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Tuberculosis research principles and priorities in children and adolescents: an international consensus statement
Moorine P Sekadde1, Silvia S Chiang2, Annemieke Brands3
1National TB and Leprosy Program, Kampala, Uganda.
Insights
Child and adolescent tuberculosis (TB) remains a critical global health issue. This study outlines key research principles and priorities to improve TB detection and treatment in children and adolescents, aiming to reduce mortality.
Area of Science:
- Global Health
- Pediatric Infectious Diseases
- Public Health Policy
Background:
- Tuberculosis (TB) affects 1.9 million children and adolescents annually, with over 95% of deaths occurring in untreated cases.
- Failure to detect and treat pediatric TB is the primary driver of mortality, highlighting an urgent need for improved research and clinical practice.
- TB is a leading cause of death in children under five years old.
Purpose of the Study:
- To establish core research principles and priorities for pediatric and adolescent tuberculosis.
- To guide future research efforts and strengthen clinical care and public health interventions for TB in young populations.
- To address the critical gap in TB research funding by focusing efforts on high-impact areas.
Main Methods:
- A modified Delphi consensus process was employed, involving an 11-member writing group and a consensus panel.
- An iterative ranking and feedback system was used to refine research principles and priorities over two Delphi rounds.
- Qualitative feedback from the consensus panel and the Child and Adolescent TB Working Group informed modifications.
Main Results:
- Eight core research principles and 21 specific research priorities were identified through the consensus process.
- The identified priorities show significant potential for developing new interventions, particularly in diagnostics, treatment regimens, and tuberculous meningitis.
- The consensus process aimed to maximize the clinical and public health impact of research despite reduced funding.
Conclusions:
- The established research principles and priorities provide a focused roadmap for advancing pediatric and adolescent TB care.
- Translating these priorities into practice could significantly improve TB detection, treatment outcomes, and reduce mortality in children and adolescents.
- Continued research and strategic funding are essential to combat the global burden of TB in young populations.
Abstract:
Each year, an estimated 1·9 million children (aged 0-9 years) and adolescents (aged 10-19 years) develop tuberculosis disease. Tuberculosis ranks among the top ten causes of death in children younger than 5 years. The primary driver of tuberculosis-related mortality in children and young adolescents is the failure to detect and treat the disease; more than 95% of tuberculosis deaths occur in children who were never initiated on tuberculosis treatment. To increase the quantity and quality of tuberculosis research required to strengthen clinical care and public health practice, the Child and Adolescent TB Working Group and its Secretariat at the WHO led a modified Delphi consensus process to generate core research principles and priorities along each step of the tuberculosis care cascade. An 11-member writing group drafted an initial list of principles and priorities, which were ranked by members of the consensus panel in each Delphi round. Principles and priorities that did not meet the consensus threshold were modified based on written qualitative feedback from the consensus panel and one-time input from other members of the Child and Adolescent TB Working Group at the group's 2024 annual meeting. Eight research principles and 21 research priorities emerged from two Delphi rounds. The research priorities have strong potential for translation into interventions, particularly in relation to diagnostics, shorter regimens, and tuberculous meningitis. With recently reduced tuberculosis research funding, these principles and priorities will focus research efforts to maximise clinical and public health impact.
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