New Road Map for Tuberculosis Control in Children Launched

Joseph Elunya, Uganda 
(First published in The Continent Observer, Uganda)
The lives of more than 74,000 children lost to tuberculosis (TB) each year could be saved according to the first plan specifically to address TB in children, released today by the world’s leading agencies in the fight against the disease. The road map, released by International Union Against Tuberculosis and Lung Disease (The Union), World Health Organization (WHO), Stop TB Partnership, and other partners.

It estimates that at least US$120 million per year would be needed to address childhood TB, including in children infected with both TB and HIV. Every day, more than 200 children under the age of 15 die needlessly from this preventable and curable disease.

The World Health Organization (WHO) recently estimated that six to 10 per cent of all TB cases are among children, and that number could be much higher because TB in children often goes undiagnosed. The “Roadmap for Childhood Tuberculosis: Towards Zero Deaths” builds on what is already known about the disease to identify clear action steps that can prevent these child deaths. Under the banner of A Promise Renewed, over 175 countries have signed a pledge, vowing to redouble efforts to keep children from dying of preventable causes, including tuberculosis.  “Any child who dies from TB is one child too many,” said Dr. Mario Raviglione, Director, Global Tuberculosis Programme at WHO. “As we know, TB is preventable and treatable; this roadmap shifts our focus from the challenges we face to immediate actions we can take.”

“If we can shift TB diagnosis and treatment out of specialized programs and into other existing maternal and child health activities, we automatically gain reach and scale,” says José Luis Castro, Interim Executive Director of the International Union Against Tuberculosis and Lung Disease (The Union) to Citizen News Service – CNS. “Combining that scale with investment in tools and medicine would save tens of thousands of lives.”

“Far too many children with tuberculosis are not getting the treatment they need,” said Nicholas Alipui, Director of Programmes for UNICEF. “Most of these children live in the poorest, most vulnerable households. It is wrong that any children should die for want of a simple, affordable cure, especially where there are community-based options to deliver life-saving interventions.”

Addressing TB in children will require at least US$ 120 million a year in new funding from governments and donors, including US$ 40 million for antiretroviral therapy and preventive therapy for children co-infected with TB and HIV. The sum is needed to improve detection, develop better medicines for children and integrate TB treatment into existing maternal and child health programs. More pediatric health professionals actively screening for TB with better tools will help capture the full scope of the epidemic and reach more children with life-saving treatment sooner.

The “Roadmap for Childhood TB: Toward Zero Deaths” recommends ten actions to be taken at national and global levels:

1. Include the needs of children and adolescents in research, policy development and clinical practices.

2. Collect and report better data, including preventive measures.

3. Develop training and reference materials on childhood TB for health-care workers.

4. Foster local expertise and leadership among child-health workers at all levels of the health-care system.

5. Use critical intervention strategies, such as intensive case finding, contact tracing and preventive therapy; implement policies enabling early diagnosis; and ensure there is an uninterrupted supply of high-quality anti-TB medicines for children.

6. Engage key stakeholders, and establish effective communication and collaboration between the health-care sector and other sectors that address the social determinants of health and access to care.

7. Develop integrated family- and community-centered strategies to provide comprehensive and effective services at the community level.

8. Address research gaps in the following areas: epidemiology, fundamental research, the development of new tools (such as diagnostics, medicines and vaccines); and address gaps in operational research and research looking at health systems and services.

9. Close all funding gaps for childhood TB at the national and global levels.

10. Form coalitions and partnerships to study and evaluate the best strategies for preventing and managing childhood TB, and for improving tools used for diagnosis and treatment.

“If a small child can summon the bravery to complete a six-month TB treatment, the global community must be similarly brave in its ambitions to defeat the epidemic,” said Dr Lucica Ditiu, Executive Secretary of the Stop TB Partnership. “To get to zero TB deaths, we must focus on the most vulnerable groups and children are the most vulnerable of all. The steps outlined in this roadmap are simple and low-cost. We owe it to the children of the world to put them into action.”

As more attention has focused on the need to address child TB, experts have sought to broaden the net and involve organizations and agencies beyond the national TB programs that have contact with children. As much as possible, the Roadmap recommends that TB services for children be mainstreamed into existing children’s health services, and more responsibility and accountability be given to primary care providers.

“By scaling up existing tools and investing in improved approaches for the future, we can turn the tide on this hidden epidemic. But we must put these tools in the hands of front-line health-care workers and use every opportunity to identify children at risk for TB,” said Dr. Tom Kenyon, Director of the Center for Global Health at the U.S. Centers for Disease Control and Prevention. “We must ensure systems are in place to serve children through existing health, community and child-centered services.”

Moving to this type of family-centered or community-centered approach, however, will require effective collaboration and joint planning among TB control programs, maternal and children’s health services, and HIV services.

By integrating critical child TB interventions into community health services, we will contribute to the global goal of ending preventable child deaths. The next step will require investment and engagement at all levels, including families, frontline health workers, and community leaders. The Roadmap equips all involved with the tools needed to fight childhood TB. As a result, children will receive the quality and comprehensive care they deserve close to home,” said Katie Taylor, Deputy Assistant Administrator, Bureau for Global Health, USAID.

“Current diagnostics, toxic drugs and inadequate drug formulations are insufficient to respond to the needs of children with TB,” says Colleen Daniels, Director TB/HIV at Treatment Action Group (TAG). “New tools will be a crucial part of addressing TB in children and current investments are minimal at best. Much more investment and commitment to childhood TB is urgently needed now”.

Joseph Elunya, Uganda 
Citizen News Service - CNS | October 2013
(First published in The Continent Observer, Uganda on 2nd October 2013)