The Paediatric Drug-Resistant TB Donation Initiative is led and funded by the Stop TB Partnership’s Global Drug Facility in partnership and with financial support from USAID.
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.
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.
For additional translations of the Field Guide, please send a note to Sentinel_Project@hms.harvard.edu.
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.
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.
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.
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.