“…Importantly, the percentage of patients who completed treatment was significantly higher in the 1-month group. This very promising regimen requires validation to define efficacy and tolerability in different populations, as shown in a recent study showing that 1HP was safely and feasibly implemented in children and adolescents in a programmatic setting in a low-resource setting in south Asia with low prevalence of HIV (Malik et al, 2021). None of the above-mentioned regimens for preventive therapy would be theoretically effective in contacts of patients with MDR-TB.…”
Section: Recommended Regimens For Preventive Therapymentioning
“…Importantly, the percentage of patients who completed treatment was significantly higher in the 1-month group. This very promising regimen requires validation to define efficacy and tolerability in different populations, as shown in a recent study showing that 1HP was safely and feasibly implemented in children and adolescents in a programmatic setting in a low-resource setting in south Asia with low prevalence of HIV (Malik et al, 2021). None of the above-mentioned regimens for preventive therapy would be theoretically effective in contacts of patients with MDR-TB.…”
Section: Recommended Regimens For Preventive Therapymentioning
“…Household and community-focused efforts to implement shorter preventive regimens for children and adolescents has the potential to improve TPT scale-up and treatment completion, which is imperative to reaching the TB prevention goals for 2022 set out in the UN General Assembly High Level Meeting for TB in 2018 [11]. A people-and family-centered approach integrated as part of frontline community-based health systems is essential for efficient and successful TPT programming and is one of the models of care recommended in the latest WHO guidance [12].…”
In this article, we highlight technological pediatric TB research advances across the TB care cascade; discuss recently completed or ongoing work in adults and corresponding significant research gaps for children; and offer recommendations and opportunities to increase investments and accelerate pediatric TB R&D.
“…young children, recently exposed and people living with HIV) [85][86][87], meaning that immunoreactivity testing can be combined with a potentially beneficial preventive intervention. Newer three-or one-month rifapentine-based regimes make preventive therapy more attractive and feasible for both patients and providers [88][89][90].…”
Section: How Should Those With Positive Tests Be Managed?mentioning
Tuberculosis (TB) still causes 1.5 million deaths globally each year. Over recent decades, slow and uneven declines in TB incidence have resulted in a falling prevalence of TB disease, which increasingly concentrates in vulnerable populations. Falling prevalence, while welcome, poses new challenges for TB surveillance. Cross-sectional disease surveys require very large sample sizes to accurately estimate disease burden, and even more participants to detect trends over time or identify high-risk areas or populations, making them prohibitively resource-intensive. In the past, tuberculin skin surveys measuring Mycobacterium tuberculosis (Mtb) immunoreactivity were widely used to monitor TB epidemiology in high-incidence settings, but were limited by challenges with both delivering and interpreting the test. Here we argue that the shifting epidemiology of tuberculosis, and the development of new tests for Mtb infection, make it timely and important to revisit the strategy of TB surveillance based on infection or immunoreactivity. Mtb infection surveys carry their own operational challenges and fundamental questions, for example: around survey design and frequency; which groups should be included; how the prevalence of immunoreactivity in a population should be used to estimate force of infection; how individual results should be interpreted and managed; and how surveillance can be delivered efficiently and ethically. However, if these knowledge gaps are addressed, the relative feasibility and lower costs of Mtb infection surveillance offer a powerful and affordable opportunity to better “know your TB epidemic”, understand trends, identify high-risk and underserved communities, and tailor public health responses to dynamic epidemiology.
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