Johns Hopkins University


Infectious and parasitic diseases

Tuberculosis, a leading killer of children globally, can be eliminated with an ambitious program of community mobilization, novel intervention strategies, and innovative new biomedical tools.

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Lead Organization

Johns Hopkins University

Baltimore, Maryland, United States

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Project Summary

TB is a leading killer of children worldwide. Tools to control TB have existed for decades but are poorly implemented. While ending TB in adults is stalled, pediatric TB is uniquely ripe for elimination. We have led development of innovative tools and strategies for controlling childhood TB:•Finding, treating, and preventing TB in school-age children •Preventing TB in children exposed in the household•Finding and treating TB in pregnant women to prevent transmission to newbornsWe use cutting-edge molecular diagnostics and short-course preventive regimens to diagnose, treat, and prevent TB in children with social mobilization campaigns to engage affected communities. In just 2 years, we have reduced TB prevalence in Tibetan refugee schoolchildren by ~60%.Our project will benefit children who are refugees, have HIV, live in slums, and are poor. Over 5 years, we can eliminate TB in children across India, with major health, economic, and cultural benefits.

Problem Statement

Tuberculosis has plagued humanity for centuries. Annually, one million children get active TB and 7.5 million become infected with latent TB. Daily, 650 children die of TB, representing a quarter million child deaths annually. An unacceptably high proportion (>50%) of children with TB are never diagnosed or treated, and only 10-15% of children exposed to TB in the household get TB preventive therapy (TPT), leaving the vast majority at high risk for disease. Since India bears the highest TB burden worldwide (>25%), including >20% of childhood TB, ending childhood TB here will accelerate global TB elimination. The World Health Organization’s roadmap for ending childhood TB has made little progress. The stalled progress to date reflects historical negligence, lack of political will, and a global lag in innovation. India has set ambitious targets to reduce TB deaths by 90% and increase TPT coverage from 10% to 95% by 2025, but a major increase in control measures is needed to eliminate TB by 2030. Our team has pioneered novel strategies and biomedical tools for TB screening and treatment in children. In 2017 we initiated the Zero TB Kids project for the Tibetan refugee children in India, a population with extremely high TB rates. Our case-finding, treatment, and prevention effort has yielded a 58% reduction in TB prevalence in just two years. We have also spearheaded interventions for household contacts and pregnant women. Leveraging this experience using innovative strategies and tools, we will work with partners across India to eliminate childhood TB.

Solution Overview

We propose to eliminate childhood TB using a multipronged strategy of •screening and treating school-aged children for active and latent TB, •preventive treatment for young children exposed to TB in households, and •screening and treating pregnant women for TB to prevent transmission to vulnerable newborns. This comprehensive approach will be built upon broad community mobilization, health education, and community engagement. Our state-of-the-art program will employing cutting-edge molecular diagnostics to detect TB disease and latent TB infection and an ultra-short course preventive treatment regimen (12 doses) for latent TB infection, rather than the traditional regimen of 270 doses. Importantly, we will use innovative implementation strategies that have proved effective at achieving impact: school- and community- based screening to detecting disease and infection; wide application of preventive therapy; and targeted screening of pregnant women to protect vulnerable mothers and newborns. We will leverage our recent success in accelerating TB elimination in Tibetan children by ~50%, improving child TB contact evaluation with simplified processes, and reducing early infant mortality by 50% through case-finding in pregnant women.We will monitor progress by measuring additional case detection ratios, TB prevalence rates, and community TB incidence rates in children. By exponentially reducing TB incidence in three states during Phases 1 and 2, we will catalyze scale up across India in Phase 3. The knowledge generated by the project will inform local, national and global approaches to TB prevention in children. In addressing a stigmatizing and impoverishing disease, we address global health inequity, social injustice and poverty.

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Project Funders

  • Johns Hopkins Alliance for a Healthier World 2017 - 2020
  • Chao Family Foundation 2018 - 2020
  • Unitaid 2017 - 2021

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