Lindsay McKenna, TB Project Co-Director at Treatment Action Group, gives an overview of the recent advances in the management of TB in children, and elaborates what needs to be done to meet the 2022 targets set in the 2018 UN High-Level Meeting political declaration to end TB suffering and deaths in children.
In March the World Health Organization (WHO) released new guidelines on the management of TB in children and adolescents. These new consolidated guidelines, which are expected to improve the prevention, diagnosis, treatment, and care of children and adolescents with TB, arrive at a critical moment. We are in the final leg of the race to the 2022 targets set in the UN High-Level Meeting political declaration and yet just 63% of children below 15 years and 72% of children under five years with TB are reached by or officially reported to have accessed life-saving TB diagnosis and treatment services.
The new guidelines offer a shorter treatment regimen for most children with drug-sensitive TB (see Treatment Action Group (TAG)'s Activist Guide to Shorter Treatment for Drug-Sensitive TB), and finally extend access to bedaquiline and delamanid to children of all ages with drug-resistant TB, enabling all-oral regimens for all (see the 5th Edition of the Sentinel Project Field Guide for the Management of Drug-Resistant Tuberculosis in Children). But in order for children and adolescents affected by TB to benefit from these advances, they need to be diagnosed.
The new WHO guidelines include recommendations intended to bridge the diagnostic gaps in children and adolescents by expanding the specimen types that can be tested for TB using rapid molecular diagnostics beyond sputum and nasopharyngeal aspirates to include gastric aspirates and stool, which is easier to collect and less invasive. The new guidelines also support the use of treatment decision algorithms to diagnose TB in children, both in settings with and without access to chest x-ray. The use of these algorithms is especially important given the limitations of existing TB tests in children, as well as their limited availability in decentralized settings where many sick children are first presented to care. These limitations are well described by Médecins Sans Frontières (MSF) Access Campaign in a recent blog, available here.
TAG echoes MSF Access Campaign's call for governments and national programs to rapidly adopt these new guidelines, and for diagnostics manufacturers, governments, and other funders to seriously invest in the development of more sensitive tests that can accurately detect TB in children using easier to collect specimen types and that can be delivered at the actual point of care.
Making better use of what we have while simultaneously investing in the development of the diagnostic tools we need is the key to ending TB suffering and deaths in children and making good on the commitments made by heads of state during the UN High-Level Meeting in 2018. To do this we need to quadruple investments in TB programs and research and development to US$19.6 billion and $4 billion per year, respectively.
Join us in using these resources to push governments, national programs, and funders to do better for children and adolescents affected by TB, and to live up to the commitments made in 2018.
By Lindsay McKenna
TB Project Co-Director at Treatment Action Group