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Management of childhood MDR-TB in Europe and Central Asia: report of a Regional WHO meeting

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BACKGROUND: As the WHO European Region has the highest proportion of multidrug-resistant TB (MDR-TB) among total incident TB cases, many children and adolescents are at risk of MDR-TB infection and disease.

METHODS: We performed an electronic survey of clinicians and TB programme personnel who attended the 2020 Regional Consultation on child and adolescent TB organised by the WHO Regional Office. We characterised access to diagnostics and drugs, and practices in the prevention and management of child and adolescent MDR-TB.

RESULTS: Children and adolescents are inconsistently represented in national guidelines and budgets; child-friendly drug formulations for MDR-TB treatment are insufficiently available in 57% of countries, and 32% of countries reported paediatric drug stock-outs. The novel drugs, bedaquiline and delamanid, are accessible by respectively 80% and 60% of respondent countries. Respondents were asked how many children were diagnosed with MDR-TB in 2019, and a comparison of this number to modelled estimates of incidence (to identify the case detection gap) and WHO notifications (to identify the case reporting gap) showed substantial differences in both comparisons.

CONCLUSIONS: Better representation of this patient group in guidelines and budgets, greater access to drugs and improved reporting are essential to reach TB elimination in this Region.

Keywords: WHO European Region; child health; childhood and adolescent tuberculosis; multidrug-resistant tuberculosis; public health

Document Type: Research Article

Affiliations: 1: Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA 2: Joint TB, HIV, and Viral Hepatitis Programme, WHO Regional Office for Europe, UN City, Copenhagen, Denmark 3: Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA, Division of Infectious Diseases, Boston Children´s Hospital, Boston, MA, USA 4: Republican Scientific and Practical Center for Pulmonology and TB, Minsk, Belarus 5: School of Health and Health-Related Research, University of Sheffield, Sheffield, UK 6: Istituti Clinici Scientifici Maugeri Istituto di Recovero e Cura a Carattere Scientifico, Tradate, Italy 7: Section of Paediatric Infectious Diseases, Department of Infectious Diseases, Imperial College London, London, UK, Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa 8: Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA, Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, MA, USA

Publication date: May 1, 2022

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