2023 The Union World Conference on Lung Health

Over the last two decades, we have gained a better understanding of the burden of TB in children and adolescents as well as of their unique needs. WHO has issued evidence-based policy recommendations and implementation guidance since 2006, stakeholders exchange experiences in the Child and Adolescent TB Working Group (CAWG), child-friendly formulations of first- and second-line anti-TB drugs have become available, donors are providing support for the roll out of child-and adolescent-friendly services and global targets were included in the Political Declaration of the 2018 UN high-level meeting on TB.

There have also been many advocacy efforts to raise awareness about TB in children and adolescents including the 2011 Call to Action, World TB Day events focused on TB in children and adolescents, the 2013 Roadmap towards zero TB deaths in children and adolescents, the 2015 renewed Call to Action, and the 2018 Roadmap towards ending TB in children and adolescents. Despite these efforts, gaps still remain in translating the policy recommendations into action, in particular at primary care level. This means that many children and adolescents do not benefit from novel tools and approaches to TB prevention, diagnosis, treatment and care. In fact, based on data submitted for the Global Tuberculosis Report 2022, the world is far from reaching the global TB targets for children and adolescents and this situation was aggravated by the Covid-19 pandemic which disproportionally affected them.

In November 2023, WHO and partners united in the CAWG, including the WHO Civil Society Task Force (CSTF) for TB, will release the 2023 version of the roadmap in line with the Political Declaration of the 2023 UN high-level meeting on TB. Building on lessons learned from implementation of the previous editions and on the 2022 WHO policy guidance on the management of TB in children and adolescents, the roadmap will provide up-to-date key actions to urgently address the persistent policy-practice gaps and also draw attention to the need to improve access to TB care for pregnant and lactating women given their higher risk of developing TB.

The purpose of this session is to review and discuss the new features of the 2023 Roadmap and the critical role that affected communities, community leaders and civil society organizations can play to support the implementation of the key actions towards successful achievement of the key milestones. Proposed speakers include an adolescent TB survivor, representatives from the WHO CSTF and Child and Adolescent TB Working Group, as well as from community organizations in Mozambique and Kenya. Speakers will highlight the role of young people in advocating for TB, how the Roadmap can be used for advocacy in a high TB burden country, and how community and civil society organisations can strengthen accountability in this area.

The session will be coordinated by the WHO and the Elisabeth Glaser Pediatric AIDS Foundation and chaired by representatives from the Child and Adolescent TB Working Group and WHO CSTF on TB.

Shortening the duration of TB treatment is critical to improve treatment adherence, promote person-centred care, and reduce patient costs, while maintaining high levels of treatment success. Recently, shorter treatment regimens for the treatment of both drug-susceptible and drug-resistant TB have been recommended by WHO. This session will review the shorter regimens that can currently be considered for the treatment of drug-susceptible and drug-resistant TB in children and adolescents and discuss the practical steps that are needed to move from policy to introduction and national scale-up in high TB burden settings. Finally, the session will review the key research questions that should be addressed to ensure children can continue to benefit from the advances made in optimizing treatment regimens for the adult population.

Given the UN high level ministerial (HLM) targets for pediatric TB were not met, it is critical to accelerate progress towards reaching pediatric TB detection and treatment targets and identifying the most promising strategies to optimize TB diagnosis for children. This symposium will provide examples of how advances in pediatric TB diagnosis have been integrated into routine practice and which data are used to monitor access to key interventions, including stool-based diagnosis, digital X-ray, and new treatment decision algorithms. Presentations will describe how these interventions are increasing access to bacteriological testing for children, successful approaches to scale up, and ongoing challenges and remaining gaps in services.

We used mathematical modelling approaches to estimate the health impact, health system costs and cost-effectiveness of the CaP-TB intervention that integrated paediatric tuberculosis services into child healthcare services and included a package of training, supportive supervision, job aids, and logistical support to support the implementation of the intervention.