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Article ; Online: Clinical outcomes in children living with HIV treated for non-severe tuberculosis in the SHINE Trial.

Chabala, Chishala / Wobudeya, Eric / van der Zalm, Marieke M / Kapasa, Monica / Raichur, Priyanka / Mboizi, Robert / Palmer, Megan / Kinikar, Aarti / Hissar, Syed / Mulenga, Veronica / Mave, Vidya / Musoke, Philippa / Hesseling, Anneke C / McIlleron, Helen / Gibb, Diana / Crook, Angela / Turkova, Anna

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

2024

Abstract: Background: Children living with HIV(CLWH) are at high risk of tuberculosis(TB) and face poor outcomes, despite antiretroviral treatment(ART). We evaluated outcomes in CLWH and HIV-uninfected children treated for non-severe TB in the SHINE trial.: ... ...

Abstract	Background: Children living with HIV(CLWH) are at high risk of tuberculosis(TB) and face poor outcomes, despite antiretroviral treatment(ART). We evaluated outcomes in CLWH and HIV-uninfected children treated for non-severe TB in the SHINE trial. Methods: SHINE was a randomized trial that enrolled children aged <16 years with smear-negative, non-severe TB who were randomized to receive 4 vs 6 months of TB treatment and followed for 72 weeks. We assessed TB relapse/recurrence, mortality, hospitalizations, grade ≥3 adverse events by HIV status, and HIV virological suppression in CLWH. Results: Of 1204 enrolled, 127(11%) were CLWH, of similar age (median(IQR) 3.6(1.2, 10.3) vs. 3.5(1.5, 6.9)years, p= 0.07), but more underweight (WAZ; -2.3(-3.3, -0.8) vs -1.0(-1.8, -0.2), p<0.01) and anemic (hemoglobin 9.5(8.7, 10.9) vs 11.5(10.4, 12.3)g/dl, p<0.01) compared to HIV-uninfected children. 68(54%) CLWH were ART-naïve; baseline median CD4 count 719(241-1134) cells/mm3, CD4% 16(10-26)%). CLWH were more likely to be hospitalized (aOR=2.4(1.3-4.6)) and die (aHR(95%CI) 2.6(1.2,5.8)). HIV status, age <3 years (aHR 6.3(1.5,27.3)), malnutrition (aHR 6.2(2.4,15.9)) and hemoglobin <7g/dl(aHR 3.8(1.3,11.5) independently predicted mortality. Among children with available VL, 45% and 61% CLWH had VL<1000copies/ml at weeks 24 and 48, respectively. There was no difference in the effect of randomized treatment duration (4 vs 6 months) on TB treatment outcomes by HIV status (p for interaction=0.42). Conclusions: We found no evidence of a difference in TB outcomes between 4 and 6 months of treatment for CLWH treated for non-severe TB. Irrespective of TB treatment duration, CLWH had higher rates of mortality and hospitalization than HIV-uninfected counterparts.
Language	English
Publishing date	2024-04-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	1099781-7
ISSN	1537-6591 ; 1058-4838
ISSN (online)	1537-6591
ISSN	1058-4838
DOI	10.1093/cid/ciae193
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Article ; Online: Evaluating pediatric tuberculosis dosing guidelines: A model-based individual data pooled analysis.

Galileya, Lufina Tsirizani / Wasmann, Roeland E / Chabala, Chishala / Rabie, Helena / Lee, Janice / Njahira Mukui, Irene / Hesseling, Anneke / Zar, Heather / Aarnoutse, Rob / Turkova, Anna / Gibb, Diana / Cotton, Mark F / McIlleron, Helen / Denti, Paolo

PLoS medicine

2023 Volume 20, Issue 11, Page(s) e1004303

Abstract: Background: The current World Health Organization (WHO) pediatric tuberculosis dosing guidelines lead to suboptimal drug exposures. Identifying factors altering the exposure of these drugs in children is essential for dose optimization. Pediatric ... ...

Abstract	Background: The current World Health Organization (WHO) pediatric tuberculosis dosing guidelines lead to suboptimal drug exposures. Identifying factors altering the exposure of these drugs in children is essential for dose optimization. Pediatric pharmacokinetic studies are usually small, leading to high variability and uncertainty in pharmacokinetic results between studies. We pooled data from large pharmacokinetic studies to identify key covariates influencing drug exposure to optimize tuberculosis dosing in children. Methods and findings: We used nonlinear mixed-effects modeling to characterize the pharmacokinetics of rifampicin, isoniazid, and pyrazinamide, and investigated the association of human immunodeficiency virus (HIV), antiretroviral therapy (ART), drug formulation, age, and body size with their pharmacokinetics. Data from 387 children from South Africa, Zambia, Malawi, and India were available for analysis; 47% were female and 39% living with HIV (95% on ART). Median (range) age was 2.2 (0.2 to 15.0) years and weight 10.9 (3.2 to 59.3) kg. Body size (allometry) was used to scale clearance and volume of distribution of all 3 drugs. Age affected the bioavailability of rifampicin and isoniazid; at birth, children had 48.9% (95% confidence interval (CI) [36.0%, 61.8%]; p < 0.001) and 64.5% (95% CI [52.1%, 78.9%]; p < 0.001) of adult rifampicin and isoniazid bioavailability, respectively, and reached full adult bioavailability after 2 years of age for both drugs. Age also affected the clearance of all drugs (maturation), children reached 50% adult drug clearing capacity at around 3 months after birth and neared full maturation around 3 years of age. While HIV per se did not affect the pharmacokinetics of first-line tuberculosis drugs, rifampicin clearance was 22% lower (95% CI [13%, 28%]; p < 0.001) and pyrazinamide clearance was 49% higher (95% CI [39%, 57%]; p < 0.001) in children on lopinavir/ritonavir; isoniazid bioavailability was reduced by 39% (95% CI [32%, 45%]; p < 0.001) when simultaneously coadministered with lopinavir/ritonavir and was 37% lower (95% CI [22%, 52%]; p < 0.001) in children on efavirenz. Simulations of 2010 WHO-recommended pediatric tuberculosis doses revealed that, compared to adult values, rifampicin exposures are lower in most children, except those younger than 3 months, who experience relatively higher exposure for all drugs, due to immature clearance. Increasing the rifampicin doses in children older than 3 months by 75 mg for children weighing <25 kg and 150 mg for children weighing >25 kg could improve rifampicin exposures. Our analysis was limited by the differences in availability of covariates among the pooled studies. Conclusions: Children older than 3 months have lower rifampicin exposures than adults and increasing their dose by 75 or 150 mg could improve therapy. Altered exposures in children with HIV is most likely caused by concomitant ART and not HIV per se. The importance of the drug-drug interactions with lopinavir/ritonavir and efavirenz should be evaluated further and considered in future dosing guidance. Trial registration: ClinicalTrials.gov registration numbers; NCT02348177, NCT01637558, ISRCTN63579542.
MeSH term(s)	Adult ; Infant, Newborn ; Child ; Humans ; Female ; Infant ; Child, Preschool ; Adolescent ; Male ; Ritonavir/pharmacokinetics ; Ritonavir/therapeutic use ; Lopinavir/pharmacokinetics ; Lopinavir/therapeutic use ; Rifampin ; Isoniazid/therapeutic use ; Isoniazid/pharmacokinetics ; Pyrazinamide/pharmacokinetics ; Antitubercular Agents ; Tuberculosis/drug therapy ; Tuberculosis/epidemiology ; HIV Infections/drug therapy ; HIV
Chemical Substances	Ritonavir (O3J8G9O825) ; Lopinavir (2494G1JF75) ; Rifampin (VJT6J7R4TR) ; efavirenz (JE6H2O27P8) ; Isoniazid (V83O1VOZ8L) ; Pyrazinamide (2KNI5N06TI) ; Antitubercular Agents
Language	English
Publishing date	2023-11-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	2185925-5
ISSN	1549-1676 ; 1549-1277
ISSN (online)	1549-1676
ISSN	1549-1277
DOI	10.1371/journal.pmed.1004303
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Article ; Online: Pharmacokinetic Data of Dolutegravir in Second-line Treatment of Children With Human Immunodeficiency Virus: Results From the CHAPAS4 Trial.

Bevers, Lisanne A H / Waalewijn, Hylke / Szubert, Alexander J / Chabala, Chishala / Bwakura-Dangarembizi, Mutsa / Makumbi, Shafic / Nangiya, Joan / Mumbiro, Vivian / Mulenga, Veronica / Musiime, Victor / Burger, David M / Gibb, Diana M / Colbers, Angela

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

2023 Volume 77, Issue 9, Page(s) 1312–1317

Abstract: Background: Dolutegravir (DTG), combined with a backbone of 2 nucleoside reverse transcriptase inhibitors, is currently the preferred first-line treatment for human immunodeficiency virus (HIV) in childhood. CHAPAS4 is an ongoing randomized controlled ... ...

Abstract	Background: Dolutegravir (DTG), combined with a backbone of 2 nucleoside reverse transcriptase inhibitors, is currently the preferred first-line treatment for human immunodeficiency virus (HIV) in childhood. CHAPAS4 is an ongoing randomized controlled trial investigating second-line treatment options for children with HIV. We did a nested pharmacokinetic (PK) substudy within CHAPAS4 to evaluate the DTG exposure in children with HIV taking DTG with food as part of their second-line treatment. Methods: Additional consent was required for children on DTG enrolled in the CHAPAS4 trial to participate in this PK substudy. Children weighing 14-19.9 kg took 25 mg DTG as dispersible tablets and children ≥20 kg took 50 mg film-coated tablets. Steady-state 24-hour DTG plasma concentration-time PK profiling was done at t = 0 and 1, 2, 4, 6, 8, 12, and 24 hours after observed DTG intake with food. Reference adult PK data and pediatric data from the ODYSSEY trial were used primarily for comparison. The individual target trough concentration (Ctrough) was defined as 0.32 mg/L. Results: Thirty-nine children on DTG were included in this PK substudy. The geometric mean (GM) area under the concentration-time curve over the dosing interval (AUC0-24h) was 57.1 hours × mg/L (coefficient of variation [CV%], 38.4%), which was approximately 8% below the average AUC0-24h in children in the ODYSSEY trial with comparable dosages, but above the adult reference. The GM (CV%) Ctrough was 0.82 mg/L (63.8%), which was comparable to ODYSSEY and adult reference values. Conclusions: This nested PK substudy shows that the exposure of DTG taken with food in children on second-line treatment is comparable with that of children in the ODYSSEY trial and adult references. Clinical Trials Registration.ISRCTN22964075.
MeSH term(s)	Child ; Humans ; Anti-HIV Agents/therapeutic use ; Heterocyclic Compounds, 3-Ring ; HIV ; HIV Infections/drug therapy ; HIV Integrase Inhibitors ; Oxazines ; Tablets
Chemical Substances	Anti-HIV Agents ; dolutegravir (DKO1W9H7M1) ; Heterocyclic Compounds, 3-Ring ; HIV Integrase Inhibitors ; Oxazines ; Tablets
Language	English
Publishing date	2023-06-05
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	1099781-7
ISSN	1537-6591 ; 1058-4838
ISSN (online)	1537-6591
ISSN	1058-4838
DOI	10.1093/cid/ciad346
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Article ; Online: Management of the infant born to a mother with tuberculosis: a systematic review and consensus practice guideline.

Hasan, Nadia / Nourse, Clare / Schaaf, H Simon / Bekker, Adrie / Loveday, Marian / Alcântara Gabardo, Betina M / Coulter, Christopher / Chabala, Chishala / Kabra, Sushil / Moore, Eilish / Maleche-Obimbo, Elizabeth / Salazar-Austin, Nicole / Ritz, Nicole / Starke, Jeffrey R / Steenhoff, Andrew P / Triasih, Rina / Welch, Steven B / Marais, Ben J

The Lancet. Child & adolescent health

2024 Volume 8, Issue 5, Page(s) 369–378

Abstract: Infants born to mothers with tuberculosis disease are at increased risk of developing tuberculosis disease themselves. We reviewed published studies and guidelines on the management of these infants to inform the development of a consensus practice ... ...

Abstract	Infants born to mothers with tuberculosis disease are at increased risk of developing tuberculosis disease themselves. We reviewed published studies and guidelines on the management of these infants to inform the development of a consensus practice guideline. We searched MEDLINE, CINAHL, and Cochrane Library from database inception to Dec 1, 2022, for original studies reporting the management and outcome of infants born to mothers with tuberculosis. Of the 521 published papers identified, only three met inclusion criteria and no evidence-based conclusions could be drawn from these studies, given their narrow scope, variable aims, descriptive nature, inconsistent data collection, and high attrition rates. We also assessed a collection of national and international guidelines to inform a consensus practice guideline developed by an international panel of experts from different epidemiological contexts. The 16 guidelines reviewed had consistent features to inform the expert consultation process. Two management algorithms were developed-one for infants born to mothers considered potentially infectious at the time of delivery and another for mothers not considered infectious at the time of delivery-with different guidance for high and low tuberculosis incidence settings. This systematic review and consensus practice guideline should facilitate more consistent clinical management, support the collection of better data, and encourage the development of more studies to improve evidence-based care.
MeSH term(s)	Infant ; Female ; Humans ; Mothers ; Tuberculosis/epidemiology ; Tuberculosis/therapy ; Consensus
Language	English
Publishing date	2024-03-21
Publishing country	England
Document type	Systematic Review ; Journal Article ; Review
ISSN	2352-4650
ISSN (online)	2352-4650
DOI	10.1016/S2352-4642(23)00345-0
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Article ; Online: Inadequate Lopinavir Concentrations With Modified 8-Hourly Lopinavir/Ritonavir 4:1 Dosing During Rifampicin-based Tuberculosis Treatment in Children Living With HIV.

Chabala, Chishala / Turkova, Anna / Kapasa, Monica / LeBeau, Kristen / Tembo, Chimuka H / Zimba, Kevin / Weisner, Lubbe / Zyambo, Khozya / Choo, Louise / Chungu, Chalilwe / Lungu, Joyce / Mulenga, Veronica / Crook, Angela / Gibb, Diana / McIlleron, Helen

The Pediatric infectious disease journal

2023 Volume 42, Issue 10, Page(s) 899–904

Abstract: Background: Lopinavir/ritonavir plasma concentrations are profoundly reduced when co-administered with rifampicin. Super-boosting of lopinavir/ritonavir is limited by nonavailability of single-entity ritonavir, while double-dosing of co-formulated ... ...

Abstract	Background: Lopinavir/ritonavir plasma concentrations are profoundly reduced when co-administered with rifampicin. Super-boosting of lopinavir/ritonavir is limited by nonavailability of single-entity ritonavir, while double-dosing of co-formulated lopinavir/ritonavir given twice-daily produces suboptimal lopinavir concentrations in young children. We evaluated whether increased daily dosing with modified 8-hourly lopinavir/ritonavir 4:1 would maintain therapeutic plasma concentrations of lopinavir in children living with HIV receiving rifampicin-based antituberculosis treatment. Methods: Children with HIV/tuberculosis coinfection weighing 3.0 to 19.9 kg, on rifampicin-based antituberculosis treatment were commenced or switched to 8-hourly liquid lopinavir/ritonavir 4:1 with increased daily dosing using weight-band dosing approach. A standard twice-daily dosing of lopinavir/ritonavir was resumed 2 weeks after completing antituberculosis treatment. Plasma sampling was conducted during and 4 weeks after completing antituberculosis treatment. Results: Of 20 children enrolled; 15, 1-7 years old, had pharmacokinetics sampling available for analysis. Lopinavir concentrations (median [range]) on 8-hourly lopinavir/ritonavir co-administered with rifampicin (n = 15; area under the curve 0-24 55.32 mg/h/L [0.30-398.7 mg/h/L]; C max 3.04 mg/L [0.03-18.6 mg/L]; C 8hr 0.90 mg/L [0.01-13.7 mg/L]) were lower than on standard dosing without rifampicin (n = 12; area under the curve 24 121.63 mg/h/L [2.56-487.3 mg/h/L]; C max 9.45 mg/L [0.39-26.4 mg/L]; C 12hr 3.03 mg/L [0.01-17.7 mg/L]). During and after rifampicin cotreatment, only 7 of 15 (44.7%) and 8 of 12 (66.7%) children, respectively, achieved targeted pre-dose lopinavir concentrations ≥1mg/L. Conclusions: Modified 8-hourly dosing of lopinavir/ritonavir failed to achieve adequate lopinavir concentrations with concurrent antituberculosis treatment. The subtherapeutic lopinavir exposures on standard dosing after antituberculosis treatment are of concern and requires further evaluation.
MeSH term(s)	Child ; Humans ; Child, Preschool ; Infant ; Rifampin/therapeutic use ; Lopinavir/pharmacokinetics ; Ritonavir/pharmacokinetics ; Anti-HIV Agents/therapeutic use ; Tuberculosis/complications ; Tuberculosis/drug therapy ; HIV Infections/complications ; HIV Infections/drug therapy ; Drug Therapy, Combination ; Antitubercular Agents/therapeutic use ; Antitubercular Agents/pharmacokinetics
Chemical Substances	Rifampin (VJT6J7R4TR) ; Lopinavir (2494G1JF75) ; Ritonavir (O3J8G9O825) ; Anti-HIV Agents ; Antitubercular Agents
Language	English
Publishing date	2023-07-20
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	392481-6
ISSN	1532-0987 ; 0891-3668
ISSN (online)	1532-0987
ISSN	0891-3668
DOI	10.1097/INF.0000000000004047
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Article ; Online: Brief Report: Suboptimal Lopinavir Exposure in Infants on Rifampicin Treatment Receiving Double-dosed or Semisuperboosted Lopinavir/Ritonavir: Time for a Change.

Jacobs, Tom G / Mumbiro, Vivian / Chitsamatanga, Moses / Namuziya, Natasha / Passanduca, Alfeu / Domínguez-Rodríguez, Sara / Tagarro, Alfredo / Nathoo, Kusum J / Nduna, Bwendo / Ballesteros, Alvaro / Madrid, Lola / Mujuru, Hilda A / Chabala, Chishala / Buck, W Chris / Rojo, Pablo / Burger, David M / Moraleda, Cinta / Colbers, Angela

Journal of acquired immune deficiency syndromes (1999)

2023 Volume 93, Issue 1, Page(s) 42–46

Abstract: Background: Although super-boosted lopinavir/ritonavir (LPV/r; ratio 4:4 instead of 4:1) is recommended for infants living with HIV and receiving concomitant rifampicin, in clinical practice, many different LPV/r dosing strategies are applied due to ... ...

Abstract	Background: Although super-boosted lopinavir/ritonavir (LPV/r; ratio 4:4 instead of 4:1) is recommended for infants living with HIV and receiving concomitant rifampicin, in clinical practice, many different LPV/r dosing strategies are applied due to poor availability of pediatric separate ritonavir formulations needed to superboost. We evaluated LPV pharmacokinetics in infants with HIV receiving LPV/r dosed according to local guidelines in various sub-Saharan African countries with or without rifampicin-based tuberculosis (TB) treatment. Methods: This was a 2-arm pharmacokinetic substudy nested within the EMPIRICAL trial (#NCT03915366). Infants aged 1-12 months recruited into the main study were administered LPV/r according to local guidelines and drug availability either with or without rifampicin-based TB treatment; during rifampicin cotreatment, they received double-dosed (ratio 8:2) or semisuperboosted LPV/r (adding a ritonavir 100 mg crushed tablet to the evening LPV/r dose). Six blood samples were taken over 12 hours after intake of LPV/r. Results: In total, 14/16 included infants had evaluable pharmacokinetic curves; 9/14 had rifampicin cotreatment (5 received double-dosed and 4 semisuperboosted LPV/r). The median (IQR) age was 6.4 months (5.4-9.8), weight 6.0 kg (5.2-6.8), and 10/14 were male. Of those receiving rifampicin, 6/9 infants (67%) had LPV Ctrough <1.0 mg/L compared with 1/5 (20%) in the control arm. LPV apparent oral clearance was 3.3-fold higher for infants receiving rifampicin. Conclusion: Double-dosed or semisuperboosted LPV/r for infants aged 1-12 months receiving rifampicin resulted in substantial proportions of subtherapeutic LPV levels. There is an urgent need for data on alternative antiretroviral regimens in infants with HIV/TB coinfection, including twice-daily dolutegravir.
MeSH term(s)	Male ; Infant ; Humans ; Child ; Female ; Lopinavir/therapeutic use ; Ritonavir/therapeutic use ; Rifampin/therapeutic use ; HIV Infections/drug therapy ; Anti-HIV Agents/therapeutic use ; HIV Protease Inhibitors/therapeutic use
Chemical Substances	Lopinavir (2494G1JF75) ; Ritonavir (O3J8G9O825) ; Rifampin (VJT6J7R4TR) ; Anti-HIV Agents ; HIV Protease Inhibitors
Language	English
Publishing date	2023-04-01
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	645053-2
ISSN	1944-7884 ; 1077-9450 ; 0897-5965 ; 0894-9255 ; 1525-4135
ISSN (online)	1944-7884 ; 1077-9450
ISSN	0897-5965 ; 0894-9255 ; 1525-4135
DOI	10.1097/QAI.0000000000003168
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Article ; Online: Population pharmacokinetics of ethambutol in African children: a pooled analysis.

Tikiso, Tjokosela / McIlleron, Helen / Abdelwahab, Mahmoud Tareq / Bekker, Adrie / Hesseling, Anneke / Chabala, Chishala / Davies, Geraint / Zar, Heather J / Rabie, Helena / Andrieux-Meyer, Isabelle / Lee, Janice / Wiesner, Lubbe / Cotton, Mark F / Denti, Paolo

The Journal of antimicrobial chemotherapy

2022 Volume 77, Issue 7, Page(s) 1949–1959

Abstract: Objectives: Ethambutol protects against the development of resistance to co-administered drugs in the intensive phase of first-line anti-TB treatment in children. It is especially relevant in settings with a high prevalence of HIV or isoniazid ... ...

Abstract	Objectives: Ethambutol protects against the development of resistance to co-administered drugs in the intensive phase of first-line anti-TB treatment in children. It is especially relevant in settings with a high prevalence of HIV or isoniazid resistance. We describe the population pharmacokinetics of ethambutol in children with TB to guide dosing in this population. Methods: We pooled data from 188 intensively sampled children from the DATiC, DNDi and SHINE studies, who received 15-25 mg/kg ethambutol daily according to WHO guidelines. The median (range) age and weight of the cohort were 1.9 (0.3-12.6) years and 9.6 (3.9-34.5) kg, respectively. Children with HIV (HIV+; n = 103) received ART (lopinavir/ritonavir in 92%). Results: Ethambutol pharmacokinetics were best described by a two-compartment model with first-order elimination and absorption transit compartments. Clearance was estimated to reach 50% of its mature value by 2 months after birth and 99% by 3 years. Typical steady-state apparent clearance in a 10 kg child was 15.9 L/h. In HIV+ children on lopinavir/ritonavir, bioavailability was reduced by 32% [median (IQR) steady-state Cmax = 0.882 (0.669-1.28) versus 1.66 (1.21-2.15) mg/L). In young children, bioavailability correlated with age. At birth, bioavailability was 73.1% of that in children 3.16 years or older. Conclusions: To obtain exposure within the 2-6 mg/L recommended range for Cmax, the current doses must be doubled (or tripled with HIV+ children on lopinavir/ritonavir) for paediatric patients. This raises concerns regarding the potential for ocular toxicity, which would require evaluation.
MeSH term(s)	Anti-HIV Agents/therapeutic use ; Antitubercular Agents/pharmacokinetics ; Antitubercular Agents/therapeutic use ; Child ; Child, Preschool ; Ethambutol/pharmacokinetics ; Ethambutol/therapeutic use ; HIV Infections/drug therapy ; Humans ; Infant, Newborn ; Lopinavir/pharmacokinetics ; Lopinavir/therapeutic use ; Ritonavir
Chemical Substances	Anti-HIV Agents ; Antitubercular Agents ; Lopinavir (2494G1JF75) ; Ethambutol (8G167061QZ) ; Ritonavir (O3J8G9O825)
Language	English
Publishing date	2022-06-24
Publishing country	England
Document type	Journal Article ; Meta-Analysis ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	191709-2
ISSN	1460-2091 ; 0305-7453
ISSN (online)	1460-2091
ISSN	0305-7453
DOI	10.1093/jac/dkac127
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Article ; Online: Tuberculosis in children with severe acute malnutrition.

Vonasek, Bryan J / Radtke, Kendra K / Vaz, Paula / Buck, W Chris / Chabala, Chishala / McCollum, Eric D / Marcy, Olivier / Fitzgerald, Elizabeth / Kondwani, Alexander / Garcia-Prats, Anthony J

Expert review of respiratory medicine

2022 Volume 16, Issue 3, Page(s) 273–284

Abstract: Introduction: With growing attention globally to the childhood tuberculosis epidemic after decades of neglect, and with the burden of severe acute malnutrition (SAM) remaining unacceptably high worldwide, the collision of these two diseases is an ... ...

Abstract	Introduction: With growing attention globally to the childhood tuberculosis epidemic after decades of neglect, and with the burden of severe acute malnutrition (SAM) remaining unacceptably high worldwide, the collision of these two diseases is an important focus for improving child health. Areas covered: This review describes the clinical and public health implications of the interplay between tuberculosis and SAM, particularly for children under the age of five, and identifies priority areas for improved programmatic implementation and future research. We reviewed the literature on PubMed and other evidence known to the authors published until August 2021 relevant to this topic. Expert opinion: To achieve the World Health Organization's goal of eliminating deaths from childhood tuberculosis and to improve the abysmal outcomes for children with SAM, further research is needed to 1) better understand the epidemiologic connections between child tuberculosis and SAM, 2) improve case finding of tuberculosis in children with SAM, 3) assess unique treatment considerations for tuberculosis when children also have SAM, and 4) ensure tuberculosis and SAM are strongly addressed in decentralized, integrated models of providing primary healthcare to children.
MeSH term(s)	Child ; Global Health ; Humans ; Infant ; Severe Acute Malnutrition/diagnosis ; Severe Acute Malnutrition/epidemiology ; Severe Acute Malnutrition/therapy ; Tuberculosis/diagnosis ; Tuberculosis/epidemiology
Language	English
Publishing date	2022-02-28
Publishing country	England
Document type	Journal Article ; Review ; Research Support, N.I.H., Extramural
ZDB-ID	2479146-5
ISSN	1747-6356 ; 1747-6348
ISSN (online)	1747-6356
ISSN	1747-6348
DOI	10.1080/17476348.2022.2043747
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Article: Defeating Paediatric Tuberculous Meningitis: Applying the WHO “Defeating Meningitis by 2030: Global Roadmap”

Basu Roy, Robindra / Bakeera-Kitaka, Sabrina / Chabala, Chishala / Gibb, Diana M / Huynh, Julie / Mujuru, Hilda / Sankhyan, Naveen / Seddon, James A / Sharma, Suvasini / Singh, Varinder / Wobudeya, Eric / Anderson, Suzanne T

Microorganisms. 2021 Apr. 16, v. 9, no. 4

2021

Abstract: Children affected by tuberculous meningitis (TBM), as well as their families, have needs that lie at the intersections between the tuberculosis and meningitis clinical, research, and policy spheres. There is therefore a substantial risk that these needs ... ...

Abstract	Children affected by tuberculous meningitis (TBM), as well as their families, have needs that lie at the intersections between the tuberculosis and meningitis clinical, research, and policy spheres. There is therefore a substantial risk that these needs are not fully met by either programme. In this narrative review article, we use the World Health Organization (WHO) “Defeating Meningitis by 2030: global roadmap” as a starting point to consider key goals and activities to specifically defeat TBM in children. We apply the five pillars outlined in the roadmap to describe how this approach can be adapted to serve children affected by TBM. The pillars are (i) prevention; (ii) diagnosis and treatment; (iii) surveillance; (iv) support and care for people affected by meningitis; and (v) advocacy and engagement. We conclude by calling for greater integration between meningitis and TB programmes at WHO and at national levels.
Keywords	World Health Organization ; advocacy ; issues and policy ; meningitis ; monitoring ; people ; risk ; tuberculosis
Language	English
Dates of publication	2021-0416
Publishing place	Multidisciplinary Digital Publishing Institute
Document type	Article
Note	NAL-AP-2-clean
ZDB-ID	2720891-6
ISSN	2076-2607
ISSN	2076-2607
DOI	10.3390/microorganisms9040857
Database	NAL-Catalogue (AGRICOLA)

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Article: Defeating Paediatric Tuberculous Meningitis: Applying the WHO "Defeating Meningitis by 2030: Global Roadmap".

Microorganisms

2021 Volume 9, Issue 4

Abstract	Children affected by tuberculous meningitis (TBM), as well as their families, have needs that lie at the intersections between the tuberculosis and meningitis clinical, research, and policy spheres. There is therefore a substantial risk that these needs are not fully met by either programme. In this narrative review article, we use the World Health Organization (WHO) "Defeating Meningitis by 2030: global roadmap" as a starting point to consider key goals and activities to specifically defeat TBM in children. We apply the five pillars outlined in the roadmap to describe how this approach can be adapted to serve children affected by TBM. The pillars are (i) prevention; (ii) diagnosis and treatment; (iii) surveillance; (iv) support and care for people affected by meningitis; and (v) advocacy and engagement. We conclude by calling for greater integration between meningitis and TB programmes at WHO and at national levels.
Language	English
Publishing date	2021-04-16
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2720891-6
ISSN	2076-2607
ISSN	2076-2607
DOI	10.3390/microorganisms9040857
Database	MEDical Literature Analysis and Retrieval System OnLINE

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