SARChI Chair highlights Paediatric Tuberculosis strides and challenges

SARChI Chair highlights Paediatric Tuberculosis strides and challenges

As the world marks Tuberculosis (TB) Day on 24 March, Professor Anneke C. Hesseling, who holds the DSI-NRF South African Research Chair (SARChI) in Paediatric Tuberculosis (TB), has shared insights into the strides being made to mitigate the burden of the disease among children in South Africa.

Professor Hesseling, also the director of the Stellenbosch University-based Desmond Tutu Tuberculosis Centre and a renowned global expert on paediatric tuberculosis, points out that various research and other efforts are underway to root out existing barriers in detecting and treating TB among children in the country.

“South Africa is one of the high-burden countries for TB and HIV, but also for drug-resistant TB. The good news is that if you diagnose and treat someone, they can actually have a good outcome. The problem is that many infected children in South Africa are actually missed and not started on treatment,” says Professor Hesseling.

“We’re missing a lot of young children with TB. There are many missed opportunities to prevent and treat TB. One of the most important things, which is still not properly implemented, is contact tracing, contact management, and screening. We actually have a long way to go in South Africa. But I do think we have the political will and we’ve learnt many positive lessons from Covid-19 which could also be transferred to TB.”

Professor Hesseling is currently part of a national working group revising the South African TB guidelines, with specific emphasis on how to better diagnose the disease among children. “Once kids start treatment for most forms of TB, they do well. So, this case detection gap is something we’re really working on in South Africa,” she adds. 

Another major research project in which Professor Hesseling is involved looked into the prevention of drug-resistant TB (MDR-TB) in children. Called TB-CHAMP, the study focused on almost 1000 children who shared the same home with a person with MDR-TB in Cape Town, Johannesburg and Matlosana. Says Professor Hesseling, “We will hopefully have the results to share with the world in quarter three of this year. That will be the first trial ever done to look at how to prevent drug-resistant TB. I think in terms of drug-resistant TB, prevention is always better than cure.”

An area that has seen strides is the type of drugs that can be used on TB-infected children. Professor Hesseling points out that research carried out locally “has really informed” World Health Organisation (WHO) policy on the use of TB drugs in children. “In March 2022, the WHO recommended that the dequaline (drug) can be used on children. The dequaline recommendation was actually based on the work we did in South Africa. Now children from baby to adolescent can access dequaline for the first time,” Professor Hesseling says.

“That’s good news because children can now access regimens that are better. But the question is, can we not do even better for children? Can we take four medicines and also treat children for only six months, just like adults? I think another area where progress has been made is medicines for children that are actually child friendly. We have a large project called Benefit Kids (a Unitaid-funded project aimed at contributing to reduced morbidity and mortality of children with MDR-TB through better access to improved prevention and treatment).”

The Covid-19 outbreak proved to be a worrying setback to South Africa’s efforts to reduce paediatric TB. Says Professor Hesseling, “What is quite sad is that Covid-19 had a very negative impact on TB care in general in South Africa. We haven’t fully recovered yet. Young children actually were the worst affected. We saw that only half the children were diagnosed during lockdown compared to when there was no lockdown. TB prevention in children really suffered due to Covid when a lot of resources were taken away from TB services. So, we are still seeing that one out of 10 people infected with TB are children, and we have a lot of TB transmission.”

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