Challenge Cluster for Post-TB Lung Health in Children in sub-Sahara Africa.

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In 2017, there were an estimated 10 million new cases of tuberculosis (TB) disease globally, and 1.6 million peoples died from TB. This makes TB the leading cause of death from a single infectious agent worldwide. However, the majority of the TB cases and deaths occur in low- and middle-income countries (LMICs), where difficulties in diagnosis and treatment contribute to poor outcomes in TB patients. While global TB reports are based on estimates of patients who die either before or during TB treatment, there is now a growing body of evidence suggesting that patients cured or successfully treated for TB have persistent health impairment, and a relatively higher morbidity and mortality after treatment, than the general population.These evidence of potentially elevated risk of adverse health consequences after TB treatment in the published literature are exclusively derived from adult data. While pulmonary TB (PTB) accounts for at least 80% of the 1 million TB cases that occur in children aged less than 15 years, there are currently no published data about adverse health consequences and/or long-term impact of pulmonary TB, including changes in the lung function, in children and adolescents who have completed TB treatment in neither high- nor low-income countries, where the burden of TB disease is particularly high. Achieving the ambitious goals of the WHO End TB Strategy will require that attention is paid not only to poor outcomes before or during TB treatment, but also to morbidity and mortality after TB treatment. In this regard, "Life and Well-being after Tuberculosis" has now being adopted as one of the two overall priority themes in the strategic plan of the World TB Union's Lung Health Department.With this Challenge Cluster proposal, we will bring together two multi-country collaborative projects, supported by MRC GCRF Foundation Awards, with specific expertise in childhood TB and in lung health in Africa, including the Reach for Kids Africa (R4KA) and Lung Health in Africa across the Life Course (LuLi). The GCRF-funded partners will additionally link with partners in national TB programs from across sub-Sahara Africa and members of the TB-affected communities, underpinned by key regional and international collaborative research networks, including the Pan African Thoracic Society (PATS), International Union Against TB and Lung Disease (The Union), West African Paediatric TB Network (WApTBNet) and TB PROOF - a leading TB advocacy organisation in South Africa. We will begin advocacy and research toward increasing the awareness of post-TB lung health with a focus on children among health care workers, TB-affected communities and policy makers from across sub-Sahara Africa. We will also develop the capacity and confidence of health care workers to evaluate lung function in children who have completed treatment for PTB, and begin to generate data that will accurately describe the prevalence of lung function impairment attributable to TB in children in sub-Sahara Africa.Our proposal will deliver on the following specific objectives within 12 months of the project activities: (i) organise a workshop on post-TB lung health in children in LMICs for paediatricians drawn from our proposed pan-Africa GCRF Challenge Cluster collaborative partnerships; (ii) train paediatricians in sub-Sahara Africa on paediatric spirometry, in order to evaluate lung function in children who have completed TB treatment; (iii) organise a participatory workshop for former TB patients and TB-affected families in West Africa, using exploratory and descriptive qualitative research approaches, in relation to household-incurred costs and strategies adopted for coping with persistent health impairments due to TB; and (iv) set up a multi-site pan-African platform for the establishment of prospective cohorts in the future, for clinical, epidemiological and applied health research.