19 October-1 December 2020
The 51st Union World Conference On Lung Health
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Channel 2
SP-04-Advancing TB prevention in children during the COVID-19 pandemic
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SP-04-Advancing TB prevention in children during the COVID-19 pandemic
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If resources are diverted away from child and adolescent tuberculosis (TB) programmes in order to fight COVID-19, consequences in resource-limited settings could be devastating. TB prevention is more important than ever but better strategies need to be developed and applied to deliver proven interventions for child TB contact management (CCM), TB preventive treatment (TPT) and BCG vaccination to newborns in the context of COVID-19. We will engage stakeholders by discussing early experiences of globally adapting CCM, TPT and BCG delivery during the COVID-19 pandemic. Sharing experiences is essential to identifying feasible and safe strategies that assist in maintaining essential TB prevention services.

12:30 - 12:35: Introduction

12:35 - 12:45: Overview of TB prevention services in children and adolescentsIn this talk, we will present a policy overview and coverage of tuberculosis (TB) prevention services among eligible children and adolescents. We will share reports from regional and country colleagues as well as partner organisations on the effect of COVID-19 on TB prevention services.
Annemieke Brands

12:45 - 12:55: The effect of COVID-19 on childhood TB preventive treatment services in sub-Sahara Africa: experiences from CaP TB projectContact investigation and delivery of tuberculosis preventive treatment (TPT) are World Health Organization-recommended core components of childhood TB programming. Between Q4 2018 and Q1 2020, the CaP TB project has supported facility-based implementation of those interventions in purposely selected sites across nine African countries. As of March 2020, project countries have started enforcing measures aimed at controlling the COVID-19 pandemic, with repercussions on accessibility to health services that varied among countries. This presentation will discuss the effect of COVID-19 control measures and interventions on delivery and accessibility of contact investigations and TPT services, as documented by key patient level indicators collected through the project framework for monitoring and evaluation. It will also discuss the effectiveness and feasibility of mitigation measures introduced to ensure continuation of those essential TB prevention services in the context of the COVID-19 pandemic.
Martina Casenghi

12:55 - 13:05: Impact of COVID-19 on 3HP rollout: experiences from IMPAACT4TBProvision of tuberculosis preventive therapy to household child contacts and people living with HIV is a key component of the END TB strategy. The IMPAACT4TB project was scheduled to begin roll out of 3HP, a new short-course TB preventive therapy regimen, in 12 high burden countries in March 2020 as the COVID-19 pandemic was beginning to unfold. As countries developed their COVID-19 response, there have been large ramifications for healthcare delivery, including contact investigations and TB prevention services. We will discuss mitigation measures and alternative models of care that have been implemented to ensure these services have continued during the COVID-19 pandemic response.
Nicole Salazar-Austin

13:05 - 13:15: Flexible child contact management frameworkThe World Health Organization roadmap for childhood tuberculosis recommends an ‘integrated, family and community-centred strategy’. Yet, there is no clear guidance on how health systems can operationalise such a strategy. it is crucial to recognise that barriers that impede successful child contact management (CCM) vary from family to family, even within the same community. COVID-19 further complicates delivery of CCM during the pandemic and recovery periods. We propose a flexible CCM framework, which goes beyond standardised approaches. Suggestions will be provided on how health systems could support a framework that is customised for each child’s/family’s needs as well as their varied environments.
Yael Hirsch-Moverman

13:15 - 13:25: Responsible use of BCG in the context of COVID-19 pandemicBacille Calmette-Guérin (BCG) vaccines are live vaccines (different strains) that have been used to protect mainly young children against severe forms of tuberculosis (TB) in high TB burden settings for many years. Recent BCG stock-outs emphasised its importance when TB meningitis cases soared among unvaccinated children. BCG’s effect on the immune system is not fully understood, but it has an immune modulating effect, which extends its use beyond TB prevention, e.g. it has proven value in treating non-invasive bladder cancer. A recent ecological study showed an association between lower mortality in COVID-19 cases and BCG coverage. However, this does not prove causality. Clinical studies are now being done to determine whether BCG protects against COVID-19 and likely other respiratory infections. We will provide an update on this topic.
H. Simon Schaaf

13:25 - 13:50: Q&A session

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E-posters
EP12-Approaches to paediatric TB prevention, diagnosis and treatment
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EP12-Approaches to paediatric TB prevention, diagnosis and treatment
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All E-posters are accessible via the "E-posters" section of the conference platform until 30 November.

EP12-208-22-Comparison of neurocognitive assessment in children with TB Meningitis and healthy controls in Pune, IndiaTuberculosis meningitis (TBM) in children affects the brain adversely and results into neurological deficit. The study used The Mullen Scales of Early Learning (MSEL), a well-established measure, to assess neurocognitive impairment among children with TBM before treatment initiation and compared with age-sex matched, healthy controls in India.
Smita Nimkar

EP12-209-22-Effect of community-based interventions on childhood TB treatment outcomes in hard-to-reach areas of Southern NigeriaTreatment Success Rate (TSR) is an important World Health Organziation treatment outcome indicator that measures the quality of tuberculosis (TB) services. We report the effect of a community-based intervention on childhood TB treatment outcomes in hard-to-reach areas of Southern Nigeria.
Okechukwu Ezeakile

EP12-210-22-Fine needle aspiration biopsy of peripheral lymph nodes in children in a high TB incidence setting: practical experience in a referral hospitalPeripheral lymphadenopathy is common in children. We identified all children (<13 years) over a two-year period who had fine needle aspiration biopsy (FNAB) done at Tygerberg Hospital, Cape Town, and determined how well FNAB performed in routine practice in a high TB burden setting and whether children were appropriately managed.
H. Simon Schaaf

EP12-211-22-The adverse effects of prolonged home isolation on adolescents with TB in Lima, Peru: a qualitative studyPeru’s Ministry of Health mandates two months of home isolation for patients with tuberculosis (TB), despite data showing the majority become non-infectious in less time. Prolonged home isolation may negatively impact adolescents’ development. Peruvian study workers interviewed 34 adolescents with pulmonary TB and 15 health providers working in TB care.
Victoria Oliva Rapoport

EP12-212-22-Feasibility of testing paediatric samples for TB diagnosis: implications of the pre-analytical phase, lessons learned and challengesPaediatric tuberculosis (TB) remains a significant cause of death globally, mainly due to difficulties in diagnosis.  Laboratory confirmation is only obtained in a minority of cases due to the difficulty in obtaining samples. The main objective of this analysis was to evaluate the feasibility of a multisample, paediatric TB diagnostic approach.
Neide Gomes

EP12-213-22-A systematic review of the diagnostic accuracy of Xpert MTB/RIF and Xpert Ultra for the diagnosis of TB Meningitis and lymph node TB in childrenWe will discuss the results of a systematic review on the diagnostic accuracy of Xpert MTB/RIF for the diagnosis of Tuberculous Meningitis and lymph node tuberculosis (TB) in children with signs and symptoms of TB.
Alexander Kay

EP12-214-22-Paediatric TB care cascade: an assessment of knowledge, attitude and practice among healthcare providers in Pune district, IndiaThe dependency on sputum for diagnosis and the difficulty of getting it from younger children is the key challenge in the diagnosis of paediatric tuberculosis. Household contact screening and isoniazid preventive therapy are not being implemented effectively due to lack of awareness on the part of healthcare providers, especially in the private sector.
Jitesh Kuwatada

EP12-215-22-Knowledge, attitudes and practices around childhood TB among healthcare workers in sub-Saharan Africa and South-East AsiaWe share the results of a Knowledge-Attitudes-Practices (KAP) survey conducted among healthcare workers (HCWs) at district level in five resource-limited countries. Our findings show great variability in awareness and experience of childhood tuberculosis (TB) case management and highlights potential barriers and facilitators to the decentralisation of childhood TB diagnosis.
Basant Joshi

EP12-216-22-Improving child TB notification through innovative case finding approaches in hard-to-reach areas of Delta State, NigeriaDespite the high prevalence of tuberculosis (TB) in Delta State, Nigeria, the child TB proportion of all TB cases has remained low. A multipronged intervention was implemented in quarter three of 2018 to address the persistent barriers. Implementing a similar strategy nationwide in Nigeria could have a major public health impact.
Ufuoma Aduh

EP12-217-22-Progress towards updated policy guidance for World Health Organization- recommended best practices in paediatric TB/RR-TB careResults from the #StepUpforTB 2020 study show promising adoption of World Health Organization policy guidance for optimal paediatric tuberculosis (TB)/rifampicin-resistant TB (RR-TB) and latent TB infection management.  Evaluating implementation of national paediatric TB/RR-TB guidelines in routine clinical care is the next step to ensuring children and adolescents benefit from best practices.
Pilar Ustero

EP12-218-22-Reasons and routes of admission among hospitalised children and adolescents with rifampicin-resistant TB receiving treatment in South Africa’s ‘injectable-free era’Children and adolescents with rifampicin-resistant tuberculosis (RR-TB) are often hospitalised during treatment. A South African policy released in September 2018 recommended injectable-free treatment for everyone with RR-TB. We describe reasons for hospital admission among individuals <16 years of age admitted for RR-TB treatment in the injectable-free era.
Juli Switala

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SP-19-Household and close contact investigation: a key gateway to TB prevention and case detection in children
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SP-19-Household and close contact investigation: a key gateway to TB prevention and case detection in children
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Children exposed to tuberculosis (TB) are at high risk of becoming infected and developing active TB disease. The World Health Organization recommends household TB contact investigation as routine public health practice. Scale-up of this intervention will be key to reach the End TB strategy and United Nations High-Level Meeting targets for paediatric TB case finding and prevention. Nevertheless, implementation of contact investigation remains challenging in TB-endemic countries. This session will review recent evidence on the effectiveness of contact investigation and TB preventive treatment (TPT) in children and discuss implementation approaches adapted for delivery in high-burden settings, including early implementer experiences on the roll-out of shorter TPT regimens.

12:30 - 12:35: Introduction

12:35 - 12:47: Assessing the risk of TB in children after close exposure: implications for implementation of contact investigation interventions in high TB burden countriesGlobally, tens of millions of children are exposed to an individual with tuberculosis (TB) annually. Drawing upon a multicohort collaboration of research groups, we aimed to explore two questions: i) estimating the risk of developing TB by time-period of follow-up, demographics (age, region), and clinical attributes (HIV, TB infection status, previous TB); and ii.) estimating the effectiveness of preventive therapy and BCG vaccination on the risk of developing TB. The results of this work will be presented in this session showing that the risk of developing TB among exposed infants and young children is very high and that most cases occurred within weeks of contact investigation initiation and might not be preventable through prophylaxis. Taken together, these findings suggest that alternative strategies for prevention are needed, such as earlier initiation of preventive therapy through rapid diagnosis of adult cases or community-wide screening approaches.
Leonardo Martinez

12:47 - 12:59: Implementation of contact investigation and TB preventive therapy provision in NepalBefore 2017, the Nepal national TB programme (NTP) mainly focused on passive case finding with limited active case finding activities. Contact tracing was implemented by the NTP in 38 high TB burden districts since early 2017. All household contacts undergo symptom screening and those screening positive are referred for tuberculosis (TB) evaluation, while children <5 without symptoms are referred for TB preventive therapy (TPT). Contact tracing of 27,982 bacteriologically-confirmed TB cases was done between March 2018 and December 2019.  There were 3,735 children initiated in TPT, with 96.8% retained in treatment (completing or still on treatment) and 3.2% discontinuing. Results have shown that contact tracing and a strong care cascade for TPT can be achieved in a low-resource setting, with an apparent immediate impact on TB outcomes. Programmes will be scaled-up throughout Nepal, through provision of adequate budget from both government and donors, maintaining routine supervision to ensure adherence and completion of TPT.
Suvesh Kumar Shrestha

12:59 - 13:11: Implementing household contact investigation in high TB burden, resource-limited settings: lessons learned from a multicountry project in nine sub-Saharan countriesContact investigation is recognised as an important intervention and it serves as a key entry point for both paediatric tuberculosis (TB) case finding and prevention. However, roll out and scale-up of contact investigation interventions remain challenging in high TB burden countries. The CaP TB project has implemented contact investigation interventions across nine sub-Saharan African countries and evaluated the cascade of care for both TB detection and TB preventive treatment. This presentation will review the evidence generated so far by the project, including early experiences on the use of the 3RH regimen under routine conditions, and discuss practical lessons learned on strategies and approaches that can improve implementation of contact investigation.
Martina Casenghi

13:11 - 13:23: Moving to shorter regimens for TB preventive treatment in children: current and future opportunitiesTuberculosis (TB) is a top cause of paediatric TB morbidity and mortality. Identifying recently exposed children and initiating TB preventive treatment (TPT) has been a longstanding approach to TB control. Short-course TPT has recently been endorsed by the World Health Organization and is an attractive solution to improving uptake and completion rates. There are many considerations for countries as they roll out short-course TPT for household child contacts and children and adolescents living with HIV. We will describe the current landscape for short-course TPT in both of these populations and highlight the gaps in our knowledge as they relate to paediatric dosing, drug interactions and efficacy. We will conclude with timelines for paediatric formulations for rifapentine and current research into 1HP and other novel short-course regimens.
Nicole Salazar-Austin

13:23 - 13:50: Q&A session

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SP-20-Improving access to laboratory-based diagnosis for young children: recent advances using stool and urine as alternative sample types
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SP-20-Improving access to laboratory-based diagnosis for young children: recent advances using stool and urine as alternative sample types
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While clinical diagnosis remains valuable, improving access to laboratory-based diagnosis for children with presumptive tuberculosis (TB) is critical to increase diagnostic certainty and ensure timely initiation on effective treatment, even more so in settings with high transmission of drug-resistant TB. Laboratory-based diagnosis in children is hampered by challenges in obtaining adequate specimens and sub-optimal performance of existing tests on pauci-bacillary specimens. Recently the World Health Organization recommended stool as a useful specimen to diagnose pulmonary paediatric TB and urine-based LF-LAM for children living with HIV. This session will review the latest evidence on the role of those alternative sample types for childhood TB.  

15:00 - 15:05: Introduction

15:05 - 15:15: Closing the case detection gap in children with TB: WHO updatesOver 1.1 million children (aged under 15 years) were estimated to have fallen ill with tuberculosis (TB) in 2018 and over 200,000 of them died, the majority before their 5th birthday. The case detection gap was estimated at 54% and was highest (63%) in children under five, due to -among others - the paucibacillary nature of TB, the lack of a sensitive point-of-care test and the challenges in collecting a respiratory sample for bacteriological testing in young children. This presentation will set the scene covering the latest epidemiological data on TB children as well as progress towards the United Nations High-Level Meeting on TB targets for children. Updated World Health Organization policy recommendations, relevant to the diagnosis and management of TB in children, will be discussed.
Sabine Verkuijl

15:15 - 15:25: Utility of stool samples for microbiological confirmation of TB in childrenIn January 2020 the World Health Organization published a Rapid Communication on the use of molecular assays as initial tests for the diagnosis of tuberculosis (TB). The conclusions support the continued use of Xpert MTB/RIF and Xpert Ultra in children including stool samples. 
Following up on last year’s symposium, two parallel evaluations of centrifuge-free stool processing methods are underway, including the Stool Processing Kit (FIND), Simple One-Step (KNCV) and Sucrose Flotation (TB-Speed) methods, in combination with Xpert Ultra. 
The head-to-head comparison includes an assessment of the performance for TB detection as well as the ease of use of the three methods.
Pamela Nabeta

15:25 - 15:35: Update on simple one step stool testing method and practical guidance on the best placement of this test in the diagnostic algorithmTo assess the accuracy, feasibility and acceptability of the KNCV SOS stool method as compared to Xpert on a gastric aspirate or an induced sputum specimen, the SOS stool method is being implemented in parallel to the routine algorithm in Ethiopia and Indonesia. This will provide more precise accuracy estimates and valuable lessons for scale-up. Modelling studies are underway to provide more insights into the best placement of the method in the diagnostic algorithms. This presentation will outline key lessons learned to be addressed for scale-up of stool processing in countries and provide insights on how it can best be placed in the diagnostic algorithm for childhood tuberculosis.
Edine Tiemersma

15:35 - 15:45: Accuracy of a novel urine test, Fujifilm SILVAMP TB LAM, for the diagnosis of pulmonary TB in childrenAn accurate point-of-care test for tuberculosis (TB) in children remains an elusive goal. A novel urinary lipoarabinomannan (LAM) test, Fujifilm SILVAMP TB LAM (FujiLAM) showed superior sensitivity to Alere Determine TB LAM (AlereLAM) in HIV-infected adults. We compared the accuracy of FujiLAM and AlereLAM in children with suspected pulmonary TB presenting to hospital in Cape Town, South Africa. There were 204 children enrolled who had valid results from index and sputum tests. Using a microbiological reference standard, sensitivities of FujiLAM and AlereLAM were similar (42% and 50% respectively), but lower than Xpert MTB/RIF of sputum (74%).   However, specificity of FujiLAM was substantially higher than AlereLAM (92% vs. 66%), suggesting that non-specific detection accounted for the apparent higher sensitivity of AlereLAM. Sensitivity of FujiLAM was higher in HIV-infected and malnourished children. The high specificity of FujiLAM suggests utility as a ‘rule-in’ test for TB in children, particularly those who are HIV-infected.
Mark Nicol

15:45 - 15:55: Keynote : overview of where we are in childhood TB diagnosisThis presentation will discuss the role of the  sample types and tests recently recommended for tuberculosis (TB) diagnosis in the context of clinical and programmatic management of childhood TB and summarise remaining challenges to be addressed to close the gap in paediatric TB case finding
Ben Marais

15:55 - 16:20: Q&A session

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EP23-TB in children and adolescents
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EP23-TB in children and adolescents
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All E-posters are accessible via the "E-posters" section of the conference platform until 30 November.

EP23-319-23-Chest-X-ray for TB diagnosis in children under 5 years living with a person with bacteriologically confirmed pulmonary TB in Africa: quality, inter-reader agreement and performancesThis study evaluates quality, inter-reader agreement and performances of chest X-rays (CXR) for tuberculosis (TB) diagnosis in children under 5 years of age, who are living with a person with bacteriologically-confirmed pulmonary TB, as part of a contact investigation study using systematic CXR.
Kobto Ghislain Koura

EP23-320-23-Classification and regression trees to predict TB disease in childrenThe diagnosis of tuberculosis (TB) disease in children is complicated by non-specific symptoms and low sensitivity of conventional diagnostic tests. We use classification and regression tree analysis to identify the best predictors for accurately classifying children (0-4, 5-9 and 10-14- years-old), who are exposed at home to TB, with TB disease.
Meredith Brooks

EP23-321-23-Epidemiology and clinical manifestations of adolescent TB in UkraineWe analysed data from 2491 cases of adolescent tuberculosis (TB) in Ukraine. We identified risk factors for each of four clinical presentations: cavitary, pleural, extrathoracic and rifampicin-resistant TB. This work can help guide diagnosis and clinical decision making in a traditionally overlooked age group for TB.
Silvia Chiang

EP23-322-23-Prevalence and predictive factors of active TB in children under 5 years of age living with a person with bacteriologically-confirmed pulmonary TB in AfricaOur study was conducted in four African countries to identify factors predictive of active tuberculosis (TB) in children under 5 years of age living in contact with a bacteriologically-confirmed pulmonary TB case. The factors identified can be used to create a score to screen for childhood TB during home visits.
Kobto Ghislain Koura

EP23-323-23-Childhood TB trends in Zambia over five years (2014-2019)Childhood tuberculosis (TB) has been underserved until recent years when there has been renewed national commitment. The Zambian Ministry of Health, through the National Tuberculosis Programme, has embarked on high impact, data driven interventions aimed at turning the tide that once seemed grim as shown by this trend analysis.
Chalilwe Chungu

EP23-324-23-Routine South African TB data: are we doing enough for children and adolescents?Although children and adolescents with tuberculosis (TB) are globally recognised as important key populations, limited approaches exist to evaluate how well TB programmes address these groups.  We used routine data to analyse TB case notification indicators disaggregated by age (0-4, 5-9, 10-14 and 15-19 years) and discuss South Africa’s progress.
Karen Du Preez

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SP-30-Towards a TB-free childhood: best practices to find, cure and prevent TB in children in Africa
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SP-30-Towards a TB-free childhood: best practices to find, cure and prevent TB in children in Africa
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An estimated 1.1 million children under the age of 15 become sick with tuberculosis (TB) each year of which 205,000 will die. However, children with TB rarely die once they receive standard treatment for TB disease. Child and adolescent TB case finding, treatment and the provision of TB preventive treatment are key strategies in ending TB. In this session, stakeholders of the Sub-Saharan Africa Regional Child and Adolescent TB Centre of Excellence will describe successful interventions for TB prevention and case finding among children/adolescents in high burden countries and explore best practices for clinical and laboratory-based TB diagnosis.  

12:30 - 12:35: Introduction

12:35 - 12:45: Finding missing paediatric TB cases through facility-based intensified case findings: lessons learned from CaP TB project in MalawiDiagnosis of paediatric tuberculosis (TB) remains challenging and results in a significant case detection gap. The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) partnered with the national TB control programme in Malawi to implement the Unitaid-funded CaP TB project, aimed at improving childhood TB diagnosis and prevention. The project rolled out a comprehensive case finding intervention in 16 purposively selected sites in six districts. Sites received training on screening and diagnosis of paediatric TB, support for paediatric-specific symptom screening of children in various entry points, increased access to Xpert MTB/RIF testing through strengthened sample collection, and transport and support for access to chest X-ray. Improvement of paediatric TB case finding has been assessed using a pre-post intervention design. Prospective data have been collected starting from first quarter 2019. The presentation will review early evidence generated by the project as well as key lessons learned that can inform successful implementation of childhood TB interventions.
Bhamu Yusuf

12:45 - 12:55: Household outreach and patient-centred engagement to increase child and adolescent TB and HIV case finding: HOPe project in south western UgandaIn a Ugandan district with the lowest tuberculosis (TB) case notification rate, we conducted household-based TB contact tracing. We evaluated TB and HIV case finding, and linkage. Community health workers and HIV testing volunteers screened household contacts for TB and HIV. Presumptive TB cases provided diagnostic specimens or were referred for specimen collection. Contacts <5yrs and people living with HIV without TB were offered isoniazid preventive therapy (IPT). Out of 1592 household members, 197 had a positive TB screen and 16 new TB cases (8.1%) were identified (4, 25% were children <15yrs). Ten (2%, 10/499) new HIV patients were identified (5, 50% were children <15yrs) and linked to antiretroviral treatment. Of the 429 contacts with negative TB screen, 375 were eligible for IPT, 279 initiated IPT (85.8%) and 195 (69.9%) completed IPT. Household-based contact tracing using low-cadre health workers is feasible and contributes to finding TB and HIV cases, especially among children who may otherwise be missed.
Pauline Amuge

12:55 - 13:05: Catalysing the introduction of child-friendly formulations of medicines for drug-resistant TB: lessons learned for new formulations and regimens in the pipelineThe presentation will focus on the key steps STBP/GDF took, in collaboration with implementing and technical partners, and lessons learned to catalyse adoption of child-friendly formulations of drug-resistant TB medicines by programmes. These key steps include identifying and consolidating demand from early adopter programmes, using the consolidated demand to negotiate price and supply terms for these formulations, funding the initial procurement for early adopter programmes and using a pooled procurement approach to meet minimum order quantities and batch sizes, and monitoring implementation and promoting sustainability. Globally, STBP/GDF provided more than 1000 treatment courses of child-friendly formulations, nearly double the estimated number of children less than 5 years old treated annually. Lessons learned on the benefits of an integrated approach to new tool introduction, from in-country demand generation through upstream supply security, and how these can apply to new child-friendly formulations and regimens in the pipeline will be shared.
Brenda Waning

13:05 - 13:15: Development of a DHIS-2 smart application for data collection and decision making for use by community health workers doing household-based TB contact tracing in UgandaContact tracing is an important way to find new cases of tuberculosis (TB) disease as well as identify household members who might qualify for TB preventive treatment (TPT). This is especially important for finding at-risk children in high burden countries (such as Uganda), where a significant number are otherwise 'missed'. Despite the importance of contact tracing, the reality is that contact tracing is challenging to implement and sustain due to the time, complexity and human resources required. This presentation will describe the development of a DHIS2-based smart application ('electronic TB contact tracing tool') to help address these barriers to contact tracing in Uganda. This application was developed to be a tool for community health workers to use while carrying out household-based contact tracing in resource-limited settings. We will describe the development process for this application, describe how it was used and offer some early end-user results and feedback.
Simon Robert Kununka

13:15 - 13:25: Improving paediatric and adolescent TB case detection in Mozambique through an Xpert MTB/RIF®- and spatial parameter-based stratified risk strategy (X-patialTB)The X-patial tuberculosis (TB) project aimed to increase the number of TB diagnoses in Manhiça district, a high TB-HIV burden area in Southern Mozambique. This study was funded by TB-REACH and embedded in routine TB surveillance of the National TB Control Programme in Mozambique. The main objective was to determine the impact of an active case finding strategy, based on Xpert MTB/RIF Ultra semi quantitative results (as a proxy of index case infectiousness) and spatial parameters, on TB case notifications in the district of Manhiça (intervention area) and compare it to a control area in the district of Magude. This descriptive cross-sectional study took place from March 2018 to February 2019 and the target population size was 16748 TB contacts. In this symposium, we will present the impact on the paediatric population, in whom a specific diagnostic algorithm was implemented to address the inherent difficulties of paediatric TB diagnosis.
Belén Saavedra

13:25 - 13:50: Q&A session

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OA-41-TB detection and treatment in mothers and children
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OA-41-TB detection and treatment in mothers and children
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15:00 - 15:05: Introduction


15:05 - 15:13: OA-41-747-24-Increasing active TB case detection rate among children in nine sub-Saharan countries: the CaP-TB Intervention We demonstrate that a comprehensive intervention, which includes paediatric-specific, systematic symptom screening of children in waiting areas of various health facility entry points, increased access to Xpert MTB/RIF testing. It also intensified household contact investigation and significantly improves, both case detection and bacteriological confirmation, for paediatric TB.

Jean-Francois Lemaire

15:13 - 15:21: OA-41-749-24-Role of urban DOTS approach on TB case finding among infertile women in Kabul: a document review Infertility is one of the serious problems for women in Afghanistan that led to mental disorders, in house conflicts, even separation and divorce. The aim of this assessment was to evaluate the outcomes of genital tuberculosis treatment along with anti-infertility treatment on fertility status of women in Kabul city.

Lutfullah Manzoor

15:21 - 15:29: OA-41-750-24-Systematic review of symptom-based screening and added value of chest radiography in screening paediatric contacts for TB in high- incidence countries We conducted a systematic review assessing the concordance between chest radiography and symptom screening to rule out tuberculosis (TB) in household child contacts in high-incidence countries. Results from six articles included in the review suggested that symptom-based screening alone was effective in classifying children unlikely to have TB.

Anca Vasiliu

15:29 - 15:37: OA-41-751-24-A systematic review of Xpert MTB/RIF and Xpert Ultra diagnostic accuracy for detection of active pulmonary TB and rifampicin resistance in children We will discuss results from a systematic review of the diagnostic accuracy of Xpert MTB/RIF and Xpert Ultra for the diagnosis of Mycobacterium tuberculosis and rifampicin resistance in children using multiple diagnostic specimen types (sputum, gastric aspiration, nasopharyngeal aspiration and stool).

Alexander Kay

15:37 - 15:45: OA-41-752-24-Population pharmacokinetics and potential, new optimised, fixed-dose combinations of rifampicin, isoniazid, and pyrazinamide in paediatric patients with TB In 2010, the World Health Orgaization revised the recommended paediatric doses of first line anti-tuberculosis (TB) drugs. We measured rifampicin, isoniazid and pyrazinamide plasma concentrations in 179 HIV-infected and uninfected children aged 0.2-12 years-old. Using model-based estimates of exposure, we suggest a new fixed-dose combination formulation, with revised weight-bands to improve exposures.

Roeland Wasmann

15:45 - 15:53: OA-41-753-24-Pregnancy and birth outcomes in multidrug-resistant TB patients treated with regimens including new and re-purposed drugs We report on incidence of pregnancy, birth and treatment outcomes among multidrug-resistant tuberculosis (TB) patients routinely initiated on treatment regimens containing bedaquiline, delamanid and re-purposed drugs in Pakistan.  Data was collected as a part of the End TB observational study.

Saman Ahmed

15:53 - 16:12: Q&A


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