Emerging evidence to reduce the burden of tuberculosis in children and young people

Tuberculosis (TB) remains a major global health challenge. Children, adolescents, and young mothers are high-risk populations for TB with unique challenges and needs. Children are often misdiagnosed or diagnosed too late, resulting in long-term sequelae or mortality, while adolescents, despite having more recognizable adult-type TB and being an important source of community transmission, can be difficult to engage in care as they often fall between pediatric and adult models of care. TB during pregnancy poses significant risks to the mother-infant pair, yet antenatal screening to ensure timely treatment initiation is often inadequate. Recent research advancements to address these challenges include more accessible TB management aids, shorter effective drug regimens, child-friendly drug formulations, strategies for active case finding to expand treatment coverage including of asymptomatic disease, and more options for preventive therapy. These advances have informed global policy and guidelines; however, major gaps in translation from policy to practice remain. This narrative review discusses the progress and identifies potential solutions with insights from the Asia-Pacific region to ongoing challenges in TB detection, treatment, and prevention in children and young people, with a view to TB elimination.