians (physicians, nurses, physiotherapists, respiratory therapists), and researchers. Its objectives were to:

1. Review the history of TB prevalence surveys that included children and the measures taken to accomplish this.
2. Review the epidemiologic science, the tools, and the related ethical considerations, for including children.
3. Review the implementation science for measuring TB burden in children, in resource-limited and -rich countries.
4. Review the reasons why the inclusion of children in national TB prevalence surveys has not been recommended.
5. Promote discussion on the inclusion of children in national prevalence surveys of TB disease.

Presentations

1. Importance and history of measuring the burden of TB disease in children
Peter Donald (South Africa)

2. The epidemiological science for measuring the burden of TB disease in children
Annelies Van Rie (USA)

3. The implementation science for measuring the burden of TB disease in children
Anneke Hesseling (South Africa)

4. Current recommendations and supportive efforts of the WHO for measuring the burden of TB disease in children
Babis Sismanidis (Switzerland)

5. Potential solutions for overcoming the challenges in measuring the burden of TB disease in children
Jeffrey Starke (USA)

6. Round-table discussion: how should countries measure their burden of TB disease in children?
Elizabeth Gardiner (USA)

Coordinators: Carlos Perez-Velez (USA), Soumya Swaminathan (India)

Chairs: Steve Graham (Australia), Carlos Perez-Velez (USA)

(Photo credit: Stop TB Partnership, Shehzad Noorani)

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)