March 2018

Catalyzing Pediatric Tuberculosis Innovation Project Launches in Lesotho





Last week, in Maseru, the Lesotho Ministry of Health launched a project to curb childhood illnesses and deaths due to tuberculosis (TB).

Funded by Unitaid and implemented by the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), the four-year project, called Catalyzing Pediatric Tuberculosis Innovation (CaP TB), aims to double detection of TB in children and treat 1,100 children for TB in Lesotho. More than 7,000 children with latent TB, who are infected without developing symptoms, will also be initiated on preventive TB treatment through the project.

“This project comes at an opportune time,” said Dr. Nyane Letsie Director General of Health Services at the health ministry, who spoke on behalf of the health minister.

Dr. Nyane Letsie, Director General, Ministry of Health Lesotho

“Many programs to combat TB have often focused on adults and very little was done on children despite the fact that these children are living in the same homes with the adult TB patients,” Dr. Nyane said.

Although TB is curable, it is still the second leading cause of death after AIDS in Lesotho and is a dangerous opportunistic infection for people living with HIV. Only 46 percent of all expected TB cases were diagnosed in 2016 in Lesotho. And while it is expected that 10 to 15 percent of all diagnosed cases in a high TB incidence country such as Lesotho should be pediatric, only 3 percent of Lesotho’s TB cases diagnosed were children.

TB is particularly difficult to diagnose and manage in children since many do not have access to the most effective tests and child-friendly treatments. Often, children with TB are misdiagnosed and treated for other ailments. Although children are more likely to develop active TB disease when exposed to adults with TB, they are rarely offered TB preventive treatment despite the recommendation by the World Health Organization. This is especially true for children with compromised immune systems due to young age, malnutrition, or HIV infection.

“As defenders of children’s health, those of us at the Elizabeth Glaser Pediatric AIDS Foundation are deeply troubled by how the tuberculosis epidemic impacts children and families, and we are determined to help find and implement innovative and effective solutions,” Chip Lyons, the President and CEO of EGPAF said.

EGPAF Senior TB Advisor, Dr. Samson Lanje, and MOH Childhood TB Program Officer, Manone Rathekoa.

Emphasizing the urgent need for greater awareness and increased screening for TB in children, the TB Program Manager in the Ministry of Health Dr. Llang Maama urged communities to work closely with LENEPWHA – the Lesotho network of people living with HIV and AIDS, the community partner for the CaP TB project. LENEPWHA will educate and mobilize communities to take up health services at their respective facilities and in their communities.

The new project will focus its work in 40 high-TB burden sites across five districts of Lesotho.

CaP TB will take advantage of the networks and projects that EGPAF has developed through 14 years of HIV-related work in Lesotho, channeling those relationships and that infrastructure into a robust operation combatting TB in all children, regardless of their HIV status.

At the same time, this project promises to improve outcomes for HIV-positive children specifically, by protecting them from one of the most threatening opportunistic infections a child with a compromised immune system can face.

EGPAF CEO, Chip Lyons, with EGPAF-Lesotho Country Director, Tsepang Mohlomi and Dr. Kellello Lerotholi.

TB treatment is highly effective. But ensuring that drug formulations are child-friendly and accessible has been a stumbling block in the global response to the epidemic. Through CaP TB, EGPAF and the Ministry of Health will dramatically increase access to new child-friendly drugs for TB treatment.

In addition to medications that were not child friendly, timely and accurate, diagnosis has been a major challenge in fighting pediatric TB.

But the availability of new diagnostic technology that helps collect samples from children, which CaP TB will introduce at dozens of new health care sites, together with building the capacity of health care workers to identify and treat TB in children, may soon help overcome that challenge as well.

Together, better treatment and improved diagnosis have the potential to radically transform the pediatric tuberculosis landscape in Lesotho and beyond.