By Joyce Ojanji

With more than half of all children with tuberculosis (TB) never diagnosed and more than nine in ten children dying from TB never receiving appropriate treatment, Médecins Sans Frontières (MSF) has launched a worldwide project aiming to increase the number of children diagnosed with the disease as well as improve their treatment experience and prevent new cases.

Taking the opportunity of a set of new recommendations by the World Health Organisation (WHO), this unprecedented initiative called “TACTiC” for “Test, Avoid, Cure Tuberculosis in Children” launched at the end of 2023 will support projects in implementing these new recommendations in over a dozen countries in Africa and Asia.

WHO has recommended a patient-centered approach to TB treatment in children. Based on a points system from the assessment of a child’s symptoms, the new recommendations enable early detection of the disease and rapid initiation of treatment.

Beyond a certain number of points, it is recommended that a short four-month course of treatment be initiated, effective against non-severe TB and using the same child-friendly formulations already widely available.

The benefits for children and families of a treatment that is two months shorter can be an enormous relief, reducing travel costs and follow-up time, as well as of course improving the treatment experience for the child.

Children under five who live in close quarters with adults with TB are often infected and are at high risk of developing active TB disease. Despite improved access to TB preventive treatment (TPT) being a long-standing global objective, only one in two TB contacts aged under 5 have access have access to it.

The WHO has now made it easier to protect children in these circumstances from becoming sick, by recommending short three-month treatments for prevention in this vulnerable group. TACTiC also aims to increase knowledge and access to these treatments.

“Recent WHO recommendations on the diagnosis of TB in children can be a game changer to increase the number of children diagnosed and put on the correct treatment. They provide clinicians and TB programs with the confidence to make the decision to treat TB in children using clinical signs and symptoms without relying on results of laboratory tests or X-rays if they are not available or when the test results are negative,’’ says Cathy Hewison, head of MSF’s tuberculosis working group.

” The implementation of these simple treatment decision algorithms can help clinicians and national TB programmes diagnose and treat more children. Our initial experiences in pilot projects have shown the number of children diagnosed with TB can increase five-fold with the introduction of these new recommendations. However, the new recommendations are not yet widely put into practice so there is a lot of work to do.”

According to her, it would be preferable to have a simple, reliable, inexpensive, and easily accessible diagnostic test to detect TB in children. However, to date, these do not exist. Thus, they are also advocating for a massive increase in resources for research and development of new and adapted tests to diagnose TB in children.

The TACTiC project aims to help MSF projects and teams, particularly those not specialized in the management of TB, initiate the implementation of the new WHO recommendations and use their experience to foster further scale-up within MSF and beyond.

TACTiC is not only about improving the diagnosis of TB in children but also about the treatment and prevention of TB in this vulnerable age group.

Training will be provided to MSF teams and their Ministry of Health and national TB programme partners on treatment decision algorithms, the interpretation of X-rays, the newly recommended use of stool samples, contact case finding and follow-up, and health promotion. Using the experience of participating in projects, a toolkit of materials adapted to settings where MSF and partners work will be developed.

In addition, TACTiC will also participate in advocacy at global international, national, and local levels to speed up the implementation of existing recommendations and call for the development of more adapted diagnostic tools.