Despite the availability of a new shorter treatment regimen for children with non-severe tuberculosis(TB), South African children are stuck with the longer six-month prescription. This is because the country failed to update guidelines for the management of childhood TB since 2013.

In an interview with Health-e News, Dr Norbert Ndjeka, Chief Director of TB Control and Management at the National Department of Health says updating the guidelines took longer than expected.

Outdated TB paediatric treatment guidelines

“We shall implement this year because the revised paediatric TB guidelines are going through final review now. Paediatric TB guidelines will introduce a 4-month regimen,” says Ndjeka.

On March 21st 2022, the World Health Organisation updated its guidelines on the treatment of non-severe TB disease in children and adolescents. The new guidelines recommend a shorter duration of treatment and reduces the standard of care which was 6 months of therapy down to 4 months.

Ndjeka says that they have just issued National Guidelines on the Treatment of Tuberculosis Infection therapy which has been approved by the national health council. And two more guidelines will be released in the next 3 to 6 months. Namely, paediatric TB and Drug-Resistant TB(DR-TB).

SA children miss out on new TB treatment

Dr Jennifer Furin, DR-TB Clinical Manager for Doctors Without Borders in Khayelitsha, says children with minimal disease do not need 6 months of treatment. She is hopeful that South Africa will soon start the rollout of this short regimen. 

“This regimen is an example of the differentiated models of care that are needed in TB. It reduces the length of time they need to take potentially toxic medications, and this is great. It shows how we need to move away from a one-size-fits-all approach in TB and it is wonderful, children can benefit from this shorter regimen immediately,” says Furin.

She says the country must be more active in assessing children exposed to TB in the household. And needs better tests for TB on samples that are easier to obtain from children (like stool). Furin warns that delays in diagnosis and treatment initiation can lead to longer-term issues like asthma.

Critical shortages of TB experts in rural areas

“Most paediatric and adolescent care is concentrated in the hands of a few experts in capital cities.  So, their care remains highly centralised and accessing it puts a huge burden on children and their families.  We need more decentralised and family-friendly services,” says Furin.

The new TB guidelines state that scaling up tuberculosis preventative treatment (TPT) is essential. Previously TPT was offered only to people who were at the highest risk of progressing to TB disease after exposure. Namely, children younger than five years of age, and all people living with HIV, regardless of age.

Furin says if TPT is not scaled up, SA will never make a dent in the TB pandemic.

“By expanding access to TPT, we can help make sure tens of thousands of people never have to get sick from TB. But guidelines alone will not be enough to address this. We need to ensure people in communities know they have a right to access it. And health providers and clinics need the tools and staff to address this issue as well,” says Furin.

Undiagnosed and untreated TB in the community

She adds recent transmissions in children are a sign that there is undiagnosed and untreated TB in the community.  She says the South African prevalence survey found there are many people with TB in the country who are either undiagnosed or who aren’t on treatment. 

But Ndjeka believes that the new TPT guidelines will make strides in decreasing South Africa’s TB incidence. “It is true that we have not done much in treating latent tuberculosis. The truth is we really took many many years trying to get guidelines approved. Collectively we must work faster in producing guidelines,” says Ndjeka. – Health-e News.