Half battle won with child-friendly TB drugs

Catherine Murombedzi Hiv Issues
WE end the year with a sigh of relief for children as there has been a milestone marked in tuberculosis treatment for them. A new and effective TB formulation for children has been unveiled.

Tuberculosis diagnosis in children has been a challenge and at times has been late that little lives have been lost.

Children are usually bedrock for pneumonia and this is at times is confused with tuberculosis and have one put on treatment for the other.

There has been work to improve tuberculosis management in children and a Childhood TB Roadmap in 2013 was formulated.

This has seen the birth of the first-ever child friendly TB drugs launched at the 46th Union World Conference on Lung Health in Cape Town in December 2015.

The world’s first appropriate child-friendly fixed dose combination (FDC) medicines to treat children are now available in a formulation. With the fixed dose combination, medication intake becomes manageable.

In the past, children even had to have tablets broken and one was not even sure if they were getting the correct dosage.

With the fixed dose combination this is going to be a thing of the past, as they get the correct fixed dose in tablet or formulations.

Dr Charles Sandy, National TB programme director in the Ministry of Health and Child Care in Zimbabwe, said TB cases in children go untreated as it is difficult to diagnose TB in them.

“There are a lot of missed TB cases in children and this is due to the difficulty in diagnosing TB in them,” said Dr Sandy.

“The basis of TB diagnosis is sputum and children do not have the capacity to cough up sputum, hence it becomes a challenge,” said Dr Sandy.

Dr Sandy said all HIV positive children must be screened for TB.

“All HIV positive children must be screened for TB and all children with TB should be offered HIV testing and counselling,” said Dr Sandy.

“TB is often missed or overlooked due to non-specific symptoms and difficulties in accurately diagnosing the condition in children,” he added.

“This calls for urgent need to strengthen the health systems to be able to manage TB and associated health conditions,” said Dr Matshidiso Moeti, WHO Regional Director on World TB Day in 2013.

TB Day is commemorated on March 24 worldwide.

In Zimbabwe, ART coverage for children is at 50 percent, but this falls short of universal coverage.

Dr Owen Mugurungi, director in the AIDS and TB Unit in the Ministry of Health and Child Care, said ART coverage for children had slightly improved, but still falls way behind adult ART coverage.

“In 2015, ART coverage for children rose to 50 percent and still more work needs to be done if all children are to be in the safe net,” said Dr Mugurungi.

The new child-friendly TB formulations have won half the battle in treating TB in children. Countries now need to ensure key decision makers and consumers know that these new medicines exist.

For Zimbabwe, the country needs to garner enough political support, scale up children health care support and meet set goals.

Switching to new formulations needs planning and financing to ensure smooth transition and effective use of old medicines.

For Zimbabwe, we rely on Global Fund support and need to work on new funding models to capture the need in more funding support.

Fiscal space needs to be created to buy these new formulations and the speed with which this is done determines the manner and effectiveness and safety children with TB will face.

The new child-friendly formulations are flavoured and the tablet is dissolvable. It usually took 24 months to treat multi drug resistant TB (MDRT), but with the new unveiled formulations the period is reduced to nine months.

SAFAIDS reported that children get TB infection at any stage, but are most vulnerable at one year to four years.

“Children get TB at any stage but are most vulnerable at one to four years and the source usually being an infectious adult in the child’s close environment,” SAFAIDS said in the health report on managing TB.

Dr Sandy said in Zimbabwe 10 percent of children were affected by TB, but they were reaching only eight percent.

“In Zimbabwe, 10 percent of children were affected with TB, but were reaching only eight percent.

There was need to retrain health personnel and the use of the gene xpert machine has been very helpful in detecting TB in children,” said Dr Sandy.

He hoped the country would have more machines soon so as to cover all areas.

Zimbabwe is one of the countries in the world with a high burden of TB.