Abstract
Childhood tuberculosis (TB) has hitherto been treated through estimation of pediatric doses through the crushing of adult pills, but the bitter taste of the pills and the inaccuracy of this dosing method presents a challenge for both patients and healthcare providers, leading to poor treatment outcomes. The TB Alliance therefore launched the Speeding Treatments to End Pediatric-Tuberculosis (STEP-TB) project to incentivize the introduction of pediatric Fixed-Dose Combinations (FDCs) of TB drugs. This case study describes the elements of this project, evaluates its impact, and highlights future challenges for pediatric TB treatment. The impact assessment incorporates both market impact as well as projected public health impact, evaluating the availability, affordability, and quality of the FDCs, and lastly providing a projection of lives saved as a result of scale-up of the FDCs to near-universal availability and utilization, based on a publicly available pediatric TB-specific model. STEP-TB resulted in the development of two child-friendly FDCs that were successfully brought to market and made available in 20 of the project’s 22 high-burden countries. On the basis of a country-specific projection of pediatric TB mortality in Kenya, scale-up to near-universal availability and utilization of the new FDCs could reduce pediatric TB-associated mortality by 2660 cases over the next 5 years. Future challenges include maintaining affordable prices for the FDCs and considering mechanisms to incentivize their introduction among high-risk groups in low-burden countries.
Article PDF
Avoid common mistakes on your manuscript.
References
World Health Organization. Best practices in child and adolescent tuberculosis care. 2018. Available from: https://www.who.int/tb/publications/2018/best-practices-child-adolescent-TB-care/en/
World Health Organization Strategic and Technical Advisory Group for TB (STAG-TB). Use of high burden country lists for TB by WHO in the post-2015 era. 2015. Available from: https://www.who.int/tb/publications/global_report/high_tb_burden-countrylists2016-2020.pdf
Bourdin Trunz B, Brouwer M. Global Alliance for TB drug development (TB Alliance) speeding treatments to end paediatric tuberculosis (STEP-TB) end of project evaluation. 2017. Available from: https://unitaid.org/assets/UNITAID-STEPTB-Final-Evaluation-04July2017.pdf
Onyango DO, Yuen CM, Masini E, Borgdorff MW. Epidemiology of pediatric tuberculosis in Kenya and risk factors for mortality during treatment: a national retrospective cohort study. J Pediatr 2018;201;115–121.
New pathways for childhood TB treatment - Lessons from the STEP-TB project. TB Alliance, Unitaid. 2017. Available from: https://www.tballiance.org/sites/default/files/child-resources/New_Pathways_for_Childhood_TB_Treatment.pdf
Global Alliance for TB drug development (TB Alliance). New milestone for children with tuberculosis reached as one million treatments of child-friendly medicines are ordered. 2019. Available from: https://www.tballiance.org/news/one-million-child-friendly-tuberculosis-medicines
RTI International. Model for assessment of pediatric interventions for tuberculosis (MAP-IT). 2015. Available from: http://www.mapit4pedstb.org/
Nash M. Making the case for child-friendly TB treatment for Inuit: challenging Canada’s double standard. 2018. Available from: https://naturemicrobiologycommunity.nature.com/users/72229-madlen-nash/posts/40701-making-the-case-for-child-friendly-tb-treatment-for-inuit-challenging-canada-s-double-standard
World Health Organization. WHO model list of essential medicines for children: 6th list. 2017. Available from: http://apps.who.int/iris/bitstream/handle/10665/273825/EMLc-6-eng.pdf?ua=1
Medecins sans Frontieres & Stop TB Partnership. Out of step 2017 - TB policies in 29 countries: a survey of prevention, testing and treatment policies and practices. 2017. Available from: http://www.stoptb.org/assets/documents/outofstep/UNOPS_out_of_step_2017_55_online.pdf
Author information
Authors and Affiliations
Corresponding author
Additional information
Data availability statement: All data used in the impact projection of lives saved is publicly available through the MAP-IT Model Platform [7] (http://www.mapit4pedstb.org/).
Rights and permissions
This is an open access article distributed under the CC BY-NC 4.0 license (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
About this article
Cite this article
Faust, L., Abdi, K., Davis, K. et al. The Roll-out of Child-friendly Fixed-dose Combination TB Formulations in High-TB-Burden Countries: A Case Study of STEP-TB. J Epidemiol Glob Health 9, 210–216 (2019). https://doi.org/10.2991/jegh.k.190812.001
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.2991/jegh.k.190812.001