Maternal and Child Tuberculosis

Goal: To serve as a community of practice for investigators, program managers, and advocacy groups who are working to improve TB prevention, detection, and treatment for women and children by integrating TB and TB/HIV services in maternal and child health settings

Objective: To share information about promising practices and experiences with country implementation; disseminate informational, educational, and communications resources; advocate for increased attention to the needs of women and their children with TB and TB/HIV; and close critical research and practice gaps in this field

Current Activities: 

• Continued advocacy around inclusion of Maternal TB notifications in the Global TB Report
• Advocacy including raising awareness about maternal/infant TB among TB and non-TB-focused fora and conferences
• Advocating for maternal/infant variables in the drug-resistant TB individual patient database
• Continue working on Cochrane Review TB Symptom Screen in Pregnancy
• Hosted a meeting to develop a TB and Pregnancy Guide in 2022

Recent Maternal and Child Tuberculosis achievements: 

Inclusion of Maternal TB Notifications in the Global TB Report. We sent a detailed motivation to the WHO GTB. Their response was generally favorable, but WHO GTB concerns about workload for individual countries and the lack of electronic based systems in many high-burden countries. Therefore notifications in pregnant and postpartum women were not included in the 2021 Global TB report.

We surveyed 5 countries with case-based electronic systems for their ability and desire to collect data around maternal TB. Four of five countries (Brazil, Lesotho, South Africa and Zimbabwe) responded to the survey. All four countries agree with the importance of collecting these data. However, in 3 of 4 countries, current systems would not allow easy collection and reporting of these data at this time, though they did indicate a desire to update their systems. 

STAG: We continued to advocate for a maternal TB representative appointed to the Strategic and Technical Advisory Group for Tuberculosis (STAG-TB). This year, the focus of the STAG meeting has been on COVID-19 and TB. We will continue to work on advocating for a Maternal/Infant representative in 2022. 

Research

Continued Work on a Pregnancy Registry: The US FDA attempted to establish a CURE Drug Repurposing Collaboratory (CDRC) to make a “Pregnancy Treatment Repository” publicly available. Due to insurmountable logistical challenges, this is no longer being pursued. The DR-TB individual patient dataset (IPD) is now being hosted at and curated by UCL, in collaboration with WHO GTB.  We are exploring opportunities to add pregnancy and infant variables as well as how to link maternal and infant data. Initial discussions were favourable. 

Cochrane Review: TB Symptom Screen in Pregnancy: Protocol published; Final analysis and manuscript pending (COVID-delayed)

Advocacy

• Raising awareness among TB and non-TB-focused fora and conferences
• CROI 2021: Pregnancy, HIV, and Tuberculosis: Current Practices and Research Opportunities
• US National TB Controller Conference: Tuberculosis in Pregnancy 
• TB and Pregnancy Guide: A group was established and partners were chosen. We aim to develop a collaboration of researchers, clinicians, patients and advocates to develop a Tuberculosis in Pregnancy Field Guide. This field guide will share evidence and best practices for preventing, diagnosing and treating DS and DR-TB among pregnant and postpartum women and their infants with a focus on low-resource settings. Work to develop the Guide will begin in 2022. 
• Advocated for a Maternal & Neonatal TB Representative in the core team of the child and adolescent TB working group (hosted by the Stop TB Partnership). Marian Loveday, one of our working group members, was added to the group.