New roadmap to end child and adolescent TB deaths

24 September 2018, New York - A new action plan outlining measures to prevent and treat tuberculosis (TB) in children and adolescents was launched today by global TB leadership in advance of the United Nations General Assembly High-Level meeting on TB.

Building on the first-ever Roadmap for Childhood TB: Toward Zero Deaths first issued in 2013, the new Roadmap towards ending TB in children and adolescents now includes recommendations on how to target young people aged between 10 and 19 years, who represent a significant at-risk group for TB.

An estimated one million children fell ill with TB (10% of all TB), and 233 000 children (under 15 years) died of TB in 2017. However, little data is available for adolescents who, despite making up 1 in 6 of the world’s population, have been largely overlooked as global momentum to address TB has grown.

“The first Roadmap published 5 years ago helped place the childhood TB epidemic into the global spotlight after decades of neglect. Today, we know more and can reach out to all young people with a clearer vision of what is needed, how to deliver it jointly with all our partners, with the priority actions and investments that are urgently required”, said Dr Tereza Kasaeva, Director of the WHO Global TB Programme. “Together, we can turn the tide on this hidden epidemic, ensuring timely access to care and prevention - saving young lives.”

Latest estimates suggest that over half (55%) of the estimated one million children with TB (0-14 years) were reported in 2017, making it a much higher gap in detection than that in adults (36%). This gap is even higher in children in the 0-4 year age-group. Finding and treating all TB cases – including among children and adolescents – is an urgent operational priority, particularly in high-burden countries. In addition, worldwide, only 23% of 1.3 million children under 5 years of age who were eligible for preventive therapy received this in 2017.

“Every child deserves a safe and healthy childhood. To honour our commitment to children, we must intensify our focus to find, diagnose and treat those at greatest risk,” said Stefan Peterson, UNICEF’s Chief of Health. “Together, we can do this through better primary care services that can reach children affected by tuberculosis everywhere.”

Tackling TB in adolescents (10–19 years)

An estimated 727 000 adolescents developed TB in 2012. Schools and other educational institutions where young people congregate provide multiple contacts for young people with infectious TB, yet few countries have a full understanding of tackling TB within this context so adolescent-friendly services for diagnosis and care are severely lacking.

In addition, peer pressure, fear of stigma, risk behaviours such as alcohol, substance and tobacco use, and co-infections such as HIV, create challenges for this age group – both in understanding the symptoms, the risks and seeking help for TB diagnosis and treatment.

The Roadmap recommends that 10–19-year-olds need adolescent-friendly services that include relevant psychosocial support and minimal disruption of education.

Ten steps to safeguard young lives

The Roadmap towards ending TB in children and adolescents recommends 10 actions to improve TB services and save tens of thousands of children and adolescent lives from TB, including among those infected with both TB and HIV:

• Strengthen advocacy at all levels -act on commitments made to date.
• Foster national leadership and accountability – allocate national resources, strengthen programmes.
• Foster functional partnerships for change - evaluate the best strategies for preventing and managing child and adolescent TB, and to improve tools used for diagnosis and treatment.
• Increase funding for child and adolescent TB programmes.
• Bridge the policy -practice gap – develop, implement evidence-based approaches at scale.
• Implement and expand interventions for prevention.
• Scale-up child and adolescent TB case-finding and treatment – include systematic screening of children and adolescents
• Implement integrated family and community centred strategies – to find the missing child and adolescent TB cases.
• Improve data collection, reporting and use – develop robust systems which capture this age group and can guide interventions that specifically address needs of children and adolescents.
• Encourage child and adolescent TB research - investments in paediatric research require US$180 million per year.

“Our children and our young people are some of the most vulnerable and susceptible to TB.” says Dr Lucica Ditiu, Executive Secretary of the Stop TB Partnership. “We must continue to focus on the most vulnerable, ramp up our commitment, investment and actions, and follow this roadmap to its conclusion - healthy children, thriving youngsters and an end to TB.”

Bringing childhood TB into the mainstream

Improving detection, prevention, developing better treatments and vaccines, scaling up prevention and case finding and integrating TB treatment into existing maternal, adolescent and child health programmes requires increased coordination and capacity building.

As more attention has focused on the need to address child and adolescent TB, experts have sought to broaden the net and involve organizations and agencies beyond the national TB programmes 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.

Implementing family-centred or community-centred approaches, will however, require not only effective collaboration and joint planning among TB programmes, but coordination with maternal, adolescent and child health services, HIV services, and other services provided outside the health sector.

Growing Global Awareness and Advocacy

The launch of the second roadmap on children, TB and adolescents combined with the United Nations General Assembly High-Level Meeting on TB present an important moment to consolidate and advance advocacy, commitment, resource mobilization and joint efforts by all stakeholders to address the burden of TB among children and adolescents.

This together with the new initiative launched earlier this year by WHO, Stop TB Partnership and the Global Fund will aim to close gaps in access to prevention and care. The Find.Treat.All #EndTB initiative aims to support countries in providing access to quality care to 40 million people with TB, including 3.5 million children, and, reach at least 30 million people with TB prevention services during the period 2018–2022. This was preceded in 2017 with the Moscow Declaration to End TB which recognized the vulnerability of women and children to the consequences of TB due to gender- and age-related social and health inequalities. Commitments were made to prioritize such populations in vulnerable situations, including women and children, as a critical step towards TB elimination.

The new Roadmap: Towards ending tuberculosis in children and adolescents is intended to be adapted by countries in accordance with national contexts and it is anticipated that it will be used by global, regional and national policy-makers; national TB, maternal and child health, HIV and other primary health care programmes that formulate strategies and plans for health services.

Resources:

• Social media toolkit can be found through here.

• Best Practices in child and adolescent tuberculosis care: http://apps.who.int/iris/bitstream/handle/10665/274373/9789241514651-eng.pdf

• Research priorities for pediatric tuberculosis: http://www.treatmentactiongroup.org/content/research-priorities-pediatric-tuberculosis

• Infographics

About the UN High-Level Meeting on TB

The United Nations General Assembly High-level Meeting on the Fight against Tuberculosis will take place on 26 September 2018, (find more here). The meeting follows the Global Ministerial Conference on Ending TB (Moscow, 16-17 November 2017), which resulted in high-level commitments from nearly 120 countries to accelerate the End TB response as expressed in the Moscow Declaration to End TB.

For more information on the UNHLM please access:
WHO: www.who.int/UNHLMonTB/
Stop TB Partnership: http://www.stoptb.org/global/advocacy/unhlm.asp
President of the General Assembly: https://www.un.org/pga/72/event-latest/fight-to-end-tuberculosis/

Source: WHO