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WHO Child TB guidance updated with Union support

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The Union is very pleased to announce that the World Health Organization (WHO) has released updated and consolidated guidelines on the management of TB in children and adolescents for World TB Day 2022, along with a detailed operational handbook to facilitate and support implementation.

Professor Steve Graham, child TB consultant with The Union, was Guidelines Development Group co-chair and member, and Dr Kobto Ghislain Koura, Acting Director TB Department, served as an external reviewer.

Important new recommendations based on careful review of the evidence include:

  • Support for decentralised care and services to detect-treat-prevent TB in children and adolescents
  • Strengthening clinical and laboratory diagnosis
  • Shorter treatment options for non-severe pulmonary TB and lymph node TB in children and young adolescents
  • A shorter and more intensive treatment option for TB meningitis
  • The use of bedaquiline and delaminid in children of all ages for the treatment of drug-resistant TB.

The Union has also updated and expanded the Diagnostic CXR Atlas for Tuberculosis in Children: A Guide to Chest X-ray Interpretation (the Atlas), to support the WHO guidelines using experience from the SHINE trial.

Two decades of child TB contribution

Prof Graham said: “The Union has a proud history of contributing to the progress made on child TB over the last two decades. The WHO child TB sub-group convened for the first time at The Union offices in Paris in 2003.”

In 2003, The Union's CXR Diagnostic Atlas of Intrathoracic TB in Children was also published and the sub-group published the first WHO Child TB management guidance for National TB Programmes (NTPs) in 2006, with the second edition published in 2014.

Since the beginning, The Union has been a core member of what became the WHO Child and Adolescent TB Working Group in 2016. This Working Group includes many active Union members, including members who worked with WHO and multiple stakeholders to develop the international Roadmap for Child TB (2013) and the Roadmap for Child and Adolescent TB (2018).

The Working Group holds its annual symposium each year at The Union’s World Conference on Lung Health. The Union Conference is the main forum that brings together practitioners, researchers, advocates, NTP staff and civil society engaged in work on maternal, child and adolescent TB. Many Union members and alumni have led or contributed to recent research that informed the recent guidelines update. An example is the recently published SHINE trial that evaluated a shorter regimen for non-severe TB in children, while The Union’s DETECT project in Uganda provided evidence to support decentralised TB services for children.

Developing the tools for success

Prof Graham added: “The Union has focused on addressing the wide policy-practice gap by developing job aides such as the Atlas guide, as well as classroom and online training to support implementation, especially at the primary and secondary care level.”

The Union projects, such as DETECT and TITI, have used these tools to provide highly successful and innovative models, and a Centre of Excellence on Child and Adolescent TB was established in the African region.

Prof Graham concluded: “The Union is committed to ongoing support for implementation of the recent WHO guidelines in order to increase detection, improve treatment outcomes including for drug-resistant TB, and to provide TB preventive treatment for children and adolescents who are recent TB contacts or living with HIV.”