Pediatric tuberculosis, a multinational approach

Jing Ren

Resident in Medicine/Pediatrics at MGH

PGY-3

 Pediatric tuberculosis, a multinational approach

I’m working on with the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) on a multi-national pediatric tuberculosis project. Pediatric TB is notorious difficult to diagnose because kids tend to have a hard time coughing up a sample to test, and the samples tend to have a lower concentration of TB so our tests are not as sensitive as they are for adults. One area on which the project focuses is increasing the availability of new child-friendly, fixed-dose formulations of TB medications. These formulations are easy to take because they dissolve in water and they reduce the number of pills kids have to take each day, improving adherence and treatment success. EGPAF is also looking at ways to improve linkage to/retention in care; not only does this improve patient outcomes but it also increase the demand for these new pediatric TB medicines, thereby stabilizing the market and making it worthwhile for more generic drug manufacturers to make these medicines, which then in turn drives down their cost.

The proposed project spans four years and ten countries across sub-Saharan Africa and India. One of my motivations for doing this rotation with EGPAF is to see how an organization coordinates this kind of multinational project, as well as see in action the type of advocacy work organizations are able to do when they are situated in Geneva in terms of influencing new guidelines that are released. I had the opportunity to assist with an analysis of the political and current clinic guidelines for pediatric tuberculosis in each country. This gave me the opportunity not only to learn about the clinical standard of care in contact tracing, diagnosis and treatment of TB in children, but also gain more insight into the nuances in policy that shifted from country to country. After analyzing multiple national strategic plans and national guidelines, it becomes easier to differentiate the countries that have the political will and funding to try to translate strategic goals into concrete action items and guideline changes.

Being able to discuss these nuances in public health policy with experts in the field of pediatric TB and watch them influence the conversations happening on the ground through our country teams who interact regularly with each National TB Program was also very interesting. The background of the members of EGPAF Geneva office range from infectious disease physicians to former Doctors Without Borders humanitarian aid workers to advocacy experts. I found surprising how few of the people who work at either the WHO setting these clinical guidelines or in these large international NGOs that help translate those guidelines into practice have ever treated a patient with that disease, but I love learning from the wealth of experience they do have in the field of public health or aid work.