The annual meeting of the Child and Adolescent TB Working Group took place on the Zoom platform on Tuesday 30 November 2021. The meeting was open to all members of the working group representing a broad range of stakeholders including paediatricians, NTP managers and childhood TB focal points in the NTP, MCH representatives, technical and financial partners, community TB representatives and WHO staff from headquarters, regional and country offices.

The main purpose of the 2021 annual meeting was to provide a summary of the reviews presented to the WHO Guideline Development Group on the management of tuberculosis in children and adolescents in May/June 2021, both related to the PICO (Population, Intervention, Comparator, Outcome) questions related to diagnostic approaches, shortened treatment of drug-susceptible TB in children with non-severe disease, treatment of drug-resistant TB, treatment of drug-susceptible TB meningitis and models of care; as well as to the background questions on the socio-economic impact of TB on children and adolescents & the engagement of adolescents in TB care.

A total of 292 registrations were received, and 192 participants attended the meeting. The meeting was divided into two sessions of 2.5 hours each.

On behalf of Dr. Tereza Kasaeva, Director of the WHO Global TB Programme, Farai Mavhunga opened the meeting and warmly welcomed all participants. He referred to the disproportionate impact of the COVID-19 pandemic on TB prevention and case detection among children and adolescents, which will make it even more challenging to reach the UN High Level Meeting targets related to children. He conveyed that WHO is looking forward to close and continued collaboration with all relevant stakeholders at global, regional and national levels to implement the new recommendations and operational guidance in the guidelines and operational handbook. Kerri Viney then presented the detailed objectives of the meeting as well as the agenda. Farhana Amanullah, Chair of the Child and Adolescent TB Working Group, gave the report from the chair on the activities of the working group since the last meeting in October 2020. Annemieke Brands and Sabine Verkuijl from the WHO secretariat provided an update on the upcoming WHO policy recommendations relevant to children and progress towards UNGA HLM on TB targets, including an overview of data included in the Global tuberculosis report and database 2021.

During the second part of the first session, the main findings of several reviews conducted for the 2022 WHO consolidated guidelines were presented. Leslie Enane presented the main findings of the literature review as well as best practices on the background question on optimizing care for adolescents with TB infection or disease. Salla Atkins and Delia Boccia presented the main findings of the literature review on the socio-economic impact of TB on children, adolescents and their families. Nobu Nishikiori then shared the findings of the analysis of Patient Cost Surveys. At the end of the session, two WHO Civil Society Task Force members, Amir Khan from Pakistan and Blessi Kumar from India provided community perspectives and views on active case finding for tuberculosis and on optimizing care for children and adolescents affected by TB.

The second session of the meeting was divided in three parts. Part 1 focussed on evidence reviews underlying diagnostic approaches in children. Kenneth Gunasekera shared the outcome of the evaluation of existing treatment decision algorithms using an Individual Patient Data set and also mentioned the ongoing work related to two treatment decision algorithms that will be included in the 2022 WHO operational handbook to be published alongside the consolidated guidelines (early 2022). Alexander Kay shared the evidence from the systematic review on the use of Xpert Ultra in stool and gastric aspirate for the diagnosis of pulmonary TB in children. Grace Bolie from DRC provided implementation considerations related to diagnosis of tuberculosis in children from a programmatic perspective.

In the second part of the second session, Anna Turkova provided an update on the sub-analyses of the SHINE trial. Anthony Garcia-Prats shared the results from the systematic review and individual patient data meta-analysis of children and adolescents treated for RR/MDR-TB. Giorgia Sulis presented the evidence from the systematic review on the treatment of TB meningitis.

In the third and last part of the second session, Courtney Yuen, presented the evidence from the systematic review on models of care for child and adolescent TB (decentralized care and family-centred, integrated care for case detection and provision of TB preventive treatment). Martina Casenghi provided perspectives on models of care from the Unitaid-funded CaP-TB project and Eric Wobudeya shared perspectives on models of care from the Unitaid-funded TB-SPEED project.

In the closing session, the Secretariat thanked all presenters and participants and acknowledged the continuing financial support for the activities of the working group from USAID through UNOPS.

The meeting agenda, recordings and PDFs of the presentations can be accessed through the links below.

Link to recording

(N.B. Please note that the recording starts a few minutes late)

Passcode: +RmD9!7V