Half the battle won with child-friendly TB drugs

Catherine Mwauyakufa, CNS Correspondent, Zimbabwe
We end the year 2015 with a sigh of relief for children as there has been a milestone achievement in TB treatment for children. A new and effective TB formulation for children has been unveiled. The world’s first appropriate child-friendly fixed dose combination (FDC) medicine to treat children with drug sensitive TB will soon be available in the market. This is bound to make medication, and hence treatment of childhood TB more manageable.

TB diagnosis in children has been a challenge due to its paucibacilliary nature; and thus has led to loss of lives at times due to late diagnosis. Moreover children are usually a bed rock for pneumonia, symptoms of which, at times, are confused with those of TB and vice versa. So it is not uncommon to put them on treatment for one, even though they suffer from the other.

Even in those children who are correctly diagnosed with TB, treatment challenges are formidable. This has been in focus and drawn lot of attention in the recent past. To improve TB management in children a Childhood TB Roadmap was formulated in 2013. This has been followed by an yet bigger achievement in the form of the first-ever child friendly TB drugs launched at the 46th Union World Conference on Lung Health in Cape Town in December 2015. Till now the adult pills have had to be broken to conform to WHO approved children’s dosage, with no guarantee whatsoever that the kids with TB were getting appropriate amount of medicines. With the availability of fixed dose formulations, this ambiguity is going to be a thing of the past. The new child-friendly formulation is flavoured and the tablet is dissolvable.

Dr Charles Sandy, National TB Programme Director, Ministry of Health and Child Care Zimbabwe, said that TB cases in children often go untreated as it is difficult to diagnose TB in children. “There are a lot of missed TB cases in children and this is due to the difficulty in diagnosing TB in children. The basis of TB diagnosis is sputum and children do not have the capacity to cough up sputum, hence it becomes a challenge. TB is often missed or overlooked due to non-specific symptoms and difficulties in accurately diagnosing the condition in children,” said Dr Sandy. Dr Sandy stressed that, “All HIV positive children must be screened for TB and all children with TB should be offered HIV testing and counselling”.

In Zimbabwe ART coverage for children is at 50%, which falls short of universal coverage. Dr Owen Mugurungu Director in the AIDS and TB Unit in the Ministry of Health and Child Care in Zimbabwe said that ART coverage for children has slightly improved but still falls way behind adult ART coverage. “In 2015 ART coverage for children rose to 50% but more work needs to be done if all children are to be in the safe net,” said Dr Mugurungi. The new child-friendly TB formulations have won half the battle in treating TB in children. Countries now need to ensure that key decision makers and consumers know that these new medicines exist. For Zimbabwe the country needs to garner enough political support, scale up children’s healthcare support and meet set goals.

“Children get TB at any stage but are most vulnerable at 1 to 4 years and the source usually is an infectious adult in the child’s close environment,” SAFAIDS said in the health report on managing TB. “In Zimbabwe 10% of children are affected with TB but we are currently reaching only 8%. Even though the use of the Gene Xpert machine has been very helpful in detecting TB in children, there is need to retrain health personnel,” said Dr Sandy. He hoped the country would have more machines soon so as to cover all areas.

Zimbabwe is one of the countries in the world with a high burden of TB. Switching to new formulations needs proper planning and financing to ensure smooth transition from the old system of dispensing anti TB medication to children. Zimbabwe, which relies on Global Fund support, must work on new funding models to capture the need for more funding. Fiscal space needs to be created to buy these new formulations and the speed with which this is done will determine their effectiveness in children with TB.

Catherine Mwauyakufa, Citizen News Service - CNS
January 2, 2015