• Sustained commitment and extensive collaboration are required within and between developed and developing countries.

DRUG-RESISTANT TB IN CHILDREN

  • TB in children has been neglected; it is underreported and extremely difficult to diagnose, and has a limited evidence base on which to base treatment decisions.

  • Diagnostics need to be child friendly, cost-effective, and operationally feasible. Application in pediatric TB should be considered in the development of any new diagnostics as early as possible.

  • New tools for clinical management, epidemiology, and surveillance are urgently needed, as is an end point for Phase III trials.

  • Extra-short-course therapy is needed for less severe forms of TB in children, but needs confirmation.

  • The value of targeted screening in high-risk populations needs to be explored.

  • The degree of exposure needs to be assessed as a possible predictor of infection, persistent infection, or disease.

  • Additional pharmacokinetic studies are needed in children.

  • An Extrapulmonary TB Trials Consortium needs to be created.

CONCLUSIONS AND POLICY DISCUSSION

  • Rapid and accurate drug sensitivity testing should be a prerequisite for the commencement of therapy, given the amplifying role of drugs in the evolution of resistant strains.

  • The South African government should collaborate in the development of capacity and infrastructure. There is only one supra national TB reference laboratory in the region, and there is insufficient capacity to cope in the regional laboratories. In addition, the capacity to conduct clinical trials is very limited.

  • Lessons can be learned from the HIV field, where major National Institutes of Health (NIH) grants for research have been linked with development and capacity development grants. Synergy between research grants and capacity development is necessary.



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