Challenges and solutions to implementing drug-resistant tuberculosis programmes for children in Central Asia

Area of Science:

• Public Health
• Infectious Diseases
• Pediatrics

Background:

• Existing guidelines for pediatric drug-resistant tuberculosis (DR-TB) primarily focus on individual patient care, lacking comprehensive strategies for national tuberculosis programs (NTPs).
• There is a significant gap in guidance for NTPs on planning, implementing, and integrating DR-TB services specifically for children.
• The Tajikistan Ministry of Health and Médecins Sans Frontières initiated a pediatric TB program in 2011, leading to the first MDR-TB treatments for children in 2013.

Purpose of the Study:

• To describe the challenges and solutions encountered in establishing a pediatric DR-TB care program in Tajikistan.
• To propose a framework to guide the implementation of pediatric DR-TB services.
• To offer a model for NTPs in resource-limited settings to develop their own pediatric DR-TB care strategies.

Main Methods:

• Case study description of a pediatric tuberculosis program in Tajikistan.
• Analysis of challenges faced during program establishment and implementation.
• Development of a proposed framework for pediatric DR-TB care.

Main Results:

• The Tajikistan program successfully initiated treatment for 21 children with multidrug-resistant tuberculosis (MDR-TB).
• Key challenges in establishing the program were identified and addressed.
• A framework for implementing pediatric DR-TB care was developed based on program experiences.

Conclusions:

• Implementing pediatric DR-TB care presents unique challenges, particularly in resource-limited settings.
• A structured framework is essential for NTPs to effectively plan and deliver DR-TB services for children.
• The proposed framework can assist other NTPs in developing and improving their pediatric DR-TB programs.