Tag Archives: News & Updates

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

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)

15 Sep

Pediatric TB course in Dhaka, Bangladesh

On July 15 2013, the Sentinel Project, sponsored by the United States Agency for International Development’s TB CARE II project, organized “Improving the Quality of Care for Children with Drug-Resistant TB” in Dhaka, Bangladesh. The workshop was attended by a total of 35 participants, primarily pediatricians from public and private hospitals and medical colleges. Local and international experts presented on pediatric MDR TB, diagnostic and treatment challenges, strategies for ensuring treatment adherence, monitoring and infection control. A special session demonstrated the gastric aspirate, a technique used for obtaining sputum samples from very young patients.  Participants discussed and recommended priority actions for scaling up the availability of services for pediatric MDR TB patients in Bangladesh. The recommendations include establishing a working group to oversee the planning and implementation of pediatric MDR-TB activities and provide clinical guidance; the design and implementation of a pilot project on contact tracing including specimen collection and referral; conducting operational research to support policy and strategy formulations; and updating medical curricula to improve education on the management of childhood TB.

15 Sep

Poster on second-line MDR-TB medications

We are pleased to share a recent poster presentation: “Administering Second-Line Antituberculous Medications to Children with Multidrug-Resistant Tuberculosis: A Qualitative Study.” The poster was presented by Erica Lessem at the Clinical Pharmacology Workshop on New TB Drugs on September 9, 2013 in Denver Colorado. This poster presents results from a very small qualitative study of clinicians providing care to children with MDR-TB, and points to the need to improved pediatric formulations for second-line drugs.

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.

07 Jun

Pediatric TB course in Chennai, India

From June 17-19 2013, the National Institute for Research in Tuberculosis and the Sentinel Project on Pediatric Drug-Resistant TB sponsored a training workshop on “Improving the Quality of Care for Children with TB and Drug-Resistant TB” in Chennai, India. The workshop was attended by 48 participants, primarily pediatricians from the public, private, and university sector, including all states of India and Nepal. The course was well-received by participants and all participants were engaged actively in the program. There was lively discussion and debate on both clinical and policy issues. The summary report can be found here, and recommendations can be found here.